Trauma Center: Under the Knife/Storyline missions

Standard Procedure
Difficulty Rating 1

This operation will be straightforward. Simply follow your assistant's instructions: select the tools she tells you to and use them in the ways she describes for each one.

Begin by selecting the sutures, indicated by a needle icon. Suture lacerations on the skin by drawing in a zig-zag pattern. Do not make your stitches too wide or too narrow, and be sure to suture along the entire laceration to get more points. If you're unable to do anything, tap the CALL button on the upper-right corner of the screen to advance the text. Repeat for all medium-sized lacerations.

Then, select the forceps as instructed and extract the glass shards by pulling the shard in the opposite direction it entered the body. If you stray too far in the wrong direction, you will miss, and the patient's vitals will drop and you will have to try extracting the shard again. Once successfully extracted, drop the shard into the tray that appears in the lower right corner. Repeat this process until all shards are removed. Next, select the antibiotic gel and spread it over the smaller cuts, which will mend them instantly and slightly raise the patient's vitals.

When all external wounds are treated, a guideline will appear. Spread antibiotic gel along it (until it turns from yellow to green) and then use the scalpel to cut along the line. Accuracy is key: if you stray too far from the guideline, you will miss and the patient's vitals will suffer. Once successful, the arm will open up. There will be 3 shards of glass under the skin. Repeat the process above to remove them: forceps, tray, then gel the cuts.

When all wounds are treated, you will zoom out of the patient. Suture the incision, again making sure that your stitches aren't too wide or narrow. Disinfect the sutures with antibiotic gel, then apply a bandage along the length of the cut. Congratulations on completing your first operation!

Standard Procedure II
Difficulty Rating 1

Use the antibiotic gel to disinfect the guideline, and then cut along it with the scalpel. You will see the stomach, with inflammations dotting its surface. Your assistant will ask you to stabilize the patient's vitals before proceeding. Select the syringe, and draw some stabilizer (green vial). Inject it into any unaffected part of the organ (touch the stylus to the screen) and the patient's vitals will rise. This tool will become invaluable in more difficult operations. Next, draw anti-inflammatory into the syringe (blue vial). Inject it into the inflamed areas to treat them (touch the stylus to the spots. You can cure multiple inflammations with a single syringe-full of anti-inflammatory). Take care not to inject the anti-inflammatory anywhere else, or you will incur a miss.

To excise the tumors (referred to in-game as the Powell procedure), begin by selecting the ultrasound. Search around the lower left area of the stomach by tapping the stylus around the screen. Once you tap on a tumor, a shadow will appear. If the shadow fades, tap the ultrasound directly over the area until the shadow is sustained. Use the scalpel to cut across it and expose the tumor. Select the drain, place it on the tumor, and slide the stylus up along the tube to drain the cytoplasm. A guideline around the tumor will appear once enough cytoplasm has been drained. Cut along it, and use the forceps to put the tumor into the tray. Use the forceps again to drag a synthetic membrane from the supply tray onto the wound. Spread antibiotic gel over it until indicated otherwise, then use the hands to fully meld the patch into the organ by rubbing it in a circular motion.

Repeat the above process until all tumors have been treated. Suture the incision and disinfect it with antibiotic gel. Finally, bandage the incision. Operation complete.

A Farewell
Difficulty Rating 2

Disinfect and cut along the guideline. The pancreas will come into view. Select the syringe and draw some anti-inflammatory. Inject it into the inflammations to cure them. Use ultrasound to locate the tumors. Cut, drain, excise, and remove each one. Apply a membrane to each of the wounds with the forceps, then apply antibiotic gel to the patches and use the hands to rub the patches in. Suture the incision once all tumors are treated. Disinfect and bandage. Operation complete.

Singing the Blues
Difficulty Rating 2

Disinfect the guideline and incise. You will zoom in on the patient's larynx. Observe the pool of blood. Select the magnification tool (in the same slot as ultrasound). Rather than draw a circle as the game advises, it is easier to instead draw a "C" to magnify the affected area.

Once you have zoomed in, use the drain to drain the blood pool. Select the laser as instructed and incinerate the polyps A quick tap with the stylus will suffice to burn them away (if you apply the laser to an unaffected area for too long, you will create an unnecessary wound and possibly a blood pool, which must be drained and gelled). Select the antibiotic gel and spread it over the resulting wounds. If a blood pool forms, drain it. Repeat until all the polyps in the area are gone, and zoom out drawing another C shape. Repeat this process for all other affected areas. If the patient's vitals begin to drop, inject stabilizer.

Once treatment is complete, suture the incision, disinfect, and bandage. Operation complete.

A Real Doctor
Difficulty Rating 2

Disinfect the guideline and incise. You will zoom in on the small intestine. Draw anti-inflammatory with the syringe and inject it into the affected areas. Use the ultrasound to locate the tumors and use the Powell procedure (cut, drain, excise, and remove). Repeat until all tumors are treated. When prompted by your assistant, use the ultrasound and check over the entire area. Once your assistant is satisfied, suture, disinfect, and bandage the incision. Operation complete.

Life or Death
Difficulty Rating 3

The operation is not as complex as implied. However, a swift hand and good coordination are required to succeed. The patient's maximum vitals will be around 30, which means there will be little room for error.

When the operation begins, the patient will be suffering cardiac arrest. To resuscitate the patient, first apply antibiotic gel to the surface (the blue bar that appears). When it turns green, select the hand tool and touch the stylus to the screen. Follow the slightly-darker bar with the stylus as it moves up and down inside the larger bar to massage the heart. If done properly, the patient will be revived with vitals at 30.

After the patient is revived, begin treating the external wounds. Suture the lacerations, remove the glass shards, and apply antibiotic gel to all small cuts. When the guideline appears, gel and incise. You will zoom in on the patient's heart, which is peppered with glass shards. Stabilize the patient if necessary, then begin removing the shards. Take care to gel each cut after a shard is removed; if cuts are left unattended, the patient's vitals will drop rapidly.

When all shards are removed and all wounds treated, the patient will suffer cardiac arrest again. Apply gel and massage the heart. When resuscitated, a large shard will protrude out of the pericardium. If necessary, stabilize the patient, then remove the shard with the forceps. Use extreme care when extracting, as even the smallest deviation will incur a miss and the patient's vitals will drop. When the shard is successfully extracted, suture the laceration. Just when all seems well, a long laceration will suddenly tear across the heart. At this point, the Healing Touch will automatically invoke (this is indicated by a star drawing itself on the screen, followed by faded colors in the game). Quickly suture along the entire laceration. The Healing Touch will fade, and you will zoom out of the patient.

