Video Game / Trauma Center (Atlus)

"Let's begin the operation!"

A series of five Medical Games (2005-2010) by Atlus for the Nintendo DS and Nintendo Wii consoles (released in Japan as Choushittou Caduceus, "Caduceus: The Great Surgical Operation"), where you get to save the world's health, one person at a time.

The first game, Under the Knife, starts out in 2018. You are Derek Stiles, a rookie doctor who has just begun his residency at Hope Hospital. Each stage/mission in the game requires you to correctly select and use a variety of surgical implements, such as the scalpel, the laser or the ultrasound, in order to cure each patient of his or her affliction. At the same time, you must avoid making too many mistakes, running out of time, or letting the patient's vitals drop below zero, any of which causes you to fail the operation and kill...your career.

Despite the unusual premise, at the beginning things seem pretty mundane. You are guided by the motherly Nurse Mary and later her younger, spunkier, stricter replacement Nurse Angie in treating injuries and removing tumors, procedures made easier by the advanced medical technology at your disposal. One day, however, Derek is the only doctor available to perform an operation far more difficult than he can handle. As he frantically tries to concentrate, Derek feels time slowing down and miraculously manages to save the patient. He soon learns that he is an heir to an ability called "The Healing Touch", thought to originate from Asclepius, the ancient Greek god of medicine.

Armed with his surgical skills and his Healing Touch, Derek and his motley crew of colleagues must aid Caduceus, an organization of medical experts, against a deadly new disease called GUILT, parasites that kill in various intricate ways. GUILT is a man-made plague, unleashed upon the world by Delphi, a shadowy cult that regards medicine as wrongfully extending life and interfering with God's intentions for when people should die.

The game has also led to several follow-ups in the series:

• Trauma Center: Second Opinion - An Updated Re-release of the original game, released on the Wii in 2006 using a more streamlined art style which is used going forward. Second Opinion retells the original story and expands on it by introducing Nozomi Weaver, a surgeon who has a different version of the Healing Touch.
• Trauma Center: New Blood - The third game in the series and the second one on the Wii, released in 2008. The game takes place in the year 2028, ten years after Under the Knife. It focused on Valerie Baylock and Markus Vaughn, two Alaskan doctors who also have the Healing Touch, trying to control the outbreak of the Stigma virus. Unlike the previous game, the game was now fully voice cast. While the story is a departure from the previous setting, it does feature cameos of Derek and Angie.
• Trauma Center: Under the Knife 2 - A direct sequel to Under the Knife, taking place three years after Derek and Angie eradicated GUILT from the previous game. The game retains the art style of the Wii games. Released on the Nintendo DS in 2008.
• Trauma Team (released in Japan as Hospital: 6 Doctors) - The third Wii game, released in 2010. In a radical shift in gameplay, Trauma Team spans 5 other professions. Alongside the standard surgery gameplay, other professions include Orthopedics, Endoscopy, First Response, Diagnostics, and Forensics. The latter two professions have a notable Genre Shift in that they both play like a text-based adventure.

The series has largely remained dormant after 2010 - a live action TV show based off of Trauma Team was in production at one point, but never got past the pilot. You can view that in all its, er, "glory" here.

This series has a character sheet. Put tropes related to the characters there.

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The page's life is in your hands! Begin Examples:

