There is no rest for the weary, and few work as tirelessly as Dr. Stiles. Three years ago, the prodigious doctor staved off the apocalyptic virus, GUILT, and possibly humanity’s extinction. Most people would have called it a day and kicked up their heels. Instead, Dr. Stiles and his boundless determination are volunteering aid in the war-torn country of Costigar and chasing rumors of a new illness.

GUILT may have been stopped, but its previous victims have yet to free themselves from its effects. Vicious tumors are appearing in post-GUILT patients at an alarming and suspiciously simultaneous rate. With the help of his assistant and the staff of Caduceus at his back, Dr. Stiles will return to the trenches of medical warfare to battle an enemy unlike any before.

From the first incision to the last suture, you are responsible for guiding Dr. Stiles’ hands in the operating room. You inject the medications, slice with the scalpel, reconnect the arteries, and bear the responsibility of every mistake. The hands-on feel is overwhelming at first, but lends a sincere feeling of realism to every procedure. At least, as real as healing a broken bone with antibiotic gel can be. While you’ll need a heavy dose of suspended disbelief, Trauma Center will never be mistaken for the digital version of Operation.

The greatest strength of its gameplay is the variety of operations. There are bones to be set, skin to be grafted, and even puzzles in need of solving to form a new vaccine. Tumors are the most common maladies facing Dr. Stiles, but the methods of removing them change from operation to operation. While one can be easily extracted via forceps, another must be severed from veins while keeping Toxicosis and rampant hemorrhaging in check. If nothing else, the game takes sadistic pride in pushing your life-saving skills to the limit.

This is just as much a real-time strategy as it is a game of reflexes and precision. Patients’ vitals continuously drop because of their wounds and the trauma of being diced. Repairing damaged areas slows the rate of decline, but injections of medication provide an immediate boost to vitals. When glass shards embedded in the lungs threaten to kill a patient at any moment, do you push her vitals to the limit and remove the shards, or pray that the next few seconds will be enough for an injection? Your assistant will talk you through the basic steps, but choosing the order and performing them quickly is up to you.

Trauma Center could have been a Simon Says game of “cut here, then there.” Instead, there is a lot of trial and error and numerous rash decisions. You will fail often, but you will also become faster, steadier, and more confident with every operation. During my first surgery, I might as well have been a dentist doing a quadruple bypass. By the third of seven chapters, my assistant’s help verged on useless nagging. It’s a great feeling to know that you’re succeeding because you’re actually improving, and not because the game is dealing new abilities to make the road ahead easier to navigate.

The tools you see at the beginning are almost all that you have to work with the whole game through. The lack of anything new may disappoint veterans of the series, but it also stands as a testament to its already solid gameplay. You might as well fault modern crosswords puzzles for lacking innovation. The Healing Touch is back as well. Invoking this wholly non-medical ability slows down time, giving Dr. Stiles a few precious moments more to finish the operation, or pump the patient full of drugs.

Dr Stiles is awarded a ranking after every operation, with points for speed, successions of proper techniques, and hidden bonuses, such as not having to use the defibrillator. Replaying missions for better grades on higher difficulties is mainly for bragging rights, and occasionally infuriating. Judging by the scoring, my haphazardly ramshackle sutures are models of perfection, but my bandages aren’t suitable for a skinned knee. One procedure in particular repeatedly ruined my combo, because I ran out of touchscreen while extracting a bone fragment. Touchscreen quirks aside, the shame of failure is almost always on your shoulders, and the game does a great job of making you feel it.

The storytelling stands with the best of Atlus’ RPGs. Like an episode of Grey’s Anatomy, there is always an emergency to grab your attention, but you keep playing for the drama unfolding around it. During his tenure, Dr. Stiles wanders through a landscape of corporate dealings, self-doubt, and weightier issues such as the use of child-soldiers in Africa. The fact that such parts are woven into the plot with natural ease, and no Hannah Montana moralism, is proof of the writer’s talent.