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 3

This GUILT is Triti. Triti has two basic strategies to keep in mind shile operating. The first takes a long time, is a little easier and slower and the second is much faster, but requires much more speed and ability.

Siege
Begin by disinfecting the incision, and cutting it. You will see the pancreas with the triangular triti. A few things to keep in mind, you must remove all the thorns on a triangle in order to excise it, if a triangle is isolated it will reproduce, and if two thorns are next to each other and there is a free slot, it will reproduce into that slot. Now take the forceps and begin to remove some thorns. You can use the healing touch at any time in this operation. Once you have all the thorns from a few triangles, take the scalpel and cut all of the yellow excise marks. There is no need to do it in a triangle pattern. Now, quickly remove the triangles with the forceps before more thorns appear to kold them in place. Keep doing this and eventually, you will have, a big sized block of triangles in the upper left hand corner. Slowly excise blocks of 3 or 4 triangles until you are left with 3 to 4 triangles left. Remember to not let triangle thorns get side by side to stop them from reproducing. Now, remove all the thorns as fast as you can and excise them quickly. The last one, if you can't get rid of it fast enough, will reproduce. Keep doing this part until you succeed. Now, suture the incision, disinfect, and finally bandage.

Flash
All right. First read the above strategy for some basic information on Triti. This strategy involves using the healing touch to stop it's reproduction. Now, disinfect the guideline. Perform the incision. Double-tap the hand icon and use the healing touch. Twenty to twenty-one hundred should be good enough. Now take the forceps, and pull out all of the thorns as fast as you can. In the healing touch, triti can't make more thorns. Now get the scalpel and slice all of the yellow marks. No need to do it in a triangle. The game will only care if you get the knife on the marks. Now get the forceps again. Grab all of the triangles and put them into the tray. If by any chance the game come out of healing touch during this step, continue removing them but you will need to use the forceps to take out thorns again if more appear. Once the triti has been eradicated, suture the incision, disinfect, and bandage.

Race For the Cure
Difficulty rating 2

This part of the story involves more than one operation. The operations will vary with the green, purple, and yellow being faster in order. Begin by choosing one of the locations on the map. You will need to get the antigen of all three types of Tetarti.

Begin by disinfecting the guideline and cutting it. There will be a GUILT parasite on the organ. Use the syringe to inject it with the medicine. It will burrow back into the organ like Kyriaki. You also get it back out the same way, use the ultrasound to find it and cut it out. Inject it with the serum again once it has stopped flashing. If you have the yellow one, it will go berserk around at this point. You will need to take the antibiotic gel and apply it to the GUILT to stop it. Repeat this process until the parasite is dead. Use the forceps to drag it onto the tray, and then cut it open. Use the drain to remove it's body fluids, then treat all of the wounds and close the patient up.

Stepping Up
Difficulty rating 3

Disinfect the guideline and perform the incision. There will be 3 small tumors which will grow in size. Once you can clearly see what color the tumors are, select the syringe and inject them with the correspondent colors. Once enough has been injected, the yellow excision line will appear. Cut it, and remove it with forceps. Do this all at once for the three tumors, since if they get too big, they will explode and release toxic gases. Apply the synthetic membrane on the wounds, disinfect with the antibiotic gel, and mend it with the hands. Now, the three Tetarti wil appear. They are all synchronized and act as one GUILT, so you have to inject all three of them for any effect. Memorize the colors of each one, yellow, green, and purple. Once they have become transparent, inject each one with the serum of it's appropriate color. If you inject all three, they will burrow back into the liver, but if you can't they may make more tumors which you will have to treat at the end of the operation. They will come back, so repeat this procedure until the Tetarti has been eliminated. Treat any wounds, and close the pacient up.

