Trauma Center: Second Opinion/X Missions
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The X Episodes are unlocked when you complete Chapter 6 on any difficulty. Chapter X has the hardest missions in the game. The difficulty is set to EXTREME and can't be changed. If you thought Chapter 6 was hard then Chapter X will bring you to your knees. Each mission is one of the strains of GUILT that you have faced in the previous chapters. You can choose to play as Derek Stiles or Nozomi Weaver for the X missions. If you complete an X mission with either doctor, the next X mission will be unlocked.
 Episode X-1: Kyriaki
Overview: Unreleased Caduceus report number 1: Concealed Blades, "Kyriaki."
Time Limit: 5:00
Kyriaki is the first GUILT you'll face in the X episodes, and by far the easiest. If you're having trouble with this one, you might want to go back to the previous missions to hone your skills (XSing or Sing the other missions are great practice).
 Getting from S to XS
Get more Cools on all your stitches, and go faster. If you're really fast, the Kyriaki might not make enough cuts to get your points up. Its extremely likely you'll get XS though, as long as you get all the bonuses.
This battle with Kyriaki isn't any different than the others you've faced, except that they make cuts a lot more often, and these cuts do a lot of damage. As such, your main concerns will be stitching up cuts quickly, and keeping vitals up.
Go ahead and disinfect the patient and make your incision.
Inside, you'll be greeted with 4 large (open) lacerations and 3 small cuts. Stitch up 2 of the cuts, then all 4 lacerations. You should be able to do this without injecting any stabilizer (though vitals will be pretty low once you're done). Go ahead and inject some midway if you have to, but you may want to consider practicing a bit more before proceeding.
Leave the last cut and jack up vitals as much as you can - either until you hit 99 or your syringe wears out. You will need them for the upcoming battle. Anyway, go ahead and stitch that last cut when you're ready.
There will be 3 small Kyriaki. Stitch up their initial cuts, and begin the fight. You've dealt with Kyriaki hundreds of times before, so I won't go into specifics - just make sure you make repairing damage your first priority. If you let any cuts stay around, the vitals will drop FAST.
Keep in mind that after you kill the first 2 in this set, 2 more will replace them. So if vitals are low, the best time to increase them is after the first kill. After you kill 5, there will only be one left. This is a great chance to increase your vitals once more. Go ahead and scalpel the Kyriaki out of the organ and repair its damage. Give it one laser blast, then give the patient 2 shots of stabilizer. Give another last blast, then 2 more shots of stabilizer. Finally, give it one more laser blast. The reason for doing this is that it will keep the Kyriaki from making more cuts.
After that last laser blast, inject stabilizer immediately, as the large Kyriaki will appear, along with 1 more small one. Stitch up the cuts, then kill the small one. Ignore vitals for now and kill the large Kyriaki - they should be high enough to take you through to the end of the operation.
After he's dead, it's standard fare. Stitch, disinfect. Make sure you up the patients vitals to 99 before applying the bandage unless you're out of time to get the mission bonus. Done.
 Episode X-2: Deftera
Overview: Unreleased Caduceus report number 2: Creeping Tumors, "Deftera."
Time Limit: 5:00
Kyriaki wasn't so bad, right? Well, guess what - this is the hardest X mission, and thus the hardest one in the game. Nice of Atlus, isn't it? On the plus side, its all downhill from here.
 Getting from S to XS
Not necessary - if you get the bonuses, you've got this.
Say to yourself - I will not get frustrated, I will not get frustrated.
This mission is 95% luck. It's not your fault if the patient dies! And oh, will he die a lot!
After making your incision, laser the tumors. For some reason, Dr. Weaver's mission has about half the tumors Dr. Stiles's does! No fair!
Regardless, it doesn't matter, as you'll have time before for the first Deftera appears to jack the vitals up to 99. The first part only has one Deftera pair, and is very, very easy. This is just like the first Deftera mission, except vitals drop a lot faster. Make sure the patient is over 50 before you drain the group for the last time, or he may die. After the Deftera is dead, just go ahead and do the standard stitching thing you've done a hundred times. After disinfecting the second cut, jack the vitals up to 90, 91 before cutting in. Give one more injection to get them to 99 before the Deftera appears.
This is where its all luck. The idea is, is that you want Deftera to have a successful, umm, "mating", as much as possible. That means two opposing colors spin around, and no other ones bump into them to interrupt it.
