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  • Annoying Video Game Helper:
    • Angie. Even better in Under the Knife 2, where there are voice clips for all this "help".
    • Elena to a lesser degree, but only because some players find her irritatingly cheerful. Otherwise, they find Elena just fine as an assisting nurse. And unlike Angie where her games only use small voice clips, New Blood is fully voice acted so it isn't super repetitive.
  • Anticlimax Boss:
    • Despite being the focus of a Wham Episode in Under the Knife 2, Nous is pathetic, even for a first boss. It only has one attack and gives the player ample time to raise the vitals whenever it's damaged. The only way to fail this operation is if you don't realize that the tumors Nous creates must be treated in the order they appear before the core can be excised.
    • The battle against the Final Boss Twisted Rosalia in Trauma Team is ridiculously simple and repetitive compared to pretty much every other boss in the series. Somewhat justified in that it's the only pathogen that was not artificially designed to be used as a bioweapon.
    • The final operation in Second Opinion is intentionally this. You operate on a mutated Savato, like on Blackwell in the main story, but this time you work alongside Naomi, who doesn't have the restriction on her Healing Touch like Derek does. While using Derek's HT before you're supposed to is still out of the question, you're still operating on a strain you've already beaten before (albeit more difficult) with a much larger advantage this time.
  • Anvilicious:
    • Dying is bad, and wanting to die or other people to die is even worse. Also, modern medicine is awesome and anything that interferes with it is bad for society at large.
    • The latter gets deconstructed in New Blood, Under The Knife 2, and Trauma Team, as some of the villains of those three games are well intentioned extremists whose attempts to improve modern medicine ultimately cause countless deaths and/or lead to insanity.
  • Base-Breaking Character: In Trauma Team, Tomoe is criticized for her perceived flat personality, dull voice acting and annoying catchphrase. Others were a bit warmer to her character, as the story portrays her as a dedicated and kind doctor, and find her backstory as a ninja to be very interesting. Not helping things is that Endoscopy is considered the worst gameplay style of Trauma Team.
  • Best Known for the Fanservice: "Moving Heart" is one of Trauma Team's most infamous levels. In Diagnostics, you sometimes need to get your patients to lift up their shirts in order to listen with your stethoscope. In that particular level, your patient is an attractive woman whose gorgeous physique is even acknowledged in-universe. Do the math.
  • Best Level Ever:
    • For players with higher skill levels, chapter 5-2, Under the Knife, is this for the game Under the Knife and its remake, Second Opinion, for making you operate on three to five Kyriaki patients in quick succession. The large amount of Kyriaki make for a fast-paced and difficult, yet fair operation that tests your skills, all without being a puzzle boss.
    • Challenge Operation A-4 in New Blood. You perform a simulated operation proctored by Derek and Angie, who introduce some interesting tricks like adding GUILT. And having you treat GUILT and Stigma at the same time. And unlike the other characters who watch over you in Brutal Bonus Levels, Derek and Angie are very friendly and encourage you to succeed, rather than taunting you about how there is no hope for you. It is also the only Challenge Operation with a proper narrative.
    • First Response in general in Trauma Team. It's fast-paced, fair, and has you deal with up to six patients at once instead of just one or a series of operations in a single chapter. Beginners will like the simplified format while veteran Trauma Center players will love the variation of the traditional surgery gameplay.
  • Breather Boss:
    • Of all the original GUILT strains, Tetarti is often seen as the easiest to treat, due to it not being able to do a lot of damage unless the player screws up the injection. The variation introduced in Second Opinion also lacks the No Miss special bonus to give the player more leeway with it. When it gets re-hashed in Under the Knife 2, its method of being more difficult is... 2 more colours to spot and memorize, which is far easier than the increased tedium and aggression of Kyriaki and Pempti respectively.
    • Soma in New Blood. Just keep the drain active on it and occasionally laser its weak "attacks" and drained core. Even when in operations that have it alongside something else, it's pretty harmless.
  • Broken Base: Trauma Team's noticeably lower difficulty. Trauma Center, like many Atlus games/series, is renowned for being Nintendo Hard, so it falls into It's Easy, So It Sucks! for many players. Others, however, hated getting stonewalled by sudden difficulty spikes in the other games (most especially in New Blood) when they just want to see the rest of the games' content, and appreciated that Team allowed players to move through it at a steady pace.