Taking a First Step
Difficulty rating 3

Disinfect the guideline and perform the incision. A giant gelatinous blob fills the left lung. Do as Victor tells you. First take the scalpel and place it on the Pempti. Then get the laser and do the same thing. Then take the antibiotic gel and apply it. Each time Victor will tell you that it has no effect. Now select the syringe and look for the blue mass moving around the Pempti. That will be your target for the injections. Inject the medicines beginning with the one on the far right. It will need to be injected into the blue area. It is moving, so be careful. The Pempti will tremble violently when you inject the pink medication, and you inject the white to neutralize that medication. Bring up his vitals. Then, alternate between the blue and orange, then the pink and white. Once you have done that, close up the patient.

Medical Research
Difficulty rating 1



The Next Step
Difficulty rating 3

Disinfect the guideline and make the incision. Inject the red nanomachines into the blue area and the Pempti will recede. Keep doing this. If you see the small tumors on the lung, laser them and treat them with antibiotic gel like in "Singing the Blues". Once the Pempti is at a minimal size, the core will appear. Laser the core. The Pempti will flood back to it's original size. Repeat the procedure, injecting the nanomachines and lasering the core. This time, the core will have an excision line around it. Excise it, and remove it. The core will regenerate, and you will be ordered to abort the procedure. Suture the incision, disinfect and bandage.

Doctors' Struggle
Difficulty rating 3

Disinfect the guideline and make the incision. Inject into the blue spot the nanomachine 2 times until the core appears. Burn it away with the laser. It will recede and become smaller. It will launch out smaller cores from it which will go to the edge of the pempti and then slash up creating lacerations on the wall of the lung. Burn away the small cores with the laser and if the main core gets bigger, laser it. At a few points, the core will release about 5 copies of itself at one time. Just try and laser as many as you can before the pempti climbs up the wall of the lung creating lacerations and small tumors such as in Singing the Blues. When they recede back, finish off the copies with the laser and treat the wounds. If it makes several copies that are resolving around the main, place the laser next to the main. As the copies go by, they will be burned away by the laser. Repeat keep lasering the core whenever it gets bigger, and lasering the copies. Once you've lasered the core enough, the pempti will recede and finally be destroyed. Treat any remaining wounds, suture, disinfect, and bandage.

Under the Knife
Difficulty rating 4

For this operation, you need to be on the third, fourth, or fifth kyriaki victim when times up or treat all 5 victims in 10 minutes to beat it.

All right, we're going to have to squeeze everything in as much as we can. Use this procedure for each patient. Gel the line and cut it. Drain the blood from all 3 of the deep wounds, pinch them closed with the forceps, suture the deep wounds and then move on to the lacerations. When the kyriaki begin cutting the organ, use the ultrasound at where the end of the cut should be with all of the kyriaki, select the scalpel so you can cut them out when they show up. When they have all been cut out of the organ get the laser and laser them all. Keep it up until they have been burnt away. Repeat the procedure for the next wave, and then apply gel all over the mass of wounds and then suture the lacerations. The large kyriaki and possibly a small will make their mark. Use the ultrasound to find and then excise them. Laser them, if there is a small one laser it again before using the ultrasound on the big one. Repeat the process, after you excise the large kyriaki, take the time while it is making a cut to stabilize. Once the large kyriaki is dead, apply gel to the mass of wounds and then suture. Close the patient up, and then move onto your next one. To complete the operation, you will need to be on your third patient when time's up, giving you a little less than 5:00 for each patient. For higher ranks, you will need to have time to spare, giving you at max 2:00 a patient.

Shifting GUILT
Difficulty rating 3

This is a mutated strain of Triti. It is generally just faster but it is a contagious strain. Occasionally, when you remove a thorn, it will vaporize. You need to drain the mist before it leaves the operation field. If it does, you will fail the operation. Use the same strategy from Forbidden Knowledge but remember to drain any mist that appears. It is recommended as usual you use the Flash method, but it may be impaired by needing to drain the mist so often during the procedure. If you cannot complete the operation with that method, use the siege strategy instead.

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.