Suture, gel, and bandage. Operation complete.

Dormant Ability
Difficulty Rating 3

Disinfect the guideline and incise. Use the magnification tool to zoom in on the spleen. Thrombi are flowing along the veins and must be extracted. To do so, first use the ultrasound to reveal a thrombi. Quickly pinch the thrombi with the forceps to halt its movement. Use the scalpel to cut the vein, then use the drain to extract the thrombi. Gel the cut, then repeat the process for other thrombi. If you are dexterous enough, you can perform this process on multiple thrombi at once. If a thrombi exits the spleen through the veins, the patient's vitals will drop slightly. Inject stabilizer as needed to maintain the patient's vitals.

Once a certain amount of thrombi have either been extracted or have passed, the patient's blood flow will change, causing the thrombi to flow even faster. Continue the procedure as stated above until the Healing Touch invokes itself again. This will slow the progress of the thrombi, making them easier to extract. Once all remaining thrombi are extracted and all wounds treated, you will zoom out of the patient.

Suture, gel, and bandage. Operation complete.

Striving for Asclepius
Difficulty Rating 1

This isn't a real operation, so there are no vitals to maintain nor is there a time limit. You will be practicing the manual invocation of the Healing Touch. Advance through the text, then select the hand tool. Select it again to change it to a star, which is how you will begin activating the Healing Touch. Draw a star along the guidelines as quickly and accurately as possible. Advance through the text, then repeat. The guidelines will fade. Continue drawing quick and accurate stars until the screen's color fades, which indicates successful invocation of the Healing Touch. Take care to draw the stars at the same size as the guidelines; if the drawings are too big or too small, the Healing Touch's effect will not be as profound.

From this point on, the Healing Touch will be available at any time during an operation. You must decide when it is best to invoke the Touch, as you can only do so once during an operation, and the effect will only last between 25 and 30 seconds, depending on how quickly and accurately your star was drawn. The effect may also be shortened by using certain tools at certain times while the Touch is invoked.

Operation complete. Depending on how quickly and accurately you drew the stars, you will receive a higher score and ranking.

Awakening
Difficulty Rating 4

If this is your first time playing Trauma Center, do not expect to complete this operation the first time through unless you are especially dexterous. Begin by disinfecting the guideline and incising. The large intestine will come into view.

Aneurysms will form on the intestine. Use the magnification tool to zoom in. Be aware of the fact that aneurysms will grow and eventually burst if left untreated, and a burst aneurysm will deal a devastating 30 to 40-point blow to the patient's vitals. However, there is a trick that can be used to avoid this, and you may not even need to invoke the newly-acquired Healing Touch.

Inject the sedative (brown vial) into the aneurysm until a guideline appears. Select the scalpel and cut along the guidelines until the aneurysm is neutralized (if you take too long, the sedative will wear off and you will need to inject more). You will be prompted to remove the aneurysm with the forceps, but do NOT do so just yet. Inject sedative into all active aneurysms and cut the guidelines around each one until all are neutralized. Now you can begin treating the aneurysms one at a time without fear of any of them bursting. Select the forceps and place the aneurysm onto the tray. Drain the blood pool, then use the forceps and drag the veins together. You do not need to use a zig-zag motion when suturing; one simple stitch is all it takes to suture the vein together. Stabilize the patient if necessary, then repeat this process until all neutralized aneurysms are removed. Be aware that not all aneurysms may be immediately visible, and that you may need to zoom out and zoom back in with the magnification tool to treat all active aneurysms. Do not let your attention waver, lest an aneurysm burst and your patient's vitals suffer.

The aneurysms will come in waves, and may or may not act on a timer, rather than completion of a previous wave in other operations (in this case, however, they appear upon completion of a wave). Larger aneurysms obviously take priority, and multiple syringe-fulls of sedative may be necessary to completely sedate an aneurysm in preparation for neutralization. Repeat the above process for each wave. During the final wave, at least 6 aneurysms of varying sizes will appear. It is recommended at this point that you invoke the Healing Touch if you so desire. When all aneurysms have been neutralized and extracted, you will zoom out.

Suture, gel, and bandage the incision. If you somehow managed this operation on your first try, then pat yourself on the back. It really is a doozie for novices. Operation complete.

Just Let Me Die
Difficulty Rating 2

Disinfect and incise. You will zoom in on the patient's lung, which is riddled with lacerations of varying sizes. While you can treat the lacerations in any order you see fit, it is recommended that you treat the small and medium-sized cuts first. To treat the large gashes, first drain the blood pool. Then, select the forceps and carefully pinch one side of the cut. Drag the sides together until indicated that it is ok to suture, then quickly suture the cut. If you take too long, the cut will reopen and a new blood pool will form, and the patient's vitals will drop. When all lacerations have been treated, you will zoom out.

Suture, gel, and bandage. Operation complete, but this is only the calm before the storm...

Please Let Me Live
Difficulty Rating 3

You're operating on the same patient as last time. It appears her condition hasn't subsided. Disinfect and incise.

New lacerations have formed. Your assistant will astutely point out that you treated these already, and that their reformation makes no sense. But it will, all in due time. Repeat the process as in the last operation. Just before you're to close up the patient, however, a new laceration forms right before your eyes.

What could possibly be causing an organ to cut itself up? Use the ultrasound and find out. You will eventually spot a shadow moving around under the surface of the organ. Advance through the text, then use the scalpel to cut across the shadow, exposing the culprit.

Behold, Kyriaki - the Invisible Blades.

Advance through the text, then select the laser. Tap the stylus on the pathogen to damage it, then again to destroy it. Soon after, new lacerations will appear. It seems this unnatural infection has friends. Stabilize the patient if necessary, and do not neglect to do so throughout the operation. Use the ultrasound to reveal the Kyriaki, then use the scalpel to cut them out. You will notice that when exposed, the Kyriaki will now create another laceration from where it was excised. You should also note that your own excision left a small cut, to which antibiotic gel can be applied to mend it.

If the patient's vitals are dropping too quickly because of multiple lacerations, you can also spread antibiotic gel all around the organ to temporarily stall the vitals' reduction. This, in tandem with the stabilizer, can help keep a patient alive long enough to suture lacerations.