When Defteras are mating, they're not running around making tumors, causing hemorrhaging, and dropping vitals like a rock - and I do mean LIKE A ROCK. Vitals plummet in this operation, very, very fast. If this segment starts with 2 blues and 2 reds coming together and making 4 tumors, you can pretty much restart right there.
You can use antibiotic gel to "herd" Deftera where you want, as they're not supposed to cross it. I find this a waste of time though, for 3 reasons: First, the Deftera often times crosses the line anyway. Second, you'll have your hands full patching up damage just to keep the patient alive. Third, every time the Deftera is repelled by the gel it hurts your vitals, which you can barely keep up as is.
That's all, really. You have to have Deftera mate properly enough so they don't cause so much damage the patient dies. Probably about 1 out of every 20 operations will be good enough for you to actually beat. After you get a good run so that you can extract a Deftera, be sure to patch up all the damage before moving onto the other one. It's all downhill from there.
 Episode X-3: Triti
Overview: Unreleased Caduceus report number 3: Contagious Nightmare, "Triti."
Time Limit: 5:00
Triti sucks. Its not too hard, but inevitably a thorn will be pulled out the wrong way, or you'll miss the dish, or you'll go too slow on one section and 4 membranes will spawn out of 1. Regardless, this mission isn't so bad, as the membranes are organized very well.
 Getting from S to XS
Go faster, make sure vitals are high. If you follow my method, this will be a non-issue.
You need to have some membranes multiply to increase your chain. If you just power through it, you won't have the points to get from S to XS. If you follow the method I've laid out, you'll get the XS - and it's not too hard that way either!
I'll try my best to describe this, along with some ASCII art to explain my meaning. I'll take it in steps. In the ASCII art, an X indicates a spot to remove.
x-----x o-----o \ x / \ / \ / \ / x \ / \ / x-----x-----x / \ / \ o-----o \ / \ / o-----x-----o \ / \ / \ / \ / o-----o
Remove the thorns indicated, starting with the 2 in the center column. Then remove the upper 2 segments. Any segment will work, honestly, but you have a little bit of extra time after this step, and the upper left ones are the furthest away from the dish, saving you some time later. Also note, that 4 membranes (2 on each side), will multiply on the bottom row. This is what you want.
o-----o / \ / / \ / x-----o / \ / \ o-----o \ / \ / o-----x-----x-----x-----o \ / \ / \ / \ / \ / \ / \ / \ / o-----o-----o-----o
While waiting for the 2 thorns in the middle column you removed to grow back, remove the 2 thorns indicated on the bottom row of membranes. By that time, the middle 2 will have grown back, so remove those.
x-----x / \ x / / x \ / -----x / \ / x \ x-----x \ x / \ / o----- ----- ----- -----o \ / \ / \ / \ / \ / \ / \ / \ / o-----o-----o-----o
Remove the remaining 3 from the top segment and the remaining 2 from the middle segment. Finally extract all 4 pieces. You need to be fast here, but not super fast. Also keep in mind the first thorn you remove in this step will turn to gas. Leave it alone until you're done with this step.
You're in the clear at this point. I can't give an exact strategy for this as it depends on how fast you are, but start removing thorns and pieces starting from the left. Make sure though, that before removing a piece, the 2 marked throrns are removed - as long as they're not present, the piece cannot get any bigger. Stop when you get down to 2 pieces left. Note: Go from the left, not from the right, as Step 5 will need quite a bit of speed, and you'll be closer to the dish.
o-----x-----o-----x-----o \ / \ / \ / \ / \ / \ / \ / \ / o-----o-----o-----o
STOP. You need to wait for all 4 thorns to regrow here, then remove them all at once. Take this opportunity to jack up your vitals as high as possible before they do regrow. Once they do, simply remove all 4 thorns and both pieces.
o-----o / \ / / \ / o-----o
Now you're home free. Patch the patient up, making sure he's at 99 vitals before applying the bandage. Not so hard, is it?
 Episode X-4: Tetarti
Overview: Unreleased Caduceus report number 4: Synchronized Venom, "Tetarti."
Time Limit: 3:00
In my opinion, this and Kyriaki are tied for the easiest GUILT to XS, as you can make mistakes on this one.
 Getting from S to XS
Speed and vitals, of course. Keeping your initial chain going longer is nice too, but by no means necessary. As long as you don't let any Tetarti get away, you'll get XS.
