Continuing my trend of “playing games that reviews didn’t like much and ending up liking them a lot,” I picked up a copy of the Nintendo DS game Lifesigns: Hospital Affairs (also known as Lifesigns: Surgical Unit in the States) recently. And I’ve been loving it.

Lifesigns, or Resident Doctor Tendo 2: The Scales of Life as it was known in Japan, is actually a contemporary of the original Trauma Center: Under the Knife in Japan, but it didn’t come out until two years later in the West — nearly three years later for Europe. The reason I mention this is that the game suffered somewhat from comparisons to Trauma Center in reviews, when in fact this is a completely unfair comparison that has diverted attention away from what is actually a very interesting game.

Don’t get me wrong. I love Trauma Center. It does its own crazytown sci-fi medical horror thing and it’s fantastic for it. It remains, to date, one of the most genuinely nerve-wracking series of games I’ve ever had the pleasure of playing, and it always manages to spin an interesting story to couple with its action-packed gameplay. The latest installment Trauma Team, which you’ll recall I was babbling on about recently, refined that formula brilliantly by toning down somewhat on the sci-fi aspects and jacking up the feeling of “this is a team of doctors working together in the same place”. Ultimately, though, as good as the story was, Trauma Team was still just as much about performing the various operations as it was about the unfolding story.

Lifesigns, meanwhile, is actually a completely different beast. Sure, it’s set in a hospital and features a number of surgery sequences, but it is not Trauma Center. Instead, I was delighted to discover, it is rather more akin to the Ace Attorney games — longstanding favourites of mine — than anything else, placing a much stronger focus on well-written character development and unfolding narrative than on the “action” sequences. It’s for this reason that comparing it to Trauma Center and complaining about there being “too much talking” — a criticism also levelled at the Ace Attorney series by some — is utter nonsense. Without the talking… well, there would barely be anything left. The talking is sort of the point. Whether or not you like that is a matter of taste, of course, but given the continued existence of visual novels as a storytelling medium you better believe that there are plenty of people out there who are more than happy to play games that are about nothing more than people talking to each other.

As the Japanese title suggests, Lifesigns is actually the second game in the Resident Doctor Tendo series, though the first never made it to the West for reasons unknown. Ultimately this doesn’t matter too much, as like the Ace Attorney games, the overarching plotlines are completely self-contained and only occasionally make reference to the events and characters of the previous game. When they do, they take their time to explain who these random characters that the protagonist knows (and the player doesn’t) actually are, too, so it hasn’t been an issue.

Lifesigns casts the player in the role of the eponymous Dr Dokuta (yes, really) Tendo, a second-year intern at the fictional Seimei Medical University Hospital. We learn quickly that he had quite an eventful first year, with one of the major events seemingly being a misdiagnosis that nearly ruined his career. We also learn that he was partially inspired to get into medicine after his mother died of cancer, and partially by the fact that his father is a heroic firefighter. We also learn that the resident evil-looking dude Dr Sawai is Tendo’s biological father and that there’s some bad blood (no pun intended) there.

The game’s first episode introduces the major characters around the hospital — Tendo’s mentor Suzu-sensei, an attractive older woman whose trademark appears to be a large cat bell around her neck; head nurse Florence, who has an alarming talent for gossip; adorable nurse Hoshi, who is clearly carrying a rather large torch for Tendo; and Aoshima, the new first-year intern whom Suzu assigns Tendo to keep an eye on. There are also a selection of other incidental characters who put in occasional appearances such as the frankly terrifying surgical assistant nurse Kurai, the deadpan anaesthetist Masui and Tendo’s relatively normal-seeming friend in paediatrics Dr Ueto. All of them are fun, distinctive and, like the characters in Ace Attorney, just the right blend of believable and caricature to make them all memorable.

The majority of gameplay in Lifesigns requires the player to move from location to location in the hospital to advance the story. The location map shows which characters are hanging out where at any given moment, though there’s no indication given as to whether the conversation you’ll have in that location is an important one or not. (Important conversations advance the plot and tend to change around the arrangement of which other characters are hanging around where; non-important ones tend not to impart useful information for the most part but are usually entertaining or give a little further insight into the characters.)

