Codex Gamicus

Life and Death II: The Brain

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Life and Death II: The Brain is a neurosurgery game. The best way to learn about it and what to do is to RTFM (Read The Manual), however, most people don't have TFM to R. If you are unfamiliar with the game and are reading out of curiosity, be warned: as one may expect, it is not for those who are easily grossed out by the sight of blood and such. However, the game's graphics are never particularly disturbing. For that, play the original Life and Death. ;)

Much of this information can be obtained from the game itself, and in fact much of the information in this FAQ has been obtained both directly from it and from our playing experiences. However, this FAQ will prevent some trial and error, and you can easily print it out, or parts of it, rather than writing down notes or memorizing things (though memorization should come naturally soon enough!) You will definitely need some form of notes the first time you do any given operation in the game, and may want to have them for subsequent times just to make sure you don't forget something.

How to get it to work[]

This game is troublesome to run on modern PCs. It will only run properly in pure DOS mode, and it is best to use an emulator such as DosBox to play it. The game works fine on DosBox 0.74, but the audio will not sound good unless you install it with the PC speaker option. (On 0.74, voices and sound effects will sound very bad on AdLib and SoundBlaster, but sound perfect with PC Speaker. Don't worry, you will hear perfect speech and sound, not bleeps and bloops. Later versions of DosBox may fix AdLib and SoundBlaster audio.)

NOTE: There's a version of the game floating around on the web that, when you go into the Operating Room to operate on a patient, you skip straight to the doctor commending you for a virtuoso performance. This is possibly an attempt to get the game to run on earlier versions of DosBox without crashing. If you play the game and this happens when you try to operate, delete the game and try to find a different version: this one is a thorough waste of time. The people who cracked it to get it to work cracked the actual game part out.

Do I need sound?[]

The short answer is "yes"; the slightly longer answer is "if at all possible". It is not necessary to have sound or music, however, the sound of the EKG (that "beep, beep, beep" thing in surgery) really helps, because its pitch changes when something goes wrong, meaning you wouldn't have to actually look at it, just listen. You'll also hear a voice say "Warning!" whenever something goes wrong.

You'll also need to drill during any operation in the game. The sound helps here, too, because the pitch of the drill changes when you drill a hole deep enough. However, if you pay close attention, you'll also see the shape of the hole change from a rounded depression into a cylindrical hole; this is when you want to release the mouse button.

Do I need the mouse?[]

Yes!!! This is essential. A joystick will do, depending on the joystick, but there's no substitute for the handling of the mouse. The keyboard is abysmal, but the game's still playable. The cursor will move slowly and diagonal movements are tricky (you must use the numeric keypad to do them properly). Holding the shift key speeds up the cursor but it's awkward. If you're in surgery, you have to either act fast, or pause the game a lot as you move the cursor over to the toolbox just so your patient doesn't bleed to death when you're making an incision.

USB mice won't work unless you're using an emulator such as Bochs or DosBox. You need a standard mouse, such as a PS/2 mouse.

Do I need the keyboard?[]

You can't play the game without one if you're using a fresh install, because you won't be able to type in your name. Also, you need the keyboard in order to hit the P key, which pauses the game during surgery, which can be great for relieving stress. Too bad real surgeons don't have such a luxury! So don't think you can squeak by with a normal mouse and USB keyboard... you need to get a normal keyboard or else run the game in an emulator.

(Here's a hint: USB mice and keyboards are evil. Don't bother with them unless you have a spare that doesn't need a USB port.)

Playing the game[]

If you haven't ever played before, when you first fire up the game, you'll be presented with a clipboard. Just type your name. You don't have to click anything, just type it. Surnames or full names work best, because if you enter, say, Jekyll, you will be called "Dr. Jekyll".

The interface is largely intuitive. You need not worry about saving the game: this is handled automatically (but be sure to exit the game properly rather than just switching the power off). The receptionist will answer most of your questions about where stuff is; of course, you can just click everywhere on the main map to find everything. It's not like you'll fall into a garbage compactor chute and die. :) This map is your map for the entire game, so you'll get used to it quickly.

Most areas of the game can be exited by clicking somewhere where there is nothing. Some others have a big EXIT button, in which case, that's what you should click. ;) (But don't click the one in the Operating Room when you're operating!) To leave the game, click the top of the screen (the parking lot) on the main map.

When a box pops up telling you to do something, that's what you gotta do to progress. You don't have to do it immediately. For instance, if you're going into the operating room, you may do well to go back to your office and select the assistants you need. You don't want to try a brain tumor operation with somebody who specializes in aneurysms, because that person can offer no help.

Your office[]

You won't visit your office much in the game, unless you like dinking with the computer on your desk (see "Secrets" section). There are two main reasons for coming here: to reassign which assistants are on your team, and to reconfigure the game.

On the game configuration clipboard, you can delete other surgeons (save slots), or write your initials into a box (these appear whenever you initial the clipboard prescribing a course of action). You can also set sound options (note that disabling digitized sounds disables the beep of the EKG) and the difficulty level.

The game begins in Novice mode. This is just fine for a beginning player, who deals mostly with ordinary problems and rarely does any surgery. Once you're good at diagnosing problems, kick it up a notch. You'll get complicated cases more often, your assistants' advice will be less helpful, and more things can go wrong during surgery. Surgery will be needed more often. The same applies from the jump from intermediate to advanced, where the full range of the game is offered.

Nightmare Mode is only available on advanced difficulty (if you check it, Advanced gets checked automatically). This seems to only affect surgical operations, and causes abnormal situations to occur more often. Be warned that sometimes two or three things can go wrong at a time. After fixing a problem, make sure another one hasn't sprung up in the meantime, and never be afraid to hit the P key and take a break. It's a luxury that real surgeons don't have!

Physical examination[]

Before you begin physical examination, click the clipboard on the wall above the patient's head. It will contain background information which may (or may not) help you in making your diagnosis. (You must do this before examination if you want to avoid being yelled at by Dr. Skelton.)

Click on the patient's face. You will see a closeup. You will immediately be able to see any abnormal pupil dilation or constriction. If both pupils are constricted or dilated, It may mean he or she has a drug problem. If only one pupil is dilated, guess what: the problem may (or may not) need some surgery, and it will definitely need a major test (see next section), but you must complete the physical examination first. Test for eye tracking by picking up the big black stick thing, clicking, and dragging around the face area. If both eyes follow it, it is normal. Next take the silver rod with the little light bulb at the end. Click it in the facial area to see if the pupils constrict normally. Next, take the card that says "Say 'Alice'" and click it in the facial area. The patient will say either "Alice" (normal), or "mbflwx" (slurred speech).