Your only concern here is going fast, as you only can let the group of Tetarti get away once and still make the time bonus.
After making your incision, you'll be greeted with 3 sets of diverticula. They appear to grow at different rates, and burst at different times. I recommend starting with the yellow, then green, then purple. Inject the appropriate antidote, then cut, but stop there. You don't have time to remove them one by one. So, inject the antidote, then cut, then repeat twice - then remove all at once. Apply the membranes all at once, then gel all at once. This will put you at a chain of 17.
That means you can't miss the first set. Inject 1 1/2 shots of stabilizer, then get your yellow antidote ready. Inject the other 2 in whatever order you wish. Remember, you cannot miss on the first round to get the 20 chain. After they die, you can miss all you want provided the patient stays alive.
From then on out, repeat the process. Inject 2 shots of stabilizer in between rounds to keep the vitals up. Every other round, you can inject 3 shots of stabilizer in between rounds - don't do this every time though, as your syringe will wear out and you'll be screwed. Always start with yellow, as this is the color of your cursor, and the sooner you eliminate the yellow gas the better.
Even though you can make mistakes, keep those limited to misses. If you inject the wrong antidote, and you get a diverticula to form, it can be really hard to treat it given your limited timetable - you'll probably want to restart.
Once they die and you stitch up and disinfect the patient, jack up vitals as much as you can. Time will be short though, and you have to be done before 1:00. The time bonus of course, takes priority.
 Episode X-5: Pempti
Overview: Unreleased Caduceus report number 5: Armored Bacteria, "Pempti."
Time Limit: 5:00
This guy isn't too hard, though if you get behind, your patient will die.
 Getting from S to XS
Shouldn't be necessary to do anything special - if you go slow even for a moment, your patient will die.
It deserves one more mention - as long as your patient stays alive, you've got this. And if you go fast, vitals won't be an issue.
After making your incision, inject the nanomachine twice, and give a shot of stabilizer to get the vitals to 99. Keep the laser centered on the core until you get an OK, where the real battle starts.
Pempti, as you've faced it before, has 3 attacks. Here's how to counter them:
Pink Bits: These guys will make cuts along the patient. If they make more than one, consider yourself hosed. Stitch it up when the blue bits begin to wash up over it. Keep the laser focused on them and they're easy.
Blue Bits: This is your only enemy in this operation. They always come after pink bits (though they can also show up twice in a row). Hold your laser at the upper part of the core to get 'em when they come out. Then travel to one side to zap the far left two or far right two at the same time. Once they die, center your laser on the middle one. The remaining 2 will wash up and create tumors. Follow them up with the laser, and zap the tumors as they recede down. Once they've settle, kill them and very quickly dust the lasered tumors with gel. It takes very, very little gel to seal them, so go fast. Get your laser back on the core, because following them will be...
Spinning Bits: If you catch them early, just keep your laser centered in the middle and they'll die. If they start rotating, you've probably lost.
So really, the blue bits are your only concern. You HAVE to get at least 2, though 3 is ideal. Practice killing these guys and you've got this in the bag.
Occasionally, Pempti will take a 2-3 second break at which time you can inject stabilizer. I don't advise taking advantage of this, because if he launches bits and your laser isn't centered on the core, you're screwed. On a special note though, if Pempti uses the pattern Pink, Blue, Spinning, Spinning, he will take a break then, so inject some stabilizer.
 Episode X-6: Paraskevi
Overview: Unreleased Caduceus report number 6: Arrow to the Heart, "Paraskevi."
Time Limit: 5:00
This little guy seems intimidating, but as long as you let some worms burrow deeper, you'll be fine.
 Getting from S to XS
Speed, speed, and more speed. You have to be quick. Spend less time lasering and more time killing. Also, you need to get a lot of Cools on your stitches.
You've got to be fast on this one. You're looking at around 1:45 to be your target time, and that's cutting it pretty close. Let worms burrow deeper - don't worry about it. That's one less thing you have to laser!
Cut open the patient and stitch up those cuts. Then get vitals up to 50 (the max for this operation). Laser the worm when it appears, cut it and stitch it. You have to fill up vitals EVERY time you make a cut on the Paraskevi. This also means don't cut worms close together, as if two pop your patient will die.
For the first part, in the small intestine, cut the initial Paraskevi and let one of the worms go. You'll get to him later. Divide the remaining one, stitch the cuts, and jack up vitals. As a general rule for this operation, let the Paraskevi move around while you're maxing the patient out with stabilizer. ONLY laser one if it starts to move its tail. You'll occasionally miss with this method, but thats okay.