  • Complete Monster:
    • Under the Knife: Erich von Raitenau, aka Adam, is the hypocritical Straw Nihilist leader of a terrorist organization who believes medicine is a product of the devil and mankind deserves to be destroyed for rejecting the "gift" of death. In order to do so, he has created artificial parasites called GUILT, all of which are highly contagious and capable of killing their victims in horrible ways all while claiming biblical justification by equating GUILT with the Seven Plagues of Revelation and himself with the "devouring angel" Abbadon (yup, the one with the locusts) while boasting to Derek that he alone will watch as Derek and friends burn in Hell. When Derek and Angie join the raid on Delphi's floating headquarters, they discover Adam has kept seven children (dubbed "Sinners" to go with his deranged ideology) in a nightmarish near-death state as culture grounds for the GUILT.
    • Under the Knife 2: Heinrich von Raitenau is the grandson of Adam, and is just as bad as his grandfather. He shares all the atrocities of the game with fellow Big Bad Patrick Mercer. Having inherited his grandfather's legacy, at an old age himself, Heinrich experiments on and uses children as GUILT hosts, including his own (whom he doesn’t care if they die). Some die and the lucky ones that don't barely survive. He also manages to give GUILT to another villain, and while Heinrich is ultimately arrested for terrorism due to creating the virus he so precariously used, he attempts to give Derek Stiles's nurse Angie Thompson GUILT, which would give Derek a Sadistic Choice between her life or Heinrich's children. In the end he was a petty, self-centered scientist who only cared about advancing his own agenda even at the cost of others.
  • Difficulty Spike:
    • 2-4 of Under the Knife (and Second Opinion) suddenly presents the player with a complex aneurysm operation, and is a common stumbling block after the more mundane operations from the prior chapters. See That One Level for details why.
    • It's always a sharp transition from the main plotline to the X Missions since you will have to deal with very aggressive pathogens and regularly plummeting vitals.
    • Trauma Team is quite forgiving, even with its normal "Resident" difficulty. But once you unlock the Specialist difficulty and revisit old levels, you'll find that the game's expectations of your skill are a lot higher and the XS requirements are very stringent.
  • Disappointing Last Level: The last non-bonus chapter of Under the Knife is basically a Boss Rush of all seven GUILT. While this part of the story does feature some suitably dramatic reveals and exposition, namely in that it reveals that Adam cultivates GUILT in seven kidnapped children, from a gameplay standpoint there's nothing the player hasn't seen before except for more difficult GUILT than in past chapters. Furthermore, the X operations are just another round of doing all seven GUILT again, this time each at the peak of their difficulty, making this chapter feel redundant. Second Opinion boils this segment down to a cutscene and features an entirely new chapter with new challenges to shake things up.
  • Ensemble Dark Horse:
    • "Little Guy" becomes surprisingly popular within the fandom, despite his very minor role.
    • Linda Reid (a patient) in Under the Knife. The major reasons are that she's at the center of Derek's character development and she's the first GUILT patient. Linda's huge popularity is probably one of the bigger reasons Angie developed a hatedom, thanks to losing her temper with Linda's suicidal tendencies and telling her to just die.
  • Fan Nickname:
    • Some just call the "Little Guy" either Michael or Hans, especially for fan fiction purposes.
    • Fans call Maria Torres "brown/black Chie" because of their similar design.
  • Genius Bonus: The series is filled with references to Greek mythology, right down to the protagonists' workplace being named after Caduceus, a staff carried by the god Hermes. The GUILT's names are also taken from the Greek words for the days of the week.
  • Germans Love David Hasselhoff: This game series is far more popular in America than Japan, to the degree that from Second Opinion onwards, the games are released in North America before Japan. New Blood and Trauma Team even take place in the United States.
  • Good Bad Bugs:
    • You can skip a Savato phase by lasering it at nearly the same time you cut it, which allows you to cut it again. Sadly, you aren't able to do it twice in a row, but it reduces the post-web phases from 3 to 2. This only works in Under the Knife.
    • In a manner not too dissimilar from a Shoot 'Em Up, Under The Knife has a tendency to heavily lag when the screen gets too hectic, sometimes approaching Healing Touch levels of slow down on its own. While this can sometimes be disorienting, it also makes some operations much more managable than they would be otherwise. Especially true for Kyriaki operations, where the optimal strategy happens to already involve letting it open up so many lacerations that the game will stop spawning them.
