I was a big fan of the late-80s hospital game Life and Death, so I've been looking forward to Atlus's new title Trauma Center: Under the Knife for the Nintendo DS. The main obstacle Life and Death faced was its interface. Using a mouse to perform surgery was very difficult, and precise maneuvers were often impossible. Just try to draw a straight line with a pencil tool in an image editor and you can imagine how hard it would be to steer a scalpel with a mouse. But the DS has a perfect interface for a surgery game: the stylus.

As far as the interface goes, Trauma Center delivers, although not completely. Control of precision tools like the scalpel and suction are effortless -- just cut across the screen to make an incision or click and draw upward to suction out blood or toxins. The game's interface puts the tools on the sides of the DS touchscreen, and the player clicks a tool to select it. Unfortunately, not all the tools are intuitive to use. The magnifying tool, which seems to be required for almost all the operations, tells you to "draw a small circle" to zoom in or out. However, the game seems to only accept an open circle, more like an overlapping "C" shape. The only way to discover this was through trial and error. I killed a lot of patients trying to decipher the game's poor directions. Another unintuitive tool is the suture. When used to close incisions, the player must sew a zig-zag pattern over the opening to close it up. However, if you do it too slowly, the sutures seem to come apart. What the game wants you to do is draw the suture very rapidly, rather than slowly but methodically. The latter was what I'd assumed, and again I had to try interminable sutures to get it right. It would have been nice for the tutorial to explain it. If you can get over these failings, Trauma Center definitely provides a more intuitive, natural surgery game interface than its predecessors.

Which leads me to the structure of the game itself. Life and Death was very much a doctor simulator. The player had to consult with patients in their rooms, examine them, make a diagnosis and determine if surgery was or was not required. The game generated patients in a reasonably effective way, so you didn't have the same experience every time. In addition, as you learned new conditions and procedures in the game, the patients' conditions became more varied, requiring the advancing player to draw on a larger and larger base of knowledge. Trauma Center isn't like this at all. There is very little interaction with the patients (we don't even see most of their faces), and the game runs from operation to operation on a rail -- the order is always the same.

Part of this difference is caused by the fact that Trauma Center is really a variety of Japanese role-playing sim or visual novel more than a medical sim. The story interludes between operations are all about the internal struggle of your character, who has to progress from green, starry-eyed, distracted kid surgeon to experienced, master surgeon. Unlike most games of this variety, however, none of these conversations ask for any input from the player -- there are no branching decision points. For example, the player cannot choose to review patient dossiers or go out with friends and improve his social demeanor. The game decides for you. Normally I wouldn't be bothered by this decision, but the fact that the surgery is so arcade-like makes the game feel shallower than it seems like it could have. The player neither musters simulated medical knowledge nor simulated social knowledge. You just have to perform all the surgeries in order until you succeed.

The weirdest feature in the game is something called "The Healing Touch." At times during surgery, things go terribly wrong and the only way to overcome the obstacle is with this essentially supernatural feature. The Healing Touch allows the player to slow down normal time on the operating table in order to complete otherwise impossible surgeries. The game's story explains that The Healing Touch is a mysterious skill, unexplainable by conventional wisdom, miraculously curative yet capable of driving its lucky practitioner into madness. To invoke The Healing Touch the player must draw a star twice on the screen. It's an effective game design tool, if a very arcadey one, but it does underscore how skin-deep (as it were) Trauma Center's medical simulation really goes.

More problematic for Western players is the very Japanese aesthetic. Some players may be downright offended by the cute, busty nurses, deferential speech, and hierarchical demeanor of the characters. But even if not, the game's characters have that characteristic overexpression of Japanese anime -- wide open mouths, overstated gestures, and stereotypical, flat speech. For example, the screenshot at right depicts your character's response just before beginning each surgery. He looks like some kind of poser wizard, doesn't he?

All in all, Trauma Center is a much shallower hospital and surgery sim than Life and Death, despite the 17 years between the two games. While Trauma Center offers better control via the stylus, I'm not sure why the developers didn't spend time refining the touch interface further. It really is the main (only?) selling point of the game. In addition, players of previous surgery games may be surprised at the lack of operating room detail in Trauma Center. Life and Death required the player to anesthetize the patient, make incisions and cauterize the interim bleeding, even use spreaders to open and close the surgical area. The operating room interface in Life and Death included trays and crash carts, and drugs were administered through IV. Trauma Center's injected treatments are -- rather weirdly -- injected directly onto the touch screen, a kind of representation of a more complex method of treatment. And vital signs in Trauma Center are collapsed into one, global "health" figure for the patient, from 0 to 99.

Don't get me wrong, I'm a big fan of license and selective framing for both leisure and educational games. But I'm a bit surprised at what Atlus chose to frame in and frame out of Trauma Center. Mostly, the game affords no strategic play whatsoever, but rather relies solely on fast-paced arcade-style action. That said, the surgeries are indeed very challenging, and the player has to think and act fast or the patient will die. In addition, the game does a great job of throwing the player directly into a procedure in the first few minutes, using the opportunity to explain how to play the game. But all in all, Trauma Center's uneven execution makes it feel more like a curiosity than a great idea. And I do wish that commercial games about non-traditional subjects used that influence to expose the tremendous opportunity -- both commercial and non-commercial -- for such subjects.