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• Acceptable Breaks from Reality:
  • The games make no attempt whatsoever to portray surgery realistically. Sutured wounds heal near-instantly, antibiotic gel mends small wounds instantly, vitals can be stabilized with a quick injection of a serum, among other fantastical depictions of surgical procedures. This is justified in the game's near-future setting; medicine has advanced immensely, making surgical procedures such as these feel routine.
  • Developers aimed for more realism in Trauma Team. The result was less Bullet Time and killer parasites, but more ghosts, flying superheroes, voicemail from dead people, and teleporting ninja butlers.
  • Even still, some of Trauma Team's patients are far less traumatized than you'd expect, Alyssa in particular. Her wounds are more consistent with being slammed into a hard surface by the blast rather than being right next to the bomb when it goes off, but it's much less disturbing to keep all of her limbs attached.
• Adaptation Deviation: While Second Opinion mainly follows the story of Under the Knife, it has some significant differences, mainly in terms of gameplay:
  • Applying membranes no longer requires you to massage them into the tissue; once you apply the gel, it's set in.
  • Triti no longer requires cutting them out with the scalpel.
  • Resuscitating patients is now done with (artistic use of) a defibrillator, rather than massaging the heart.
  • The bomb in the bomb-defusal "operation" is completely different, designed to take advantage of the Wii Remote and Nunchuk's motion sensors.
  • The original Chapter 6 is compressed down to a cutscene in order to make way for an entirely new chapter.
• Adaptation Distillation: The original final chapter of Under the Knife is boiled down to a cutscene in Second Opinion that summarizes the events thereof. This is mainly to introduce a Second Opinion-exclusive chapter without padding out the game. The original version's operations are basically just a Boss Rush of the seven GUILT types anyway, which is a bit redundant since both versions of the game feature another boss rush chapter as a post-game series of Brutal Bonus Levels.
• All There in the Manual:
  • If you haven't played Second Opinion you won't know what Naomi and Little Guy are referencing when they are talking about not talking about their pasts. They're both ex-Delphi agents.
  • Second Opinion does this to itself - the climax of the main plot is glossed over so it can launch straight into the remake content and can be downright disappointing if one doesn't have access to Under The Knife to see the full version. It does close up some plot holes, though, such as how Delphi actually learned about Triti.
  • Gameplay-wise, in addition to containing several hints, such as that antibiotic gel can be used to repel parasites, the manual to Second Opinion has a glossary explaining several medical terms used throughout the game.
• Another Side, Another Story:
  • Trauma Team's main gameplay hook. To elaborate, several events during the game will have multiple doctors address the situation in their own storyline. A patient Gabe diagnoses will be operated on by CR-S01. An accident first attended to by Maria will have patients that get operated on by Hank. Of course, in the finale, all six work together on a massive problem.
  • Second Opinion has Derek Stiles on one side and Nozomi Weaver on the other, and their stories merge in the final chapter.
• Anti-Frustration Features: While multitasking several fiddly jobs at once is a core part of the gameplay, the games will occasionally throw you a bone.
  • For instance, in the first game, the laser will never "break" while operating on Pempti (which requires you to use it constantly and could kill a patient in the normal recharge time). This is justified as being a special "scalar laser" that was specifically developed to completely eradicate Pempti cells, but is too intense for regular use.
  • Defeating Savato causes the wounds it caused to vanish along with it.
  • Chapter 6-8 in Second Opinion is the one time you can prematurely use a Healing Touch on Savato. This is because Derek and Nozomi take turns operating on the patient, and Nozomi is allowed to use her Healing Touch without rendering the operation Unwinnable by Design since she operates on the lower half of the patient's heart. Derek still needs to save his Healing Touch for the very end, though, since he's responsible for the upper half, where Savato is always finished off.
• Arbitrary Mission Restriction: X-6 in Second Opinion is a Paraskevi operation that caps your simulated (or not...?) patient's vitals at 50 rather than the usual 99. There isn't any in-story explanation (not that the X operations really have a plot to begin with) as to why this is, since all the other X operations and Paraskevi operations let you go up to 99, it's just there to ensure that you cannot cut more than one Paraskevi without needing to heal the patient.
• Arc Words: "Rosalia" and "Beginning..." in Trauma Team. The former pops up constantly during Naomi's investigations, while the latter is Patient Zero's last words.
• Armor-Piercing Question:
  • RONI delivers a double-whammy to Gabe when he suffers a Heroic BSoD over his son developing Wermer's Syndrome, and thinks it's pointless to be there to help him.
    RONI: Dr. Cunningham, do you truly feel your work is pointless?
    Gabe: Huh...!?
    RONI: There is one thing that is unclear to me. All people die, so medicine is ultimately pointless. But, Doctor, I have observed patients leaving with smiles. Is helping people smile pointless as well?
  • Alyssa asks Naomi for lunch, and Naomi starts going over the ingredients she'll need for curry. As she speaks to herself and begins wandering off, Alyssa asks if Naomi is planning for lunch or dinner.
• Artistic License – Biology: The GUILT virus, in which the T stands for "Toxin", is often referred to as a tumour, when it's pretty clearly a parasite. However, some characters speculate that GUILT is a toxin which causes part of the victim's tissue to mutate into a parasite that starts tearing the rest apart. Also, Deftera looked more like a tumor in Under The Knife than it did in the remake.
• Artistic License – Chemistry: The story of Trauma Center: New Blood revolves around a fictitious mineral from the country of Culuruma which is known as Culurium and is highly valued for its almost limitless applications in the medical industry. Unfortunately, a revolutionary new pathogen, named Stigma, was accidentally created and discovered in a lab rat with Culurium-based synthetic blood. A Biomineral that can be used to create synthetic blood has yet to be discovered in real life and probably doesn't even exist.
• Artistic License – Medicine: Naturally, since this is a video game, not a training tool for aspiring real-life surgeons. You'd have to be really lucky to come out of an O.R. with debilitating tumors, viruses, or lacerations treated in less than five or even ten minutes; even "minor" surgeries take at least 30 minutes.
• Artistic License – Military: In Under the Knife 2, it is mentioned that the rescue of the Sinners was performed by the "UN Army". While likely meaning the United Nations Peacekeepers, the UN does not operate their own army and relies on the contributions of national armed forces, and Peacekeepers do not conduct those kind of raiding operations.
• Art Shift:
  • Trauma Team's anime style suddenly shifts to a more intense, detailed one when Gabe trashes his office.
  • Trauma Team also shakes up the art style, especially during operations.
• Asshole Victim: The series has a fair amount of patients who are jerks and/or outright villains.
  • The first patient in Under the Knife 2 is said to be a member of a criminal organization that poaches rhinoes, before he was injured by being bitten by a crocodile.
  • Two of the victims in the Forensics section in Trauma Team.
    • Dennis Taylor, in the very first case of Forensics, was actually murdered because he was a drug dealer.
    • The more notable example of this is Stephen Eldred, in the penultimate Forensics case (pre-Patient Zero). He is found dead in a bombing and believed to have been the serial bomber; however, Naomi and Little Guy eventually deduce that in reality, Eldred was receiving money to voice the auditory bomb threats by the real bomber, Sandra Lieberman. When the money-hungry Eldred attempted to blackmail Lieberman, the bomber made Eldred describe his own self (a Caucasian male) in the final bomb threat before killing him off for good.
• Ass Kicking Pose: Surgeons in this series have a flair for the dramatic, such as when they are about to begin an operation. Derek does this even in a car when they are being kidnapped and even yells out when they are trying to silently escape a prison cell.
• Asteroids Monster: The GUILT Paraskevi has to be cut in half, and the halves cut into half as well, until 16 little Paraskevi are produced, each of which is small enough to be extracted safely.
• As You Know: Lampshaded repeatedly in Trauma Team as Gabe's computer gives him basic medical information.
  Gabe: You're just an encyclopedia of things I already know.
• The Atoner:
  • CR-S01 from Trauma Team works to reduce his prison sentence. Subverted: He didn't do the thing he's atoning for.
  • Dr. Weaver from Second Opinion helped Adam develop GUILT by keeping the "incubators" alive. She then cooperates with Caduceus in the battle against GUILT to make up for that.
• Barbie Doll Anatomy: Chest operations on female patients in the first game show their uncovered breasts, but without nipples. Other games instead opt to cover the breasts with pieces of cloth. Trauma Team mixes this, covering things when possible but just having it be undetailed when it can't be avoided.
• Belligerent Sexual Tension: Angie and Derek. They start out hating each other, but become friends over the course of the first game, despite still having some minor arguments every now and then. A Running Gag in Under The Knife 2 is other characters asking what the deal between them is. In the epilogue, they become an Official Couple.
• Beneficial Disease: The various fictional diseases, barring the original GUILT, come with beneficial effects, intended or otherwise.
  • Neo-GUILT in the Under the Knife 2, while dormant, has the capability of augmenting its host in various ways. It only begins actively harming its host when activated.
  • Master Vakhushti of New Blood is infected with Cardia which causes an alteration of his personality. This Stigma is also countering his existing disease of diencephalic sclerosis, and is the only thing keeping him alive. He passes away shortly after Cardia is treated.
  • Rosalia's unique disease, the original Rosalia Virus, has the capability of suppressing other illnesses that would affect her. Sartre's attempts to maximize the benefits of this disease end up setting the stage for the game's final chapter.
  • Naomi's GUILT infection interacts with her Rosalia Virus infection, turning into a form that lets CR-S01 eliminate both at the same time.
• Big Bad: There's always someone masterminding the man-made diseases that you fight in the games.
  • Adam of Under the Knife and Second Opinion is the head honcho of Delphi, using his twisted views to create GUILT.
  • Master Vakhushti is revealed to be the one behind the theft of the Stigma research in New Blood and lent it to Kidman as a biological weapon.
  • Henrich von Raitenau, Adam's grandson is the leader of the Delphi remnants in Under the Knife 2 and has been attempting to achieve his predecessor's goals. Patrick Mercer and Reina Mayuzumi are also eventually revealed to be the ones behind Neo-GUILT research, though their goals are not aligned with Delphi's.
  • In Trauma Team, there is no mastermind behind the Rosalia virus outbreak. The epidemic arose from the actions of an Unwitting Instigator of Doom, who was studying the virus and trying to benefit mankind.
• Big Damn Heroes:
  • Maria's juggling five near-death patients entirely on her own. Just as the situation turns bleak, cue the paramedics and a surge in vitals for all patients.
  • Maria gets her own when she rides a crate of Rosalia vaccine Slim Pickens style to Resurgam.
• Body Horror:
  • GUILT and Stigma do some very nasty things to their victims' bodies. In Trauma Team, Naomi contracts the Rosalia Virus which then absorbs the genetic disease in her DNA, ie. GUILT, and "evolves". The result, Twisted Rosalia, looks like a black caterpillar curled up and pupating inside her heart.
  • The 'claw' on the liver, which is composed of the black bruises that cover organs. It pulsates in a way that makes it look like it's trying to crush the liver.
  • How about the simple fact that the Rosalia Virus is a form of viral hemorrhagic fever gone wild that is basically eating you from the inside out, causing you to bleed uncontrollably out of every orifice (including your eyes)?
• Boring, but Practical: Valerie's Healing Touch. Derek and Markus have Bullet Time, Naomi restores vitals with every successful action she does, and Valerie...stops vitals from decreasing. It's not as fun as the other three, but it's also very beginner friendly and makes it easier to get an XS using her over Markus on operations that require you to not let vitals go below a certain point.
• Boss Game: In the first game, after finishing the second chapter, nearly every playable operation is related to GUILT. Second Opinion attempts to mix things up with Nozomi Weaver's chapters, but the final stages are still mostly GUILT operations. Subsequent games throw in "regular" operations amidsts GUILT/Neo-Guilt/Stigma operations to keep the gameplay fairly diverse.
• Boss Rush: The final chapter of the first game has Derek operating on the progenitors of the seven GUILT strains, though thankfully not all in the same operation.
• Blatant Lies: Gabe and RONI have a lot of fun abusing a bot program's Artificial Stupidity.
• Breakable Weapons: In games before Trauma Team, the tools "break" from overuse (most visible with the laser) and you have to wait for a new one. Savato spins webs that have to be cut by the scalpel, but are so corrosive, the scalpel is destroyed in the process.
• Breather Episode: In the middle of the final arc of Trauma Team, one level breaks away from the heroes' efforts to combat the Rosalia epidemic for an Endoscopy mission on Chloe the cat, who swallowed something. Subverted. It turns out what Chloe swallowed was two fragments of Albert Sarte's skeleton, which were infected with Rosalia.
• Brutal Bonus Level: Completing the main storyline in all games except Trauma Team unlock the X missions, which take the super-pathogens encountered across the storyline and crank the difficulty up to eleven. Team unlocks a difficulty that lets you play every level as if it were an X operation.
• Bullet Time: Derek and Markus' version of the Healing Touch slows time to a crawl from their (and in Markus's case, his partner's) perspective, allowing them to make rapid surgical maneuvers that would be impossible without it.
• Bulungi: The first chapter of Under the Knife 2 takes place in the Republic of Costigar, which is also Dr. Tulba's home country.
