Fantastically Challenging Patient

They didn't cover this in medical school.

McCoy: You can't be serious. That thing is virtually made out of stone!
Kirk: Help it. Treat it.
McCoy: I'm a doctor, not a bricklayer!
Kirk: You're a healer. There's a patient. That's an order.

— Star Trek: The Original Series, "Devil in the Dark"

A competent human surgeon is presented with a case of Bizarre Alien Biology and maybe Human Outside, Alien Inside. The surgeon is more than competent operating on normal people, then his skills are tested in a unique, out-of-bounds circumstance.

In sci-fi and fantasy, there are many beings that have different anatomy than Humans, requiring a different set of surgical skills should they be wounded. For example, Time Lords, Zabraks, and Centaurs have two hearts.

The patient in question can be an alien or some kind of fantastical terrestrial creature, like an elf or leprechaun. Dinosaurs also count, since they're extinct, as do giant versions of existing animals. Some — like Elves, Vulcans, Klingons, Romulans, and the aforementioned Time Lords — appear human but have different anatomy, leading to overlap with Human Outside, Alien Inside. Depending on the injury, the patient might be able to tell the human doctor what's wrong and what to do. If the injury is bad enough that the patient's unconscious... good luck.

This trope would also apply to humans that may have magic, superpowers, or a Superpowered Evil Side that comes out when the patient is "harmed", which would cause problems for doctors in ways that regular patients would not.

See Anatomically Ignorant Healing for what can go wrong. Often overlaps with Open Heart Dentistry. Because the doctor simply has no idea what they're doing, Harmful Healing may ensue. May involve heaping helpings of Applied Phlebotinum. May lead to I'm a Doctor, Not a Placeholder (as in the page quote).

Contrast They Would Cut You Up, where the medical procedure being performed is not meant to be life-saving, and Alien Autopsy, where the creature is cut open post-mortem. Sister Trope to Fantastic Legal Weirdness and Fantastic Religious Weirdness.

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Examples:

Comic Books

• Fantastic Four issue #258 has Manhattan doctors discuss a peculiar patient found badly mangled with broken bones aplenty. They have the patient bandaged from head to toe and give him a "sugar and booze" (sucrose and methanol 3% solution) intravenous drip. Some doombots abscond with the patient, taking him to Latveria, where Doctor Doom (no, Not That Kind of Doctor) manages to heal him. The patient is revealed to be Terrax the Tamer, aka Tyros the Terrible.
• New Avengers volume 1, issue #48 has Luke Cage, a hero with indestructible skin require multiple surgeries.
  • Averted with the first, as a Power Nullifier was present, which negated his indestructibility.
  • Played straight with the second. Because no medical equipment would have been able to penetrate his skin, and the aforementioned device was not present. The eventual solution was to have Doctor Strange and the Wasp shrink themselves, and undertake a Fantastic Voyage by entering Cage's body, to perform the relevant procedure, as only Cage's skin is indestructible.

Fan Works

• Played for Drama in the Mork & Mindy Dark Fic Goodbye. Mork, an alien, is in a car crash, and dies because the doctors cannot operate on him.
• Averted in If Wishes Were Ponies: Harry was turned into a unicorn colt after ending up in Equestria. As he was grievously injured thanks to Dudley and his gang, he was immediately taken to the hospital. Since he's a unicorn colt, the doctors already know what to do to help him. The only thing about him that surprises the doctors is the fact that Harry's magic is actually helping his body to heal faster (which leads to Twilight coming to visit him and eventually taking him in as her ward).
• With This Ring: Orange power rings are excellent healing tools in the right hands, but they don't always come with comprehensive medical data on the target species, as Paul discovers when he rescues some injured Darkstars.
  Okay, scanning. Nothing on the second guy's species but the woman conforms more closely to the standard humanoid template. I still need to copy her body chemistry but at least I know where everything is supposed to go. Huh, and no temptation to 'improve' things. Blackened and roasted organ tissue evaporates and is replaced by fresh brown/green. That looks? About right. Anything obviously toxic in the blood..? No, right, best I can do then. Fat, muscle and skin and I hope her species doesn't have belly buttons.

