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Trauma Center

Under the Knife

(Atlus USA; US: Jul 2007)

Pecking Towards Perfection

I’m afraid I’m not the ethical, meticulous, skillful doctor I thought I would be. I often forget to disinfect the patient. I make hurried incisions for which I’m duly admonished. I poke; I prod all in the hope of being efficient. I forgo the gentle touch for the flurry of quick pecks. Whenever I burn patients with a laser when I should be suturing them, Nurse Angie Thompson warns me to be more careful. Well, of course Nurse Thompson, but maybe if you’d help out by handing me the correct instrument instead of talking, I wouldn’t have used the darn laser. I’m a surgeon you know, I’m under a lot pressure. Frankly, I don’t even see patients, I just see a series of steps to take and take quickly. So stop getting in my way, Angie. Stop talking during my operations. Don’t you know I have the “Healing Touch”?


I wasn’t always like this. At first I cared very much for each patient. Well, okay, at first I was just queasy. When I first popped Trauma Center: Under the Knife into my DS and played through the tutorial levels on the train home from work, I almost threw up. While the graphics are far from realistic, even the idea of sucking puss out of tumors was enough to make me lightheaded. Normally, I’m pretty meek when it comes to blood, but after a few operations it didn’t bother me so much. I could stand the puss. I just feel bad for whoever looked over my shoulder.


The Nintendo DS continues to see the release of interesting new titles that hold forth on the promise of the touch screen to provide new types of games. Like Nintendogs, Trauma Center expertly integrates the physical motion into the gameplay. Holding the stylus is much closer metaphorically to the physical labor of surgery than a joystick could be. And while the gameplay is not much more complex than that board game classic Operation, it required the DS to be successful. However, like Nintendogs, it feels a little thin. The sheer physicality of the action plays more to a sort of rote skill than strategic thinking.


Under the Knife casts the player as Dr. Derek Stiles, a young surgeon at Hope Hospital. The game alternates between scripted dialogue and interactive operations. First you read along as the characters banter about the story and the newest patient you must save. Then it’s time to play. The patient’s chest appears before you and you have roughly five minutes to walk through a series of steps to disinfect, cut, inject, suck, and suture the patient. Oh, and then roll a bandage over the bloody scar. It sounds kind of gross, but it works very well. You quickly find that the graphics of hemorrhaging tumors abstract in your mind and become representational signposts, pointing the way through a procedure. Not unlike how I’ve heard doctor friends talk about their first experiences with gross anatomy. Once you’re past the initial shock, you begin to see an intricate set of steps that must be taken, just like most jobs. The more you know and understand something the more it becomes abstracted into a formal system.


The designers at Atlus frame the action of the game with an increasingly goofy story that sees Dr. Stiles develop a special power, the “Healing Touch”, before being enlisted to fight a new plague of “medical terrorism”. I can see why they think the story is useful. It shapes your progression. But it’s not necessary and actually detracts from the experience. In fact, the story played strongly against my desires as a player. Dr. Stiles begins the game a careless nitwit. You play through one surgery and rush off to get drinks despite warnings from the nurse, only to find that the patient has relapsed and almost died due to your carelessness during the operation. The idea that I botched the operation disturbed me enough that I replayed the level five times trying to find the part I missed. I slowly realized you couldn’t. As a player you only had agency during the operations, not during the story. So no matter how much you wanted to do a good job, to be a good doctor, Dr. Stiles was still going to be careless and rush off.


It’s the operating that makes Trauma Center fun. Being a surgeon has a built in tension that few jobs can claim. People live or die. I think it would be possible to abstract any job into a system that could underlie a game. Most any job requires you progress through a series of ritualized steps to achieve specific goals. Phoenix Wright: Ace Attorney does the same for the courtroom. Given this, it’s surprising how few jobs show up in games. Let’s see, there have been doctors, lawyers, pirates, assassins, soldiers, gangsters, and plumbers (though he really didn’t seem to fix many leaks). I have no idea if Mortgage Bond Traders: Big Swinging Dicks or Web Dev Center: Validating CSS Stylesheets would be as immediately exciting as surgery, but I think they could be. Because what Trauma Center, and hell, going to work everyday generally reveals is: we have fun when the details fall away and we can concentrate on perfecting the task at hand. You are simply doing.


I realized this the first time I didn’t really care if a patient died. For the first ten levels, I was so worried about killing a patient, so wracked with guilt, that I would turn my DS off rather than lose a level. This rebooting process became quite tiresome, as many of the levels require multiple attempts to perfect the tightly orchestrated steps required to keep a patient alive. So I started letting them die. Well, they don’t actually die; the arrogant Dr. Kasal steps in with a, “You’re done here. I can still save them!” The first time I was relieved, thinking, “Gosh, Dr. Kasal, please get Betty’s vitals back up.” But quickly, I tired of him too. It wasn’t long before I developed a bit of God complex. I mean seriously, doesn’t Dr. Kasal realize, I have the “Healing Touch”? Only doctors with the “Healing Touch” can perform medical miracles. Then that fiction dissolved away as well and I simply wanted to reenter the game to perform the procedure correctly. And that’s when Trauma Center truly became fun, when I understood I just needed to find the right pattern of pecks and scrapes to make it through the level.


The professor and psychologist Mihaly Csikszentmihalyi discussed this phenomenon in his 1991 book Flow: The Psychology of Optimal Experience. After years of research he found that people who were happy at their jobs were happy in general. Brilliant, I know. But what made people happy at their jobs was a scaling level of challenge. He surveyed people from around the world in all manner of jobs and many reported a similar phenomenon. People reported being happiest when they felt they understood their job, yet still felt they were challenged and pushed by the work. Under these circumstances, they reported entering a state of flow, a state where they felt like they could handle anything. This was true of people from mechanics to CEOs. This sort of scaling challenge can also be found in games.


Obviously, Trauma Center does not a doctor make. An episode of ER probably displays more accuracy. But the game does suggest something interesting about the way we work at any job or activity. On some core level we are all seeking to master the systems around us. Trauma Center reveals that the fiction of the game doesn’t matter so much as the well-paced challenge. It seems that whether it’s sucking puss from tumors or blasting zombies, we all need a job to master. The details just get in the way.

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