So You Want to be a Surgeon?

An appreciation and retrospective on Trauma Team

This piece is part of my Appreciations series. If you would like an introduction to the series, read it here.

Think of any famous medical drama or dramedy that’s aired in the last ten or so years. What are the common components? An ensemble cast whose relationships are complicated and who struggle with personal moral dilemmas, whether drawn out over seasons or knotted up tidily each episode. A patient with a stupefying or inscrutable ailment, whose condition changes suddenly and violently, putting the clinical skills of his or her healthcare providers to the highest test.

Remember that time a psychopath went on a killing spree in Grey’s Anatomy? Good times, good times.

Now imagine you’re watching that drama or dramedy, be it House, Grey’s Anatomy, Scrubs, with one twist: you have to be all the people you see on TV and do all their jobs. All by yourself. (Or with one friend).

That’s what happens in the topic of my first Appreciation: Trauma Team, a game developed for the Nintendo Wii by Atlus in 2009. Trauma Team puts you in the shoes of six doctors working at Resurgam Hospital in Portland: a general surgeon, a first responder (not quite a doctor, but close enough), an orthopedic surgeon, an endoscopic surgeon, a diagnostician, and a forensic pathologist. Throughout the course of the game, you as the player are asked to rotate through these roles — perhaps diagnosing a patient’s symptoms as the diagnostician, Gabriel Cunningham, then correcting a heart abnormality as the star surgeon, CR-s01 (yeah, that’s his name.) Or you’ll meet a crash victim and stabilize her with the first responder, Maria Torres, and then glue her bones back together in orthopedics with Hank Freebird (yeah, that’s his name too.)

The North American box art for Trauma Team. From left to right: Maria Torres, first response; Gabriel Cunningham, diagnostics; Naomi Kimishima, forensic pathology; CR-s01, surgery; Tomoe Tachibana, endoscopy; Hank Freebird, orthopedics.

Although Trauma Team is a standalone game, it spiritually succeeds a line of similar games made in the early 2000’s called the Trauma Center series. Atlus, a Japanese developer well-known for their Shin Megami Tensei and Persona role-playing games, developed a fairly consistent formula for its Trauma Center games, released for Nintendo DS and Nintendo Wii. Following the storyline of a single doctor protagonist, these games usually involved significant science fiction and fantasy elements, in which the doctor in question (you!) faced off against genetically-mutated super diseases designed by evil corporations to take over the world. Luckily, the protagonists were uniquely suited to take on this challenge because they were descendants of the Greek god Asclepius and had access to a special power known as the Healing Touch, which would allow the player to slow down time and boost a patient’s vitals during surgery. For a highly official, in-depth, and not-at-all satirical look at the series, watch this video.

Yes, that Asclepius.

Trauma Team takes a decided step toward realism compared to its predecessors. The original Trauma Center series set up surgery like an arcade game: patients had a “vitals” bar, and the player also only had 5 minutes to save the patient from open to close without the vitals dropping to zero. This led some missions to be brutally difficult. But perhaps the most distinctive element is that surgery and other medical gameplay in all of the Trauma Center games is either touch (DS) or motion (Wii) controlled. This critical element immerses the player in Trauma Team too: everything, from slicing open skin to applying bandages with the forceps to using a defibrillator or performing CPR, is done using the Wiimote and Nunchuk, which provides a great tactile sense of doing things “right.” Although the technology is far from perfect and the controls can be awkward and unresponsive at times, the Wii’s overall integration of motion control has yet to be matched.

There is one key way in which Trauma Team is different from its predecessors: Atlus made it more accessible (and less arcadey) by doing away with the time limits for procedures and toning down the intense, Nintendo-hard difficulty for which the previous entries were notorious. The difficulty levels — Intern (easy), Resident (normal), and Specialist (hard, and only unlockable after beating the game) — are far less punishing and can be changed at any time. Players can play missions over again to get higher ranks and scores, providing the game with a decent measure of replayability.