When you reach a location, important conversations tend to unfold automatically and occasionally require some input from the player. This is accomplished in a similar manner to in Ace Attorney, whereby you open up your Court… sorry, Medical Record and present various objects, concepts and characters to the other person. Yes, much like in Ace Attorney, your inventory is not necessarily restricted to holding physical items; instead, as the plot unfolds, Tendo will take various notes, which he can then discuss with people. Usually if you’re stuck at some point, you simply have to present something to someone else to advance the plot along. Occasionally, there are sequences where you have to convince another character to do something — these unfold in much the same way, albeit with more dramatic music and visual effects and an on-screen meter depicting how close you are to successfully convincing them. Presenting the wrong piece of information in these scenarios can lead to a bad ending, so you have to be careful — though bad endings don’t necessarily mean the end of the game.

What with Tendo being a doctor, you’ll be unsurprised to note that you do actually get to do a bit of doctoring around the place, too — life in a hospital isn’t just flirting with the nurses and hanging out with the pervy old cancer patient who can’t resist pinching female doctors’ bottoms. No, at least once in each of the game’s five episodes, you’ll find yourself having to deal with realistic medical cases, beginning with an examination in which you must successfully diagnose their symptoms, and usually concluding with a surgery sequence in which you must treat their ailment accordingly.

The diagnosis sequences are like a simplified version of Dr Cunningham’s episodes in Trauma Team (or it’s perhaps more accurate to say that Dr Cunningham’s episodes are like expanded versions of Lifesigns’ diagnostic sequences) — after having an initial discussion with the patient, you’re presented with a view of them that you can look up and down and then interact with in several ways — inspecting areas visually, using a stethoscope to listen to the body’s sounds and palpating areas by rubbing the touchscreen. The patient will generally give you a few clues here and there (“ooh, it hurts more on the other side…”) but for the most part you’re expected to perform a thorough examination to find all the symptoms. Unlike in Trauma Team, there’s no chance of missing anything as you can’t proceed until you’ve made a successful diagnosis; and also unlike Trauma Team you don’t have to worry about eliminating possible candidates by matching symptoms to your database. Tendo knows his stuff — though often the visual examination is followed up by one or more “spot the difference” ultrasound/X-ray/CT/MRI scans in which you have to circle the abnormal areas on the touchscreen and pin down a final diagnosis.

The surgery sequences, meanwhile, are not very much like Trauma Center at all… aside from the fact that they’re incredibly tense and quite challenging. Rather than tending to follow the same format, requiring the player to remember the appropriate means to deal with “common” ailments such as lacerations, tumours and inflamed areas, each surgery sequence in Lifesigns is a unique procedure that doesn’t necessarily involve opening up the patient. For example, in the first episode, you’ll find yourself performing an appendectomy as your first operation, then later you’ll be navigating a catheter through someone’s blood vessels in an attempt to stop some internal bleeding.

The diversity of tasks in the operations means that rather than trusting the player to switch between tools as they need to, each surgery is split into a number of smaller objectives which must be achieved in linear sequence to progress. Making mistakes injures the patient and causes damage to their vitals bar, and there’s no convenient “cure all” stabiliser to inject here — though performing a task quickly and accurately has a chance of restoring the vital signs somewhat. There’s also a “concentrate” button that displays the areas on which you’re supposed to perform the current action along with the movements required, but all the time you’re holding down this button the operation’s time limit is zipping by five times faster than usual. Experienced surgeons will, of course, be able to complete the operations without having to rely on this at all, and in at least one situation the ending of an episode is determined by how quickly you complete an operation. (You can save beforehand… but as noted before, the “bad endings” to each episode aren’t game-ending, so it’s often worth continuing and perhaps replaying the game later to see the different possible conclusions.)

I’m only partway into the second episode so far so I’ll refrain from speaking further on the plot and whatnot, but so far it’s been pretty great. It successfully combines the character- and dialogue-driven narrative of the Ace Attorney series with the tension of Trauma Center and comes out feeling like its own distinctive experience. While, yes, there is a lot of talking, as I said earlier that’s sort of the whole damn point. This isn’t a kinetic novel with arcade sequences like Trauma Center was (that’s not a criticism, incidentally) — it’s a visual novel/adventure game in which performing surgery plays an occasional role, but in which the relationships between the hospital staff, the patients and the other people in their respective lives is brought to the forefront. It’s a really interesting game, and I strongly suggest you check it out if you’re a fan of games that are a little bit off the beaten track.