Suture any lacerations the Kyriaki create, and burn the Kyriaki with the laser. Once it appears that all Kyriaki have been defeated, a trio of lacerations will occur. Use the ultrasound to reveal the mature stage of Kyriaki. Excise it, then burn it with the laser. It will burrow back into the organ, at which point the process must be repeated. After being excised and burned 3 times, Kyriaki will be defeated once and for all. Suture any lacerations, and you will zoom out.

Suture, gel, and bandage the incision. Operation complete.

You've just fought and eradicated Gangliated Utrophin Immuno Latency Toxin, better known as GUILT. Kyriaki is but one strain of this disease that you will come to operate on in Trauma Center: Under The Knife, so be sure to mentally prepare yourself for the struggles to come.

For Everyone's Sake
Difficulty Rating 2

Disinfect and incise. You will zoom in on the heart. Your objective is to replace a faulty heart valve with a synthetic version. Gel and incise across the new guideline. At this point, the patient will suffer cardiac arrest. Apply gel and massage the heart until successfully revived, then stabilize vitals. This will occur at random during the operation, so be prepared.

Use the magnification tool to zoom in, then drain the blood pool. Select the scalpel and carefully cut along the 3 guidelines that appear in succession, taking care to monitor the ECG (Electrocardiograph, the device that monitors heartbeat) for irregularities. Should an irregularity appear, suspend the procedure until the pulse either stabilizes or fibrillation occurs. If the latter does occur, gel and massage the heart and stabilize vitals.

Once the valve is completely excised, remove it with the forceps and place the new synthetic valve in its stead. Suture it in place, then zoom out. Suture the incision on the heart, at which point you will zoom out of the patient.

Suture, gel, and bandage. Operation complete. You are now officially a heart surgeon.

GUILT
Difficulty Rating 2

Disinfect and incise. You will zoom in on the lacerated small intestine. This patient, same as in "Please Let Me Live," is infected with Kyriaki. Conversely, this operation will be almost exactly the same.

Begin by suturing lacerations, draining and closing the larger ones with the drain and forceps. When all initial wounds are treated, Kyriaki's presence will become apparent. Use the ultrasound to pinpoint the pathogen, excise it, and burn it with the laser. Suture any lacerations, and gel smaller cuts. If desired, use the gel + stabilizer trick as described in "Please Let Me Live" to maintain vitals. The mature Kyriaki will perform its signature tri-laceration once all first-stage Kyriaki are defeated. Excise the mature Kyriaki, burn it, and suture/gel the lacerations. Repeat this process until Kyriaki is defeated, at which point you will zoom out.

Suture, gel, and bandage. Operation complete. This was probably easier since you've fought Kyriaki once before, wasn't it?

Something Precious
Difficulty Rating 4

Disinfect and incise. You will zoom in on the stomach, which is plagued by dark and light-colored medium-sized tumors. These will create smaller tumors over time, but all of them can be burned away with the laser. Exercise caution with the laser, as it can create small wounds and possibly blood pools that will need to be drained and gelled. When all tumors are burned away, quickly stabilize vitals and prepare yourself for...

Deftera - the Creeping Tumors

As described in the briefing, Deftera comes in two types, A (the blue type) and B (the red type). The tumors will move around the organ, occasionally creating a medium-sized tumor that must be burned away with the laser, along with any small tumors that spawn alongside it. Eventually, both Deftera types will come together into a single entity. Select the drain and begin draining the tumor's cytoplasm. If enough cytoplasm is drained before Deftera separates, you will successfully damage it, as evidenced by the tumors' faded colors. Repeat this process 2 more times, for a total of 3, and the tumors will begin to convulse rapidly. When the convulsing stops, a guideline will appear. Very quickly select the scalpel and excise Deftera, because as long as it is in this state, it will rapidly spawn medium and small-sized tumors, which will drain the patient's vitals. Once Deftera is excised, remove it with the forceps and apply a patch to the wound. Gel and massage it in place, then burn away any remaining tumors with the laser. When all ailments have been treated, you will zoom out of the patient. Even if vitals are low, it is not necessary to stabilize them at this point.

Suture, gel, and bandage the incision. Your view will shift to the patient's chest, and your vitals will be conveniently maxed out at 99 for you. Gel and incise once again, and you will zoom in on the lung.

This is where the operation gets tricky: there are two pairs of type A and type B Deftera. If two like types meet, instead of combining into a single tumor, they will instead spawn several medium-sized tumors and the patient's vitals will drop. It is crucial (and often times reliant on luck) to separate the Deftera into two pairs of opposite types, lest the medium and small-sized tumors spawn out of control and the patient ultimately succumbs. This can be done by use of antibiotic gel, which is at least somewhat effective in steering the tumors in other directions. Conservation of laser power is key when burning away lesser tumors: prioritize the incineration of medium-sized tumors first, as this will halt the further creation of small-sized tumors. Always remember to stabilize vitals as necessary. If the situation becomes desperate, invoke the Healing Touch.

Treatment of the Deftera themselves is the same as stated above. Wait and/or steer two opposite types into each other, then drain the cytoplasm. If you're quick enough, draw a barrier of antibiotic gel around the joined pair to prevent the other pair from splitting them apart, as this will create more tumors to be burned away and damage the patient's vitals. When the cytoplasm of one pair is completely drained, excise and remove the Deftera, then patch, gel, and massage. Once one pair has been successfully removed, the operation will become much easier. Treat the second pair, burn away any remaining tumors, and you will zoom out.

Take this opportunity to stabilize vitals for extra points. Suture, gel, and bandage. Operation complete.

As stated previously, Deftera does require a little luck to successfully defeat. If you fail the operation, simply try again and hope for better luck.

An Explosive Patient
Difficulty Rating 3

Surprise! It's a BOMB! It will detonate if you make a mistake or let a trigger reach its critical point. Begin by selecting the magnification tool. Magnify the water tanks. If all the water from the left tank goes into the right tank, the bomb will detonate. Take the drain and suck the water out of the right tank, then place the drain into the left tank and slide the stylus down to put the water into that tank. This will buy you time to neutralize this particular detonator's mechanism. In total, the bomb has 3 contingencies:


 * 1) The water drains completely from the left tank and it triggers the main ignition mechanism, detonating the bomb.
 * 2) The electronic back-up ignition reaches maximum temperature and causes detonation.
 * 3) A microchip connected directly to the dynamite is incinerated and causes the dynamite to explode.