However, realism is definitely a relative term when discussing Trauma Team. It includes a couple of old series stand-bys, including “stabilizer,” a magical green fluid the surgeon can inject to raise vitals, and “antibiotic gel,” medical miracle matter that disinfects wounds, fuses bone, and also raises vitals. The presentation of the game, in contrast to actual medical procedures, is bright and colorful. Blood springs up from wounds in large, pink, cartoony blobs every few seconds, waiting to be sucked up by the drain you move around the screen with the Wiimote. Tumors are bright purple spherical lumps that you snag with the snare of your endoscope. Find a bone that’s shattered into 7 pieces in orthopedics? Not to worry! Just use the antibiotic gel to glue the pieces all back together (it’s almost, like, I don’t know, a puzzle!) in a flash, and voila! A femur is reborn! Atlus obviously gives players these shortcuts to limit frustration and tedium — remember, actual surgery takes years upon years of training and education to properly perform — but the sequence of actually performing life-saving procedures with your own two hands lends enough realism and thrill to the experience to allow you to suspend your disbelief.

A screenshot of surgery in Trauma Team. Note the clean interface, the cartoon-stylized anatomy and blood, and the giant steel beam sticking outta this dude’s liver.

But this is no pedestrian appendectomy simulator. Each gameplay mode brings unique challenges to the table and demands a different skill set. Surgery and first response are by far the most intense modes: in surgery you must keep your patient alive, and in first response you must stabilize a number of patients with diverse injuries for a certain amount of time before the ambulance arrives. Both of these are intense modes involving prioritization — which wounds can wait to be sewn up, which red-tag patient clinging to life to try and resuscitate first. Orthopedics and endoscopy are less intense, but require greater skill and focus — orthopedics focusing on precision as you screw in plates and hammer in pins, endoscopy focusing on gentleness and nimbleness as you manipulate the scope and its various tools in the lungs or digestive tract.

Performing CPR during first response requires you to time the movement of your Wiimote with the rhythm of “your” on-screen arms. Notice how the arms are bent? Yeah, that’ll get you kicked out of a CPR class.

Diagnostics and forensics are the modes which most divert from traditional Trauma Center gameplay. In diagnostics, you use patient interviews, observations, and lab tests to (with the help of a snarky artificial intelligence) diagnose seemingly complex and obscure conditions. Forensics is by far the darkest and grisliest mode: the player, as a forensic pathologist, examines corpses and the scenes of crimes to deduce causes of death that point to a particular murderer. Crime scenes are creepy, gory, and solitary, and the cases are legitimately suspenseful. The player must synthesize evidence and periodically answer logic questions correctly to prove that the reasoning pans out. The “vitals” system doesn’t really work out in diagnostics or forensics (or orthopedics, for that matter), so in these modes the player is only allowed so many wrong guesses or failed procedures before it’s game over.

Okay, so the quizzes aren’t that hard. But the music that plays during the reasoning quizzes is really badass.

What makes the mechanistic bones of the game meaningful is the tissue that overlays and encircles them: the characters. Specifically, the ensemble cast features characters that interact well with each other — although they rarely fight with each other (Trauma Team is exceedingly plot-driven and not very character-driven), they help each other with cases and with personal problems. And, as part of the up-to-eleven style of the game, each character’s backstory and struggles are…interesting. To name a few, your surgeon, CR-s01, is called CR-s01 because that is his prison number. Having been a top-notch surgeon before his incarceration, he is offered a deal by the state to do surgery in exchange for a reduction in the life sentence he earned for committing a mass chemical-weapon murder he doesn’t remember.

Take a minute for that to sink in.

Other characters’ personal struggles are, though quirky, easier to understand and relate to. Coming from a wealthy samurai clan (and being able to teleport at will), the endoscopy specialist, Tomoe Tachibana, grapples with her family’s wishes for her to return to Japan and her own wish to make a career for herself in America, with her own ambitions and quest for peace. Hank Freebird, the muscular orthopod, moonlights as a superhero (because of course he does), but does it in honor of his deceased army buddy, whose death still haunts Hank’s nightmares. The forensic pathologist, Naomi Kimishima, is the most arcane: clearly struggling with a troubled past and lamenting her own impending mortality, she tries to allow the dead to tell their stories through her work, sometimes literally with a cell phone that records the final words of the corpse lying before her. Maria, the first responder, doesn’t work well in teams. Gabriel, the diagnostician, is Gregory-House-lite.

These (well, some of these) are real problems that real people have, and although their circumstances are outlandish, the writing for each character and the growth they experience, depicted in hand-drawn, stop-motion, comic-book-style cutscenes, lovingly and artistically draws the player closer to the people they are meant to represent. The style of the game is such that missions are sandwiched by relatively, but not overly long, cutscenes that advance the story, providing a good mix between the high-intensity missions and relatively passive storytelling.