• Bunny-Ears Lawyer: In contrast to the main characters of the previous games, the entire main cast of Team fits this to an extent.
  • Surgery: CR-S01 is an amnesiac condemned criminal who performs operations in exchange for reductions in his sentence.
  • First Response: Maria is a hot-headed Action Girl who, in her first mission, arrives at the scene in plain clothes, on a motorcycle, and beats up the fireman in charge. She also sees ghosts.
  • Orthopedics: Hank is a bumbling Gentle Giant... who also has super strength and can fly, and is an actual superhero.
  • Endoscopy: Tomoe is the heiress to a powerful Japanese clan. She's also a ninja. And so is her butler.
  • Forensics: Naomi is a disobedient Ice Queen who has the supernatural ability to hear a dead person's last words.
  • Diagnostics: Gabe is by far the most normal of the cast, but he's still a Brilliant, but Lazy Dr. Jerk, with his weirdness quotient partially being picked up by RONI, his AI assistant.
• Butlerspace: Tomoe Tachibana's head butler Hanzou constanly does a ninja blur teleport thing. He even manages to appear from nowhere on a transatlantic flight.
• Butterfly of Death and Rebirth: The primary motif of Trauma Team, along with flowers. It becomes more apparent after the halfway point of the game, when all introductory missions to each character's specialties are done with. Once the Rosalia outbreak begins, the frames around each mission preview, which are usually scenes from the game, become a blood-red pattern of monarch butterflies over Asclepias flowers.
• Captain Ersatz: Diagnostician Gabriel Cunningham◊ from Trauma Team looks and acts very similar to Spike Spiegel, down to smoking damaged cigarettes. Too bad Steve Blum isn't voicing him. Some fans also think he looks like an anime version of House.
• Captain Obvious: Navel/Little Guy early in the Raging Bomber case.
  Navel/Little Guy: The only thing we can say about this bomber is that the victims were killed by bombs.
• Call-Back:
  • When you extract the Rosalia virus tumor in the final endoscopy mission and the Twisted Rosalia virus in the final mission the screen briefly says DEFEAT like in the previous games when GUILT or Stigma is extracted.
  • In Under the Knife 2, just before "operating" on the mechanical lock, Derek recalls ''An Explosive Patient'', the operation concerning the conference hall bombing from Under the Knife 1/Second Opinion.
    Derek: Well, I did have to disarm a bomb once with a scalpel and a laser. That was interesting.
  • RONI mentions adding "To hell with that" during "Moving Heart", and later, during "The Simplest Truth", where she defies direct orders, she mentions she referred to the "To hell with that" in her database.
  • In one of Gabe's early cut scenes, the Chief invites him to go with her to a medical conference in Japan. Come 'Healing Warrior', when Tomoe goes back home to Japan, guess who shows up to be her support?
  • When a prison guard in CR's cell collapses during the Rosalia virus outbreak, his partner would rather point his gun at CR instead of calling an ambulance. Genre Blindness aside, his reactions make some sense when you consider that at that point the outbreak was in its early stages and CR is doing time for bio-terrorism.
• Catchphrase: In Trauma Team, each specialty gets one:
  • Surgery: The patient's life is in your hands (used in the original Trauma Center games as well.)
    CR-S01: Let this disease pass from this world.
  • First Response: The first moments are the most critical
  • Orthopedics: Work your marvel with strength and skill
    Hank: Rock solid!
  • Endoscopy: You must seek what lies within
    Tomoe: ______ path of honor.
  • Diagnosis: Your mind is the ultimate tool
  • Forensics: The truth can never truly die
    Naomi: The dead shall speak. Let's put together the truth of what happened here.
• Central Theme: Trauma Team deals heavily with how one determines their life and the way they live and all six doctors confront this theme in one way or another:
  • CR-S01: With his life basically stripped away from him, he finds meaning as a doctor who wants to save lives as a means to repent.
  • Maria: Her firey passion to save lives to live up to a desire to be a hero for others comes into conflict with others where she feels like she has to do everything herself, only to realize that even heroes need help sometimes.
  • Tomoe: As someone who abandoned her family to practice medicine, she follows her own path to live up to her high standards.
  • Hank: Seeing the beauty in life, he does all he can, both as a hero and a doctor, to save as many lives as he can, even when those around him don't.
  • Gabe: Finding nothing left to his life but failure and bad memories, he is slowly renewed by individuals whose dedication to their own lives and occupations allows him to see more to his own life.
  • Naomi: With her life slowly coming to an end due to her genetic disease, she does all she can to ensure a future that she knows she won't be a part of.
• Changing Gameplay Priorities: Your skills in one game may not transfer flawlessly to the next. For instance, suturing in Under the Knife greatly favors accuracy where you'll get a Cool by drawing long, narrow zigzags across the laceration, while Under the Knife 2 favors speed and lets you get away with a large, hastily drawn Z over a laceration. New Blood favors consistency due to how its scoring system is beneficial with a long unbroken Chain, and is more prone to overwhelming you with tasks as if the level is designed for 2-player co-op.
• Character Portrait: Standard throughout all the series, Trauma Team being the sole exception.
• Chekhov's Gun:
  • At the end of Chapter 2 of Under the Knife 2, a new pathogen is discovered in Emilio's liver transplant and is promptly treated. Its identity and source remain a mystery until the final chapter, where Blackwell and Victor trace it to the Hands of Asclepius and their Neo-GUILT research.
  • Several in Trauma Team. A big one: whatever did happen to that girl Maria rescued all those years ago?. Actually in the last chapters it's shown that the girl Maria saved was Rosalia.
• Cherry Tapping:
  • ...Sort of. In one mission of Under The Knife / Second Opinion, Derek has to perform an operation on an airplane. There's a gimmick where the plane flies into turbulence occasionally, and if you do anything while the plane is shaking, a laceration appears. So why is this here? Pretty much because if you use the Ultrasound, a laceration still appears. The freaking ULTRASOUND.
  • It's possible for the vitals to drop to 0 because you made a mistake on the end-of-operation bandage, although you'd have to be in a real hurry and/or careless for this to happen since at this point, you can just raise vitals before putting the bandage on. If you're feeling really cruel, you can close up the patient, bring the vitals up to 99, and then repeatedly misapply the bandage over and over until the patient dies of, uh, the pain of having an adhesive peeled off their skin or something.
• Code Silver: All of the games so far feature some sort of break-in or hostage situation.
• Color-Coded for Your Convenience: Each character/discipline in Trauma Team has an associated color: red for CR-S01 (surgery), orange for Maria Torres (first response), green for Hank Freebird (orthopedics), purple for Tomoe Tachibana (endoscopy), blue/indigo for Gabriel Cunningham (diagnostics), and silver/white/gray for Naomi Kimishima (forensics). It's pretty close to a Rainbow Motif.
• Compressed Adaptation: Second Opinion pulls this on the final chapter of Under the Knife, turning it from a rematch with every single GUILT to a quick summary in order to quickly set up the arc exclusive to SO.
• Continuity Nod: A few in Trauma Team; notably, Esha notes that one patient's spinal tumors were deemed inoperable by Concordia, and Naomi remarks that she didn't expect to find someone else with the hands of a god at Resurgam if the player earns an XS rank on the stage where she assists Tomoe.
• Co-Op Multiplayer: New Blood lets two players operate together. Trauma Team does as well and attempts to balance the roles of the two players in various ways, depending on the type of operation. Diagnostics and Forensics are one-player only, although the second player can still use their Wii Remote cursor to point out things for their partner.
  • For general surgery, the tools get divided before the mission starts.
  • In First Response, the initial batch of patients can be allocated between the two players. As new patients come in, each player is assigned every other patient.
  • In endoscopy, control switches from one player to another based on time.
  • In orthopedic procedures, the players swap after each action.
• CPR: Clean, Pretty, Reliable: If you're not using the Magical Defibrillator to restore a patient's heart, the game has you massage the heart by hand instead. Sometimes you do it without cutting into the patient and there doesn't seem to be any mention of broken ribs afterwards.
• Criminal Mind Games: In Trauma Team, after the Raging Bomber leads you on a long trail involving the use of a decoy killer (Stephen Eldred) and almost kills Naomi's friend Alyssa, Naomi ends up in the bomber's house. She discovers that the bomber wired four cell phones to four bombs, and instructs Naomi that in order to exit the room alive, she must use the clue papers found by the phones and investigate by looking around the room to find the proper codes.
• Critical Annoyance:
  • When vitals fall to 25 or lower, the doctor/assistant will speak up to alert you and the heart monitor will become slightly louder. If you're playing in the harder difficulty levels where the vitals can plummet, this can happen many times in succession as you juggle the patient between the thresholds.
  • Trauma Team triggers a shrill beeping alarm whenever the current patient's vitals fall under 30. This never goes away unless the vitals are restored above that threshold, cardiac arrest is occurring, or the patient is transported out. It persists in mid-op cutscenes.
• Critical Existence Failure: It doesn't matter how many injuries get inflicted to the patient, no matter how life-threatening, they'll be fine until their vitals drop to 0. (Besides the cases of the instant-failure conditions further below, anyway.)
• Cult: Delphi, who are medical terrorists that see medicine as being against nature and developed GUILT as a sort of counter-balance. Explicitly inspired by the Aum Shinrikyo cult that infamously committed the 1995 Tokyo subway sarin attack. And by "explicitly" we mean it: X-3 in Under the Knife (but not Second Opinion) has Adam state that he studied the attack for his own research.
• Cure for Cancer: The Rosalia Virus disintegrates any other sort of virus it comes into contact with, which made Patient Zero physically unable to become sick or diseased since her antibodies kept the virus in check. Without the antibodies, the Rosalia Virus is an incredibly lethal plague that disintegrates blood and bone too, killing people in mere days. Patient Zero's adoptive father attempted to extract the antibody as a miracle cure, but got infected with the virus in the process and was driven to madness, resulting in both of their deaths and kickstarting the overarching plot of the game.
• Damn You, Muscle Memory!: Players of Under the Knife would have honed their skills by pretending the Healing Touch didn't even exist, as every level in that game penalized them for using the Healing Touch unless completely necessary. Transitioning to the other games results in an uncomfortable discovery that some missions have time limits so stringent, especially on Hard, that the Healing Touch is needed to get that S or XS rank. That, and several procedures are remarkably different, especially the suturing technique.
• Darker and Edgier:
  • While Under the Knife and Second Opinion are medical dramas at its core, the medical terrorism aspect prevents it from becoming too dark as it mostly becomes about Derek and the Caduceus staff trying to contain and defeat GUILT and take down Delphi. New Blood however deals heavily in more realistic circumstances. Mainly it sees the main trio dealing with individuals out for their research, having them kidnapped and attempting to murder them, and sees them in the crossfire in several military operations, one of which includes an armed rebellion. As such, Under the Knife 2 replicates aspects of New Blood's darker tones.
  • Trauma Team, especially once you get to later chapters, can be seen as more sadder and depressing considering the subject matter of said chapters.
• Deadly Delivery: There's a serial murderer in Trauma Team who kills her victims by masquerading as a postal worker, then "delivering" a package containing a hidden bomb.
• Disc-One Final Boss: In the first game and its remake, an operation with Savato is set up as seemingly the Final Boss, due to the dramatic choir music, the GUILT assaulting the victim's heart, and the raised time limit. But once you finish 5-9 and have worked out treatment plans for each strain of GUILT, you still have one more chapter to go before the credits roll. The final level still involves treating Savato, just a souped-up one.
• Diving Save: Little Guy tackles Naomi when the bombs strapped to a suspect go off.
• Does This Remind You of Anything?: The conflict between the Razu and Dal tribes in Under the Knife 2. The conflict between the Hutus and the Tutsis, and the bloody civil war that ensued.
• Do Well, But Not Perfect:
  • In some operations, saving the patient as quickly as possible will not score you enough points for an S or XS rank. You will have to allow for more problems to occur to heal them and receive extra points.
  • Under The Knife 2 throws this out in favor of having a set of bonuses that you must get 2000 points from in order to get the S or XS rank. If it says to do something at least X times, there is typically exactly X of that task for you to do. In short: doing perfect WILL get you an S or XS rank... except when mailing your fission, in which you MUST do a certain number of actions in a certain amount of time without any misses before ending the mission.
  • Trauma Team does away with this completely by giving each operation a strictly fixed amount of actions that will result in a Good or Cool. Dragging on an operation for longer can only lower your score. Because of this, despite operations in Trauma Team being easier to clear, they are much harder to get XS ranks on. One blogger has described Trauma Center's difficulty as Tsundere (harsh on the outside, but soft on the inside) and Trauma Team's as Deretsun (soft on the outside, but harsh on the inside).
  • It is possible to sacrifice your rank in order to achieve a higher numerical score. However, the game gives rank higher precedence than score when saving your best performance. So achieving a high rank can lock you out of topping the leaderboards.
• Don't Try This at Home:
  • From the Under The Knife and Second Opinion manuals:
    This game is intended for entertainment purposes only and contains no medical advice. Do not attempt any of the operations from this game in real life.
  • Completing all the X missions in Second Opinion gives us this:
    However, remember that you're not actually a doctor, so you shouldn't perform surgery in real life. ...Unless, of course, you are a doctor. In which case, we would advise you not to tell your patients how many tries it took you to complete a game about surgery.
• Dressed to Heal: Played straight and subverted throughout each game. Notably, in Trauma Team, Tomoe wears a lab coat over her kimono.
• Dual Boss: Second Opinion features one operation in which you must operate on two strains of GUILT at once. New Blood also does this with Stigma a few times, as well as one bonus operation featuring Stigma and GUILT at the same time.
• Dub-Induced Plot Hole: Japan, America, and Europe have been swapped around quite a bit, causing a lot of confusion. First, the setting of Under the Knife was changed from Japan to America and what was previously America was changed to Europe. Not so confusing at first. Then the remake Second Opinion introduces Dr. Kimishima. Originally a doctor who's stripped of her medical license in America, moves to Japan, then bargains for amnesty back in America, she now loses her medical license in Japan, moves to America, and bargains for amnesty in Europe. Then New Blood, which takes place in America in both versions, cameos Dr. Stiles, said to be from Japan in both versions.
• Dynamic Entry:
  • When a school bus comes out of nowhere in Trauma Team and crashes into the middle of a crowded mall. In the middle of a crowded mall's THIRD FLOOR.
  • Maria's return in "Time for Rejoicing" involves dropping into the hospital while standing on top of a huge crate dropped by a helicopter. She is totally nonchalant about it and has to be seen to be believed.
• Dysfunction Junction: Tomoe Tachibana, professional Yamato Nadeshiko Ninja endoscopist who has dishonored her family and has abandoned ties with her native country of Japan is the player character with the least personal issues.
• Early-Installment Weirdness: Under The Knife on the DS plays very differently to its remake and sequels. For example:
  • You don't get a conventional level select screen, and instead have a traditional mid-story save file. While the Challenge option lets you replay completed operations, you cannot revisit story cutscenes without starting a new playthrough or loading a save from a previous point.
  • There's only one difficulty setting, and your rank caps at S, even for the X missions.
  • Organs and bodies were rendered to look more realistic, rather than bright and colorful like in later installments.
  • Character art was drawn in a much more "shonen" style than later games; compare Derek and Angie in Under the Knife◊ to Second Opinion◊.
  • A different set of sound effects is used than the one shared by every game from Second Opinion on.
  • The operation is automatically failed if the player gets 20 "misses".
  • Every strain of GUILT was given a new, sleeker design, whereas in Under the Knife, they were mostly blobs of various colors.
  • Triti had to be cut out with the scalpel before it could be removed.
  • You can't restart operations; you either need to exit to the main menu or fail it.
  • Among the surgical tools you can use at any time is the Hand (used to massage membranes after you attach them, as well as for CPR) and the Bandage (used to close the patient at the end of every operation). Due to their extremely limited uses they were removed from the tool selection in future games; the massaging step of applying gauzes was removed altogether, while the Bandage only becomes selectable when relevant.
  • The game doesn't explain where you get your end-of-operation special bonuses from, unlike subsequent games.
  • The only method of restarting a patient's heart is through a hand massage minigame where you have to follow a bouncing horizontal bar. Later games drop this mechanic in favor of a defibrillator, and even when New Blood brought back CPR-based resuscitation, it's done differently as a "press the buttons in time with the rhythm" minigame as opposed to following a bouncing bar.
  • The Game Over messages that state the characters resigned in shame and disappeared aren't present, instead it's just a simple "Retry?" prompt over an image of Stiles sadly wandering the street.
• Easy Level Trick:
  • By tapping A instead of holding it, Cheir becomes stunlocked and is unable to attack. This works for both normal and fused variants, meaning any operations starring it become effortless until X-1, and any that feature it alongside other things become much easier.
  • If one doesn't care about rank, Triti becomes much easier to deal with if the player activates Healing Touch right away and removes all the triangles before they have a chance to spread.
• Easier Than Easy: In addition to the usual modifications that come with selecting the Easy difficulty, Intern difficulty in Trauma Team also allows the player infinite continues. The only penalty is that you don't actually get a rank if you use the continue option.
• Eldritch Abomination: All the GUILT could qualify, but especially Aletheia, which is an eye that grows in the patient's heart and stares at you during the operation. It really drives the point home that these creatures are nothing but artificial monstrosities.
• Emo Teen:
  • Linda, at the age of 14 (or 17, depending on the release), just wants to die. In her defense, depression turns out to be an indicator of GUILT.
  • Hank's suicidal patient Claire would also be one, if she wasn't over 20.
• Evil Is Not a Toy: In the 6th chapter of Second Opinion, Nozomi expresses this sentiment about the Z-Cells, which are derived from Adam's own body. According to her, even Blackwell understood that GUILT cannot be controlled, and the Z-Cell treatment is bound to backfire at some point. Right after she says that, the Z-Cell treatment gives rise to a GUILT outbreak right before her very eyes.
• Evil Is Not Well-Lit: The GUILT research labs in Under the Knife and Under the Knife 2 are all dimly lit.
• Failure Is the Only Option:
  • Sometimes it doesn't matter what you do, the patient(s) will die.
  • In Under the Knife 2, when you have to operate on three patients in ten minutes, regardless of how quickly you complete the operations, you still won't have enough time to save Emilio.
• Fanservice:
  • Usually avoided with tasteful placing of the patients' bodies or a blanket in the right place. Still, Dr. Myers' operation for Paraskevi definitely qualifies, what with the camera starting out right on her exposed (undetailed) breasts before zooming in on her chest cavity. She is significantly reduced in cup size and more tastefully covered in the Second Opinion version of the same operation.
  • So, how are you introduced to Reina Mayuzumi? A shot that lovingly details every sexy curve of her body, complete with heaving cleavage shot specifically provided in its own boxout.
  • If this isn't fanservice, life sucks.
  • Maria's introduction has her come out of the shower to answer a call - wearing only lower underwear and a Modesty Towel around her neck, with the dangling ends covering her breasts, with the camera panning up her body as she does. She also gets a Toplessness from the Back shot when she first comes out of the shower.
  • Naomi's necklines plunge like the stock market, and Hank's isn't much better.
  • Dr. Cunningham's second female patient wears lacy black lingerie to go with her rose-pattern black stockings.
• Fatal Flaw: Discussed by Dr. Hoffman in Second Opinion and Under the Knife 2. A doctor cannot operate on themselves both physically or mentally. This is also a test for them as well, that the bonds they forged and the training and wisdom they imparted on their fellow doctors, is enough to save them. In Second Opinion in particular, the protagonist Derek Stiles comes down with GUILT, and it's up to the new Player Character Nozomi to save him.
• Final-Exam Boss: The last strain of Neo-GUILT in Under the Knife 2 summons waves of the six types of GUILT you've already faced in the game (thankfully, four of the original strains didn't make it in - more than a few people would annihilate their cart if they had to face Triti or Savato again). To be even able to damage the boss, you need to take each type out with the strategies you used in previous battles with the strains.
• Fission Mailed: Episodes 4-1 and 4-2 in Under the Knife 2 involve Derek attempting to invoke his Healing Touch and failing, to highlight his Heroic BSoD from the end of the previous chapter. You get the "Operation Failed" display, but the game still calculates your score and you proceed with the plot.
• Five-Second Foreshadowing: In Under the Knife 2, a chapter consisting of multiple Kyraki patients ends after you treat the second-to-last patient, with the team getting ready to operate on Emilio. Sure enough, Emilio dies before Derek can even cut him open.
• Filler: New Blood did away with dialogue-only chapters, so every chapter involves an operation. This leads to a lot of operations and characters that are only vaguely related to the plot, and many "sudden emergencies" that require surgical intervention. This is done for the sake of keeping the gameplay varied, since one of the biggest complaints about Second Opinion was the stagnant gameplay.
• Flunky Boss: Savato occasionally summons some of its young when creating a laceration, and the Queen Kyriaki in UtK2 will lay eggs that spawn lesser Kyriaki if ignored. The foremost example, however, is undoubtedly Aletheia, whose main method of offence is summoning modified types of the six varieties of GUILT previously encountered in the game.
• Foreshadowing:
  • In the first 'First Response' scenario, you end up with someone who suddenly starts having convulsions after you treat her wounds. She has a black bruise mark on her neck. It could be mistaken for a sort of burn or soot marks if you're not looking at it directly. The bruise and the convulsions are both symptoms of the Rosalia virus. The weirdness of it all states 'Yep, Trauma Team has a super virus of its own'.
  • Of all the forensics levels, the very first is the only one that doesn't involve inexplicable madness or an unknown disease that remains so well after the case is solved.
  • The third Diagnostics level, and its followup Surgery likewise deal with an early meeting with the Rosalia Virus.
  • Chapter 3-2 of Under the Knife 2, Prime Time, starts with Derek... combing his hair. Angie chews him out for it. During and after the surgery, all Angie does is glare at Derek and asks him to take the situation more seriously. At the end of the chapter, she goes away in a huff when Derek remarks that due to the journalist's requests for interviews, his week will be busy. This is the first hint that he's letting the popularity go over his head even if he doesn't mean to- and that he's overusing the Healing Touch.
• Fun with Acronyms: GUILT stands for Gangliated Utrophin Immuno Latency Toxin, even though the GUILT are clearly parasites (though it's implied the parasites we see are created from the victim's own cells). In the Japanese version, Guilth doesn't stand for anything.
• Forensic Drama: The Forensics mode in Trauma Team, naturally.
• Game-Breaking Bug: Mature Kyriaki can disappear on you if you suture the first slice before it spawns. This has a tendency only to manifest during a speedrun of the DS games.
• Gameplay and Story Integration:
  • In Chapter 1 of Under the Knife 2, Derek hasn't had a need to use the Healing Touch for a while and tries to keep it under wraps so he doesn't rely on it too much, until he has to use it at the end of the chapter. Rather ironic considering what happens later in the story.
  • In Trauma Team, the First Response episode "So Begins Death" sees all medical transports preoccupied with a train crash while you treat your patients. As such, you can't send out any stabilized patients and maintain vitals while treating your remaing patients. This wouldn't be so much of a problem if it wasn't for the fact that most of your patients are infected.
• Gameplay and Story Segregation:
  • You don't need to use the Healing Touch outside of moments when it's activated automatically due to the plot kicking in, but everyone will comment on how you're using it all the time.
  • It is entirely possible to complete "Awakening" without even using the Healing Touch. Derek still collapses from the strain of apparently doing so anyway.
• Gameplay Roulette: Trauma Team consists of six different types of gameplay for each of its protagonists. CR-S01 has the original gameplay style of the series as he conducts operations, while three other characters have variations on this theme: Tomoe specializes in endoscopy (maneuvering a specialized tool with a camera and minimally-invasive surgical instruments to operate on hard-to-reach parts of the body), Hank specializes in orthopedics (surgery pertaining to the skeleton, such as setting bones), and Maria specializes in first response (providing on-site treatment in emergencies so victims may be safely transported to the hospital). Naomi and Gabriel, on the other hand, have text-based adventure segments based on their areas of expertise, investigation and diagnosis (respectively).
• Good Doc, Bad Doc: Derek Stiles (good doctor) and a number of rivals, including "death doctor" Tyler.
• Gory Discretion Shot: In almost all operations, you have to first perform an incision to open up the body and see the conditions inside. However, this stage is always skipped when a level involves brain operation, where you start "inside" so to speak, presumably so that the player doesn't have to see a man's scalp being cut open.
• Greater-Scope Villain: He didn't intend the consequences, but Albert Sartre killed Rosalia and set Trauma Team's events in motion.
• Guide Dang It!:
  • When it comes time to deliver the final blow to Savato, a Healing Touch automatically activates. When you still can't get it, that's the cue to use your in-game Healing Touch to double the effect and freeze time completely. Gee, I hope you hadn't used that at any point in the operation beforehand...
  • The titular Under the Knife mission, where you're told you need to operate on five Kyriaki patients in a space of only ten minutes, a feat that's incredibly hard (though not necessarily impossible) to do. The thing, though? If you've made it to the third patient or farther, you're told that "reinforcements" will make it in time and take care of the other patients, and you can slow down and not mind the timer if you're not going for S Rank. Unfortunately, people are liable to restart the mission before the timer runs out if they think they can't beat it, and thus can get completely stuck.
  • In Trauma Team's forensics mode, searching a crime scene can sometimes become this. Have fun pixel-hunting...
  • The series is full of small Guide Dang Its; for example, Deftera can be maneuvered using antibiotic gel as a wall, Triti's reproduction is reliant on the thorns on the edges of the affected area — which is only referred to in-game in a manner so vague as to be useless, in the notes that most people just ignore, and after you've had so much trouble that the operation is probably unsalvageable by the time you actually get the hint in-game — and blood pools appear faster if there is already a pool nearby.