Zoom out of the tanks, then zoom in on the dynamite in the lower left corner. There are yellow-colored trigger devices implanted into the top of each explosive charge. Select the forceps and carefully pull the device out, at which point it will be taken away for you. Repeat this for all the other trigger devices. Upon removing two of the devices, the electronic back-up ignition system activates, and the temperature of the detonator begins to rise. However, the main ignition system will be rendered obsolete once all trigger devices are extracted. Gel the electronic detonators to reduce their temperature until each meter is empty, then zoom out. Zoom in on the control chips in the upper right corner.

These control chips are connected by circuitry to wires that in turn connect to the electronic back-up ignition system. As your assistant advises, deduce which chips connect to the wires which connect to the detonators, and incinerate the proper chips with the laser. If you incinerate one wrong chip, the bomb will immediately detonate. Also, keep an eye on the temperature monitors, and gel them if any of them rise too high. As chips are burned away, the monitors they controlled will become obsolete, but the ones that remain active will rise in temperature that much faster.

Once both the main and back-up ignition devices are neutralized, the timer on the bomb will go haywire. The timer will be removed to reveal a second timer with a 15-second fuse, connected to the bomb by dozens of wires. It is strongly advised that you invoke the Healing Touch at this point. Select the scalpel and, very carefully, tap ONLY the red wires. The game is sensitive to the stylus' touch, and the slightest twitch could sever a white wire and detonate the bomb. Once all red wires are severed, the bomb's final mechanism will be deactivated, and the bomb itself successfully defused.

"Operation" complete. Take a breather, because this was easily the worst patient you will ever operate on.

Miracle at 9,800 Feet
Difficulty Rating 2

A man has fallen ill in the middle of a flight. It seems he's suffering from pleural effusion, and the fluid needs to be drained from his lungs before he suffocates. The plane is also headed for a storm, which means it isn't going to be a smooth ride. Gel and incise, regardless.

Begin by selecting the magnification tool and zooming in. Use the ultrasound and search around the organ. When a shadow appears, select the scalpel and cut across it. Drain the fluid that appears, then gel the cut. At random points during the operation, the plane will begin to shudder from turbulence. Immediately drain any fluid on the lungs and gel the cuts, then suspend the procedure. The view will begin to shake violently; don't do ANYTHING to the patient until the vibrations have completely subsided, or you will injure the patient and incur a miss. Stabilize the patient and resume the procedure when able. If any fluid was left on the lungs while the area was turbulent, inflammations may occur and will require anti-inflammatory. Also, the location of fluid pockets will change after every bout of turbulence. Zoom in and out on different areas, using the ultrasound and removing pockets of fluid where you find them, taking care to stabilize vitals and suspending the procedure when turbulence becomes violent.

When all areas are treated, you will zoom out. Suture, gel, and bandage. Operation complete.

Forbidden Knowledge
Difficulty Rating 4

Disinfect and incise. You will zoom in on the pancreas, which is covered with an odd membrane. You're actually looking at one of the most annoying GUILT strains to ever exist.

This is Triti - the Contagious Nightmare. An apt description, considering its required method of extraction.

There are two ways to extract Triti. Both of them require a steady hand and plenty of patience, and both are dependent on when you decide to invoke the Healing Touch.

The first method is a slower, more practical approach. Your greater enemy will be the clock, and the battle will be of attrition. Your goal is to force the Triti towards the upper-left corner of the screen, to the smaller side of the pancreas. Begin by selecting the forceps and pulling the thorns of the membrane straight up, then placing them on the tray. Do this quickly and for the entire lower-right group of Triti, then select the scalpel and cut all along the yellow guidelines. Speed is better than accuracy here; your patient's vitals will not suffer drastically from excessive scribbling, as long as you're only scribbling on Triti. Once a triangle is completely excised, select the forceps and extract it (if you take too long, a thorn may respawn, and you will have to re-excise any triangles the thorn touched). Unfortunately, this is where Triti's nasty trick comes into play.

If at any time two thorns exist on a triangle, and the space on that same side is empty when you extract an excised triangle, then a new triangle will form where the two thorns were. This occurs for every instance of a triangle with two thorns and an empty space on any side, for every excised triangle extracted. This means that Triti can multiply extremely rapidly if complete attention is not paid due. Therefore, it is crucial that you remove all thorns on empty sides of every triangle before removing other triangles. This is also the reason your goal is to "back Triti into a corner," so that it cannot continue reproducing as you extract it. Also, if by accident you drop an excised triangle back onto the organ, it will immediately become active once again and spawn a new triangle on all three sides. This three-side multiplication will also occur if a triangle is marooned by itself on the organ at any time, regardless of how many thorns it has.

Removing the lower-right group of Triti will cause multiplication, but it will be towards the upper-left. Continue to remove the thorns and excise the triangles in rows, then remove the triangles one at a time. Keep an eye on all other active triangles for thorns as you extract (remember that you only have to remove thorns near empty spaces, you can leave thorns in the middle of the membrane for the time being), until you've backed the pathogen into the corner as planned. As more and more of the membrane is removed, thorns will respawn quicker. When you're down to your last two rows, totaling about 6 triangles or less, invoke the Healing Touch and remove all remaining thorns. Excise the triangles, and try to remove them before your Touch wears off. If the Touch does fade, you will have to rely on your own reflexes to finish off the GUILT.

The second method for extraction dictates that you activate the Healing Touch as soon as you've incised into the patient. This requires extreme reflexes, because your goal is to completely extract Triti before the touch wears off. This method is much quicker, though not necessarily easier.

Keep in mind all the while that Triti will do damage to your patient's vitals. In particular, there will be one triangle that occasionally fades to purple and flashes, dealing damage proportionate to how many triangles currently exist. Stabilize vitals if they drop too low, and continue the extraction as normal; don't pay this damaging triangle any extra attention. Simply excise and remove it when you get to it.

Once Triti is completely extracted by either method, you will zoom out. Suture, gel, and bandage. Operation complete.

When you first start extracting Triti, expect at least 3 new triangles to form unless you're performing the "Flash" method (invoking the Healing Touch at the start). If after that point you make a mistake which causes more than two or three triangles to respawn at once, consider giving up and retrying the operation. Remember, the clock is your greater enemy.