    • In Second Opinion, while waiting for your scalpel to be replaced after cutting a Savato web, you can repeatedly tap to Z button while keeping A held down to "use" the scalpel in short bursts. This can save you some time for this phase of the fight.
    • You can prevent the Kyriaki queen from laying eggs in Under the Knife 2 by having eight lacerations on screen at once, due to a memory limit preventing more from appearing. Doesn't stop her from cutting the patient for vital loss, however.
    • While dealing with Bythos, place your stylus on the GUILT's core, then touch the tray you are supposed to transfer it to. Lift the stylus and watch as the core is magically transported to the tray, thus bypassing the entire Bullet Hell segment of the level.
    • Cheir can be stunlocked by repeatedly pressing A on it with the laser instead of holding it, which dramatically cuts its difficulty down. This amusingly also makes it become less threatening when two of them fuse together instead of the opposite.
  • Ho Yay: Adel and Derek in Under the Knife 2. In one scene about halfway through, Adel's reaction when he discovers that Derek wasn't the doctor who operated on him is suspiciously similar to how a person would react to their partner's infidelity.
  • It's Easy, So It Sucks!: Trauma Team to many longtime fans, with the lack of bosses other than the pitifully simple Twisted Rosalia being a particularly sore point. The leniency when it comes to losing patients in First Response and making mistakes in Orthopedics, as well as the ability to abuse saving in Forensics and Diagnosis also drain whatever difficulty those modes could present.
  • It Was His Sled: Few go into Under the Knife/Second Opinion these days without knowing that you have to defuse a time bomb at one point. It's even the image for Unexpected Gameplay Change.
  • Jerkass Woobie: Master Vakhushti from New Blood is no saint, but is nonetheless one of the most sympathetic antagonists in the series. Once a successful and noble surgeon, he was betrayed by his own government when trying to save lives,went insane, and became an arms dealer specializing in the bioweapon Stigma. The real tragedy is that said bioweapon was the only thing keeping his diencephalic sclerosis (aka, brain petrification) at bay, though it also amplified his mental instability, effectively forcing the main characters to Mercy Kill him via removing the Stigma. Due to all of this, it's pretty hard not to feel bad for Vakhushti.
  • Launcher of a Thousand Ships:
    • Derek is paired with any remotely attractive male character (this is Atlus after all). Tyler and Victor come to mind.
    • CR-S01 has been paired with all of main characters of Trauma Team, characters not even in the game, and his sister and adoptive father.
  • Memetic Mutation:
    • The song "Gentle Breeze" from Under the Knife 2 has become a meme:
      • There is a 2000s YouTube fad which basically takes Gross Up Close Ups or otherwise candid frames from SpongeBob SquarePants and applies different visual effects to them, with the effect changing to the notes of the song. The videos are often titled "(name)ward" (derived from Squidward) or a corruption of the presented character's name, such as "Spwoangebarb" or "Poartrake".
      • The song has also been associated with the unrelated "oh worm?" meme, as the video which popularized it used the song as background audio.
    • Thanks to Game Grumps, it's all too easy to see Dr. Hoffman as a senile, condescending doctor obsessed with cranberries...with two hook hands.
    • Comparing Maria Torres with Chie Satonaka from Persona 4.
  • Memetic Psychopath: Thanks to a late-game scene in Under the Knife 2, Adel Tulba is best remembered as a doctor gone Ax-Crazy who notes that the "'Healing' Touch" is also good for "KILLING!"
  • Moral Event Horizon:
    • Adam is a deranged lunatic who wishes for humanity to be wiped out via horrible parasites, and he crossed it by taking seven innocent children and using them as incubators for GUILT.
    • Much like his predecessor Adam, Heinrich von Raitenau harvests the GUILT parasites from the bodies of innocent children, but he crosses the line even further by using his own son and daughter as living incubators for the diseases.
  • Narm:
    • In Under the Knife 2, the "operation" where Derek tries to practice his Healing Touch and is unable to pull it off would be pretty heartbreaking, except that the "Operation Failed" overlay still says "The medical board will be notified." Notified for what, failing a personal practice session that doesn't hurt anyone?
