Having been burned by Lifesigns, another hospital simulation on the Nintendo DS, I was keen to have a spin at the more popular Trauma Center: Under the Knife. Those of you who read my Lifesigns review will remember that I was frustrated by the RPG/visual novel aspects and minigames. Fortunately, these are mainly absent in Trauma Center: this game is all about surgery, surgery, surgery! Slicing flesh! Draining fluids! Injecting serums! Excising tumours! Sewing the patient back up again afterwards! Man, if I could just find a game which gives me all the thrills and excitement of violating people's bodies with surgical equipment I'd be a happy man and wouldn't have to kill so many hookers.

Instead, Trauma Center advances the plot with short (no more than a couple of minutes) non-interactive dialogue sequences between the surgeries, which includes a quick pre-surgery briefing so you have some idea of what to do. Another one of my problems with Lifesigns was that it guided you by the hand a little too much - you were told precisely what to do, when, and shown how to do it all the time. Trauma Center gives you a little more credit than that; after guiding you through the first few surgeries, it gives you free reign to do what you need to do; little icons at the side of the screen give you access to the full range of surgical tools provided. It is also somewhat more forgiving than Lifesigns - although it is still fundamentally a Do It Again, Stupid game - and you can boost your patient's lifesigns (giving you much-needed extra time and leeway to make a few mistakes) by injecting them with a nasty-looking green serum.

What's wrong with it then? Well, first off let's look at the between-surgery scenes. You'd think I'd be able to overlook the problems I have with them and focus on the surgery, but I can't, mainly because these issues frequently overspill into the surgery itself. The first problem is that I can't feel any sympathy for any of the characters in the game; they're all completely horrible people. The protagonist is a lazy bum whose negligence almost kills a patient early on in the game, and it strained my credibility somewhat that he was still allowed near a scalpel after that; what's worse is that as far as I could tell there was no way to avoid this happening, despite the fact that I, the player, was perfectly happy to keep the patient open and ping him with ultrasound all day if necessary. All throughout the operation in question the nurse kept saying "oh, wait, shouldn't we check this?" and the doctor was all "fuck you, I'm a doctor! I know what I'm doing!" It is extremely frustrating to get the impression that you're being forced to fail, even if you're personally entirely happy not to, and especially when it's during one of the supposedly-interactive parts of the game; it's as if I'm not really playing the doctor, I'm merely guiding his hands while he does the operation and makes the actually important, plot-affecting choices. (The game is, in fact, replete with instances where I was desperate for an opportunity to make some kind of choice to steer the main character away from the path he was blundering about on.

The other characters are no better. They are constantly horrible to the protagonist - sometimes justifiably, as with the negligence case, but often not. They keep secrets from him, gossip behind his back, and say to his face that he's an incompetant idiot who needs to get his shit together. It's all in this very irritating tone - "You need to keep up on your paperwork and get here on time and devote every waking hour to your patients and get six hours of sleep without fail otherwise you're a worthless human being, you pitiful fucking worm... ah, don't look like that, we're all pals here!" - and it frequently intrudes on the surgeries, especially if you aren't doing it perfectly. Frankly, it's incredibly off-putting: I'm sure some people out there might like the idea of being yelled at by a bitchy nurse, but I'm not one of them.

The other issue I have with the between-surgery plot is a matter of its tone. The problem with surgery simulations is that you are inherently dealing with subject matter which many people might find mildly upsetting (pancreatic cancer, anyone?), and you need to find a way to tackle it in a way which isn't overly insensitive while still actually getting to grips with the issue. One approach is that taken by Lifesigns, which to give it its due it handled very well, is to present a careful and nuanced treatment of sensitive medical issues like euthanasia and the right of patients to refuse treatment, drawing on techniques used on TV hospital dramas. An alternative approach, of course, would be to focus on entirely fantastic and fictional illnesses and medical procedures, so that you're not spending all your time focusing on things that real people actually die of.

Trauma Center seems to veer between these two approaches in a haphazard manner. By the end of the first episode, it becomes apparent that the main character has psychic powers and might be descended from the god of medicine. Apparently, later on in the game you encounter weird manmade diseases produced by a secret society. At the same time, you have the aforementioned negligence subplot, cancer, car crashes, and other deadly-serious matters. The result was I had no idea whether I should treat the game as a serious hospital drama or as a light-hearted hospital fantasy, and the mixture of the two didn't quite seem to work.

The straw that broke the camel's back, however, was the game's "Do It Again, Stupid" gameplay. Specifically, I can't get past the fourth operation in episode 2, where you have to cure someone of a fistful of aneurisms. No matter how much soothing gunk I inject the patient with to stop them swelling, no matter how much I use the protagonist's magical time-slowing powers, I can't beat it, not least because it's very unforgiving - you automatically lose if more than one of the aneurisms burst. Frustrated by the operation, irritated by the plot, I felt no desire to continue playing and quit at that point, having played for less than an hour. It appears that the person I borrowed the game from did the same, so at least I'm not alone in this. It does not help that the surgery interface is extraordinarily picky (sometimes failing you if, for example, you put a millimetre too much bandage over a patient's wound). It is overprecise - games shouldn't expect you to have a 100% perfectly-calibrated touchscreen - and it is unhelpful, simply not giving you enough feedback to understand what you did wrong (I have no idea why it kept taking me dozens of attempts to stitch up the patients' wounds, despite following the instructions, for example).

Apparently, Trauma Center inspired a Wii-based version; perhaps it will be more fun (and more forgiving), or at least provide a bit more entertainment when there's a room full of people laughing and giggling and hacking at someone's insides with a scalpel. I honestly can't recommend the DS version.