Trauma Center: Under the Knife/Storyline missions

Ratings of Difficulty

 * 1) Easy
 * 2) Slightly difficult
 * 3) Difficult
 * 4) Very hard
 * 5) Insane

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

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

This like in Shifting GUILT is a stronger strain of the original. It is the evolved form of Tetarti. Use the same procedure from Stepping Up. The Tetarti will give you less time to memorize the color codes and may be moving while they are flashing. You will also have less time to inject the serum. If you fail to inject them, they will create new tumors.

Infection
Difficulty rating 4

This is a new GUILT, Paraskevi. It's a fibrous worm like GUILT that targets the heart. Perform the incision. There will be 3 small cuts on the intestines, suture them. Now a worm like GUILT will crawl out. When Victor tells you to use the laser to find a weakness, laser the bushy tail. Take the scalpel and make a quick slice around the middle of the Paraskevi. The worm will slice in half, leaving 2 wounds. You need to cut it small enough so that you can excise it without killing the patient. You will have to cut it up into 16 pieces to remove them all. But for now, we only need to do a few at a time. Laser both of the worms tails and cut them both. You will have fourths now. If the Paraskevi reaches the top of the operating zone, it will move to the next area where it will be waiting for you. Treat all the wounds and stabilize until 2 of the fourths have left the operating field. Laser both fourths, and you have 8 pieces now. Raise the vitals if you need it, and laser them all now. Cut 2 or 3 of the pieces and laser all of the pieces again. The smaller pieces can be removed by the forceps into the tray and cut a few more out. Repeat this process until all of the pieces have been removed or have escaped. Now treat all the wounds and stabilize. You will move onto the second of four operating fields, where the ones who have fled will be waiting. Repeat this process and get to the next operating field. Here, is where you want to stop it. Use the healing touch, laser and cut. If any of them escape, you will have a short chance to get them. The last one is especially small, covering about one third of the screen. Make sure that the pieces are lasered and still at all times if they aren't being removed, because if they manage to get to the heart, she will die. At around this point, you should have removed it all. Suture the incision, disinfect, and bandage.

Devil
Difficulty rating 2

This is an archetype of the Savato GUILT. Disinfect the guideline and cut it. There will be a few lacerations. Suture them and wait with the laser selected. A cut will appear and several small GUILT bodies will come out. Try to laser them as they come out so you can get the most in the least amount of time. This will happen multiple times so be ready. If too many GUILT bodies are around at the same time, they will gather into a small swarm which can't be lasered. When they move out of the swarm, they will have created a large light blue GUILT body which will drop the max vitals dramatically. Laser this, and proceed with lasering all of the smaller ones. Once there are no more GUILT bodies, treat the wounds and close the patient up.

Death Awaits All
Difficulty rating 3.5

NOTE: Do not use the healing touch in this operation until the guide tells you to.

Disinfect the guideline and cut it. You will be zoomed into the heart with a web on it, and a purple bug on. The purple bug will be referred to as the main Savato. Select the scalpel, and Angie will interrupt you to read an analysis about it. Select the scalpel again, and place it on one of the Savato webbings. Don't cut it from side to side, just keep it on the webbing and it will cut. The scalpel will melt and you will need to wait for a bit for the next one. During this time period, use the stabilizer to bring up the vitals, and have the laser ready. The main Savato will occasionally run around and make a new strand of webbing, when this happens, it will also release many of the small GUILT bodies from Devil. They will need to be treated the same way. Other guides may tell you to ignore them and laser the large ones, but that's not the best option. Laser them before they form a swarm, and if they do make a swarm, ignore them until they spread out again, and then laser them. When you have the scalpel icon again, select it and repeat the process. When you have removed all of the pieces of web, the main Savato will run around and recreate the web. This will happen two more times. Before you use the scalpel on the web again, use the stabilizer and laser to bring up the vitals and stop the smaller GUILT bodies. If the web begins to turn red, use the scalpel immediately. If it gets too red, it will drop the vitals dramatically. Repeat this process until the Savato stops recreating the web. It will have stopped draining energy from the heart and the purple layer on top of it will be able to be lasered. Get the laser, and apply it to the top of the main Savato. When you have destroyed a layer of the protective layer, it will create a laceration and release small GUILT bodies, like in Devil once again. Laser them as they come out if you can. If they get out of control, focus on the main Savato and laser a bunch when they are packed together but not swarming. Continue lasering the main Savato until all of the purple is gone from it and it begins running around. Cut it with the scalpel, and Victor will appear to give you the serum for it. Repeat the process, but after you've cut the savato with the knife, inject the serum into it. It will go crazy and create multiple lacerations. You will automatically go into the healing touch. You need to survive for a short time. Stabilize the condition and suture some wounds for points. In place of the hand icon, the icon for the healing touch will be there. Select it, and draw the star. Time will literally stop, allowing you to give you the final injection. The Savato will stagger around, and die. All of the wounds will be miraculously healed. Suture the incision, disinfect, and bandage.

First Sin
Difficulty rating 4

This is the most concentrated form of Kyriaki. Disinfect the guideline and perform the incision. Drain the blood from the large wounds, pinch them together with the forceps, and suture them. Move onto the smaller wounds now. Two Kyriaki will appear, use the ultrasound to find them then excise them. You will need to stabilize constantly; the patient's vitals will drop much faster than the normal GUILT operations. They will need to be lasered three times each. The next round of Kyriaki will come about. Treat these the same way, stabilizing constantly. Once the Kyriaki is removed, apply antibiotic gel to the mass of wounds, and then suture them all. Leave one wound and stabilize all the way to the max; 99. Treat the final wound and the large Kyriaki along with a small one will make their entrance. Use the ultrasound to find them. The small one should be your first priority. Laser the small one until it has burnt away. Proceed with finding the large Kyriaki and burning it. Once the Kyriaki has been completely removed, treat all of the wounds. Suture the incision, disinfect, and bandage.

Second Sin
Difficulty rating 3.5

This is the most concentrated from of Deftera. Disinfect the guideline and make the incision. Laser the tumors. The pair of Deftera will appear, continue to laser the tumors as they appear and keep the vitals up. When they meet, drain them. Continue this process for the first part. When you have defeated the Deftera, treat all the wounds and close the incision. Make the incision on the next part for the lungs, and begin. This time, the wrong pair of Deftera will join which will create two tumors and drop the vitals. Instead of waiting for the two pairs of the same color to combine, put gel in front of the two colors to drive them away from each other. Be sure to laser all the tumors when you can. When a pair meets up, drain them immediately and as fast as you can otherwise, another Deftera will meet with it and drop the vitals again. It gets much easier once one pair is finished. If the vitals are dropping too fast, laser all of the tumors while stabilizing. Once you are done. Close the incision.