Let's see out the month with another game-related treatise that nobody's going to read!

I had sort of hoped that the idea of the X-missions from the first Trauma Center game had just been replaced with Hard mode in the second one, but I had no such luck - when you get to the end of the game, after the credits have gone past, it happily announces that "you now have access to the Confidential Operations". These appear at the bottom of the list of episodes under Chapter X, and when you select them the difficult selector is replaced with one giant tab reading "EXTREME". This is a completely appropriate name for them, other suggestions being "brutal", "apocalyptic" and "obviously unfair".

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As you might reasonably expect, X-Kyriaki is an absolute bastard. Much the same as in the first game, the X-missions certainly don't start you off gently, and I failed this one within fifteen seconds the first time. The procedure is much the same as before, where you have to deal with the existing wounds then three waves of lung-sharks, but this time even allowing the initial wounds to burst will have a decent try at killing you instantly. Once you've got past those, the damage dealt by the cuts that the Kyriaki make has been upgraded so much that in addition to the ultrasounding, gelling and stabilizing you had to do in the first game during the first two waves, you really need to suture absolutely every laceration as it's made.

With some practice and luck it's just about possible to get past the first two waves without using the Healing Touch, which you really need on the second half. As soon as the last wound is dealt with, the star-shaped cut heralds the arrival of the Queen lung-shark. The good news is that this time it's alone - the bad news is that it comes with pupae that hide within the organ and will hatch if not dealt with quickly, releasing up to five more Kyriaki at once. Needless to say, it's important to get used to ultrasounding the whole area quickly, scalpelling everything out, then dealing with the damage caused before finally bringing out the laser and starting the whole hideous cycle over again.

If you follow that pattern, the whole procedure doesn't seem too bad - though I'm not in a hurry to try it again or anything, and I had to pause the game frequently to think about what I was going to do next and give my hand a rest in general. A lot of the final battle against the Queen is made a lot easier when you understand how it works and what order to do things in - you have to prioritize the eggs, and when the Queen is visible there's ample opportunity to heal up as long as you deal with the occasional new cut it makes quickly, so if you can keep your calm then it's just about possible within the time limit. By the way, compared to the three or four of the first game, you have to laser it six times, and this target hit count remains pretty much constant throughout the rest of the missions. Cripes.

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X-Tetarti is an absolute bastard, though you wouldn't expect it from something that's been reasonably easy up until this point (even in the X-missions of the first game). This time, the procedure is still similar, but the speed you have to work at might best be described as "superhuman". Even on the very first cycle, you don't have enough time to fill three syringes with the corresponding colours and inject them all - instead you have to get a feel for how much you absolutely have to draw into the syringe, and use the precious half-second you save to your advantage. All this while you're trying to remember which colours you're dealing with at all (though on the positive side you only have to hold them in your head for a picosecond, the amount of time you're allowed to deal with them). If you somehow manage to hit them all six times, then you're let through to the third of these monstrosities.

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Just like it was before, X-Pempti is an absolute bastard. All pretences of fairness that I said were introduced in the main game are swiftly eliminated - this time around, it launches attacks that cause overwhelming numbers of cuts, polyps or just general vitals drain unless you react within microseconds. If you ever let more than one of them launch at a time you're pretty much stuffed, because while you're trying to repair the damage you'll be hit with another attack, and generally you'll rapidly begin to fight a losing battle.

I got past this one by continually pausing and unpausing to let me see where the cores were going to go just before they attacked, therefore allowing me to place the laser pre-emptively and prevent most of them from starting. This is something that I feel is quite close to cheating. But it isn't, because it's a mechanic that the game provides, so there. Even with that advantage, it still gets you mathematically if you're unwary, because the lower core has two more hit points than the top one, meaning that if you do the obvious and alternate your attacks, then when the bottom one goes into its berserk mode with the other destroyed you'll never be able to withstand the onslaught long enough to finish it off.

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As the first Neo-strain, X-Nous is an absolute bastard. The mechanics of it are much the same as in the main game - remember which order the tumours appeared in and deal with them all in turn before attacking the main body in the same way - but much like in X-Tetarti, the time limit that you have in which to drain and scalpel the synchronized tumours has become much stricter. Here you have to handle strings of up to six of them, and I'm not completely sure how to actually do that without the Healing Touch to slow down time - I can just, just manage the rounds of five if I'm lucky. As if that wasn't enough, the amount of damage that the tumours do while they're active has been ramped up, so the time that you usually had to recover your wrist between rounds is instead spent recovering your patient, and you have to watch the stabilizer as well as the appearance of new tumours while memorizing their order, and your eyes end up pointing in opposite directions.

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Once you get past that, X-Bythos is an absolute bastard. I thought it was quite fun when you encountered it in the main game, but much like Pempti, its attacks have been augmented beyond any reasonable expectations. It will rumble about causing cross-shaped cuts of four and subcutaneous bleeds that you have to race to keep up with and you'll barely have time to hit it with the laser at all. When you do, you'd better make sure that it's right in the bottom right corner, because otherwise you're never going to pincer it out past the rapidly rotating lights. And - as seems to be a running theme in the X-missions - you have to do it six times.