Finally, take the pin and prick the left and right sides of the face. It goes without saying that you should not poke the needle in the patient's eye. If you do, you'll be kicked out of the room immediately and be chastised by Dr. Skelton. If you want to torture people, there are plenty of other games you should play instead. If there is pain, the patient will either say "OUCH!" or "OOOG!" (there's no difference; it's random). If there's no pain, you will get no response and it will automatically be noted on your clipboard.

Check the clipboard to ensure that each row is checked off in the "face" category. It doesn't matter which boxes are checked until we're done with the examination, because we must complete the examination before anything else, but it should still give you clues as to what may be wrong.

Now we move on down to the hands. Take your own hand and lift the patient's arm, then release while the arm is lifted. The arm will fall either gracefully or abruptly. Repeat for the other arm. Then, use the mallet to test the reflexes at the elbows. Be careful not to click in the blue border around the scene, or you will exit and have to click on the arms and try all over again. The reflexes will either be a slight or exaggerated movement. Test for pain in the arms the same way you did for the face, though this time there are no bad places to stick it into.

The legs follow exactly the same procedure: lift and drop, bonk with the mallet, prick with the pin. When you're done, review the clipboard. You can always come back to it if you can't figure it out yet.

You can often figure out what's wrong from this alone. If there are zero abnormalities, the problem is simply a headache and you should prescribe aspirin. (Resist the urge to refer the patient to a psychiatrist for hypochondriasis.) If both pupils are abnormally dilated or constricted and don't respond to light but nothing else seems wrong, the patient has a drug problem and should be referred to a psychiatrist. If there is weakness in one limb, and nothing else, the problem is peripheral neuropathy: just have the patient exercise the extremity. For other cases you want to refer to the neurology book, the classroom, or if you're really lazy, the Diagnosis and Treatment section of this FAQ. If you can't figure it out and suspect something serious, you may have to order a major test; see the next section.

Be warned that migraines, infarctions, hysterical paralysis, and brain tumors(!) are annoyingly similar to each other (they tend to affect an entire side of the body). Pay careful attention to the symptoms. Infarctions and tumors will show up on major tests; the others will not. Hysteria is often simpler than migraines: no slurred speech and no aggravated reflexes.

It is often the case that you can figure out what's wrong long before the examination is complete. Complete the examination anyway, or Skelton will chew you out.

Major tests[]

"Major tests" refer to the MRI, CAT scan, X-ray, and Angiogram tests.

Hint: You don't need to order a major test unless one (and exactly one) pupil is abnormally dilated, unless you suspect a brain tumor, in which case both pupils will be normal.

Dr. Skelton advises you to order no more tests than necessary, and order tests only when the physical examination warrants it. We recommend starting with the angiogram: it'll show almost anything wrong. Turn it on and check both sides. Only one side will have a problem, so you can easily see if there is one by comparing the left image to the right; if they're different (aside from simply being mirrored images of each other), there's a problem. If you don't recognize the graph, go to the angiography lab and look at the diagrams and look for the one that exactly matches the one you saw (be careful: it may be a mirrored image). If there is no problem, you can try one of the other tests, but it's more likely that you misunderstood the nature of the physical examination data. Look at the data you gathered again and see how it matches up with the neurology book. Be very careful to note which side of the brain has the problem if there is one.

Don't bother with X-rays unless you're absolutely sure the patient has a subdural hematoma (the only thing they can show) and nothing shows up on the other major tests, but it's doubtful it would fail to show up elsewhere.

For infarction, prescribe therapy. Other problems will require the appropriate operation, which leads us to the real challenge of the game: performing surgery.

NOTE: Always, always pay attention to the patient's medical record before ordering an MRI or CAT scan. If the patient has a pacemaker, an MRI will cause it to fail and the patient will die. If the patient is "allergic to crab or other shellfish", do not order a CAT scan, because the patient will have an allergic reaction and die. Angiograms are always safe. X-Rays may pose a small danger; I'm not sure. Also, it seems the MRI and CAT scans in the game don't show which side the problem is on; a subdural hematoma on the left shows up the same as one on the right. This is not enough! You must know which side to operate on if there is a problem, however, if the major tests don't show which side the problem is on, your physical examination data should help you. Usually a problem in the left brain will cause problems mostly or only on the right side, and vice versa, but with some afflictions, they're on the same side; refer to the neurology book. But never resort to surgery unless at least one major test backs up your claim.

Diagnosis and treatment[]

Too lazy to use the in-game neurology book? Here's a quick rundown, but if the patient doesn't cleanly fit into one of these, refer to the book.

  • Headache: No physical symptoms, major tests shouldn't be ordered and they will all be normal. Prescribe aspirin.
  • Migraine: Speech slurred usually, one side paralyzed. The paralyzed side might report no pain, and reflexes on that side will be aggravated. WARNING: A migraine and a tumor have very similar symptoms. If there is no pain on one side, aggravated reflexes, and weakness in limbs on one side, order a major test such as an angiogram. Migraines will return normal on all tests; tumors will not. Prescribe codeine.
  • Cocaine addiction: All physical signs will be normal, except both eyes will be dilated (large) and won't respond to light. Major tests should not be ordered and will be normal. Refer to psychiatrist.
  • Morphine addiction: Same symptoms as cocaine, but pupils will be constricted (small) rather than dilated (large). Major tests should not be ordered and will be normal. Fatal if untreated. Refer to psychiatrist.
  • Hysterical paralysis: Paralyzed on one side (weakness in limbs). Speech will be normal, pain may or may not register normally, and reflexes will not be aggravated. Major tests should not be ordered and will be normal. Failure to prescribe correct treatment causes schizophrenia. Refer to psychiatrist.
  • Infarction: One pupil will be dilated and not respond to light. Paralysis will occur on the opposite side and pain will not be present there. A major test should be ordered and most will show the problem (X-rays won't); it does not matter to you which side the problem is on. Speech will be slurred if infarction is on left side. Prescribe physical therapy.
  • Neuropathy: One limb will be weakened; all other results normal. Major tests should not be ordered and will return normal. Exercise the extremity.