H-M

• Hard Mode Filler: Chapter 6 in Under the Knife requires the player to fight all the GUILT strains that had been defeated earlier on the game, but with the difficulty dialed up a fair few notches. Justified in-story as the patients being incubators for GUILT. Second Opinion replaces this with a new chapter entirely.
• Hard Mode Perks: On operations with difficulty levels that can be changed, you can only get the XS rank on Hard difficulty.
• Harder Than Hard: The "Extreme" difficulty for Second Opinion, New Blood, and Under The Knife 2, which only applied to the X Missions. According to the developers, Trauma Team's "Specialist" difficulty elevates all operations to X Mission difficulty.
• Healing Hands: Not the usual, instant-healing kind, though - Naomi's Healing Touch shares a name with the trope, and adds to the patient's vitals every time she gets an OK or better when it's active.
• Healing Potion: Two varieties; one is the antibiotic gel, which slightly raises a patient's vitals when used but is more importantly used for a host of other tasks, such as healing smaller wounds and affixing many things, and the second is the stabilizer, which is more in-line with a traditional Healing Potion in that it is used solely for increasing vitals.
• Heroic BSoD:
  • Derek's guilt over his failure to save Emilio in Under the Knife 2 results in him being unable to use the Healing Touch for almost an entire chapter.
  • CR-S01 has a hard time remembering the truth about his stepfather, Albert Sartre, and the college incident during a surgery. Thankfully, it doesn't last long.
• Heroic Sacrifice: Richard Anderson endures three operations, without painkillers, just so Victor and Derek devise a cure for Pempti. Sadly, he dies three days later, as the surgeries have finally taken their toll on him. He spends his last minutes convincing Hoffman to take the reins of Caduceus — and pulling him out of his cynical anti-surgery attitudes. It works.
• He's Back!:
  • Dr. Hoffman finally returns to active surgery work in chapter 5-1 of Under the Knife and Second Opinion after two decades of refusing to practice surgery, ready to unleash the Healing Touch as if nothing has happened.
    Dr. Hoffman: How can I help?
  • In Under the Knife 2, Derek snaps out of his Heroic BSoD in 4-8 after he remembers why he became a doctor in the first place.
    Derek: Derek Stiles... Didn't you pursue this career to give people hope?! I'm not a doctor if I give up hope before my patients!
• Hospital Hottie: Pretty much the entire cast of protagonists fits this to some degree. CR-S01 and Maria Torres even take it further, being respectively Mr and Ms. Fanservice in Trauma Team.
• Hospital Paradiso: Inverted in Under the Knife. Joining the cutting-edge medical facility Caduceus is considered to be the selfless choice for Dr. Stiles, while staying at Hope Hospital would be more in the interest of his own happiness. Played straight in Under the Knife 2, in which Dr. Stiles declines a high-paying desk job at Acropolis Pharmaceutical in favor of continuing as a surgeon at Caduceus.
• Hypocrite: In an early episode of Under the Knife/Second Opinion, Angie yells at Derek about proper bedside manner after he tries and fails to reassure a patient that the operation will go fine. Cut forward a few episodes, and she tells a suicidal teenager that she should kill herself.
• 100% Completion: The final Doctor Medals in Trauma Team for CR-S01, Maria, Hank, and Tomoe require getting XS ranks on every single operation. The remainder involve various tasks such as finishing an operation with only "Cool" miniranks or finishing every first response operation without losing a single patient. Mercifully, Gabe's medals are glorified scavenger hunts, and Naomi's are quizzes on various medical factoids.
• Ideal Illness Immunity: Rosalia in Trauma Team is miraculously able to live in perfect symbiosis with a super-virus that renders her immune to any other form of disease. Unfortunately, Albert Sartre's attempts to research and exploit this for the good of medicine end in failure, and anyone else who contracts the infection is subjected to an agonizing case of Body Horror bruising, dementia, and death.
• Idiosyncratic Difficulty Levels: Trauma Team's have a doctor theme: Intern, Resident, and the unlockable Specialist.
• Idiot Ball: Derek was given one in ''Under the Knife" in 1-6. He should have been smart enough to know the patient needed to be examined again, but since the game wanted to hammer the fact that he's a mess and a rookie, he let the guy go. It goes as well as you'd expect.
• Im Dying Please Take My Macguffin: In his dying moments, Richard Anderson hands over leadership of Caduceus to Hoffman.
• Interface Screw:
  • The first two Wii games both have an in the dark operation, where you have to use various sources of light in order to see what you're doing. By the end of one operation, the only thing you have is the flash of a camera, which of course only lasts for a second or so, so you have to use it and remember what you saw.
  • In Under the Knife 2, there's a few dark operations - you receive a penlight to work by, but need to aim it (it's added to your surgical tools menu). Additionally, one of these takes place in a moving vehicle, and the screen shakes back and forth periodically.
  • Trauma Team has an operation where your endoscope's flashlight fails. You have to navigate by the glowing gates used as navigational aids in your HUD.
  • Occurs in-universe in Trauma Team during some orthopedic missions, when the guideline for cutting artificial bone malfunctions.
• I Know Mortal Kombat: Lampshaded in the special message in Second Opinion awarded for completing all of the X operations, informing you that, no, you don't, and shouldn't attempt surgery just because you completed the game without undergoing proper education and training first. And that if you are a licensed surgeon, that you shouldn't tell your patients how much you struggled at a surgery video game.
• Ironic Name: The Asclepias genus of plants is named after the Greek god of medicine. In Trauma Team, the flowers are intermediate hosts to the Rosalia virus.
• I Surrender, Suckers: Happens with one of the Delphi members in Under the Knife 2.
• It's a Wonderful Failure:
  • "...Derek had no business practicing medicine in the first place."
  • Trauma Team has you listen to a recording of whatever doctor you were playing as giving up on medicine forever... except in the final chapter, where you get to hear Rosalia's tormented lament over all that's gone wrong.
• It's Personal:
  • In Trauma Team's forensic mode, a bomber tries to kill Naomi by sending her a rigged teddy bear. Morality Pet Alyssa, an eight-year-old girl, innocently takes it and is blown up. Naomi is not happy about this.
  • In the fourth case, when Naomi sends a guitar broken by one of the bomber's bombs to be analyzed by Little Guy, he realizes it is a musical legend's guitar valued at about $100,000. Needless to say, he's not amused, and drops the trope name verbatim.
• Just Plane Wrong: Under The Knife has an operation called "Miracle at 9,800 ft." ("Miracle at 3000 m" in the Japanese version, thus ruling out localization-related Unit Confusion), referring to the operation taking place aboard a passenger jet. However, 9,800 feet is far too low of a cruising altitude for such aircraft; they usually cruise at 30,000-40,000 feet. The only possible justifications for flying that low would be if the plane was ascending after takeoff, descending to prepare for approach, or had to hold that altitude for some urgent reason, none of which are stated. This error is averted in Second Opinion as the equivalent level is just named "Caduceus on a Plane" instead.
• Kidnapped Scientist: A major plot point in New Blood, where the terrorist group forces you to operate on their guinea pigs.
• Last-Minute Hookup: It's heavily implied that Derek and Angie get together in Under the Knife 2's ending, if the ending epilogue to the first game wasn't enough.
• Leaning on the Fourth Wall: "Little Guy" in Trauma Team is represented in his chat window by a Mii.
• Littlest Cancer Patient: Amy Chase, Tyler's sister, is introduced in Under the Knife to show that GUILT doesn't spare children, and the situation looks so hopeless that, had it not been for Derek's surgical skills, Tyler was considering euthanizing her to end her suffering.
• Locked Room Mystery: One of the stages in the Forensics mode of Trauma Team. In fact, the stage has the exact name as the trope.
• Loophole Abuse: In the final diagnosis of Trauma Team, the army tries to stop Gabe from making any further diagnosis, and installs a spyware program on RONI to stop her from recording symptoms. To get around this, Gabe makes "friendly conversation" with the patient to uncover his symptoms, and asks RONI to record some "meaningless, friendly observations."
• Love Makes You Evil:
  • In Under the Knife 2, Patrick Mercer's motivations for his Neo-GUILT research is so that he can save his comatose wife.
  • In Trauma Team, the culprit of the third case is revealed to have been this, although it was also paired with brain tumor-induced Ax-Crazy.
• Luck-Based Mission: The pathogens' attacks and movements are slightly randomized, and sometimes getting a great rank (or just being able to save the patient) can boil down to the right things happening at the right time.
  • More specifically, if a Deftera pair starts bouncing everywhere but against each other, Pempti decides to use its tumor-inducing attack followed by the cutting one, or the Tetarti huddle together making it easy to inject the wrong one, you can say goodbye to your S rank. In fact, this is Deftera's MO: how easy or hard the operation can be depends purely on whether it's willing to cooperate at all.
• Made of Iron:
  • Valerie's Healing Touch makes the patient into this - no matter what happens, be it colossal screwups, stab wounds, or a frustrated player shanking the crap out of them with the scalpel, for the next 30 seconds or so, their vitals will not move at all (except for cardiac arrest).
  • Also, in-universe, Tomoe's father in Trauma Team. When he needs to be operated on, they can't inject him because the needle not only fails to penetrate his skin, it bends in half. They also require a katana to open an airway to insert the endoscope.
• Magic A Is Magic A: Despite their fantastic nature the games are very consistent with how Healing Touches work. A Healing Touch used subconsciously out of desperation costs the doctor nothing and can last quite a while, while an intentional one exhausts the user and last for a brief time proportional to their focus. Two different Healing Touches can be used in concert without interfering with each other. Meanwhile, two of the same Healing Touch will stack. This includes the same doctor using a desperation healing touch and an intentional one simultaneously.
• Magic Versus Science: A major focus of the franchise, given the conflict between the Healing Touch, which is associated to the Greek God of medicine, and the GUILT, which are genetically engineered diseases.
• Magical Defibrillator: Zig-Zagged all over the place.
  • In what might be an example of The Coconut Effect in action, Under The Knife uses a defibrillator correctly — Angie attempts it offscreen, and you respond to a flatline with a cardiac massage. Second Opinion changes these operations to incorrectly apply the defibrillator instead. The subsequent games follow suit, and employ the cardiac massage in situations where a defibrillator cannot be used, though some operations also swap this out for the correct procedure of a heart massage.
  • In a particularly jarring scene in Trauma Team, CR-S01 orders his support not to touch a patient who was undergoing ventricular fibrillation (which is when you're actually supposed to use a defibrillator...), only to whip it out after the patient started going into cardiac arrest. Even worse, a huge deal is made of the fact that they can't use the defibrillator on a flatlining patient while the power is out. In the interim, CR-S01 is seen giving the patient chest compressions, which is what you're supposed to do for a flatline.
  • Trauma Team tends to be pretty accurate when it comes to using the defib in First Response levels: when there's only one heartbeat before the patient flatlines, they're suffering cardiac arrest and given chest compressions. When there's one followed by a very erratic pattern, they're undergoing ventricular fibrillation and you need to use the defibrillator.
• Marathon Level:
  • Prior to Trauma Team, you also get to see the time limit for your operation during the briefing. The most common time limit is 5 minutes, so any mission that gives you more (usually 10 minutes) falls into this, and often because you have to work on multiple patients.
  • Diagnostics and Forensics in Trauma Team have only 1 difficulty level and are unranked, but each mission can take up to an hour to complete. There's a reason you can save in the middle of a mission.
  • While the Orthopedics operations are longer than the other types of operations due to a greater emphasis on precision over speed, "Spreading Infection" is ridiculous, taking anywhere between 15 to 20 minutes on average to complete. In contrast, the next longest Orthopedics operation takes around 10 minutes.
• Maximum HP Reduction: Several operations or circumstances can reduce your patient's maximum Vitals:
  • If Savato's larvae are allowed to combine into a larger blue one, the presence of that will reduce maximum vitals until it's destroyed.
  • Operation X-6 in Second Opinion caps the patient's vitals to 50 with no in-universe justification, ensuring that the player can only divide Paraskevi once before having to stabilize the patient.
• Meaningful Name:
  • Derek Stiles' initials refer to the DS console, and his surname to the DS Stylus.
  • Second Opinion also features a doctor named Nozomi Weaver, the first syllable of her surname being a reference to the Wii console (and the Wii-specific features of her bonus missions) and her initials to the Nintendo Wii. Neither this nor the DS example is present in the Japanese version.
  • The military transport carrying the Rosalia vaccine has the call sign "Leukocyte" - a.k.a. white blood cell.
  • The leader of Delphi, and patient zero of GUILT, is named Adam. Just in case you really didn't get it, the cutscene in Second Opinion revealing Adam is the source of the Z-Cells is called "Original Sin".
• Medical Game: These games are about doctors who start out treating mundane injuries and illnesses, but are later confronted with patients afflicted by horrific artificial diseases or deadly pandemics. Some of the parasites from the first game include a strain that carves up the patient's insides with Combat Tentacles, and another that secretes carcinogens to cause tumors.
• Medical Horror: Being a series developed by the same company behind the Mega Ten games, the entire series has bucketloads of it. The Virus and Body Horror are especially prominent.
• Mirror Chemistry: A "Chiral Reaction" indicates that a GUILT is present in a patient. What precisely this means is left unclear, though it may be suggesting that GUILT have opposite chirality to humans.
• Miscarriage of Justice: Ultimately what CR-S01's conviction as a bio-terrorist boils down to in Trauma Team. Due to his amnesia, CR was unable to effectively defend himself or prove his own innocence, leading to him being declared guilty of the Cumberland College incident. While we discover his innocence over the course of the game, the fact that he is innocent is never rectified or even addressed at the end.
• Mood Whiplash:
  • "Proud One" starts out as one of the funniest chapters in Trauma Team, due to the interactions between Dr. Cunningham and The Comically Serious patient, but it suddenly becomes tragic as soon as Samuel starts to die before your eyes.
  • Played for catharsis in the final operation in Trauma Team. To defeat the Twisted Rosalia, you have to first go through four hectic stages of destroying its outer shell, and then destroy its core. After the mad scramble beforehand, one would certainly expect the final stage to be also a complete chaos. In reality it's the opposite. All music stops when the player opens the heart and exposes the core, and the final steps are simple and straightforward - inject cardioplegic solution, excise the microfilm, inject the serum, with the only obstacle being a non-reversible countdown, during which all characters become unusually quiet. When the Twisted Rosalia is defeated, soothing piano music begins to play, the core disintegrates in white light, and Naomi's vitals stabilize, creating a cathartic sense of victory after extreme stress.
• Mundane Made Awesome:
  • During most of the game, you feel like you are playing Space Invaders on someone's stomach. But again that is indeed awesome. Also, the final GUILT parasite at Under the Knife is a giant spider parasite that creates a web that seems to "absorb" heartbeats. Also the parasite looks like it's on fire.
  • The Healing Touch ability in most games is depicted as surgical Bullet Time, invoked by the surgeon concentrating very hard.
  • Awesome Center, an Affectionate Parody fan video, exaggerates the sci-fi elements of the games for laughs.
  • It's implied that on the X missions you're pretty much operating on a zombie.
  • The trailer for Trauma Team takes this and runs with it.
• Musical Nod:
  • In the first Raging bomber mission Naomi finds a broken guitar, she asks little guy about it he says it belonged to "musical legend, Ben Frank" which is a reference to Benjamin Franklin (the guy who wrote the song for the credits)
  • The Stigma operation music in New Blood quotes GUILT's theme.
  • Trauma Team has several nods to music from Second Opinion, usually when Naomi is involved. They include a somber piano rendition of Second Opinion's main theme and a piano rendition of its final boss theme when you stop her heart in the last operation.
  • The briefing music for particularly serious procedures in New Blood and Trauma Team becomes a variation on Under the Knife's briefing theme.
  • The Hope Hospital theme also gets referenced in the Caduceus theme of New Blood and Naomi's office theme in Trauma Team.
• Mystical Plague: It's heavily implied that both Rosalia and the virus she harbored are supernatural in essence. She correctly predicted that her death was just the beginning of the pandemic, and her ghost manifested before Maria to warn her of it. Also, people who are infected with the virus somehow know to link their illness to the name Rosalia, despite never having met her before.