Race For the Cure
Difficulty Rating 2

This mission is actually split apart into at least 3 and at most 5 different operations. You will be searching for immature samples of a new GUILT strain to create 3 new specific serums to combat the mature strain. There are two of two different types of GUILT, and one of the third type that you must collect, dispersed throughout Angeles Bay. Each operation will be the same, except for the third and final GUILT sample, and is as follows:

Begin by disinfecting and incising. This is the immature form of Tetarti. Inject the serum (brown vial) into the GUILT, and it will take damage, burrowing into the organ. Excise it by using the ultrasound and cutting it out with the scalpel. Gel the excision, then inject the GUILT with the serum again. Repeat this process until the GUILT is disabled, then use the forceps to extract it and place it on the tray. Slice the pathogen open with the scalpel, then drain the fluids to acquire the antigen sample. Suture, gel, and bandage the patient. Operation complete.

You will repeat this process again until you find the other two types of this GUILT strain. When you're about to finish off the third and final type, it will go berserk, darting around the patient's organ and steadily dropping vitals. Spread antibiotic gel on the pathogen to subdue it, then extract it and acquire the sample.

Once you have samples from all three types, the mission will be complete. If you acquire a sample that you already have, you will simply have to pick another location and operate again.

Stepping Up
Difficulty Rating 3

Disinfect and incise. You will zoom in on the patient's liver. Three diverticula will be present, and will begin growing in size. Once they begin growing, each one will have an apparent color. You will have 3 new color serums: gold, green, and violet. Inject the same-color serum into each diverticula until a guideline appears. Treat the diverticula like aneurysms: inject and cut, but do not remove until all are neutralized. If a diverticula reaches critical mass, it will release a toxic gas that will heavily damage the patient's vitals. Once the diverticula are neutralized, remove them, place a patch on the wound, gel, and massage in place. When all three diverticula are treated, the GUILT will appear.

Observe Tetarti - the Synchronized Poison.

The key word is "synchronized." Though it appears as though there are three different GUILT, they act as one entity, and take damage as one entity. Notice that when they first appear, they will have a distinct color, like the diverticula. They will begin to move, and their colors will vanish. Memorize which Tetarti are which color, and inject the same-color serum into that Tetarti. If the correct serum is injected, the GUILT will freeze. When all three GUILT are injected with the proper serum, they will temporarily vanish and take damage. If you inject the wrong serum into any of the Tetarti, two new diverticula will form and must be treated same as before, else they will deal damage to the patient's vitals. If you lose track of any of the Tetarti, it is advisable that you simply wait for them to burrow back into the organ and reappear, then try again. Remember to stabilize the patient's vitals every so often.

Tetarti will move faster the more damage it takes, but as long as you can keep track of which Tetarti is which, it all comes down to how quickly and accurately you can inject the pathogens with the proper serum. If you accidentally inject the serum into the organ, you will incur a miss and the patient's vitals will drop slightly. With a little practice, this mission can be completed very easily, without even using the Healing Touch. If you're ambidextrous, try using two styli (use one to draw the serum, and the other to inject it into the GUILT).

Once the Tetarti are defeated, suture, gel, and bandage. Operation complete.

Taking a First Step
Difficulty Rating 2

The head director of Caduceus, Richard Anderson, is infected with GUILT. It's time for another episode of trial and error. You will be working with Victor Niguel, the head of Caduceus' R&D division. Your objective is simply to "do everything he tells you," because the purpose of this operation is to figure out what makes this newest strain of GUILT tick. Gel and incise.

You will zoom in on the lung, which is filled with a gelatinous fluid, with a hazy blob moving around within.

This is Pempti - The Armored Bacteria. And it's quite a resilient pathogen.

Victor will prompt you to attempt to excise the GUILT. Select the scalpel and draw on the gelatinous surface. Do not worry about the patient's vitals, they won't drop, nor will any lacerations form. Continue scribbling until Victor is satisfied, then select the laser when prompted. Touch the stylus to the screen and keep the laser steadily going until its charge is depleted. Victor will then ask you to apply antibiotic gel, the formula of which he has supposedly tweaked. Apply the gel until indicated otherwise. Victor will then ask you to inject the contents of 4 different vials into the GUILT: 3 serums, and a neutralizer. Draw the blue serum. Your target is the hazy blob moving within the gelatinous membrane. Try to gauge when the GUILT will appear for long enough to inject a full syringe of the serum, and which direction it will move in, and begin injecting on the far side of the blob in the direction it's moving. If the blob moves away from the syringe, you will incur a miss. It's normal to miss quite a few times during this operation, and it will not drastically affect your score (it shouldn't matter unless you're trying for an S rank anyway). Once the serum is successfully injected, the membrane will react. Victor will then ask you to inject the pink serum. Do so, and the membrane will react again. Then you will be asked to inject the orange serum. Comply, and suddenly, Pempti will start reacting violently, dropping the patient's vitals steadily over a short period of time. Quickly draw some neutralizer from the gray vial and inject it into the blob. Expect to miss quite a few times, because your field of view is flashing, and the blob is still moving. When you're successful in subduing the GUILT, Victor may or may not prompt you to inject stabilizer, depending on how far your patient's vitals fell. Inject the stabilizer, but DO NOT inject it into the membrane.

Now Victor will suggest a different attack angle. He will order you to alternate injecting the blue and the orange serum. Then, alternate between the pink serum and the neutralizer. Pempti will react in a different manner, one that seems to satisfy Victor. A guideline will appear in the middle of the membrane: excise a sample and place it onto the tray, then you will zoom out.

Suture, gel, and bandage. You may not have cured the patient, but the operation is complete nonetheless.

Medical Research
Difficulty rating 1



The Next Step
Difficulty Rating 2

It's time for round 2 with Pempti, and this time you have a new weapon in your arsenal, freshly created from the puzzle you just finished. Gel and incise.

The lung's condition has deteriorated since the last operation, but Pempti sure hasn't. That's about to change, though. Inject the new apoptosis-inducing nanomachine into the hazy blob, like you did with the serums in "Taking A First Step." Pempti's gelatinous membrane will suddenly shrink to half its original size; finally, you're getting somewhere. Tumors will form as the membrane recedes. Laser and gel them as they appear, then inject more nanomachine. After another injection, Pempti will be only a fraction of its original size. Treat the remaining tumors, and suddenly, the hazy blob reveals itself as Pempti's core. Select the laser and incinerate it, at which point it turns black and Pempti becomes inactive...or so you thought. Pempti's core comes back to life and the membrane along with it, growing to cover the entire lung again. Restart the procedure: inject the nanomachine to draw out the core, treat the tumors, and then laser the core. This time, an excision guideline will appear. Excise the core and place it onto the tray. Just when you thought you'd won, a new core appears and Pempti regenerates again. Doctor Kasal will order you to abort the operation.

