- At first, the operations in Under the Knife / Second Opinion are relatively low-tension operations: removing glass from a patient's arm, removing tumors from another patient's stomach, burning away polyps from someone's throat. Might make some players queasy, but nothing really life-threatening happening. However, the operation at the end of the first chapter is a Wham Episode, giving you the first life-or-death operation in the game. Defibrillator, done. Remove glass shards from patient's chest area, done. Open up patient and oh god there are shards of glass in his heart too!
- Linda Reid, a patient with suicidal tendencies, can hit a little too close to home for those who have attempted suicide or have a close friend who has. Luckily, Stiles patches up her wounds, and gives her a talk that manages to give her new perspective on life, and she gives up on her suicidal tendencies. Then her wounds re-open on their own, and we get our first encounter with GUILT and its effects. Also, just consider: how long were those strains of Kyriaki inside her, cutting her up from the inside?
- Just take a moment to think about what GUILT and Stigma do to those they infect. That is what could happen if someone bio-engineers a disease.
- Most pathogens want to keep their host alive. Plagues usually are only so deadly because they've jumped species and do things that would be nothing too dangerous in their usual host, but very bad for their actual one. GUILT and Stigma don't observe this rule. As genetically engineered diseases, they do everything in their power to make sure their victim is dead as fast as possible. They don't care about their own survival. What's worse, when they sense that they're being threatened, they resolve to do as much damage as they possibly can, with the singular goal of killing the person they're in before they can be removed.
- Trauma Team has a pretty scary one in terms of the main threat, which almost puts GUILT and Stigma to shame. The Rosalia Virus causes WAY too many people to die. And when a person truly dies, they bleed to DEATH through anything with a hole, including their EYES. Sandra Lieberman (The Raging Bomber) demonstrates this as the game gives the player a good close-up of her face as she succumbs to the disease before dying in an explosion.
- Rosalia is filoviridae (Ebola-type virus) that is spread by butterflies, or more accurately, the wing scales they shed during their migration period. While giving you a touch of Ax-Crazy provided it spreads to the brain. It also just happens to leave it's trademark black bruises in the shape of a freaking CLAW on the liver of most victims. It's likely a consequence of the bruises forming near the entry point of the liver but it still looks frighting.
- It gets worse when Naomi contracts it. Twisted Rosalia is essentially a giant worm in her heart.
- By Under the Knife 2, Neo GUILT also causes Ax Craziness.
- In earlier operations, if you fail an operation, another doctor will simply take over for you, securing the patient's life. However, in later operations, whoever you're playing as is often the only doctor capable of dealing with whatever is inside the patient, which means if your patient's vitals hit 0 (or you run out of time), your patient will outright die.
- In Under the Knife 2's final operation, the Big Bad has rigged the room to infect everyone inside with Neo-GUILT if she dies. Oh, and she has to be operated on, because she is infected with Aletheia. And the operation has several ways of knocking out a large fraction of her vitals or outright killing her if you make certain mistakes. Good luck.
- The final Episode of Under the Knife (not Second Opinion) reveals that GUILT is cultivated inside seven different children, all of which are labeled as "Sinners"; Adam's implication is that they are guilty of some sort of sin bad enough to deserve this fate. In Under the Knife 2, we find out that such biological atrocities run in the family: Heinrich does the same with his own children.
- In Trauma Team, Tomoe's mission Resolution is rather creepy: you guide her endoscope through a shifting maze of collapsed rubble with only the desperate cries for help from those trapped within to guide you. The appearance of some of the victims you can find are pretty jarring and are somewhat of a Jump Scare since they're in 3D, in which you can see their full face and hands. Pretty frickin' unsettling.
- Another one in Trauma Team, at the end of one of Naomi's missions a bomb (inside a teddy bear) that is supposed to kill Naomi is taken by Alyssa and EXPLODES WHILE SHE'S HOLDING IT. Even though it was supposed to kill Naomi, it killed Alyssa's parents and almost killed Alyssa herself, leaving her orphaned. So in a really bad way, the Raging Bomber still wins, by killing even more people then she wanted. Although it makes it more satisfying once you finally catch her and she soon meets a somewhat similar fate by her own weapon.
- Not only that, but the bombings examined by Naomi had the bombs explode at practically point-blank range. The third and fourth victims never had a chance to see their deaths coming.
- The villain of New Blood reveals after you defeat the final operation that he's suffering from diencephalic sclerosis, which he was using Stigma to counteract. Translated from medical jargon, that means that his brain is petrifying. That's a horrible thing to imagine, though it does explain why he dies so quickly after Stigma is removed.
Nightmare Fuel / Trauma Center
Dr. Stiiiiiiiiiiiles...do you know what else Trauma Center is good for? It's also good for...SCARING!