N-R

• Nigh-Invulnerable: Pempti generates a large amount of gelatinous fluid, all produced and maintained by its core. If the core is burned down by normal medical tools, it can regenerate rapidly. As Victor puts it, it has a lot of contingency plans to become really tenacious. Half a chapter is devoted to Victor developing new devices to combat this thing, and when it's cornered, it starts attacking.
• Nintendo Hard: It's an Atlus series, what did you expect? They finally had to cave and add an easy mode in the sequels. It'll still break your arm. It seems that many of the operations in New Blood were designed around having two players, and both Healing Touches available, so operating alone, though possible, can be ESPECIALLY hard.
  • Made worse by the fact that each game is hard in its own way. The original favored precision (no quick gestures for stitches, you have to make sure it's very even and narrow), New Blood favored consistency (a long unbroken Chain factors in greatly towards a good total score), and Under the Knife 2 favored raw speed (such as the challenge on Bythos being that most players simply can't heal faster than the patient takes damage). Which game is the worst ends up depending on your particular playing style.
  • Trauma Team fixes these problems, and in many missions, failure is essentially impossible.
  • And just when you've finished the main story after everything it's thrown at you, the X missions will proceed to give you a run for your money.
• No Mouth: The first response patients in Trauma Team. They only get one when you're required to perform an intubation.
• No Item Use for You: One operation in New Blood gives you no stabilizer and a limited gel supply. If you run out of gel you'll just have to take measures such as making the incision or putting on the bandage without the gel (which results in getting a "Bad" rating on either action), or suturing puncture wounds shut instead of using membranes (also results in Bads). It is possible to avoid these actions if you are conservative with your gel use, however. An operation in Under the Knife 2 has a similar restriction and can be just as difficult.
• Non-Indicative Name: The "Autopsy" mode in Trauma Team. A more accurate (but less snappy) name would be "Forensic Investigation", since at no point do you actually perform an autopsy beyond just looking at the corpse.
• Nonstandard Game Over:
  • Time limit aside, there are occasional circumstances that will end an operation immediately regardless of other factors, including allowing Triti vapor to escape or letting Paraskevi burrow into the heart in Under The Knife / Second Opinion and touching an active pin on a mind-control device in New Blood.
  • Normally, failing an operation leads to a more senior doctor taking over, or another character lamenting that the patient will now die, followed by a monologue about the player doctor's Heroic BSoD. However, failing the quasi-operations on some death traps (such as the bomb in Under The Knife and the lock in New Blood) just results in a wordless Fade to White followed by the retry prompt.
• Normally, I Would Be Dead Now: Thanks to the amazing surgical skills some of the doctors possess, patients survive:
  • GUILT strains that cut open the heart (and in a few cases, take over the heart completely, leaving huge tumors/an absolutely massive main body that uses part of the heart as an eye-like structure).
  • Multiple aneurysms bursting in the brain.
  • And in Trauma Team, eight-year old Alyssa survives an explosion from a bomb that she was holding, despite several other grown adults dying instantly after suffering the same fate.
• Nostalgia Level: Operation A-4 in New Blood, supervised by Derek and Angie, has you operating on simulated patients infected with GUILT. And in the last two patients, GUILT and Stigma at the same time.
• Not Quite Dead: A rarity for this series, in Trauma Team, one of Hank's patients, a depressed girl, gets shot and loses all consciousness in his arms. He later learns that Maria was able to resuscitate her, and cannot contain his happiness.
• Not Using the "Z" Word: Naomi clearly suffers from some aftereffect of GUILT, but it's never referred to as that. Even when Rosalia complicates the condition and mutates into something worse.
• Obligatory Swearing: Trauma Team ups the saltiness quite a bit from the previous games, most of it is thanks to Maria Torres' Hair-Trigger Temper.
• Obstructive Bureaucrat:
  • This series loves to subvert this trope - the government officials such as Anderson, Holden, and Tillman end up doing some badass things to save people, even at great personal cost.
  • Played straight once in Under The Knife, where one tells Sidney off for shipping life-saving GUILT medication to various hospitals because they aren't FDA approved yet.
• Obsolete Mentor: Derek and Caduceus itself over the course of Under the Knife 2 until the replacement organization is revealed to be corrupt and its newly minted doctors equipped with an artificial Healing Touch are all on the brink of death from GUILT.
• Oh, Crap!: Naomi has one of these in the episode "Crime of Passion" when she realizes the package she just received is a bomb. And her 8-year-old Morality Pet ran off with it when she wasn't looking...
• Ominous Latin Chanting:
  • The music for the final GUILT, Savato and part of the final Stigma, Cardia.
  • The Ominous Pipe Organ in both of Cardia's themes and Aletheia's theme (albeit not nearly as much as in Cardia's).
• One of Our Own:
  • In Second Opinion, Derek must be operated on by Naomi when he gets infected with Kyriaki and Paraskevi.
  • In Trauma Team, the final mission has CR-S01 operate on Naomi Kimishima after the Rosalia virus inside her mutates along with her genetic disorder.
• Open Heart Dentistry:
  • In Episode 6 of New Blood, the trio is given a guard dog named Pepita that they become attached to. When Pepita is shot, saving the trio's lives in Episode 6-4, our doctors take it upon themselves to operate on it, despite having no veterinary training. Admittedly, the best they can do is administer first aid by extracting the bullets and patching up her wounds. They send Pepita to be treated by a proper expert afterwards.
  • See also Open Bomb Dentistry in the first game's "Explosive Patient" operation - The reason you can defuse the bomb is because your NPC partner used to date a guy on the bomb squad.
  • In the same vein as the New Blood example, Trauma Team has you perform a simple endoscopy on a cat. Which becomes not so simple when Rosalia shows up.
• Operation Game of Doom: Several of the viruses get particularly nasty if you don't remove them carefully enough, or touch something you're not supposed to while moving the parts to the surgical tray. In a more literal example, the first game has Derek actually defusing a bomb with his surgical equipment while taking care to avoid detonation.
• Orphaned Series: The last game in the series was Trauma Team, released all the way back near the middle of 2010. There's been no word of any future titles since then. Even when Atlus published surveys asking for customer feedback on their games, the Trauma Center series has often been excluded from consideration.
• Parasites Are Evil: The main threat in the DS games are the bioengineered plagues known as G.U.I.L.T. Unlike normal parasites, G.U.I.L.T. specifically damage the body in a way that ensures the host suffers in agony before dying. If they detect outside interference, such as a doctor trying to save the patient, they speed up the infection to try and kill the host before they can be dealt with.
• Percussive Maintenance: In a few instances of cardiac arrest during First Response, you correct it not with the usual chest compressions, but with a single, strong strike to the chest.
• Previous Player-Character Cameo:
  • Derek and Angie appear in a few chapters of New Blood, and even host a post-game bonus challenge where you operate on a virtual simulation of the GUILT strains from the first game.
  • Derek shows up a couple times in Trauma Team, though you never see his face or hear his name.
• Psycho Serum:
  • In the sixth chapter of Second Opinion, Caduceus Europe tried to use samples from Adam's body to create a super-healing agent called Z-Cells. It didn't go any better, and the guy who came up with the idea was revealed to be a Delphi mole.
  • Neo-GUILT serve as performance-enhancing substances. Bythos enhances bodily functions and motor skills (it was basically used as a steroid); Sige sharpens the user's thought processes, which is what enabled the artificial Healing Touch; Aletheia halts the user's aging; and while Nous isn't explicitly shown to have such an effect, the meaning of its name and the fact that its original host went brain-dead imply that it was some sort of learning agent. But since they are derived from GUILT, Side Effects Include... agonizing death once the parasite inevitably awakens. Sige in particular drove Adel totally nuts.
• Pulled from Your Day Off: Trauma Team opens Maria's story with her being needed on her day off due to high load.
• Puzzle Boss:
  • Triti. The execution isn't particularly difficult, it's more about trying to figure out how to remove its tiles without making it generate more.
  • Brachion functions as one between all the Stigma strains; the puzzle lies in how to efficiently extract its grapplers while keeping the toxins in check.
• Rapid Aging: This happens right at the end of Under the Knife 2 to Reina Mayuzumi, who had been using the Aletheia strain of Neo-GUILT to preserve her youth.
• Rank Inflation: Not only is there the S rank, but Second Opinion introduced the XS rank, available only on Hard, Extreme/Specialist, and Special.
• Real Is Brown: The graphics designers worked hard to invert this for Trauma Team, and based the majority of their design work on the theme of vibrant colors.
• Red Eyes, Take Warning: In Under the Knife 2, all Delphi terrorists have red eyes (except for their leader Heinrich).
• Recurring Riff:
  • The operation briefing theme from the first game makes return appearances in both New Blood and Trauma Team. The former uses a straight cover for Stigma pre-ops, while the latter has a darker remix that it applies to particularly tense conferences.
  • The tracks that play during most of the final arc in Trauma Team all share a similar musical segment.
• Recycled Premise: A lot of operations in Under the Knife 2 are similar to several procedures in New Blood, only given more difficulty. For instance, it combines both the gallstone and appendix operations into a single level and you have to do it without the Healing Touch due to story circumstances.
• Roadside Surgery:
  • Trauma Center:
    • The chapter Caduceus on a Plane has you doing surgery on a plane that sometimes experiences turbulence.
    • Another level exclusive to the Wii version has you doing emergency surgery at a car crash site, where the lights are failing.
  • Under the Knife 2
    • Derek and Angie are forced to treat a broken arm of one of their kidnappers, while in a moving vehicle that's evading police pursuit.
  • Trauma Team
    • First Response subverts this concept. While you do use some tools shared with Surgery, you're just performing first aid, stabilizing the patient so that they can be transported to hospital for proper treatment.
    • A few Endoscopy levels are set outside of the hospital, including one where you navigate through rubble at a disaster site.
• Rush Boss: Onyx of New Blood has an incredibly deadly attack that can end the patient in a few hits. However, if the player can find the real copy quickly enough each time, they can complete the level without seeing Onyx attack at all.