Again, I could only defeat this using my pause-unpause tactic, giving myself time to think about what I was selecting and effectively speeding up how fast I could move across the screen (and you might as well just assume that this is the way I'm playing these from now on, because without that crutch they're not intended to be completed by humans). I lost count of how many times I'd hit it and didn't even use the Healing Touch for this one, but even with my replacement time-slowing, I looked up at the timer once I'd defeated it to see that I had five seconds to go. So I had to stitch up the incision, forget about the gel and bandage it at the speed of light to prevent the effort from going to waste.

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X-Sige is an absolute bastard. The idea of it basically being Kyriaki on acid still applies here - you have to fix initial cuts before scalpelling it out of the organ and then blowing into the microphone to clear the resulting gas while healing as fast as you can in a supremely awkward manoeuvre. As soon as you can see the resulting hole, you have to repair it (with about half a second to gel the membrane) and keep the Sige bodies still before their rapid bouncing does too much damage to your vitals. It's important not to let it stay in the organ for too long, either, or it'll cause a load of subcutaneous bleeding that'll all burst at once and fail you the operation instantly.

I realized that my tactic for getting past this was going to run me out of time when I had only made three hits on it with one minute to go, so I tried using the Healing Touch out of desperation, ignored all problems that Sige was causing and went straight for it, somehow scoring three more hits in a row during slowed time and then just having the vitals to spare to repair everything at the end.

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X-Aletheia is an absolute bastard, and a strong message from Atlus that this is not a game meant to be played by normal people with their primitive human reflexes and reaction times - it's instead meant for killer cyborgs from the future. Like the previous final boss Savato, it has multiple stages, but each of them is a variant of one of the other strains - the eventual goal is to jab it in the eye with a syringe enough times for it to expose its veins, and then cut those, three times, but the eye only opens when one of the smaller bodies is defeated. My procedure for it went something like this:

Mini-Kyriaki: Easy enough (and I mean that in the most relative way possible) - concentrate on lasering them one at a time, paying attention to the directions they're swimming in, and use the serum in between each one. Ignore all other injuries until you first see Nous appearing, when you should stitch everything up in preparation.

Mini-Nous: Drain and excise the top and left ones, quick, then serum it. When the rest of them dive back into the organ, start with the stabilizer, healing back up to the 90s during the pause that it gives you. When the secondary tumour appears, drain and scalpel it, then hold it with the forceps while the others change positions - this stops a second one from appearing, and you need to do this because you don't have enough time to excise two in one cycle unless your fingers are bionic. When it gives you the chance, complete the carrying away of the secondary tumour and excise a primary one, then use the serum. With that done, you should get to the first vein stage.

Mini-Sige: You have to pay attention to the rhythm of their movement, because you only just have time to gel and then cut from the moment they've just moved. Do that and then inject serum, then clear up any clouds that have formed and repeat.

Mini-Tetarti: I think this is the hardest and most crucial bit of the entire operation, unexpectedly for Tetarti being by far the easiest GUILT before. You're given half a second to see the colours, then they turn white and you're on your own until they start swimming around. The secret here is that each colour will always start one place anticlockwise from the place where they first appear - if you know that and pause the game right when they show their colours, then you can inject them all and get past this stage instantly. Which is just as well, seeing as if you don't do that, let's face it, you're buggered.

Mini-Bythos: After the second vein phase comes another of the hardest sections - the trouble with this lot is that as they go around in their sort of Dashing White Sergeant of death, they cause subcutaneous bleeds that will then explode unexpectedly when you use the serum. Therefore, you need to keep checking if they're around, and it's not easy with the tubby green things floating about over them. They seem to form more when cores are left lying around, so you need to get those out as soon as possible, and it might be better to wait until you've got three out of the eight of them out already before starting with the serum. I don't know - perhaps I only got through this by sheer luck.

The Revenge of Mini-Sige: Oddly Pempti is reserved as a secondary enemy in this operation that only ever appears if you make too many mistakes earlier on, but I'm not complaining. This goes pretty much in the same way as the last Sige stage. The same tactics apply - gelcutserumdrainstartagainhandfallsoff.

If you get past that, and have injected enough of the serum by then, then all that remains are two vein-cutting stages in a row, a cruel test of your shattered nerves - now that your hands are shaking like mad, here's a final test to see if you can hit the right spot accurately among the ones that'll kill you instantly. But I did it, and it's just as well because I didn't want to go through all that again.

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I would rank them by difficulty like I did before, but I'm not sure how - they're all totally impossible. I suppose X-Tetarti and X-Nous seem slightly less insurmountable than the rest of them because you're given some semblance of breathing space, but honestly, each one of them seems to be designed for people who fought their way through the X-missions of the first game and thought they just didn't present enough of a challenge.

Anyway, I now have a star on my save file as well as a certain pride, and the only remaining nagging feeling is that the developers somewhere in Japan are busily thinking up a final boss for the new game that's even more impossible than this one. I really don't want to think about it.