The last three require surgery:

  • Subdural hematoma: One pupil will be dilated and not respond to light. Eye tracking will be normal for both eyes. Speech may be slurred if hematoma is on the left side. Paralysis occurs in one side of the body but pain and reflexes will be normal. A major test must be ordered and should show the problem; Angiograms and X-rays will show which side, although physical examination data may help determine which side as well. Operate for subdural hematoma.
  • Brain tumor: Weakness will occur in arms or legs. Reflexes will be aggravated. Pupils are not constricted or dilated. Speech impaired if problem is on left side. Pain will not be present on the side opposite of the tumor. Major tests must be ordered and should show the problem (except X-rays); angiograms will show which side, although physical examination data may be used as well. Fatal if untreated. Operate for brain tumor.
  • Aneurysm: One pupil will be dilated on the opposite side of the aneurysm. This pupil will produce no light reaction and its eye will exhibit no tracking. Weakness of limbs may also be present on the opposite side. A major test must be ordered: angiograms work best and will show what side the problem is on. Other tests are less reliable, and X-rays will show nothing. Fatal if untreated. Operate for aneurysm.


Preparing for surgery[]

You might want to look into the cafeteria beforehand if you need a bit of comic relief.

Unless you're 100% certain of who your assistants are (for instance, if you just began the game, it's Schmidt and Helprin, an excellent team for subdural hematoma operations), it's best to check if you have the right people for the job. Or if your assistants got into a fight last time, you'll definitely want to review who you choose this time!

Other than review your notes, there's not much you can do but brace yourself.

Choosing your assistants[]

Your eyes and ears are your best assistants in surgery, especially in Nightmare Mode, when you'll probably see things are wrong before your assistants do if you're paying enough attention. Regardless, you should pick your assistants carefully, just in case your attentiveness slips, or if you become so focused on what you're doing that you neglect the patient's health. Having the right assistants can sometimes mean the difference between getting a helpful response, or just getting "Something is not right here, doctor...", although the latter can still be helpful if you can quickly see what's wrong. Regardless, never, ever rely on your assistants: they won't see everything every time before it's too late.

  • Norah Griffin: Specializes in aneurysms; dislikes Schmidt. For an aneurysm operation, it's a tossup between her and Schmidt. I'd take Griffin if you're not used to aneurysm operations; Schmidt once they become routine for you.
  • Emil Kahn: Monitors respiration and blood pressure; dislikes Brandt. A general-purpose guy. He's useful if you don't need Brandt. Helprin might be better if you don't use the two together.
  • Heidi Schmidt: Monitors EKG and respiration; dislikes Griffin. Schmidt is a must-have (unless you need Griffin) if you're playing without sound and can't hear the EKG. You should try to watch it as much as possible and not rely on her to catch what's wrong, but you can never be too careful. Her value is somewhat reduced if you actually have sound; Kahn might help you out more in that situation. It's your call.
  • Craig Helprin: General-purpose. This guy's good to have: he'll keep an eye on things. Sometimes others will yell at him, but only because he's so concerned for the safety of the patient (not to mention the staff). Usually, this should not be a problem.
  • Jim Slade: General-purpose; has trouble with women (Griffin, Schmidt, Brandt). He specializes in typical operating procedures such as incision, retraction, and drilling. Every operation requires incision and drilling, giving him some consideration for all operations, but he won't get along well with either Griffin or Brandt, your aneurysm and tumor specialists accordingly, so don't take him for those until you're used to such operations and don't need Griffin or Brandt.
  • Elizabeth Brandt: Specializes in brain tumors; dislikes Kahn. Got a brain tumor and don't know what to do? Call in Brandt. Otherwise, you're just wasting her—and your own—time.

If you're lazy, here's some general guidelines.

Good teams in general:

  • Schmidt and Helprin
  • Kahn and Helprin
  • Kahn and Slade
  • Helprin and Slade

Good teams for brain tumors:

  • Schmidt and Brandt
  • Helprin and Brandt

Good teams for aneurysms:

  • Griffin and Kahn
  • Griffin and Helprin

Bad teams:

  • Griffin and Schmidt (conflict)
  • Griffin and Brandt (specialize in different operations)
  • Kahn and Brandt (conflict)
  • Griffin and Slade (conflict)
  • Schmidt and Slade (conflict)
  • Slade and Brandt (conflict)

Surgical tools[]

This is intended as a reference, and to increase the bulk of the FAQ to make it look better than it is. ;) It's not too necessary to print out: you can figure out what most things are by right-clicking them. But at least read it if you're not an experienced neurosurgeon, and if you are, you wouldn't be reading this unless you're bored anyway. :)

Some tools are not available in the subdural hematoma operation, but you won't need them.

Bottom tray[]

  • Bone wax: Used to clean away blood and stop bleeding in specific situations. See the walkthroughs to see what those situations are. Found on the bottom tray: it's a yellow block.
  • Dissector: Just below the scalpel. It is used when separating the dura from the bone flap in brain tumor and aneurysm operations. It looks like a little screwdriver, which it isn't. ;)
  • Drill: Used for drilling holes. It looks really big and bulky when you pick it up. the pitch of the drill will change when you need to let go. If you have no sound, watch closely and stop when the rounded depression becomes a small cylindrical hole. Drill too much and you'll penetrate the brain, with obvious consequences. Use the drill at the wrong time and you'll be rightly ejected from the operating room. (See "drill bits" below.)
  • Electrocauterizer: Used to stop bleeding in specific situations.
  • Irrigator: Also called "eyedropper" or "dropper", this is used to drip water on the skull (to make it safe to drill burr holes), or on the dura mater or brain (to keep the brain from drying out).
  • Metal ribbon: Used to prevent puncturing the brain with the fine bit.
  • Rainey's clips: Used to stop bleeders when incising the scalp. (The correct term is actually Raney clips, but the game consistently uses the spelling Rainey.)
  • Scalpel: Looks like a knife, which it is. Used for cutting incisions. If you slip while holding the knife, you will be warned (and your performance may or may not be considered imperfect depending on what you're using the scalpel for; you're allowed to slip a little when incising the scalp). If you misuse it outright, you'll be thrown out of the Operating Room and somebody else will have to do the operation for you, which of course is marked as a failure.
  • Suction: Used in hematoma operations to suck out the hematoma. Refer to the subdural hematoma operation section for details.
Drill bits[]
  • Trephine bit: This is the bit that is on the drill when you first enter the Operating Room (and it's always the first one you need). This is the only drill bit available in subdural hematoma operations. It drills burr holes in the skull. You must be irrigating at the drilling point while you're drilling, or the brain will overheat. It looks vaguely like a hook, but you'll never need to switch back to it after putting another bit on the drill (unless you were screwing around, which you shouldn't be doing).
  • Fine bit: Used to drill small suture holes in the skull. The bit looks like a small needle.
  • Bone saw bit: Used to saw between burr holes in the skull. It looks appropriately like a saw.
  • Smoothing bit: Used to grind away the sphenoid ridge. It looks ball-shaped, or diamond-shaped depending on how you perceive it.