Suture, gel, and bandage once you zoom out. Operation complete.

Doctors' Struggle
Difficulty Rating 4

After yet another puzzle, Victor will have finally come up with a way to completely obliterate Pempti. Your newest tool is an upgraded laser--one with infinite charge. As Victor aptly states, it's time to take care of Pempti once and for all. Gel and incise.

Inject nanomachine into the core until the membrane recedes, thus exposing it. Burn Pempti's core with your new laser. Instead of simply being charred, this time the core is destroyed completely. But the membrane remains, and the core regenerates, though smaller than before. Take note that Pempti has just evolved and will now start fighting back.

Pempti will begin producing miniature cores, which execute 3 different attacks. If the cores come out one at a time and move to the edge of the membrane, Pempti is preparing to cause lacerations. Quickly laser these mini-cores as they appear. If you take too long, they will dart across the organ and cause lacerations. If a mini-core gets by you, quickly adjust your aim and take out the one following it. If you continue to miss taking out the mini-cores, they will continue making lacerations which you will have to suture. If you did miss a mini-core, suture any lacerations and stabilize vitals.

The second attack is when 5 mini-cores move to the edge of the membrane at once. Incinerate as many as you can with the laser. Any remaining cores will stretch the membrane to the edge of the organ before receding again, leaving tumors behind. If the mini-cores stretch the membrane again and tumors exist on the organ, these tumors will burst and drop the patient's vitals. When the tumors are either treated or burst, gel the wounds.

The third and final attack begins when Pempti emits mini-cores that orbit the main core. Simply hold the laser in the path of the orbiting mini-cores and they will be destroyed one after another. Leaving them will cause the patient's vitals to steadily drop, depending on how many mini-cores exist.

At certain intervals between attacks, Pempti's core will completely expose itself. Take this time to burn it with the laser until indicated that the core has been damaged by an "OK" sign. Do not, however, neglect the mini-cores or the patient's vitals. Once Pempti's main core has been damaged several times, the core will vanish. The membrane will stretch across the organ, and then it too will vanish. Pempti has finally been cured.

When you zoom out, suture, gel, and bandage the incision. Final Score: Doctor Stiles: 1, Pempti: 0.

Under the Knife
Difficulty Rating 5

A GUILT outbreak has occurred. You will be operating on 5 different patients back-to-back. That's the good news. The bad news is they're all infected with Kyriaki.

Each operation is the same as the "GUILT" operation, where you were tested after being hired at Caduceus. The only difference is how many Kyriaki you're up against in each patient. The advised pattern to follow as you proceed is as follows:

Ultrasound and excise ALL immature Kyriaki. Spread antibiotic gel all around to stall the drop in vitals and mend your excision marks. Inject one syringe full of stabilizer. Suture one laceration. Laser all Kyriaki once.

Repeat until all the Kyriaki are destroyed, then continue spreading gel, stabilizing, and suturing. Be sure to stabilize vitals to 99 before suturing the final laceration after you deal with the immature Kyriaki, in preparation for the mature one. If the patients vitals are already high, consider skipping the 'stabilizing' step in the pattern, and simply gel and suture.

Towards the end of the mission, on the fourth and fifth patients, the mature Kyriaki will have an immature Kyriaki with it. Both of them will cause lacerations. Prioritize locating and excising the immature Kyriaki first. Once it is defeated, you will have only the mature Kyriaki to worry about.

When you've cured a patient of Kyriaki, you do not need to stabilize the patient's vitals. When you move on to the next patient, their vitals will already be at 99, and taking time to stabilize a cured patient will only waste time. You have at most 2:00 minutes for each patient if you intend to operate on all five of them. With this in mind, simply suture, gel, and bandage your incision when the patient is cured.

On one final note, you need only save the first three patients in order to complete the mission. Backup will have arrived to take care of any remaining patients, should you have fallen behind. If time runs out in the middle of an operation, simply finish the operation to complete the mission (provided you made it to the fourth patient).

If you need practice, go back and play the "Please Let Me Live" or "GUILT" missions and try to get S ranks on both of them. If you made it through, then congratulations on completing this doozie of a mission.

Shifting GUILT
Difficulty Rating 4

Triti is back, and it's mutated. The mutation has caused it to evolve an airborne communicability. In lay-man's terms, this means Triti is now as contagious as the common cold.

The procedure to extract Triti will be exactly the same as in "Forbidden Knowledge." The operation itself, however, has subtle differences. The first and most noticeable difference is that Triti's thorns will now occasionally vaporize. You must quickly remove this vapor with the drain. The second difference is that the thorns regenerate at a quicker rate.

If a vaporized thorn floats outside of the playing field, the operation will be aborted. It is not game over--yet. Doctor Kasal will step in, and you will start on a new patient. If the vapor gets past you a second time, Doctor Hoffman will take over. If you screw up a third and final time, it's game over. In the case that you start on a new patient, the clock will not be restarted, meaning you will have that much less time to work. And your Healing Touch still only works once.

Use either the "siege" (whittling down Triti and using the Healing Touch on the final rows) or the "flash" (invoking the Healing Touch immediately and extracting Triti before it fades) method, same as in the "Forbidden Knowledge" operation, in order to cure the patient. Make sure to drain any vaporized thorns, and keep an eye on the thorns that remain, lest they grow back and throw you off by causing Triti to multiply.

When Triti is completely extracted, suture, gel, and bandage the incision. Operation complete.

GUILT Evolves
Difficulty Rating 3

Like Triti, Tetarti has also mutated. And like the "Shifting GUILT" operation, the procedure for Tetarti has not changed; only Tetarti itself has.

Gel and incise. When you zoom in on the organ, treat the diverticula with the appropriate serums. The diverticula will grow at a quicker rate than before, which means you must work quickly to neutralize them. Once the diverticula are treated, Tetarti will appear. Inject the serum into the Tetarti once their colors fade in order to damage it. After at least 3 successful injections, Tetarti will begin moving as soon as it reappears, requiring more attention to keep track of them. They will also be moving around the organ faster. If Tetarti proves too quick for your reflexes, remember you have the Healing Touch to slow down time.