Films — Animated

• Battle for Terra: Inverted. After human pilot Jim Stanton crashes his one-man craft on planet Terra, native alien Mala comes to check on him. Stanton is breathing with difficulty, since his air supply is almost exhausted, and he can't breathe the heavy Terran atmosphere. Mala has to cobble together an oxygen collector to keep Stanton alive.

Films — Live Action

• King Kong Lives sees the titular gorilla having surgery performed to give him an artificial heart. The problem? Kong is 60 feet tall.
• Leprechaun 3: Scott is bitten by the titular Leprechaun and begins turning into one, so he goes to the hospital. Tests are run; his blood is green, his brain scan reads "FUCK U", and his EKG reading is little leprechaun prints.
• Star Trek VI: The Undiscovered Country: When Bones tries to save the wounded Klingon Gorkon, he doesn't actually cut Gorkon open, but he does insert some sort of medical device into the open chest wound. As Bones points out while trying to treat Gorkon, Klingon anatomy is not the same as Human anatomy, and Bones has no medical training in helping Klingons. Gorkon ends up dying of his wounds.
• Superman Returns: After Superman comes crashing down on Metropolis following him lifting Luthor's island into space, the doctors try their best to help him. They are able to remove the remaining slivers of the Kryptonite shard Luthor shivved Supes with from the still-open wound and apply a defibrillator shock (which browns out the whole building for a second) when his heart enters V-fib, but they are not able to do anything further because of his invulnerable skin. Fortunately, that was all that was needed.

Literature

• In Animorphs #29: The Sickness, Ax the Andalite comes down with a disease called yamphut, which requires his tria gland to be surgically removed. Unfortunately, the gland is located in his head and the Animorphs can't take him to a hospital without possibly blowing their cover to the Yeerks (on top of the complication of a human with "primitive tools" operating on an alien). Cassie has to do the surgery herself, though she's just a veterinarian-in-training who has done little more than neuter animals. Fortunately, she manages with help from the good Yeerk Aftran, who enters Ax's mind so she can tell Cassie exactly where his tria gland is.
• Dr. Greta Helsing: Greta is a world-renowned Super Doc for supernatural beings. As a Muggle with a Degree in Magic, she sometimes needs to enlist magical help — there's cutting-edge osteopathic surgery for Mummies, but the bandages still need to be ritually reapplied.
• Lensman: In Second Stage Lensmen, an unnamed surgeon at one point complains about the difficulty in stitching up the wounds of the dragon-like Worsel the Velantian - the surgeon had to bore holes with an electric drill and use linesmen's pliers.
• Monster Girl Doctor centers around Glenn Litbell, a human doctor who specializes in treating non-human patients, from lamia to mermaids to gigas and everything in between. The series goes to great pains to describe the difficulties that these monster girl patients have due to their biology, requiring the aid of a specialist to treat them.
• Sector General is about a multi-species far-future hospital in deep space, whose staff are regularly confronted with the need to use either medicine or surgery to save the life of a member of a previously-unknown sentient species, who is either too medically ignorant or too unconscious to explain the correct treatment to them.