Middle tray[]

IV bottles[]

Note that you can refill a bottle by loading it in (if it isn't already), then reloading it with the same thing. But also be warned that you have a limited supply of each kind of bottle!

  • B: Blood. It's helpfully colored red to remind you. Load it in the IV before doing anything that will cause a lot of bleeding, like using the scalpel on the scalp. Can also rectify falling blood pressure, but use dopamine in emergencies (see Syringes).
  • G: Glucose. It's colored purple in VGA mode, or light blue in EGA mode. This is blood sugar. Keep the drip going with glucose if you don't need blood or mannitol. It's loaded in the IV at the beginning of the operation.
  • M: Mannitol. It's colored yellow, which will probably remind you of urine, which helps you remember that you need to use it when the urine bag is low. Don't use it when urine output is normal.
  • S: Saline. It's light blue in VGA mode, or gray in EGA mode, and it contains blood salt. If you run out of glucose, which is possible if you're a slowpoke, use this instead. It can also be used to fix blood pressure, however, blood is better if you still have it (you should). If pressure doesn't go back up, try dopamine.
  • A: Atropine. Used to correct bradycardia; fatal in other situations. You get multiple shots. NOTE: If you are not using a mouse or joystick, you can press A to inject Atropine. Otherwise, use the mouse or joystick.
  • B: Antibiotics. Injected anytime before you make your first incision; see Opening Procedure. You only get one shot, but it's all you need.
  • D: Dopamine. If blood pressure is rapidly falling and the patient isn't bleeding, inject this. If the patient is bleeding, putting blood in the IV is a better idea; if it doesn't help, or if your IV is tied up with Mannitol, then inject dopamine. You only get one shot.
  • L: Lidocaine. Used to correct PVC; fatal in other situations. You get multiple shots. NOTE: If you are not using a mouse or joystick, you can press L to inject lidocaine. Otherwise, use the mouse or joystick.
  • N: Nitroprusside. Induces low blood pressure (hypotension); used after opening the skull in brain tumor and aneurysm operations. Without it, excessive bleeding will occur and cause death. Of course, you shouldn't inject it if you don't need it. You get one shot.

Top tray[]

  • Cotton swab: Used to wipe away blood. You don't need to do this except when you can't find the center of a bleeder because there's so much blood (hopefully this won't occur too often!)
  • Drain: Used only in subdural hematoma operations; placed in the burr hole after the hematoma is removed. It appears on the tray in other operations, but is not used. The drain should be sutured to the scalp after being placed.
  • Drape: Used to drape the head; see Opening Procedure.
  • Gauze: Appears only in brain tumor and aneurysm operations. Used on the scalp flap before pulling back the dura flap.
  • Gloves: Pick this up after picking up the soap. Your hand will change color. It serves no purpose in the game except as a formal step of surgery, but you can't omit doing this. Your gloved hand will also be used to turn the patient's head, to pull up the scalp flap, and to feel the dura mater.
  • Iodine: Used as an antiseptic in the opening procedure.
  • Soap: Picking this up is the very first step of surgery. It serves no use except to clean your hands, but you can't begin the operation before doing this.
  • Staple gun: The very last tool you use in any operation. Used to shut the scalp flap; several are needed.
  • Sutures: Used to stitch things. Don't use these to stitch the scalp shut when you're done; use the staple gun for that. Use stitches at all other times you need to secure something.


The ultrascan is only used in brain tumor operations to locate the tumor. To open the ultrascan display, press the Ultrascan button between the exit button and the microscope button.

  • Ultrascan: Used to scan parts of the brain. See the section "Brain Tumor Operation" for details.


The microscope is used in tumor and aneurysm operations. It will work differently depending on the operation you are performing; see the steps of the appropriate operation for details.

  • Irrigator: Same as the irrigation tool in the bottom tray.
  • Suction: Similar to the suction found in the top tray, but this is much smaller and more precise. This is used to suck out a brain tumor, and any grey matter necessary to get to it.


These are things that are not in your tray that you can use or must keep your eye on.

  • Blood pressure monitor (B.P.): Shows blood pressure; if the numbers fall below 110/70, you must take a course of action to rectify the situation; see Possible Complications and Remedies.
  • Carbon dioxide monitor (PCO2): Monitors carbon dioxide; see respirator. If this level goes above 45 or below 13, the patient will die.
  • Exit button: Don't click this if you want to be a responsible doctor.
  • IV bottle: The bottle with the liquid at the bottom of the screen. See "IV Bottles" in Tools - Middle tray.
  • Respirator: Leave it on low unless the carbon dioxide reading is above 32; then switch to high. If it's below 32, switch it to low, otherwise, the patient will hyperventilate and die.
  • Spinal tap: Directly to the right of the IV bottle. Opened to relax the brain when it is tight. After doing so, one must feel the brain, then close the spinal tap. If you keep it open for about 3 minutes, all the cerebrospinal fluid will leak out and the patient will die.
  • Time: Shows how long you've been working. Never really needed except when irrigating the brain: the brain must be irrigated at least once every five minutes or it will dry out.
  • Urine bag: A bag of you-know-what. It acts more like a meter: if it's full and it's yellow from bottom to top, with only a tiny sliver of empty space at the top, everything's peachy. If it's falling, load mannitol in the IV—now! Don't let it empty or your patient may go into shock due to renal failure and die.

Possible complications and remedies[]

You may want to print out this section. You won't encounter complications too often... unless you're in Nightmare Mode. Whatever your difficulty settings, things can and probably will go wrong at least once, and you'll need to know what to, at least if you really do care about your patient.

The EKG monitors the heartbeat. If you have sound on (hopefully you do; if you don't, you better watch the EKG display!), it will give a distinct, high beep when it reaches the middle of the graph. The graph should have a large peak in the middle with a small dip afterwards. This means the heart is functioning normally.

If it is flatlined except for two blips, the heart is slowing down, a condition called bradycardia (or brachycardia). The sound of the EKG will also change. Inject atropine immediately. Failure to do so will result in death. Injecting it at any other time will also result in death.

If the EKG's trace is a single valley, that is, roughly a V shape, the heart has premature ventricular contractions (PVCs). Again the sound of the EKG will change. Inject lidocaine immediately. Failure to do so will result in death. Injecting it at any other time will also result in death. Remember: atropine for bradycardia (or "A for B", if that helps you remember), lidocaine for PVCs.