    • In the original story, Derek's heartfelt speech about why he wanted to join the medical profession includes the statement, "Diseases are painful." It's such a Captain Obvious moment, especially from a surgeon dealing with life-threatening illness, that it comes across as an amusing understatement.
    • The infamous operation on a time bomb for both the concept and the "justification" for Derek even being able to pull it off despite his lack of expertise...the nurse walking him through it just offhandedly mentions that she "used to date a guy on the bomb squad", and that's apparently all the explanation required.
  • Narm Charm: Hank Freebird in Trauma Team, who is shown to be an actual superhero with a Flying Brick powerset and takes bullets without even flinching... and he manages to be a pretty likeable character even with how boundary-pushing he is.
  • Never Live It Down:
    • The fandom is not going to let Angie live down the moment in Second Opinion where she tells a suicidally depressed teenager to "just die". The fact that she is never punished for this (at least on screen) makes it even worse, although that could be chalked up to Derek helping Linda through things shortly after.
    • Adel from Under the Knife 2 will always be remembered for the time he remarked that the Healing Touch is also good for "KILLING!", even though he was brainwashed by a strain of Neo-GUILT.
  • Older Than They Think: This wasn't the first major surgery-based game (that would be Life and Death for MS-DOS, Amiga, and other operating systems of the time) but since it's been fifteen years since that game was made, it is often credited as the first surgical game. It might as well be, considering the rarity of Life and Death these days. In fact, it isn't even the first DS surgery game! That belongs to the first Kenshūi Tendō Dokuta game, which was only released in Japan, although the second game in the series was localized in US and EU as Lifesigns. It notably focuses on realism, however, and places much more emphasis on the characters than the surgery.
  • Player Punch:
    • In Under the Knife, you can't help but hate Adam for what he did to Amy Chase.
    • After operating on him so many times, and succesfully eradicating his Pempti, Richard Anderson's body gives out and he dies.
    • In Second Opinion, Derek Stiles, who's been the protagonist and Player Character for much of the game, comes down with GUILT. Fail to save this patient and there is no mention of calling in a backup surgeon; Director Miller straight up tells Naomi to contact Caduceus USA and that Derek Stiles will be missed.
    • The discovery of the Sinners is what really drives home the point that Adam is pure, undiluted, irredeemable evil.
    • Under the Knife 2 punches you with Emilio's death. He was a sinner, he survived a new form of GUILT that was dormant in a transplanted liver for him, and then he gets infected with GUILT again. Derek plans to operate on him after taking care of several other patients, but when he's ready to operate on Emilio, he dies. The operation fails no matter what you do and Derek is locked out of his lifesaving Healing Touch for a while.
    • In Trauma Team, the final phase of "Proud One". The patient, agonizing due to the effects of the Rosalia Virus, knows he is going to die and begs Dr. Cunningham to tell his Last Words to his family. The gameplay changes in that you are no longer looking for symptoms, but for reasons to encourage the poor guy to keep fighting for his life. Then the chapter ends, and Naomi heavily implies that the patient did not make it...
  • Retroactive Recognition: In New Blood, Markus is voiced by Troy Baker in one of his first video game roles.
  • The Scrappy: Angie is the deuteragonist, yet gets a lot of hate because of her self-righteous attitude. Many fans found it extremely hard to forgive her after she tells Linda Reid, a depressed, suicidal, teenage patient, that "she should just die"; and after she blames Derek for Emilio's death by saying that he became arrogant and negligent due to relying too much on his Healing Touch, which leads the doctor into a depressive spiral that makes him lose his Healing Touch for a whole chapter.
  • Scrappy Mechanic:
    • The fact that the X operations in Second Opinion have two versions where the only key difference is which doctor, and thus which Healing Touch, is used and that using a Healing Touch disqualifies you from an XS rank. If you're trying to nail 100% Completion, that means that you have to get XS twice on each operation, one for each of the two barely-different versions (since you can't use either doctor's Healing Touchnote ) of the operation.
    • The procedure to treat burn wounds in New Blood and Under the Knife 2 is also quite annoying, enough to qualify any mission where you're required to do that as That One Level. Case in point, the mere fact that you're allowed to treat burns with synthetic membranes instead of having to transplant skin in the Trauma Team mission "Blade of Resolve" makes that one far easier than it would be otherwise.
