When Peggle: Dual Shot failed to fill the role of my next “bedtime” game – a logic-orientated puzzle game, preferably – I went in an entirely different direction. I’d been longing to play some of the classics from the Nintendo DS library that I’d missed, and compiled a shortlist that contained the debut entries in the Phoenix Wright, Etrian Odyssey, and Trauma Center series. The unique qualities and positive reputation of each had drawn me to them for years – and I still plan on playing the “runners up” at… some point – but I ultimately went with the latter of the trio, if anything for its comparable brevity.

Intentionally designed to make use of the Nintendo handheld’s then-novel touch screen, Trauma Center: Under the Knife debuted in Japan in June 2005, roughly six months after the launch of the Nintendo DS. It arrived on North American shores a couple months later and alongside games like Kirby: Canvas Curse, Meteos, and Phoenix Wright, was a highlight of the system’s excellent second wave of software. Atlus published the game, which originated within their Shin Megami Tensei team as a long desired project of the game’s producer, Katsura Hashino. Kazuya Niinou was enlisted as director, a role he’d resume soon after for, how about that, Etrian Odyssey, and naturally, many more SMT and Persona regulars also contributed to the game’s development.

Inspired by shows like ER and Chicago Hope, Trauma Center was equal parts surgery simulator and visual novel. I’m not a doctor (despite playing one here) but it seemed to me like the surgery gameplay was rooted in realism. The order of actions, the tools I used and how I used them, it all seemed to come together realistically, logically in the procedures, even when I was clearly dealing with fictional diseases or maladies. But surely having an actual patient’s life in your hands can’t be this fun, right?

Stripped of the weight of a comparable real life situation, I learned how to treat patients and often with clear direction. Very rarely was I left to my own devices. A patient’s health was always foremost in my mind, but a time limit and the persistent input of a nurse helped to ensure I acted expeditiously. Within an hour or so, I was familiar with the half dozen tools at my disposal and how to deploy them with the touch screen. Seeing as there were only so many ways a scalpel or syringe could be implemented, I treated a good number of repeat or similar-to-counter ailments over the game’s eight hour runtime (or ten, counting failed attempts).

The difficulty generally escalated at pace as my avatar Derek Styles (his initials being DS, you know, as in Nintendo DS), advanced from unsure rookie surgeon to hot shit within Caduceus, a fictional division of the World Health Organization. His personal insecurities frequently plagued him in internal monologues, even though he had a wonderful support system of fellow doctors and nursing staff (who can relate, right?). Their voluminous conversations rarely verged outside the medical topic at hand, but everyone had two cents and chimed in when appropriate. The cast was a tight knit bunch by and large with a variety of interpersonal relationships, although things rarely approached soap opera level. When the artificial disease GUILT was introduced though…

As Derek’s skills bloomed, he was tasked with treating patients suffering from increasingly dire conditions. Many were stricken with unknown woes that they often couldn’t outright treat; rather they had to settle on temporarily improving the patient’s condition. Through his experiences with these folks, Derek’s colleagues catalogued multiple strains of GUILT, an artificial disease created by a group of medical terrorists. Their motives essentially boiled down to the desire to let nature run its course in the dying, without the interference of the healthcare industry “artificially” prolonging lives. Things quickly spiraled out of control, from approaching a soap opera to straight up science fiction.

Treating GUILT was an involved process that varied between breezy and borderline impossible. There was one strain in particular that I simply couldn’t figure out. The few times it appeared, I read FAQs on how to counter it and watched multiple videos, all to no avail. I just couldn’t wrap my mind around how it spread. Others have, for what it’s worth, but in those instances I had to deal with it, I just slowed time through a special ability and worked as fast as possible. There were similarly frustrating moments, like when I booted the game up after months away; of my two hour runtime “overage,” forty minutes can be attributed to this sequence. On the whole, it was an enjoyably challenging game though.

With Trauma Center: Under the Knife, the developers at Atlus took themselves seriously, but never strove for true-to-life realism. Whether in the heat of surgery, be it a calm routine operation or when battling a ludicrous artificial disease, I always felt that what I was asked to do made sense, and perhaps even had a real life counterpart. The same can be said of the narrative, which started out practically with a focus on the personal development of my avatar’s skills and confidence, before escalating into globetrotting confrontations with a medical terrorist organization. These pairings worked well together, proving to be a natural fit for the Nintendo DS and to my knowledge, Trauma Center remains one of the best, and few examples of such a surgery-oriented game.