There are no other traces that will appear on the EKG, except of course for the squiggly line, which indicates ventricular fibrillation and leads to the flatline, which means your patient is taking a trip to the morgue. Technically, a flatline indicates cardiac arrest, which in real life can be rectified (rarely, but possible), but in the game, it cannot. If you see the squiggly line, or hear the EKG beeping rapidly, don't bother panicking: it's already too late. The doctor will give you a good scolding (be sure to pay attention!), and you'd better hope you don't repeat your mistake.

If you want to avoid a flatline (and if you don't, stop playing the game), you'll want to look out for these things as well:

  • Never let the IV go dry. Your eye will probably naturally see the level of fluid in the IV as you work, so you shouldn't have a problem. Ideally you want glucose in the IV, or blood when cutting, but sometimes you need to load mannitol for low urine output. If you want glucose but have used it all, try saline.
  • Carbon dioxide level should be 32. If it rises above, switch it to high (do not let it reach 45!); when it reaches 32 or below (and before it reaches 17), switch it to low, which is the normal setting. Otherwise, no touchy. If it's on the wrong setting for too long, you guessed it: he's gonna die.
  • Blood pressure should be 110/70. (EXCEPTION: it can and will be much lower after injecting Nitroprusside, in which case it will fall to 50/30.) The first number is called systolic pressure, and the second is diastolic pressure. Both will fall at the same time, so you only have to pay attention to one number. It will fall if the patient is bleeding, unless blood is loaded in the IV. If it falls below 110/70, load blood in the IV if mannitol isn't tying it up. If you don't have blood or it proves ineffective, try saline. If this fixes nothing and it's falling fast, do not let the first number fall to about 83: if it's sustained for more than a few seconds, the patient will die. If it's falling into the 80s and isn't going back up, you have an emergency, and you must inject dopamine—NOW! If you already used up your shot... well, keep blood or saline in the IV and pray.
  • If the patient is bleeding, which he will be in various stages of the procedure, take the appropriate action. Bleeding is not abnormal, but if you don't act quickly, the patient will die, and sooner than you'd think. The appropriate action might be applying Rainey's clips, or bone waxing, or cauterizing, so check the walkthrough to know what to do. If he bleeds too much, he will die, and he'll probably die sooner than you would expect, so don't dilly-dally.
  • The urine bag is that yellow bag you see between the patient's head (or the internal parts thereof) and the tray displays. Actually, this acts more like a meter of urine output: if it's full and yellow, everything's okay. If it's emptying, put some mannitol in the IV. If you don't, the patient will go into shock due to renal failure. If you're cutting and need blood in the IV, then stop cutting, fix up all bleeders, and wait for the bag to fill, while making sure nothing else goes wrong. Whatever the situation, don't use mannitol when the bag is full: reload it with whatever you were using before, or whatever you need next.
  • If the brain or dura mater is exposed, it will dry out if you fail to irrigate it, and we don't have to tell you what happens in that case. Just use the eyedropper to irrigate it once every minute or so. It can wait up to five minutes, but don't push your luck: you're supposed to be saving the patient's life, not ending it!

Opening procedure[]

Before you begin operating, be sure you're aware of the operational hazards. Do not rely on your assistants to tell you something is wrong before you look up the answer in this guide: keep an eye on everything at all times!

Every procedure begins the same way:

1. Soap up. Take out the top tray and pick up the soap. It should disappear.

2. Don gloves. Just click them; your hand should change color appropriately.

If you try to omit these steps, you'll get yelled at. Just do them.

3. Turn head to the correct side. Just click the head and drag it. If you don't know which side is the correct side, you should have figured that out before ever ordering your patient into the operating room! You may be confused as to which way to turn the head, even if you know which side of the brain the problem is on. The way the patient is oriented, "your left" and "the patient's left" are the same thing: if the patient's problem is on the left side of the brain, click and drag the head to the right, so that the left side of the head is facing you. (If that sentence confuses you, ignore it. Just remember to drag in the opposite direction of the problem.)

4. Completely cover the patient's scalp and forehead with iodine. Be thorough, but not messy. Being messy won't mean failure, but it'll mean you'll get yelled at and your performance won't be considered perfect. Keep it above eye level, definitely. If you didn't get enough on there, one of your assistants will probably object.

5. Inject antibiotics (the 'B' syringe; not the A syringe!!). If you don't, you'll endanger the health or even the life of the patient without good reason. You only get one shot of antibiotics, but one shot is all you need.

6. Pick up the drape and place it on the head.

7. You should see an incision line. Don't cut just yet: put blood (the red bottle marked B) in the IV. If the situation demands Mannitol be loaded instead, wait for the urine bag to fill before proceeding.

8. Cut along the incision line. Be careful, but not too slow: if the patient bleeds too much, he will die. You'll want to stop when you've cut about 1/4 of the way (as you get better, you can go to about 1/3, but do not cut too much just yet or you're just asking for fatal loss of blood). If you're using a keyboard, you'll want to stop when you see about four to eight bleeders (the ever-expanding red circles of blood).

9. Place Rainey's clips over the bleeders. If a bleeder turns from bright red to dark red (can be seen with VGA graphics only), you're in big trouble: that means that area is getting saturated with blood and it needs a clip now. It shouldn't happen if you're careful and quick. If you see this, it's a sign you need to be less reckless next time. You'll be done when you have 20 clips (10 pairs) along the incision line.

10. Repeat 8 and 9 until you've got Rainey's clips all along the incision line. Take a deep breath, double-check the patient's status (you have been watching everything the whole time, right?), and touch the scalp with the hand. This will lift the flap that you made. This will probably make you slightly queasy upon first seeing it, but you'll quickly realize it's just simple computer graphics and nothing to be afraid of.

11. If this is a subdural hematoma operation and you don't see a crack, congratulations: you've either turned the head the wrong way, or the patient has no subdural hematoma, and you'll be ejected from the operation due to your incompetence. Otherwise, release the mouse button, take the fish hooks, and use them on the scalp flap to hold it up.

If you're doing a subdural hematoma operation, read the following section, otherwise, jump to the section called Opening the Skull.

Subdural hematoma operation[]

Read the opening procedure section and follow all the steps. This picks up where it left off:

1. Irrigate the center of the fracture using the eyedropper. If there's no fracture, you either botched the operation or are in in the wrong section of this guide. :) You should see it dripping water. Failure to do this will cause the brain to overheat when you drill, and the result is Mr. or Mrs. Deceased. Don't remove the eyedropper until step 4.