  • Signature Scene: The mission where you defuse a bomb with surgery tools in the original game (3-6). It's not widely remembered because it's fun or challenging or anything, but because it was a ridiculously big Unexpected Gameplay Change.
  • Stoic Woobie: CR-S01/Erhardt Muller in Trauma Team. He was hated by his parents, his adoptive father went insane and killed his sister and thousands of other people. He was then convicted of killing those people and sentenced to 250 years in jail. Even when he can reduce his sentence by performing surgeries, he has to go back to his cell shortly after the operations and thus can't hang out with the rest of the cast. Despite all of this, he doesn't seem that affected on the outside.
  • Strawman Has a Point: Tyler Chase, as the titular Death Doctor. Despite the first game's anti-euthanasia bent, he makes a lot of convincing arguments in favor of it before you cure Amy.
  • Suspiciously Similar Song:
  • That One Achievement: One of the achievements in Trauma Team requires you to get a Cool rating while shaving a bone in less than one second. That's incredibly fast, and you need to be accurate in a step where you can easily over or undershoot, and runs contrary to the more relaxed atmosphere of Orthopedics. You only need to do this once but it will take plenty of practice to get the timing right.
  • That One Boss: Considering it's an Atlus franchise, this is a given. Examples can be found here.
  • That One Level:
    • From Under The Knife and its remake Second Opinion:
      • "Awakening" (2-4) has the player operating a patient's large intestine to remove aneurysms. The long process involves magnifying each lesion, shrinking it with a needle, cutting it with the scalpel, extracting it with the forceps, draining the excess blood and finally stitching the vessels together. Eventually, multiple aneurysms start appearing simultaneously, forcing the player to juggle the sedative between them, as it only lasts a short time before the aneurysm swells again. If they're not careful, the aneurysms will burst and cause vitals to plummet. The final wave of four to five aneurysms at once all but prompts the player to use their newly-gained Healing Touch to grant themselves the breathing room to manage everything.
      • 5-2, the eponymous "Under The Knife" in the original, can be this for players if they're not paying attention, or completionists if they are. You only have to take out 3 Kyriaki to progress the story. But the mission involves five, and they become geometrically more difficult as you progress, leading to a functional plague of the accursed things in the last stage. And have we mentioned that you have to take care of all of them within 10 minutes? (On the plus side, if you do manage to clear all five patients in that horrifyingly tight time limit, you automatically achieve an S-rank, no matter the actual score. A job well done. Furthermore, as long as you get to the third patient in time, reinforcements will arrive to take care of any remaining patients even if the timer runs out.)
      • "Fallen Heroes" (6-7 of Second Opinion) is a multi-stage GUILT operation where you alternate between two doctors and have two Healing Touches to expend, and you are likely to need both to get by. Your first patient has Triti, already an infamously tricky pathogen to treat. The second is a far more straightforward Kyriaki patient. The third is Deftera with a twist — blood regularly pools on the operating field and can obscure and interrupt your treatment attempts. The final is a whole Paraskevi on the patient's heart, and if you let even a single fragment burrow in, it's an instant Game Over.
    • From New Blood:
      • "Lost in Flames" (2-5), where you're treating a burns victim. The process to treat a burn involves injecting clear skin with culture fluid, cutting the skin loose, placing three pieces of skin onto a burn and securing them with antibiotic gel. However, blood appears frequently and at random spots over the wounds, and will dislodge any unsecured skin. Worse, the burns overlap, making it far too easy to put a piece of skin over the wrong one, which will inevitably be removed once a blood pool forms.
      • "Strike Force" (7-2) involves three patients. The first one is infected with Brachion, a Puzzle Boss that eats up a large amount of time. The second operation is a simultaneous Cheir and Soma infection, which is a nasty combination, but can be overcome with the right strategy and a little luck. The final patient is infected with both Soma and Onyx, the latter of which is hidden until it is either spotted with the magnifier or launches a surprise attack while you're treating the former. If you lose, you have to try again from the beginning.
    • From Under the Knife 2:
      • "Abduction" (5-4) requires extraction of a bullet from the patient's heart, and you have very little room for error — a tight time limit of 1 minute and a max vital cap of 15. As soon as his chest is opened, the patient will undergo cardiac arrest, forcing the player to treat the wounds while the vitals quickly plummet. Once you've treated all the wounds, you have to restart the heart through a heart massage, and the timed prompts to tap the screen can eat up what little time you have left.
