So you've spent half your life hacking at Orcs, obliterating alien hordes, and dragging leisure-suited misfits around the world. Now you're looking to do something useful for humanity. Well, your timing is great. Toolworks General is looking for a few good surgeons to assume the burden of a few appendectomies, infections, and vascular grafts. No problem at all!
When you start the game, you'll need to sign in on the receptionist's clipboard. She'll welcome you and prompt you to go to the classroom, but let's not do that yet. Using whichever input device you have (a mouse is ideal for this game), set your difficulty level to Novice until you've successfully completed both operations. Erase the scrawl in the box at the bottom of the option screen by clicking on the small Erase checkbox; then draw your own initials in the space provided. You can turn off the sound at this point, but don't unless you absolutely have to: The sounds of the EKG and of the clamps closing are extremely useful.
Click outside the box to signify you're done setting parameters. Now you're ready to hand-pick your surgical staff and start seeing patients. Since your first operation will be an appendectomy, let's go into the Staff room and choose knowledgeable and cooperative assistants. Otherwise they'll be of no help at all in the OR (Operating Room).
Look over the six files by first clicking on the filing cabinet, and then on each name (NOT in the small check-box). You'll get a photo and brief description of each staff member. Gregory Danielson is a must for appendectomies; click on his check-box. But that means that you will NOT want Beverly Kabes on your staff, nor will you want Laurelee Menzies (whose area of expertise is irrelevant to this operation). Kim Brewer would be a good choice if you're looking for a general nurse to assist; if you have trouble keeping your eye on the EKG, then pick Ken Shepherd instead of Kim. If you're anticipating trouble with incisions, David Manglier would also be a decent alternative. My personal picks are Danielson and Brewer.
Click on the door of the Staff room to leave and head into the Classroom. Watch the blackboard and listen closely; the advice is basic (most can be found in the manual). When class is over, click on the door and the receptionist will tell you where your patient is.
In the patient's room, there's no need to look at the clipboard yet. The patients' complaints all sound the same, and your main diagnostic tool is to palpate the abdomen, so click on the abdomen of whoever's in bed. Click all around the area; be sure to get each quadrant at least once or you'll be reprimanded further on down the line. In this, the first half of the game, here are the guidelines for diagnosing: If there is no pain response anywhere on the abdomen, that signals intestinal gas and should be OBSERVED. If there is pain response all over the abdomen, that signals an infection and should be MEDICATED. If there is pain only in some parts of the abdomen, that could be either appendicitis or kidney stones; you MUST take an X-RAY (even if the pain is only on the patient's left side and thus unlikely to be appendicitis). If there are kidney stones, they'll appear as a clump of small white dots ABOVE the pelvis (surrounded by black). If such stones appear, your action should be REFERRAL (since urology is not the field you're in). If no stones are present, that's appendicitis! Click on OPERATE on the clipboard and exit the patient's room.
If you've just booted up, you'll be advised to check in on the phone (the copy protection). Do that if you need to; the receptionist should then inform you that they're waiting for you in OR. Head for the OR and here we go!
LIFE & DEATH Part 2
On the upper right is the section of the patient's body with which you'll be working. Beneath the body is a message box (it may not appear instantly) where words of encouragement, advice, and scorn will appear from your two assistants. Next to it is a small bottle representing the current fluid connected to the patient's IV. At the left is the EKG and the anesthetic machinery, and below that are a tray and two drawers (currently closed) with all the instruments you'll need to operate. You can see that the anesthetic is OFF and the breathing and heartbeat are regular. You'll want to learn to keep your ears tuned to that EKG; if the pitch changes or if the constant beeping stops, you'll have to turn your attention to the problem. Although you have assistants who will be commenting along the way, I'm going to assume you're in this alone.