Live-Action TV

• Babylon 5: In the Pilot Movie "The Gathering", Vorlon Ambassador Kosh is badly wounded in an Assassination Attempt. Because Vorlons spend all their time in "encounter suits" that hide their true forms, Dr. Benjamin Kyle has no idea where to even begin in his attempts to operate to save Kosh's life. Station telepath Lyta Alexander is forced to break Earth Alliance law and read Kosh's mind without his consent to get the information Kyle needs. J. Michael Straczynski then used them being transferred back to Earth to be interrogated on what they learned to explain them having been Put on a Bus in the series proper in favor of Talia Winters and Stephen Franklin.
• Doctor Who:
  • In "Spearhead from Space", the Doctor is taken into a hospital after being found unconscious in a field nearby (having just been forced to regenerate by the Time Lords) and is given a routine series of examinations revealing his Bizarre Alien Biology for the first time in the show, most significantly an x-ray showing his two hearts. The hospital calls the Brigadier over to investigate these oddities, thus revealing to him that the Doctor (who he last saw during a Cyberman invasion) is back on Earth.
  • In the TV movie, the Doctor is shot as soon as he lands in San Francisco. He's rushed to hospital, where the human doctors successfully remove the bullet, but then they accidentally kill him with a heart probe while trying to figure out why his heart rate is so high. The Doctor tries to warn them that he's not human, but they think he's delirious.
  • Comes into play a couple of times with medical student Martha Jones as companion in Series 3:
    • In "Smith and Jones", Martha is asked to listen for the Doctor's heartbeat (in disguise as a human patient). When Martha hears two heartbeats, she gets lambasted by her teacher for putting the stethoscope in the wrong place. She later successfully gives the Doctor CPR by pumping both hearts.
    • In "The Shakespeare Code", when the Carrionites stop one of the Doctor's hearts, the Doctor has to guide Martha through restarting it again.
  • In "The Tsuranga Conundrum", Graham and Ryan become the doulas for a humanoid alien man. Downplayed since neither are doctors, though Graham tries to use his knowledge of Call the Midwife as substitute.
• In Jessica Jones (2015), the difficulty of performing life-saving surgery on a Nigh Invulnerable superhero gets briefly explored. When Jessica has to bring Luke Cage to the hospital after he suffered a brain injury the doctors and nurses can't exactly use standard procedures; when attempting to give him injections, needles bend or break off, and trying to relieve swelling on the brain of a man you can't cut to get inside his body is a formidable task.
• The Orville: Despite being an experienced (and seriously talented) doctor, Claire doesn't know everything about every alien species, and often asks patients questions about their biology or expresses surprise at learning something about them. In "New Horizons", she has to ask Yaphit how he feels when he loses a piece of his tissue (he's a blob alien). She learns in the exact same episode that the only thing in existence that can give a Moclan a stomach ache is a piece of a blob alien (Yaphit wasn't amused).
• Star Trek
  • Star Trek: The Original Series:
    • "The Devil in the Dark" has a mining colony be terrorized by an unknown creature. Captain Kirk and First Officer Spock explore the mine, and find the creature — a Horta. When it advances, they fire their phasers at it, creating a wound and causing it to retreat. However, once Spock conducts a psychic rapport with the creature, he and Kirk realize it's a brood mother defending her egg clutch. Doctor McCoy is brought in to heal the creature, which he does with silicon-based spackling compound. This ad hoc bandage works well, to the doctor's surprise.
      McCoy: By golly, Jim, I'm beginning to think I can cure a rainy day!
    • In "Journey To Babel", Bones performs surgery on Spock's father Sarek. As a Vulcan, Sarek's organs are arranged a bit differently than a human (his heart is where a human's liver is, for example), and Spock is the only crew member who can donate blood to him.
    • The episode "Spock's Brain" has a humanoid alien incapacitate the crew of the Enterprise. Upon recovery, they discover that she has absconded Spock's brain, leaving his body alive but mindless. It becomes the episode's mission to track down the brain thief and recover Spock's brain before his body fails from lack of purpose. Bones is ultimately able to operate on Spock and get his brain back in.
  • Discussed in the Star Trek: Deep Space Nine episode "Prophet Motive". When Dr. Bashir is unable to figure out what's wrong with Grand Nagus Zek using standard tests, Quark asks him to perform exploratory surgery. Bashir refuses to do so, believing it to be unnecessary.

Tabletop Games

• In Dark Heresy, Medicae tests performed to heal aliens suffer a penalty, as most Imperial doctors are trained to operate on humans and are unfamiliar with Bizarre Alien Biology. On the flip side, operating on an ork instead gives a bonus to the test because orks are so resilient that the doctor probably won't make the injury much worse.