Hem fracture.png

2. Take the drill. Be careful with this thing, now! Drill until the pitch of the sound (and the shape of the hole) changes, then immediately release. Drill too far and you'll kill the patient! Be sure to keep your hand steady.

Hem drill.png

3. Take the bone wax and use it to clean up the blood. This also stops the bleeding.

4. You don't need the irrigation now that the hole's in place; put the eyedropper back in the tray.

5. Take the scalpel and cut up the hole you made until it's all red. You don't have to run it over every single pixel, just try to get most of it. (If you slip with the scalpel, nothing bad will happen, but your performance will be considered imperfect.) This red stuff is clotted blood. Guess what? This is the hematoma! If you got this far, you shouldn't have any big problems, but don't take your eyes or ears off the EKG and other readings!

Hem cut.png

6. Suction out the gook using the suction tool. Click and hold the mouse button in the hole. After a second or two, you should see red stuff being suctioned away; when it turns white, immediately release the button. The color of the stuff in the hole should change. You will probably see a few pixels of red still in there. Don't worry about them. Be careful when putting the suction back on the tray. If you're not careful, you may miss and the suction will activate. This won't cause anything bad to happen, but Skelton won't like it and your performance will be considered imperfect...

Hem suction.png

7. Now you need to set up the drain tube. Place the end into the hole. You'll see this drain protruding from under the scalp flap when performing closing procedures. Don't worry, that is exactly what you're supposed to see.

Hem drain1.png Hem drain2.png

8. You need to stitch the drain into place. Take the suture and stitch it to the scalp, not the bone or the drape, but the peach-colored flesh below where you cut at the start of surgery. If you do it right, you'll see a black line placed across the drain. Failure to do this won't be fatal or anything, but Skelton won't like it if you forget, so don't forget.

Hem drain3.png

You got the hematoma! But you're not done just yet. Jump to the closing procedure section.

Opening the skull and the dura mater[]

If you're reading this, you should be doing a brain tumor or an aneurysm operation, and you just placed the scalp flap on the fish hooks. If you're not that far along yet, read and follow the opening procedure. Both of these are far more complicated than the subdural hematoma operation, making the operation much longer, and more things can go wrong. If you need just a little more discomfort, be warned that this is a tricky bit. Brace yourself, and whatever you do, don't give up.

The first step is to create a diamond-shape bone flap in the skull. You must bore four holes in that diamond shape, but don't grab your drill just yet. Just read for now until we get to step 1. The four burr holes will be:

  1. The extreme right
  2. The top
  3. The extreme left
  4. The bottom

You will want to make all the burr holes as equidistant as possible, that is, the distance between any two holes should be the same length. Put the irrigator to the extreme right (or whatever hole you're working on now) and make sure it's dripping properly. You'll also want them to be as far apart as possible. You don't have a whole lot of room to work with, so you want as much of that precious little space you can get.

1. Irrigate at the point you want to drill. If you're not irrigating while drilling, the patient's brain will overheat.

2. Next, drill a small burr hole with the drill at the place you're irrigating. If you have sound, hold the mouse button until the sound changes; if you have no sound, just take it easy and stop when see a cylindrical hole filled with dark gray. Don't drill too deep or you'll penetrate the brain, and we know what happens then, don't we?

By the way, we recommend using the ENTER key on your keyboard (on the numeric keypad is fine if you wish) to drill, even if you use the mouse. There are two reasons: one, at least some versions of DosBox are buggy and the drill won't stop when you release it if you use the mouse. Two, if you use your mouse hand to press ENTER, that means you have no hand on the mouse, and therefore it is impossible to skid the drill by having your hand slip.

3. Repeat steps 1 and 2 until you have four holes in a diamond shape.

Ld2 drill1.png Ld2 drill2.png

4. Take the dissector (it's just below the scalpel) and click on each burr hole once. Don't forget to do this! If you fail to do it, Bad Things will happen and you'll be yanked from the operation.

Ld2 diss.png

5. Place the saw bit on the drill (which looks, appropriately enough, like a tiny saw on a drill bit). Click and drag to connect the four burr holes. This is a bit tricky: try to keep your hand steady in a straight line. If you get slightly off and are admonished, always continue from your last cut. When you're done, put the drill back on the tray.

Ld2 saw1.png Ld2 saw2.png

6. You may want to make sure blood is in the IV. Use your hand to pick up and pull out the diamond-shape bone flap you have created. Drag it to the lower left of the operating table and place it there to keep it out of your way.

7. You now have lots of bleeders!! (This is why you may want blood in the IV). Bone-wax all the small bleeders around the rim of the area you created. If you're in Nightmare Mode, prepare to act fast! Note that, unlike when you made the burr holes, bone wax will not wipe away any blood. This will be the case for the rest of the operation, too. Use cotton swabs to wipe away blood instead.

8. Quickly use the electrocauterizer to cauterize the remaining bleeders. Don't move to the next step until all bleeding is stopped (wait a few seconds to make sure, and while you do, double-check that the patient is in stable condition). Remember: bone-wax the bleeders on the rim; cauterize the others. (If bone-wax just won't make a bleeder go away, try cauterizing, and vice versa.) When you think you've got them all, wipe all blood away with a cotton swab, and wait five to ten seconds to make sure. You may also want to use the cotton swab to identify the center of a bleeder if there is too much blood in that area.

Ld2 saw3.png

9. Now you must clean the edges of the skull bone and remove the dark-grey sphenoid ridge (you'll know what it is when you see it). Place the ball-shaped grinder drill head on the drill. Drag it along the exposed bone edge and the sphenoid ridge. Be sure to remove the sphenoid ridge entirely. Using the drill where there is no sphenoid ridge won't hurt, so long as you have the drill in the right area (don't try it on the poor sap's flesh...). If DosBox is being cranky and the drill won't stop when you release the mouse button, press ENTER to make it stop. Strangely, bleeders will not appear until you have all of the bone edges gone. Be sure you get these bleeders to appear, because if you try to incise the dura while the edges are not perfectly clear, you will tear the dura.

NOTE: if this is an aneurysm operation, you must be extremely thorough in removing the ridge. Even if it looks like you got it all, run the drill over the area a bit more—sometimes you have a fragment left that's too small to see, but it gets in the way when you go under the microscope later.

Ld2 ridge1.png Ld2 ridge2.png

10. Bone-wax the bleeders. Be quick! Don't bother with cauterizing. When you think you've gotten everything, wipe all blood away with a cotton swab and wait five to ten seconds to make sure. Check all vital signs.