      • "A New Ally" (6-1) has the player treat post-Triti, but with a limited supply of antibiotic gel and no stabilizer, while they have to contend with a mixture of toxicosis and bleeding that's sapping away the patient's vitals.
      • "Truth Unveiled" (7-3) gives you three brain aneurysm patients to treat, and each patient always has one last wave of multiple aneurysms at the same time. The final patient even throws in pus and tumors into the mix just to make things more complicated. You still only have a single use of Healing Touch to expend among all three, so you're forced to work through at least two barrages of aneurysms without it.
      • "Hall of Shadows" (7-5) gives you three burn victims to treat but only 5 minutes to do so. Each patient also presents with increasingly severe burns and less area for skin culture.
    • From Trauma Team:
      • Tomoe's mission where you have to locate Cunningham under a huge pile of rubble is difficult due to the multiple branching paths, which, couple with the endoscope finicky controls, can cause the player to become lost.
      • Hank Freebird's mission "Friends", where the player has to treat spinal ependymoma followed by hemangioblastoma, can also become this as the final hemangioblastoma is soft tissue, which must be pulled off carefully. This alone wouldn't qualify it for this classification if the player wasn't under a quite strict time limit until the hemangioblastoma reattach themselves to the blood vessels supporting them.
  • They Changed It, Now It Sucks!: Fan reception to the gameplay being divided into six different styles in Trauma Team was mixed. While the traditional Surgery missions and First Response were praised, Orthopedics was considered too repetitive; Forensics and Diagnosis were deemed too much of a genre shift; and Endoscopy was met with a mostly negative reception due to the clunky controls.
  • They Wasted a Perfectly Good Character: Adel starts out a largely sympathetic character that is apparently bound to be Derek's apprentice, but quickly becomes Out of Focus past the first chapter of the sequel. He barely has any impact in the story, joining HOA halfway through the game and requiring to be saved from a Neo-GUILT in the final chapter.
  • They Wasted a Perfectly Good Plot: In Under the Knife 2, the premise of an African country being devastated both by a civil war and a mysterious pandemic is interesting in its own right, but it's only the focus of the prologue. The rest of the game has the main characters dealing with the remnants of Delphi and a corrupt corporation back in Japan/America (depending on if you play the Japanese or English version), while the aforementioned plot points are largely forgotten and still unresolved by the epilogue. This is especially jarring considering New Blood already did a similar plot later in its story which integrates Stigma in its plot as a means to wage biological warfare.
  • Unintentionally Unsympathetic: One of the major reasons that Angie is seen as The Scrappy to so many players. We're intended to sympathize with her because of her tragic childhood as Dr. Blackwell's daughter, and her strong commitment to saving lives. The problem is that Angie's hot temper and emotional immaturity just make her too frustrating for people to want to sympathize with. It definitely didn't help that she once lashed out at a depressed teenager and got no comeuppance for it.
  • Viewer Gender Confusion: Adel Tulba in Under the Knife 2. He's a black guy who can perfectly pass as a woman to new players.
  • Waggle: Ultimately, this is what makes the endoscope operations in Trauma Team so hated. It forces you to move the Wiimote forward like when using a defib, but you need to constantly pull it back and forth rather than it being uncommon and rarely appearing more than two times every ten operations, or fifteen patients in First Response. You also need to look around to do things, which is far slower than moving with the ultrasound while undergoing surgery. These factors together mean that it's painfully slow compared to the much-loved Surgery and First Response, but doesn't have the laid-back atmosphere of Orthopedics that makes it work. Rather than implementing motion controls in a way that feels natural and fluid like the others, Endoscopy feels forced and unnatural.
  • The Woobie:
    • All of the Sinners, by virtue of being young children orphaned and subjected to horrific experiments, but Emilio takes the cake. His suffering is prolonged by his PGS, which destroys his liver. Then during the transplant, he ends up contracting a second GUILT. When that's taken care of and it seems his life will finally take a turn for the better, Emilio is at the epicenter of a terrorist attack that infects him with Kyriaki, which ultimately takes his life.
    • In Trauma Team, Rosalia Rosselini. An innocent girl that only wants to help people ended up killed by her own stepfather because she is the carrier of a doomsday virus.

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