- 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.
- Paraskevi in particular doesn't just try to damage the patient, it tries to burrow its way deeper and deeper, until it's at the victim's heart. If it goes inside that, it's an immediate game over.
- 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.
- At least GUILT and all its horror-inducing injuries are fictional, right? Turns out the various strains are inspired by other real-life deadly pathogens or diseases. They may not be as lethal as GUILT, but being subject to those diseases is not pleasant.
- 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 frightening.
- It gets worse when Naomi contracts it. Twisted Rosalia is essentially a giant worm in her heart. The implications that it's the result of Rosalia and the remnants of GUILT mixing together only make it more disturbing.
- 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". In Under the Knife 2, we find out that such biological atrocities run in the family: Heinrich does the same with his own children.
- Imagine being in the shoes of a parent who discovers their child is a suitable subject for this nefarious purpose. No wonder why Blackwell joined Delphi to save his daughter.
- Conversely, imagine being in Angie's shoes, having to live with the knowledge that the only reason you were spared from this atrocity is that your own father helped to inflict that very same atrocity on several other children.
- What's to say that there are other children who have also been kidnapped for the same purpose but didn't manage to survive this long?
- In Under the Knife 2 while Angie and Derek were kidnapped by Delphi, Heinrich openly boast about his plans to use Angie to cultivate a new strain of GUILT, and use Derek as it's first test subject as a punishment for Blackwell's 'betrayal', and the duo for foiling the organisation's plans time and again. Now you know the consequences of what will happen to the two protagonists should you fail the 'surgery' to disable the lock to cell they were held in...
- 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 ending of Naomi's second level in Trauma Team: Veronica suffers a seizure while she is locked in her room. She desperately calls for help, clawing her hands at the door until they bleed, which the game shows in gory detail. Her calls are unanswered, and she dies in horrible agony.
- 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.
- At the end of the Final Boss of New Blood, if all 20 of the Final Desperation tumors explode, it takes 750 off the vitals. It literally kills the patient seven and a half times.
- The X missions in Under the Knife 1, 2, and Second Opinion not only took all the already complicated and stressful GUILT/Neo-GUILT surgeries up to an entirely new level in terms of difficulty. You will be performing them without the by now familiar and perhaps comforting assistance of Angie or any other ally by your side, with only the Big Bad taunting you the entire time in the background on futility of your struggle against them. The feeling of isolation can be quite chilling to some.
- When they are not Tearjerker describing Derek abandoning medicine forever, the Game Over screen for Under the Knife 2 can be quite the Nightmare Fuel implying the death of Derek and Angie at best, or a Fate Worse than Death at worst.Chapter 6-4, 6-6: Six months passed after the abduction of Derek Stiles and Angie Thompson. All leads were exhausted; no one even knew if they were alive or dead. The battle against Delphi's bioterrorism worsened day by day... And before long, Derek and Angie faded from memory.Chapter 7-5, 7-6, 7-7: The mission to contain the threat posed by Neo-GUILT ended in failure; modern medicine was powerless against what was beyond human understanding. Derek Stiles was never found, and his illustrious reputation faded into obscurity. To this day, it is uncertain whether or not humanity was freed from the cursed legacy of GUILT.
Nightmare Fuel / Trauma Center