The two kinds of heart problems you'll run across are PVC and Bradycardia. With PVC, the EKG will drop in pitch and the line will plummet and bounce back (see the manual for a picture). The cure for this is a quick injection of Lidocaine, already in a hypo in the bottom drawer (marked with an "L"). PVC is easy to remember because it will look like a "V" on the EKG. Bradycardia shows a relatively flat EKG, and the beep will stop altogether; this requires an injection of Atropine, marked with an "A" and sitting next to the Lidocaine. Think of "A" going with "B" and you can easily recall Atropine going with Bradycardia. (These sorts of mnemonics are exactly what help most medical students get through school.)
Once in a while, the patient's blood pressure will drop. This will happen without fail if you don't start the patient on IV blood before you begin cutting. If the heart rate does drop, put blood in the IV and quickly clamp and cauterize all bleeders. But if the rate drops to 50, immediately inject the patient with Dopamine (in the bottom drawer, marked "D"). You only have one hypo of Dopamine and unlimited hypos of Atropine and Dopamine.
Since the patient's still awake, you're not likely to run into EITHER problem! So let's get down to some hacking and slashing of an entirely new kind.
Open the bottom drawer (just click the fingertips on the end of the drawer), and open the top drawer. From the top drawer: Click on soap to wash; click on gloves. Click on the large bottle with the "A" on it (it's antiseptic). Holding the button down, move the antiseptic cloth all over the skin; try not to leave any unwiped areas. The area will be shaded with black dots to show where you've wiped. Return the antiseptic to the drawer, and pick up the sterile drape (the folded cloth on the left). The cursor will change to a square; place this square all the way to the upper left corner of the abdominal window so that the corner of the square fits neatly into the corner of the window (don't leave any visible area in between) and click. You should get a very thin, almost unnoticeable line around the abdomen -- virtually no drape at all. This is crucial since you'll need every available millimeter of space with which to operate. If the square cursor vanishes and is replaced by the hand, and the abdomen window flickers slightly, you've done it right. (A comment in the message box may confirm it.)
Close the top drawer. Turn on the gas. Pick up the hypo labeled "B" (the antibiotics) in the bottom drawer, and move it over to the skin; click to inject, and the hypo will vanish. Get a bottle of blood (it LOOKS like blood) from the drawer, and click it on the full bottle next to the message window; that bottle should change to blood. This will prevent the patient's blood pressure from dropping as you make your first incision. Close the bottom drawer, and pick up your scalpel.
You'll be making a McBurney's incision (page 92 of Lindstrom's notes). From your point of view, you'll be making a single, straight cut from the upper left corner of the abdomen to the lower right corner. Make the line as long a possible; this is also crucial because it determines the size of the wound you're creating, and you need a BIG wound to get at the appendix. So, start and end as close to the very corners as you can (without cutting the drape). Incision technique isn't easy; you'll need to learn to cut as straight as possible while also cutting QUICKLY (which helps to keep the incision neat). Practice is the only solution here.
Make that incision in the abdomen. Then drop the scalpel, pick up the forceps (lying horizontally above the scissors) and clamp a bleeder (the widening circles of red that will appear along the incision). As you clamp, you should hear a "click" and you'll probably get a comment affirming the action. Another forceps will have appeared; clamp all the bleeders. When all the bleeders have stopped spreading, pick up the cauterizer (looks like a soldering iron on the left edge of the tray) and click once LIGHTLY on each bleeder. You may need to do this 2 or 3 times on each, but eventually you'll have cauterized them all. Then remove each clamp, one at a time, and using either sponge or suction hos (S-shaped), remove the blood.
Pick up the skin spreader (the butterfly-shaped mechanism at the bottom of the tray), and click it on the incision. The skin will peel away and reveal a layer of subcutaneous fat. Congratulations! Get somebody in the room to wipe your forehead.
All the while, of course, you'll be listening to the EKG and injecting the proper fluid when necessary. Also keep your eye on that bottle; when the blood is about to run out (don't wait till the last moment), put in a bottle of