S-Y

• Sadistic Choice: Derek is forced to make a seriously hard choice in 3-6 of Under the Knife 2: either save Emilio and Heather first, and potentially let two patients in bad condition possibly die or develop complications, or operate on said patients first... and let Heather and Emilio possibly die or develop complications. Sadly, the latter happens and Emilio dies. Not helping matters is that both Emilio and Heather wanted the other to be saved before them.
• Save the Villain:
  • In the first game, Derek confronts Blackwell, one of the lead scientists behind the development of GUILT, who's been infected with the seventh strain — Savato. Derek cures his GUILT so that he can face his crimes and make amends with Angie.
  • In Under the Knife 2, when the HOA's anti-GUILT serum causes Heinrich's mutant GUILT to activate and ravage his body, Derek jumps in to save Heinrich by curing the GUILT through the tried-and-true methods, keeping it from causing more havoc and to allow Heinrich to be brought to justice.
  • At the very end of Under the Knife 2, Derek is forced to save Mayuzumi from the activated Neo-GUILT because the culture tanks around her are rigged to explode and spread havoc if she were to die. He also tries to save a despondent Mercer, but the UN soldiers have shot him through the heart and Angie tells him there's no saving him.
  • The final mission in the Orthopaedics chapter of Trauma Team sees Hank confront a mall shooter who has an inoperable spinal tumor. The shooter injures himself in an attempt to escape, and despite the crowd's protests, Hank opts to get him to a hospital to treat his wounds and his cancer so that the shooter can face justice.
• Science Hero: The main character is part of an organization dedicated to advancing medical science enough to eradicate disease, while the bad guys are a Knight Templar organization who believe that medicine violates God's will by denying humans "the blessing of death". It's zigzagged when you notice said science hero also uses superhuman focus abilities inherited from a Greek demigod which he activates by drawing a pentagram, and he can apparently lose these abilities if he "loses faith".
• Sequel Escalation: Under the Knife 2 reuses several familiar procedures but puts in a cruel twist to make them more challenging, particularly if they are reused in later chapters. Brain aneurysms? UtK2 sics 3 of them in a row on the player and complicates things by throwing in pus and tumors at the end. Burn victims? 3 of them in a row once again, with a much shorter time limit than usual.
• Sequential Boss: The Challenge missions in New Blood would have you operate on multiple patients in a row, with the vitals from the last carrying over to the next. Sort of justified in that it's supposed to be a VR simulation, not real operations.
• Serial Killer: Sandra Lieberman from Trauma Team is a serial killer who targets famous people. She causes several deaths by disguising herself as a mailwoman and delivering bombs disguised as innocent items to her unsuspecting victims. Her horrifying crimes earns her the nickname "Raging Bomber".
• Serious Business: While surgery is in fact an important and serious concept in real life, the games still manage to wring every moment for all its worth. There's a TV show revolving around live, on-screen surgeries in New Blood.
• Sexy Packaging: The Japanese packaging◊ for Trauma Team makes great use of Maria's... assets. Do note that North Americans are not shafted out of this, as this art is used for the cover of the NA instruction manual as well. Sexy Instructions?
• Shadow Archetype: Under the Knife 2 has three notable examples:
  • Adel Tulba to Derek. The latter possesses the Healing Touch naturally, but suffers a Heroic BSoD that causes him to lose the ability to use it. Adel too is deeply affected when he learns that this caused Derek to back out of an operation meant to save him, which had to be completed by Dr. Hoffman. The difference between the two is reflected by their reactions to these crises: Derek pushes himself to continue working and eventually forces himself to remember why he became a doctor in the first place, which makes him regain his Healing Touch. Meanwhile, Adel leaves Caduceus for the Hands of Asclepius and gains an artificial Healing Touch through Neo-GUILT therapy, which eventually causes him to succumb to dementia and shock, forcing Derek to save him.
  • Reina Mayuzumi to Director Hoffman. The latter is naturally able to use the Healing Touch, but grows extremely reluctant to use it after he loses a patient despite his abilities, and is always wary not to exceed his limits. Meanwhile, Mayuzumi uses the Aletheia strain of Neo-GUILT to retain her young looks, and intends to introduce the use of Neo-GUILT treatment on a large scale despite being aware of the risks posed by its nigh-inevitable failure, only stopping once it has an effect on her.
  • Patrick Mercer to Professor Blackwell. The latter was forced to become a Delphi researcher against his will to ensure the safety of his daughter Angie, whom he genuinely loves and esteems, readily agreeing to help fight GUILT afterwards. On the other hand, Mercer is a bureaucrat in charge of medical research involving GUILT who ends up using it for his own ends, wanting to exploit its properties to bring his wife out of a coma, willfully shunning his daughter Heather in the process and not showing any remorse in being responsible for the suffering caused by Neo-GUILT.
• Shipper on Deck: Nearly everyone in both Hope Hospital and Caduceus ships Derek and Angie and their budding romance is often the subject of their workplace gossip.
• Ship Tease:
  • A lot for Derek and Angie during the extra content of Second Opinion. From blatant (Angie being so hysterical when Derek is infected with GUILT that Weaver flat-out asks why she hasn't said anything to him yet) to subtle (the final shot of the credits is a living room/study with a corkboard over a desk. The board has pictures of everyone at Caduceus except Derek, so it's probably his place. All his coworkers are at the edge of the board, except Angie, whose picture is front and center.)
  • After a bit in Second Opinion, there's quite a lot of Ship Tease for Naomi and Navel in Trauma Team.
• Shoot the Shaggy Dog:
  • Despite your best efforts (not to mention, three operations and two research puzzles), Anderson succumbs to Pempti in Under the Knife / Second Opinion.
  • In Under the Knife 2, Emilio is cured of his PGS, liver failure and a Nous infection, only to die just a few chapters later, due to a terrorist attack that infects him with Kyriaki.
  • Master Vakhushti dies anyway after you remove the final Stigma from his body in New Blood.
• Shout-Out:
  • The first game's patients are named after the actors and characters of ER, House, Scrubs, and Grey's Anatomy.
  • Chapter 3-8 of Second Opinion is titled "Caduceus on a Plane". The symbol of Caduceus is a caduceus: two snakes wrapped around a staff.
  • Not to mention the fact that the person you have to help in chapter 7-1 of New Blood is named after Rose and Blanche from The Golden Girls.
  • The opening sequence of New Blood is bears resemblance to the opening credits of House.
• Shown Their Work:
  • The planner of the Diagnosis mode in Trauma Team put an enormous amount of effort into doing research, to the point at which staff members started consulting him when they were feeling sick.
  • Along with GUILT, the supervirus in the game, they are based off infamous parasites ranging from Toxoplasmosis (Kyriaki's inspiration which has a side effect of increasing the suicidal behavior of certain animals) to Scleroderma (Triti). Yes, Delphi turned already dangerous parasites into even more deadlier organisms.
  • The Medal Challenges found across the Forensics missions in Trauma Team are all reasonably accurate multiple-choice quizzes pertaining to medical knowledge.
• Shut Up, Hannibal!: Adam gets a lot of this from Derek and Naomi in the postgame levels.
  Adam: "Man crawls on the earth like vermin, only breeding and fighting for all eternity. Yet you dare judge them... You, who lost the ability to die."
  Derek: What's that even supposed to mean?!
• Sliding Scale of Shiny Versus Gritty: The surgery graphics started off somewhere in the middle and slid toward shiny in future installments. This culminates with Trauma Team, in which tumors are represented by red gems. The character designs, on the other hand, got a bit more gritty in New Blood.
• Smoking Is Cool: Gabe is always smoking. Even while he's taking a shower. This is even brought up by Hank.
• Socialization Bonus: Trauma Center: New Blood can be completed entirely in singleplayer, but having a competent partner in co-op makes some operations much easier: not only do you have a second pair of hands, but you can use both Healing Touches in the same operation.
• Solve the Soup Cans:
  • Both Under the Knife and Under the Knife 2 feature simple puzzles that are supposedly related to complex biological science, given to Dr. Stiles to solve for whatever reason.
  • Under The Knife / Second Opinion handwaves it by saying the scientist who gives Derek the puzzle isn't interested in the solution, just his problem-solving methods and everyone else at Caduceus did the same puzzles.
• Spoiled by the Manual: In the manual of Trauma Team, their respective section goes into great detail about Naomi Kimishima's terminal disease, something that isn't learned about in-game until quite a bit later.
• Stealth Hi/Bye: Tomoe Tachibana and her butler are fond of this in Trauma Team. It's not quite a true Stealth Hi/Bye, since the player can visibly see them appear and disappear even while the other characters can't, but it's close enough.
• Stone Wall:
  • Triti. Unless you refuse to use the stabilizer, Triti will not kill the patient. However, it's irritating to remove the entire thing without a fast hand or the Healing Touch, and may very well make you lose by draining the 5 minutes you're given. God help you if it manages to expand.
  • Stigma Ops is less proactive with its attacks, relying on the core absorbing nutrients to do any real damage to the patient. If the player can regularly keep everything on the field in check, it can be treated without even needing to touch the stabilizer. That said, Ops can take a lot of laser exposure before it succumbs, and unlike Pempti, Ops fights don't come with unlimited laser.
• Supernatural Phone: Naomi, The Coroner, has a phone through which she hears the Last Words of the current victim.
• Suspiciously Similar Substitute: The first strain of Stigma, Cheir, behaves very similar to Kyriaki, though it differentiates itself with additional attacks that it gains in its mutations.
• Suspiciously Specific Denial: In Trauma Team, Gabe and RONI are given an order to stop examining a soldier, and spyware is installed on RONI to keep an eye on them... but then she realizes that due to Artificial Stupidity, it will only report when Gabe is engaged in blatant diagnostic activity. Cue Funny Moments as Gabe has a chat with his new buddy while idly mentioning that they are not looking for symptoms.
• Suspicious Video-Game Generosity:
  • During some of the Final Bosses, the game will automatically deploy the Healing Touch for you. This does not mean "Just in case you used your Healing Touch already, here's another one." It means "Hope you haven't used your manual Healing Touch yet, because if you can't use it here, enjoy your inevitable defeat!"
  • For Pempti operations, you're given a special laser that never burns holes in the patient, and never breaks or needs to cool down. This is because Pempti requires sustained use of the laser to defeat.
• Synthetic Plague: Played straight with the GUILT and Stigma, but not with the Rosalia virus, which is either a natural mutation or a Mystical Plague.
• Take That!: Gabe tells RONI that he's a "real doctor" that went to medical school, and not someone who took online classes to get their degree.
• Take Your Time: Unlike in the previous games, the actual surgeries in Trauma Team have no time limit.^note There are three exceptions: CR-S01's final mission and Tomoe's final two missions pre-pandemic. The former has him performing an operation on a bombing victim before the FBI takes him back into custody, and the latter's two levels involve a man whose lungs are rapidly filling up with blood and a mission where Tomoe uses her endoscope to search for survivors in rubble with a structure collapse imminent in a few minutes.
• Talking Is a Free Action: Whenever a character gives you advice during an operation, time, vitals, and any active GUILT/Stigma stop until they are finished talking. There's a handful of exceptions, though. If any chatter is more than one "message box" long, time will almost always stop and you'll have to advance the text normally (this DOES extend the Healing Touch duration, but it's almost always a bad thing). If it's just a one-line observation (or Angie helpfully reciting, step-by-step, the procedure you're doing as you do it for the fifth time), you won't be interrupted and the game will keep going.
• Techno Babble: The main method through which GUILT can be exposed in a patient is something called a "Chiron Test" that checks for chirality and emitted wavelength intensity of GUILT cells. How it is performed is never really elaborated on, in gameplay your assistants' dialogue about chiral reactions is really just a way of measuring the amount of GUILT remaining in a patient.