It will take more injections than when you first faced it, but when Tetarti is cured, you will zoom out. Suture, gel, and bandage. Operation complete.

Infection
Difficulty Rating 4

After a break-in and an altercation, Doctor Myers has been infected with a new strain of GUILT, one that Victor claims is fibrous in nature and therefore a "pain in the ass." This is only true if you have bad hand-eye coordination. Gel and incise.

You will zoom in on the small intestine. There will be lacerations, but they're different in nature and fewer in number, too much so to be Kyriaki. When you treat them, a worm-like pathogen will appear from within the intestine.

Paraskevi - The Arrow To The Heart. This GUILT is a ticking time-bomb (though not in the literal sense). It's on a mission to kill, and do so quickly. Which means you will have to be quicker.

Begin by selecting the laser and burning the tip of the tail. The GUILT will turn gold in color and freeze. Advance through the text, then select the scalpel and cut across the GUILT, not along the length of it. Paraskevi has suddenly split into two worms, and left a pair of lacerations in its wake. The procedure should follow a similar pattern as if you were treating Kyriaki:

Burn all Paraskevi worms with the laser. Spread gel to stall dropping vitals. Inject stabilizer. Scalpel the Paraskevi to split them into new pairs. Suture lacerations. Repeat.

Alternatively, you can skip suturing lacerations in favor of attacking Paraskevi. You will have to continuously spread gel to keep vitals from dropping, and they will drop fast as more lacerations are created.

Paraskevi will move around atop the organ. When it approaches the top of the screen, it will burrow into the organ and disappear. It's time to chase it. Assuming you saved a few lacerations, suture all but one and stabilize vitals to 99. Suture the last laceration, and your view will shift to the stomach. Any Paraskevi that escaped the intestine will appear here immediately and all at once. Begin attacking them again, as before. As Paraskevi is cut into smaller segments, the worms will move that much faster, towards the top of the screen, where they will burrow into the organ and move on to the next one.

Once you've cut Paraskevi down a total of 4 sizes, reducing it to 16 segments, laser the tails of each worm to stun them. This time, select the forceps and place the worm onto the tray for disposal. This is how you ultimately damage Paraskevi.

The GUILT will start in the small intestine, move to the stomach, then the liver, and its journey will culminate at the heart. Your goal is to completely extract Paraskevi at the liver, if not sooner. When you reach the liver, you should invoke the Healing Touch and cut down/remove any segments that remain. If any worms make it to the heart, you will have one last chance to remove them all. If Paraskevi burrows into the heart, the patient will instantly be killed, and it's game over.

When Paraskevi has been completely extracted, you will zoom out of the patient. Suture, gel, and bandage your incision. Operation complete.

Devil
Difficulty Rating 2

Surprise, surprise: there is yet another new strain of GUILT. The patient you're to operate on is only the second person to be infected with this particular strain. Gel and incise.

As you zoom in on the lung, you will see a few lacerations. Suture them and stabilize, then have your laser at the ready. After a moment of inactivity, a new laceration will form and up to a dozen GUILT will reveal themselves. This is the immature form of Savato, the final GUILT strain. Quickly focus your laser in the middle of the laceration, where the bugs are coming out. Laser any that remain.

Occasionally, if 5 or more immature Savato exist, they will group together and form a larger, blue-colored, and still immature Savato. Be warned, this blue Savato will drop the patient's maximum attainable vitals. Maximum vitals will first drop to 75, then 50, and then 35 when multiple blue Savato exist, and the vitals themselves will drop by around 10 points each time a new blue Savato is formed. Spread gel to stall dropping vitals, inject stabilizer, suture, and then burn away the smaller immature Savato. Incinerate the blue Savato once the rest have been defeated, or else the remaining pathogens will simply group together and form more blue Savato.

After at least four waves, the GUILT will be cured. Repair any remaining wounds, and you will zoom out of the patient. Suture, gel, and bandage. Operation complete.

Death Awaits All
Difficulty Rating 4

Do not, under any circumstances, invoke the Healing Touch at any time during this operation until stated otherwise. If you invoke the Healing Touch prematurely, you will NOT be able to complete the operation.

You'll be operating on the father of your assistant, Angela Thompson. Seeing as she's dependent on you to save her long-lost father, it's strongly advised that you do not fail. With this in mind, gel and incise.

This is the final GUILT: Savato - The Face-off With Death.

As you zoom in on the heart, the web constructed upon it will be immediately noticeable, as well as the spider-like mature Savato sitting atop it. Should you attempt to use the laser on the pathogen, it will simply dart out from beneath it. This obviously isn't going to work, so try cutting the web. Select the scalpel and hold it against a strand of the web until it is cut. Your scalpel has inexplicably melted, but seeing as spares were brought, you can continue.

Continue cutting strands of web, pausing occasionally to stabilize vitals or "poke" at Savato with the laser until a new scalpel becomes available. Savato will occasionally spin a new strand of its web, spawning a number of immature Savato along with it. Laser these immature Savato if you wish; if you leave them, they may create a blue Savato and drop vitals, but they will do no more than that. For now, you can safely ignore them. Also, if you ignore the web for too long, it will begin turning red as it prepares to sap the life directly out of the patient. If it turns completely red, vitals will drop by around 30 points.

Savato will spin 3 new webs after you destroy the first. When the final web is completely removed, any remaining immature and blue Savato will be absorbed into the mature pathogen. Savato will then appear to become inactive, only moving around the heart. Take this time to raise vitals to 99, then resume the attack.

Select the laser and begin burning the mature Savato. If the mature pathogen absorbed any immature doppelgangers, it will take more time to burn away Savato's "armor." As you burn Savato, it will become agitated and eventually create a laceration, spawning immature Savato. Once again, it is safe to ignore them for the time being. They will create blue Savato, and may occasionally cause vital damage, but even if the entire heart is swarming with the smaller pests, the patient is not in any real danger. Also, if you neglect the mature Savato for too long, it will take the offensive, creating 3 lacerations at random. As long as you continue to stabilize vitals, suture all lacerations, and stay on the offensive, the patient's vitals will maintain and Savato will continue taking damage.