11. The layer that's under where the bone flap was is called the dura mater. This is not, technically, part of the brain, but for our intents and purposes, it may as well be. You have to irrigate it every minute or so or it will dry out (this includes other layers when we get to them). Start by irrigating the dura mater right now for a couple of seconds.

12. We're going to open that dura mater up and get at the brain! Take a deep breath and double-check that all vital signs are normal. You have been watching them the whole time, haven't you?

13. Inject nitroprusside (N). (It's actually possible to do this earlier in the operation, such as before opening the bone flap.) The blood pressure will drop to a state of hypotension. Do not inject dopamine; low blood pressure is exactly what you want right now to prevent excessive bleeding. If the blood pressure is too high when you begin cutting, the patient will die very quickly. Likewise, do not have blood in the IV; glucose would be good here. Avoid saline and, as always, only use mannitol to fix a low urine bag. Speaking of which, it may drop to about 2/3 or even 1/2 full; don't load mannitol unless it keeps falling.

14. Here's the tricky part. You must drill small suture holes in the skull, which we'll need later in order to put the bone flap back in when we close everything up. First, pick up the metal ribbon. This will be used to protect the dura mater and the brain from the drill. When you place the ribbon, it should be wedged between the skull bone and the dura mater. Place it under the bone edge running from the top to the left.

Ld2 suture holes1.png

15. Place the needle-shaped head on the drill. Put a hole in the middle of the bone edge, as close as you can to the edge while getting the entire hole on the skull bone itself. Make sure that the area you're drilling has the ribbon underneath it!! Also, if you try to put the hole in the wrong place, you will puncture the brain regardless of where the ribbon is, so be as exact as you can in its placement.

Ld2 suture holes2.png

16. Repeat 13 and 14 for the other three edges: place ribbon, then drill.

17. Remember the bone flap that we removed? We need to put suture holes in that, too, but we don't need the ribbon. Put four holes in the center of each edge of it, and one hole in the exact center. You may now pick up the bone flap and place it in the tray to keep it out of your way.

NOTE: This step can be done during the closing procedure instead; however, the holes you created in steps 14-16 cannot and must be done now.

18. Take the sutures and insert sutures in each hole you created. (But not the holes in the bone flap, which should already be in the tray.) Put one more in the exact center of the dura mater (the place the puncture hole in the bone flap would go if we were to drop the bone flap in now). The sutures are needed to keep the dura from tearing when you begin your incision. Later, we'll also thread the sutures through these holes and the holes in the bone flap, stitching everything together.

Ld2 suture holes3.png

19. Take your empty hand and click it on the dura. You will be told if it is too tight. If it is, open the spinal tap and click on the dura again. This should relax it, after which you must close the spinal tap.

20. You must now incise the dura. Systolic blood pressure (the first number) should be around 50-60 by now, thanks to the nitroprusside, and it will fall to 50. Click a little to the left of the top corner, then drag the mouse in a counterclockwise diamond, hugging the bone edge. Don't try to incise more than half the dura at a time, because it's very easy to end up with a fatal loss of blood here. Also be sure to stop if you see too many bleeders. Do not connect the incision into a full diamond. Doing so will disconnect the tissue and it will die, which is a Bad Thing because this very tissue is protecting the brain. Therefore, you should leave a small amount of space between the starting and ending points of the near-complete diamond. As you make your incision, be sure to hug the bone as close as you can, or your dura flap may be too small and you'll have to abort the operation.

Ld2 cut1.png

21. As you may have guessed, there are bleeders to attend to. Cauterize them.

22. Take the gauze and click on the scalp flap. (Remember when we pulled that back and put it on the fish hooks? Feels like ages ago!) We're going to pull our makeshift dura flap (yes, yet another flap!) and put it against this gauze to keep it moisturized. Otherwise, the tissue will dry out and die.

Ld2 cut2.png

23. Click the dura flap with your empty hand. It should fold up into the gauze. Don't get too grossed out!

You should now be looking at the exposed brain. (Actually, you're looking at the arachnoid membrane, but whatever.) You may finally look up the procedure specific to your operation. Whew! Be sure that the patient is in stable condition, and irrigate the brain about every minute!

Brain tumor operation[]

If you're reading this, things could be worse: you could be fixing up an aneurysm. This still ain't a piece of cake, though. You should have just finished opening up the dura flap and are looking at the exposed brain.

1. Click the ultrascan button. It's just to the left of the big EXIT button (the one you should never need), and has a picture of waves coming down from a box attached to a cable. The tray area will now be covered by an ultrasound display.

NOTE: When in ultrascan mode, you cannot access the tools in the tray. If an emergency develops or you need a tool for some other reason (e.g., to irrigate the brain), turn off ultrascan, then turn it back on when you're done.

2. Pick up the sensor at the bottom-right of this ultrascan display. Click and hold over the exposed brain. If you're lucky, you'll find the tumor here (it's a circular white blot), and when you do you can go to the next step now. If you didn't find the tumor, it's (hopefully!) on another layer. Put the sensor back and click the top right button in the ultrascan display. The display will change color. Use the sensor to find it again. If you did, go to the next step now. If you didn't, click the button again to get to the third layer, and repeat the sensor thing all over again. If you still get nothing, irrigate the brain (you should be doing it every minute!), then double-check each layer all over again. If there's definitely nothing there, you either misdiagnosed or turned the head the wrong way, and must now abort the operation with the big EXIT button you should never have to click.

Ld2 scan.png

3. Remember which layer you found the tumor on; you'll need the info soon. Also note the X and Y coordinates of the center of the tumor. (You don't have to get the dead center, but get as close to the center as you can.) The top coordinate is X and the bottom one is Y. Turn off the ultrascan by clicking on the ultrascan display.

4. Click the microscope button (between the ultrascan button and the respirator switch). Click on the arrow buttons until the X and Y coordinates match the ones you got from the ultrascan. You don't have to pinpoint it, but you should be very close. The top scale shows the X coordinate and the right one shows the Y coordinate. You're still irrigating, too, aren't you?

Ld2 micro1.png

5. You need to suction down to the layer the tumor is on to get rid of it. Take the suction tool and suction the layer you see under the microscope. A small hole will appear, which will change color with each click. If the tumor is on layer one, click once; if it's on layer two, click twice; if it's on layer 3, click three times. You should see a solid black spot after clicking the appropriate number of times. This black spot is a part of the tumor. The tumor will be much bigger than the suction hole, so don't suction it out just yet: keep suctioning around the area, exposing more black tumor matter, until you see the entire tumor surrounded by healthy matter on the same layer. Don't stop suctioning around it until you clearly see it completely surrounded by healthy tissue; if you fail to remove a tiny bit of it, your operation will be considered a complete failure.