• Temporal Paradox: Done accidentally in Trauma Team. The first Surgery mission is a direct follow up of the second Diagnostic mission. Keep this in mind. At the end of the first Surgery mission it branches out to the third Orthopedics mission which then leads to the third Diagnostic mission. However, by the time you choose that last one, you'll notice that the intro of that mission literally states that the first Surgery mission didn't take place yet. So, in the end, it's most likely that the writers of the game accidentally put the writing tense in the wrong order in the third Diagnostic mission.
• Tempting Fate: Episode 6-5 of Second Opinion has Derek and Naomi see the fruits of Caduceus Europe's Z-cells, which are the product of attempting to repurpose GUILT to treat wounded soldiers. The patient demonstrates a remarkable recovery, but Naomi is well aware that GUILT is uncontrollable and hopes she's not around to witness when it backfires. Right on cue, the patient coughs up blood and develops a GUILT infection, infecting several other conference attendees.
• Thanking the Viewer: Done quite well in Trauma Team, when post-credit Gabe speaks directly to the player, after which you are treated to a message from all doctors thanking you.
• Theme Naming:
  • Caduceus, Delphi, and the Chiral Test for detecting GUILT all stem from Greek Mythology. The names of the seven GUILT strains are based on the Greek names for the days of the week.
  • Under the Knife 2 introduces the Neo-GUILT, named for four Greek-derived concepts from Gnosticism: Nous (Intellect), Bythos (Depth), Sige (Silence) and Aletheia (Truth).
  • New Blood used more Greek, this time from different parts of the body.
  • And then there are patients whose names are a mix and match of the characters and actors of House, Scrubs and ER.
    • Patients in the second game use names from Grey's Anatomy, another medical drama. Also, some doctors borrow one of their names from these four series. Examples: you have Derek Stiles vs. Derek Sheppard, Dr. Robert Chase from House and Dr. Tyler Chase from Trauma Center are both blond, and to some extent Adel is a Spear Counterpart to Adelle from Grey's Anatomy.
• There Is No Kill Like Overkill: In New Blood's final surgery, Cardia's Desperation Attack has the potential to inflict 750 points of damage, which is enough to kill the patient seven and a half times.
• Timed Mission: Every mission, as it were. That is, until Trauma Team, which drops the timer for the vast majority of the missions. Take note that this doesn't mean the game no longer rewards swift treatment. Your completion time is still tracked and can factor in to scores and bonuses — you just don't see the timer until you get your results and rank.
• Time Stands Still: At the end of Under the Knife, you automatically use your Bullet Time healing touch. If you use it again, time freezes. Completely.
• Title Drop:
  • The missions Under the Knife (5-1) and Second Opinion (6-4).
  • The Japanese titles for Trauma Center games include 超執刀 (super surgeon), which is also displayed when the player gets an S Rank.
• Too Awesome to Use: Your Healing Touch can certainly save you... but what if you need it later? Made worse if you started with the first game, which penalized your score for using it on most operations; later games practically expected you to use it if you wanted XS-ranks on certain missions, but then would happily return to final bosses that required you to save your Healing Touch till the end of the battle.
• Toplessness from the Back: Tomoe bathing in her very first cutscene. Maria Torres is an even better example. Watch her first cutscene, right after she steps out of the shower.
• 20 Minutes into the Future: All of our most dreaded diseases (AIDS, cancer...) are all but gone. Then GUILT shows up...
  • But of course. We have antibiotic gel!
  • And yet they all seem to be there for Trauma Team, particularly in Diagnosis. Searching for a cure to them even motivates the events that start the viral outbreak.
• Two Girls and a Guy: In New Blood, we have Markus Vaughn, Valerie Blaylock, and Elena Salazar.
• Understatement: In CR-S01's bio, it mentions that he was involved in the Cumberland College incident that killed several people. By several, they mean everyone on campus.
• Unexpected Gameplay Change: The games like to throw in at least one mission that has nothing to do with operating, such as defusing a bomb in the original and Second Opinion using a scalpel, forceps and laser. It's just like operating, only the patient's a mechanical device that can kill you if you mess up! Additionally, the bomb is completely different between the two games.
  • New Blood has you using forceps to crack a freaking toy lock.
  • In Under the Knife 2, it's a mechanical door lock instead - this has the advantage that locks won't kill you, but the alarm goes off if you mess up at all. Though it's implied by the Game Over screen that if you fail that one, you're as good as dead.
  • Trauma Team continues the tradition by having you search through rubble for survivors of a bus crash. With an endoscope.
• Unstable Equilibrium: In several busier operations, if you make a mistake and take too long to correct it, not only would you lose time but you may also allow other unsolved problems to develop, especially if you had to take time to raise vitals. The Pempti GUILT strain is built around this trope, as a slip-up can cause the operation to spiral out of control.
• Unwanted Assistance:
  • Maria Torres can't stand anyone assisting her in her job unless it's absolutely necessary. And even then, she treats them as incompetent losers.
  • RONI helpfully tells Gabriel things he already knows, such as what an x-ray is. This is a Justified Tutorial, but it doesn't make Gabe any more happy at being advised with everything he's already been doing exceptionally well for a living.
• Unwinnable by Design: The final operation of the first game requires you to use the Healing Touch at precisely the right moment, meaning that if you've used it before then for any reason (with only one or two exceptions, when the games decide to be lenient), it's a guaranteed game over.
• Unwitting Pawn: Derek in Under the Knife 2 by Mayuzumi and Mercer. They both prey on his arrogance to gather data on the Healing Touch, allowing them to engineer new strains of GUILT that grant the ability to their hosts.
• Upgraded Boss: Whenever you revisit a pathogen, the game usually throws in an extra twist or mechanic to keep things interesting.
  • Kyriaki, Pempti, and Tetarti are re-introduced in Under the Knife 2 and have extra mutations to keep veteran players on their toes. Kyriaki introduces the Queen Kyriaki who can lay eggs that hatch into more Kyriaki if not dealt with, Pempti splits itself into two to force the player to divide their attention, and Tetarti gets more colors to track.
  • Each time you re-encounter Cheir in New Blood, it gains an additional attack like tumor creation or giant lacerations to complicate treatment. Onyx also develops the ability to sap vitals when it's on its last legs just two levels after its introduction.
• The Vamp: Reina. Technically she's The Dragon, but given all the horrible things she does to Derek and the fact that she carries the final strain of Neo-GUILT, she might as well be the Big Bad.
• Variable Mix: This occurs during Hank Freebird's operations in Trauma Team. The operations start with a base soundtrack that adds more instrumentation with each successful series of combos you perform. A single screw up causes the last set of added instruments to immediately drop out.
• Video Game Cruelty Potential: Because First Response will only issue a Game Over if you reach a certain amount of deaths, it's possible to let some of the troublesome patients die if you're getting overwhelmed. You can even intentionally kill your last few patients to end a level quickly.
• Voice Grunting: The first game features a few voice clips from the characters who assist you in operations. The remake Second Opinion also adds some for the playable characters. Under the Knife 2 goes all out with over one hundred short voice clips from the whole cast, including such gems as I DISAGREE and everyone saying Dr. Stiles's name in various ways. New Blood and Trauma Team just use full voice acting.
• Violation of Common Sense:
  • Getting an XS rank occasionally requires you to let the disease tear apart your patient's body so you can get a high enough score or chain. Trauma Team reworks the scoring and grading system to disincentivize "farming" injuries for points.
  • A very common strategy for clearing the first bonus operation in Under the Knife, which is easily one of the most difficult of the operations, is to not treat the lacerations made by Kyriaki and simply keep the patient alive through liberal use of antibiotic gel and stabilizer in between treatment steps. ^note This works as it exploits the presence of an upper limit of injuries that can be displayed on screen. By not treating the lacerations, Kyriaki will eventually stop attacking while you're working.
  • Getting XS for 4-6 of Second Opinion has a criteria: "Follow 10 of Victor's orders." If you work quickly, you'll only manage to get nine. To get the tenth, you need to let the patient's vitals plummet a bit when Pempti reacts adversely to the medication, after which Victor will tell you to raise his vitals before proceeding.
  • Getting a cool on bandaging a patient requires you to almost completely cover the wound. Covering the entire thing like you should doesn't reward you as much.
• Virtual Sidekick: Dr. Cunningham is assisted by the Rapid Operation Network Intelligence (RONI), an artificial intelligence that helps him diagnose patients by comparing their symptoms with a vast database. Despite being a mass-produced computer, RONI starts to show traces of humanity the more it interacts with Cunningham, displaying interest in playing cards with him, adopting some of his snarky personality and even delivering a philosophical speech about the importance of medicine to snap the doctor out of a Heroic BSoD.
• Wham Episode:
  • The second operation on Linda Reid in Under the Knife and Second Opinion, where Kyriaki, the first strain of GUILT we see, suddenly makes its introduction.
  • Chapter 5-1 of Under the Knife/Second Opinion is a positive example: Hoffman is back!
    Dr. Hoffman: How can I help? [...] My medical license has been an ornament for far too long... It's time I made good on the Hippocratic Oath.
  • Chapter 2-6 in Under the Knife 2. GUILT is back, and not only that, it's a new strain. Someone is still developing the parasites that were presumed to be eradicated in the first game.
• What Happened to the Mouse?: Trauma Center 2 begins with Derek and Angie being sent to Costigar to investigate a mysterious plague that has been ravaging the country. This plot point is completely forgotten after the first chapter concludes, save for a single episode much later when Adel suddenly falls ill due to it... which only raises the question of whether the disease is now free to spread through Japan.
• "Where Are They Now?" Epilogue: Done twice in Trauma Team. The first is during the epilogue where Tomoe gives Naomi who was recently cured from Twisted Rosalia a quick rundown on how each playable character is doing. Then after that, you get the secret voice recordings.
  • Maria continues to argue with her fellow paramedics.
  • Hank has become close with Claire, and still doing heroics as Captain Eagle.
  • Not much has changed for Gabriel.
  • CR-S01 returned to prison, but he's still doing surgeries.
  • Naomi learns that being cured from Rosalia also cured her genetic disease, which means she has a chance to raise Alyssa.
• Who Will Take The Kids?: Played straight in Trauma Team after Alyssa is nearly killed by a bomb and orphaned. Naomi takes her in the ending.
• Wolfpack Boss: Certain levels, particularly in the sequels, combine multiple simpler procedures onto a single patient. This can culminate in a patient being simultaneously afflicted with 2 different but (relatively) simple strains of GUILT or Stigma. And in once case, three at once.
• You ALL Look Familiar: The Delphi members in Under the Knife 2 all share the same sprite with different expressions.
• You All Share My Story: The stories in Trauma Team are all connected, and late in the game, all six doctors come together to fight the epidemic CR-S01 allegedly released before he lost his memories.
• You Are Not Alone: Chief Patel's message to Maria, when the other medics arrive to assist her in her final chapter just as she starts to get overwhelmed by the patients' worsening conditions.
• You Did Everything You Could: All the other characters tell Derek this when he fails to save Emilio's life. It is not enough to prevent him from having a Heroic BSoD that nullifies his Healing Touch for an entire arc.
• Your Days Are Numbered: In Trauma Team, it's revealed that after Second Opinion, Naomi Kimishima was diagnosed with an incurable disease and is living on borrowed time. The epilogue of Trauma Team reveals that eliminating Twisted Rosalia, which was a fusion of the disease and the Rosalia Virus, cured her.

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