The dialogue and storytelling, like in most Japanese games, is a huge focus, and often fairly heavy-handed and dramatic. The character writing is cheesy or cringe-worthy at its worst, but heartfelt and subtle at its best, and there’s definitely more of the latter than of the former in this game. The voice acting is excellent; industry heavy-hitters Nolan North (famous as Nathan Drake in Uncharted) and Travis Willingham (most cartoons, games, and English-voice anime for the past decade-plus) voice CR-s01 and Gabriel Cunningham, respectively, leading a cast that lends each main character credibility, gravitas, and authenticity. Even extras and minor characters are well-voiced, delivering lines emotionally and with impact. The story itself begins slowly, working through the daily lives, procedures, and struggles of each of the separate characters. Players can choose missions at their own pace, playing through the storyline of each character all in a row or choosing to follow a larger chronological order. In the second half, however, the six doctors’ storylines intertwine as they combat a mysterious hemorrhagic disease that strikes their town, and the mission order becomes set in order to take the player efficiently through the genuinely gripping storyline.

A typical cutscene panel. Did I mention they wear their street clothes in the operating room? Forget CPR class, this one’ll get you tossed out of life.

To me, Trauma Team’s lifeblood is a sparkling, original, and eclectic instrumental soundtrack. Composers Shoji Meguro, Atsushi Kitajoh, and Ryota Koduka, deservingly recognized for their work elsewhere, all shine again in Trauma Team. Smooth, ambient jazz accompanies the pathologist’s computer or diagnostic work in the lab. Disco-inspired dance beats crescendo as you chain together skills in orthopedics. High-tempo, wailing guitars and crisp-yet-frantic drums accompany a patient’s descent into cardiac arrest or the steady deterioration of disaster victims as you try to keep them all from death. Wistful, melodic piano rises in the background as Naomi reflects on the lives and deaths of the cadavers before her, or as Tomoe writes a letter to her family in Japan. Composers Shoji Meguro, Atsushi Kitajoh, and Ryota Koduka, deservingly recognized for their work elsewhere, all shine again in Trauma Team.

As with all of the fixtures in my Appreciations series, Trauma Team holds a place here because I like it, but also because I think it’s been important to my life. Trauma Team, specifically, but generally all of the Wii Trauma Center entries were something that my sister (currently a pediatric resident) and I could enjoy playing cooperatively. I fondly remember many a summer night spent together performing white-knuckle heart surgery, racking our brains over a diagnosis, or blanching in shock while uncovering clues during a particularly long and suspenseful murder case.

These experiences definitely led me to think of medicine as a “cool” profession; Trauma Team has no shortage of dramatic flair, just like its TV and movie counterparts. But, importantly, the game did a fantastic job of revealing the human side of doctors and making me live through their stories in a way that only games can. The characters emphasized over and over again: the most important thing in medicine and in life is to do what you can for yourself and those around you, whether that means taking advantage of second chances like CR-s01, keeping your family ties strong like Tomoe, or serving the people of your community like Hank. Games frequently receive criticism for their over-the-top, unrealistic, and shallow storytelling. Trauma Team is sometimes guilty of the first two, but not the third. If you can get past the flashy, action-packed exterior (this goes for any game), poignant stories and lessons to be learned abound.

It would be a lie for me to say that Trauma Team isn’t one of the things that led me to want to be a doctor, that it didn’t affect me emotionally or that it didn’t teach me anything. A playthrough of Trauma Team offers me a window into a well-crafted world that’s much like the one I’m entering now: one where doctors, though flawed, uncertain, and scared, rise to the challenge to do what’s best for their patients in their time of need. And even though Grey’s Anatomy might be more ‘realistic’ (ha), House more thrilling, or Scrubs funnier, in Trauma Team I have the ability to save (virtual) lives directly through my own actions, getting a great story out of it all the while. In my view, nothing can compare to that.

So, have a Nintendo Wii or WiiU? Buy Trauma Team, which is available physically on the Wii and both physically and digitally on WiiU. (Disclosure: I have no affiliation with or loyalty to Atlus, the developers of Trauma Team.) If you don’t own a Wii or are not a video game person, etc., not to worry. There’s plenty of YouTube footage available (search “let’s play Trauma Team”), and I can also make some killer soundtrack recommendations if you comment for them (you can also find those on YouTube).