Video Games

• The premise of the indie game Fae's Anatomy. The players are medical professionals who work together to diagnose and cure various medical conditions in an Urban Fantasy world.
• Dr. Borville of The Legend of Zelda: Twilight Princess refuses to treat the injured Zora prince Ralis, and you overhear some townsfolk remarking that he won't treat Ralis because he's Zora. It's suggested to be a combination of plain old Fantastic Racism and Borville being too proud to admit that he doesn't know enough about Zora physiology to treat the youngster (as is mentioned in the official strategy guide).
• Surgeon Simulator 2013: In one operation, you open a metal capsule with a hiss of steam, revealing an opened alien lying in front of you with an array of bizarre internals of all shapes and sizes. As you're taking the role of a surgeon, your goal is to perform a transplant of one of several bizarre organs.

Western Animation

• Futurama: Inverted. Dr. Zoidberg is a Decapodian with Bizarre Alien Biology who mostly operates on humans. Most of his operations result in Anatomically Ignorant Healing. Professor Farnsworth defends him at one point by saying he's one of the best doctors out there... for every species except humans. He then blames the crew for Zoidberg's failures: he wouldn't mess up so much if they weren't humans!
  • His introductory scene of giving Fry a checkup shows that he has no idea what a human is.
    Zoidberg: Alright, open your mouth and let's have a look at that brain. No, no, your other mouth.
    Fry: I only have one.
    Zoidberg: Really?
    Fry: Is there a human doctor I could go to?
    Zoidberg: Young lady, I am an expert on humans! Now, pick a mouth, open it, and say [sound that cannot be made with an open mouth]!
  • Zoidberg's practices have become so infamous among the medical community that other doctors refer to him as a noun.
    Doctor: Man, the guy who did this must have been a real Zoidberg.
    Hermes: It was Zoidberg!
  • The DVD Commentary outright says the idea with Zoidberg was to invert the dynamic between Dr. McCoy and Spock (with a human doctor treating an alien whose biology he didn't understand).
  • Played straight in "Roswell that Ends Well" when Zoidberg is captured by the U.S. government of the 1950s and the scientists at Roswell try to dissect him. His species has so many redundant organs that being partially dissected doesn't hurt or even scare him. He even considers Fry and Leela throwing his own organs at the president "an honor".
    Scientist: Heart.
    Zoidberg: [bored] Take, I have four of them.
• Justice League: In "The Enemy Below", Aquaman is injured by an antitank rocket, and the surgeons can't get a needle into him to help because his skin is super-tough.
• The Owl House:
  • In "Eclipse Lake", Luz Noceda comes down with the illness "Common Mold". While the illness is harmless to witches (treated no more seriously than a cold or basic flu), Amity points out that, as Luz is human, they have no idea what effects it will have on her body.
  • Discussed in "Thanks to Them". Hunter gets possessed by Belos, and while he eventually manages to drive him out of his body, he's left scarred, drained, and barely clinging to life. Camila tells Vee to call an ambulance, only for Willow and Luz to point out that a human doctor would have no idea how to treat Demonic Possession, let alone how to treat a Grimwalker.
• Transformers: Prime: Inverted in the season 1 finale. Raf is exposed to Dark Energon, something that is dangerous enough to Cybertronians, but is lethal in humans if not treated in time. Ratchet, a Cybertronian, tries to treat Raf, but is forced to admit, (to his shame), that he doesn't know enough about the human body to treat Raf, and ends up needing the help of Nurse Darby.

Real Life

• Kind of. In 2018, Dr. Fred Wu posed a question to his fellow doctors on Twitter: "If you show up at a code, and the patient is a centaur who had a cardiac arrest, ignoring the joules question, where do you think the defib pads should go?" Answers varied, depending on whether the centaur has a human heart, a horse heart, or both. Some argued that because the horse heart is stronger than the human heart, it should be saved first. Others argued that the human heart would most likely supply blood to the brain and should therefore be saved first. One doctor even suggest a MacGyver-esque method involving putting the horse hooves in water. Another pointed out that they should probably ask a veterinarian who has experience with horse cardiac arrests for the best solution.

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