Once you've burned off Savato's armor, indicated by an "OK" sign, select the scalpel and tap Savato with it to damage it. If you're quick, you can select the laser and immediately start burning Savato again. If you register another "OK" sign, select the scalpel and damage Savato again. Otherwise, it will regenerate its armor and you will have to laser it off again. Once you've attacked Savato with the scalpel twice, Victor Niguel will show up and provide you with a new black serum to ultimately defeat Savato. Advance through the text, and begin attacking Savato one final time. Burn off the armor, suture lacerations, stabilize vitals, and when Savato is vulnerable, attack it with the scalpel. Savato will absorb any blue and immature pathogens that remain, before feebly crawling around the heart. Stabilize vitals to maximum, then draw the black serum and inject Savato.

Savato will move to the middle of the heart, where it will begin its final stand. It will create 9 lacerations at once, then move around and begin creating 5 lacerations at random. Though this sudden offensive is frightening, the Healing Touch suddenly invokes itself. Suture a laceration or two, then take note that the hand icon suddenly changes itself into a star.

Invoke the Healing Touch manually.

Time will completely stop. The clock, the patient's vitals, Savato, all of it will freeze. Take a breath, then begin calmly and slowly suturing all of Savato's lacerations. Stabilize vitals to 99. Finally, draw the black serum and inject it into Savato. Watch and relish your victory as Savato writhes about and then finally vanishes, completely renewing the heart.

After you zoom out, suture, gel, and bandage. Operation complete.

First Sin
Difficulty Rating 5

You're operating on an intubated child, whose sole purpose in life (currently) is to incubate GUILT archetypes. This particular child, dubbed the 'First Sinner,' incubates Kyriaki. "Sick" only begins to describe Delphi's rationalizations. Gel and incise.

Kyriaki was never easy, and it hasn't gotten any easier. The operation will be the same as in the "GUILT" or "Under The Knife" operations. The difference is the patient's vitals will drop at a quicker rate when lacerations exist. Use the gel, stabilize, suture, laser method as stated in the previous Kyriaki operations. Before you suture the final laceration caused by the immature pathogens, stabilize vitals to 99. Prioritize defeating the immature Kyriaki that accompanies the adult. As long as you continuously spread gel and stabilize vitals, everything else should fall into place.

When Kyriaki is defeated, suture, gel, and bandage. Operation complete.

Second Sin
Difficulty Rating 4

The 'Second Sinner,' as it were. This one incubates Deftera. Gel and incise.

The procedure has no difference whatsoever from the "Something Precious" operation. However, as you spread gel to steer Deftera, the GUILT is likely to spawn a medium-sized tumor. Use the gel in moderation. Also, vitals will drop more quickly, smaller tumors will spawn more quickly, and more medium-sized tumors will be created whenever like-type Deftera collide. Prioritize incineration of the medium and then small-sized tumors, and stabilize vitals anytime you get the chance, because that chance won't come often. As in the first Deftera operation, there is some luck involved.

When Deftera is excised, suture, gel, and bandage the incision. Excise the two Deftera in the lung, then suture, gel, and bandage again. Operation complete.

Third Sin
Difficulty Rating 4

Time to help the 'Third Sinner.' This one has a bad case of Triti. Gel and incise.

This operation is exactly the same as the "Shifting GUILT" operation, except vaporized thorns, if they drift to an empty space on the organ, will create new triangles. Thorns also respawn quicker. Finally, seeing as you're working on the stomach, it is advisable to work downward instead up upward. The "flash" method of extraction may not be possible here, given the amount of Triti that exists when you incise.

Pull thorns in rows, excise in rows, and extract the triangles. Work downwards. Stabilize vitals, and drain any vaporized thorns immediately after they appear. Make your Healing Touch use count.

Suture, gel, and bandage once Triti is extracted. Operation complete.

Fourth Sin
Difficulty Rating 3

The 'Fourth Sinner' incubates Tetarti. Gel and incise.

Neutralize all diverticula, then treat them. When Tetarti appears, it will begin moving immediately, and its movements will be quicker. Keep track of which Tetarti are which to the best of your ability, and inject them with the appropriate serums. If you must use the Healing Touch, save it for after the first four or five injections, or you will find it exceedingly difficult to complete the operation.

Suture, gel, and bandage when Tetarti is defeated. Operation complete.

Fifth Sin
Difficulty Rating 4

Pempti again, this time in the 'Fifth Sinner.' Was the Pempti research worth the cost of Richard Anderson's life? It's up to you. Gel and incise.

The operation is the same, except that vitals drop faster due to tumors or lacerations, and mini-cores act quicker. You'll be on your toes during the entire operation, but the procedure is the same from the "Doctor's Struggle" operation.

Suture, gel, and bandage when Pempti is defeated, hopefully for the final time. Operation complete.

Sixth Sin
Difficulty Rating 4

Another case of Paraskevi, ailing the 'Sixth Sinner.' Considering Paraskevi's nature, it kind of makes you wonder why this child isn't already dead. Gel and incise.

The operation is exactly the same as "Infection", except vitals will drop slightly faster. Once again, the pattern is laser, scalpel, gel, suture, stabilize. Repeat until the Paraskevi is reduced to sixteenths. Extract the segments whenever you get the chance, stabilize before you move on to another organ, and invoke the Healing Touch when you reach the liver.

Suture, gel, and bandage when Paraskevi is extracted. Operation complete.

Final Sin
Difficulty Rating 4

The 'Final Sinner,' and the final GUILT. With this, the sources of GUILT will be cured, and GUILT will eventually die out. Gel and incise.

Once again, it is imperative that you do not use the Healing Touch until after it automatically invokes itself once.

The procedure is the same, as is the operation. Cut the web strands, stabilize vitals, and ignore any immature/blue Savato that appear. When the webs are destroyed, stay on the offensive. The mature Savato will be quicker to start fighting back with lacerations this time around. Gel, inject stabilizer and suture any lacerations that Savato creates. Once the armor is burned off, scalpel the pathogen. Quickly laser and scalpel again, or else burn off the armor and attack with the scalpel. You should be able to chain the laser and scalpel attacks until Savato is vulnerable, seeing as Victor isn't around to interrupt you this time.

When Savato is vulnerable, stabilize vitals to 99, then inject the black serum. After the Healing Touch automatically invokes, invoke it again to freeze time completely. Suture all lacerations to up your score, stabilize vitals, then kill Savato with a final injection.

Suture, gel, and bandage. Operation complete. Coincidentally, this is also the end of the story, so enjoy the well-earned epilogue.

But it's not the end of the game...