Continue on fighting Paraskevi, always cutting the smallest segment available to you until you can finally extract it. Just extracting 2 bits in the small intestine will be fine, 4 would be nice if you can pull it off.
In the stomach, you'll have the 1 large worm you let go at the beginning, plus whatever else got away. Let the large worm dig deeper once more, and do your best to extract everything left here. Again, don't sweat it if anything gets away - you don't need to worry about that yet. Try to get another 4 extracted in this stage.
Now comes the liver. Hopefully all that is here is the large worm from the first cut. If not, I'd recommend lasering him while he's slow and mop up anything else that's left first. Cut the big guy once more, and let one half get away. It's at this point you need to be concerned about segments getting away from you, as if you get overwhelmed at the next part, the heart, your patient is dead. Kill the remaining Parveski in the liver.
Finally, in the heart, you only have one midsized worm left. Finish him off, being very careful not to let anything get away from you. Stitch the patient up, disinfect, jack the vitals up to 50, bandage.
 Episode X-7: Savato
Overview: Unreleased Caduceus report number 7: Faceoff with Death, "Savato."
Time Limit: 10:00
This is it! The final XS mission! If you were able to handle all the rest, this will be no problem.
 Getting from S to XS
What you'd expect - more Cools, faster time, and high chains.
The key to beating this operation is knowing how Savato behaves. Practice a few times, not going for XS, just to get a feel for how Savato responds to different stimuli. Once you can predict him, you've got this.
Note: Just like the first Savato in the storyline, you CANNOT use Healing Touch until the very end, even with Weaver (her Healing Touch is Derek's in this operation).
After cutting into the patient, you'll be greeted with Savato's familiar web. Be sure to cut along the intersections, so you can get more at once. For the first two webs, make the mini-Savatos low priority, especially if you're close to the end. Once you move to a new area, all of them will disappear. Also, get a feel for how long the scalpel takes to come back - you can start cutting a good 1/2 to 1 second before the ding indicates it is available.
As for the third and final web, make sure you mop up the mini-Savatos as much as possible before cutting the last web. Any mini-Savatos left over will be absorbed into the adult Savato, increasing his attack speed throughout the rest of the operation. Two or three are no big deal - in fact, I've noticed some operations to be much easier after Savato absorbs a small number of them.
The next part is much harder, and requires some experience. I recommend trying this one a few times just to get the feel of how Savato behaves. However, don't worry about keeping vitals at 99 - you can't. If you don't keep up the attack, Savato will attack more, which means vitals will drop more, etc. Shoot for 45-50ish.
Now, when to attack? Pay attention to the rumble in the wiimote. If it's rumbling, it means you're hitting him. You have to do one strong attack with the laser. If you pause for too long, Savato will just regen the damage. Start lasering Savato. If he moves in one direction, loops around, and stops roughly where he began, thats good. Let go over the laser while he's looping, and center it back on him when he stops. Another good time to attack is after he does his 3 cut attack. Just center it on him and fire. This is a bit more dangerous though, you need to make sure the patients vitals can handle the cuts being there. Finally, there will be times when Savato will very briefly give off a soft red glow. This basically means he's taken a chill pill, and is an excellent time to attack.
If you're lasering Savato and the rumbling stops, you should stop as well. He's just turned himself invincible, and is about to attack. Clear up his attack and try again.
As a general rule, you should not have to track Savato very much with the laser. Wait until he more or less settles in one spot, and give him a zap. You can let up for brief moments while hes flailing about, but for the most part, press the attack. Try your hardest not to let the laser's power run out, because after you break through his barrier, he'll release a bunch of mini-Savatos, which you need to zap once they're released, or they'll spread out and get in your hair.
It's hard to put it into words, so all I can say is practice. You'll get a feel for Savato, and before you know it you'll be able to beat him with 5 minutes left.
For the final part, when Savato flips out, let him go for 50ish seconds while you stitch like a madman (when playing as Stiles, you'll need to inject stabilizer in between stitches, but as Weaver you can just stitch). You need a lot of Cools to go from S to XS, and this is where you get them. Don't go over a minute! The first healing touch CAN and WILL eventually run out, which means you lose! After you stop time, stitch up all the cuts, inject the serum, and finish this!