Ld2 micro2.png Ld2 micro3.png

By the way, if you didn't find the tumor here, try and find it again on the ultrascan: don't keep digging in the wrong place, or you will be thrown out very quickly.

6. Now that you see the entire tumor, just suction it out. Be careful, though: you don't want to suction out too much healthy brain matter! Be sure you got every little bit of the tumor, or Skelton won't be happy...and neither will the patient!

Ld2 micro4.png

That's it! Put the suction on the tray, click the microscope button to close the view, and jump to the closing procedure.

Aneurysm operation[]

Curse your luck for having to deal with one of these, take a deep breath, and brace yourself. If you're in the right place, you've just moved the dura flap into the gauze on the scalp flap. You will quickly learn the origin of the phrase surgical precision!

1. Click the microscope button. It's right next to the respirator switch. You'll see a microscopic view. Cool! (Note that this will be very different from the microscopic view in a brain tumor operation.)

2. You should see a line running down the center. Or you might see a bunch of bone in the way; if you do, you didn't remove enough of the sphenoid ridge. If this is the case, click the microscope button again to return to the normal view. Put the dura flap back down. Use the grinder (remember, the ball-shaped one) and grind away the entire area of the sphenoid ridge. Put the dura flap back up, and try the microscope view again. Repeat this until you see the vertical line going clear down the center in the microscopic view. You will still see a bit of bone, but it's no problem if it's out of your way.

3. The line is the Sylvian fissure (the game calls it "Sylvan", but "Sylvian" is the proper term). Pick up the tweezers (or "microforceps") and click to the left of the fissure.

4. Pick up the microscissors (the arachnoid knife works, too). Move them to a position near the tweezers, drag along the Sylvian fissure, and release. Be extremely careful here: if you miss the fissure, you will slice the patient's brain and the patient will die. You're not allowed to make mistakes this time. Replace the scissors and the tweezers. The cut should look as illustrated below:

Cut in sylvan fissure

5. Take a retractor (strip of metal with a curl at the end). Click on the brain lobe to the left of the fissure. Drag it out about a quarter inch, then place a retractor on the other lobe, and drag that one out about a quarter inch. You'll see a small bunch of tubes - these are blood vessels you need to cut. There should be about three. Do not pull the lobes too far apart, or the patient will suffer permanent brain damage.

3 vessels.png

6. Take the microscissors and cut the vessels.

7. Cauterize bleeders. By the way, you're still irrigating, right?

8. Before you continue retracting, take a look at the pictures below. Thanks to an err.. volunteer patient we can compare healthy arteries to the "thickening" caused by an aneurysm:

Healthy.png Aneurysm.png

Underneath the saddle-like structure on the right image is the aneurysm. Continue retracting—carefully—until the second arachnoid membrane (refer to the image above) is visible. It will be a dark area to one side of the large artery. NOTE: These images represent the right side of the brain, on the left side you would see this mirrored

9. Thanks to Dr. Skelton's post-op slides, we can see the area where we should make the next incision ("You should have cut THERE doctor"):


Cut with the microscissors as before. As long as you stay within the area you should be fine (one might even get away with carving his own initials in the patient's brain, but who'd do such a thing), nevertheless Be careful! The carotid artery and the optic nerve are just beneath. You don't want to kill or blind the patient, do you?

A clean cut through the second membrane

10. You can now continue retracting the lobe; in this case you'd want to use the right retractor until the thickening is fully exposed. Use the microscope controls (lower left in the image) to center your view.

NOTE: When using DOSBox - If you are holding down the left click button with the mouse and moving it but for some reason the lobe doesn't want to retract, you may need to hold down both the Enter key and the directional arrow key in the direction you wish to retract instead.


11. This is the area we've been trying to get at the whole time! Use the rhoton dissector (the black tool with the teardrop at the end) to click in the middle of the highlighted area (refer to the above image) and drag a few milimeters down. Do this twice. This will retract the two layers, revealing... the aneurysm, as shown below:


12. The aneurysm is the artery with the forked ball (or in other words, the squiggly part in the middle). Take the rhoton hook (the black tool with the bend on the end). Move it to this ball and click, hooking it over veins crossing the aneurysm. Click and drag the veins down so they're no longer in the way. Oh, you better still be irrigating as needed!


13. Take the rhoton dissector and click on the ball again.

14. Take the rhoton hook and drag across the tissue under the ball. We're trying to elevate the aneurysm. Repeat until you get it right if you don't on the first try.


15. Apply the aneurysm clip to the neck of the dilation.


16. Remove the retractors.

Whew! Go to the closing procedure! But don't get too hasty. Do you want to throw away all that hard work?

Closing procedure[]

As all operations in the game open the same way, so do they close. There is little to worry about now, but keep watching the EKG and the other status indicators just in case something goes wrong. You'd hate to lose all that work, wouldn't you?

For brain tumor and aneurysm operations:

1. Close the dura flap.

2. Stitch it shut with the suture tool. Put down at least ten stitches. Do not even consider using the staple gun instead.

3. Pick up the bone flap from the tray, and drop it in where you had originally taken it from.

4. Click each of the small sutures sticking up from the suture holes and the center hole using your gloved hand. This attaches the flap to the skull using the sutures you so carefully placed earlier. If you get the message "can't reach the bone flap suture hole", guess what: you messed up earlier when putting holes in the skull and bone flap, and it's too late to do anything about it now. If so, continue anyway; it's still a successful operation if you didn't make any other major mistakes, but you won't get in the Hall of Fame.

5. Put the gauze back in the tray.

From here, the closing of each operation is the same. If you are performing a subdural hematoma operation, you've just placed and sutured the drain, and will begin closing procedures from here.

6. Click the fish hooks. The scalp flap will fall back down.

7. Remove the Rainey's clips one at a time, placing them back on the tray.

8. Take the staple gun and put a few staples on the incision line. Be careful: if you miss slightly, you will get a warning, and if your performance was perfect so far, it ain't perfect now. When you've put down ten staples or so (staples that missed don't count), you will have successfully completed the operation, and the game will automatically take you out of the operating room (for once, you're being kicked out because you did it right!). Dr. Skelton will lecture you on any points that need refinement. If you did it perfectly, you will get your place on the honor roll (Hall of Fame)!

Secrets, extras, and fun stuff[]

There's an ELIZA program you can find hidden in the game. ELIZA was a computer program simulating a psychotheraptist that basically faked its way through demonstrating that it had AI. It would never pass the Turing test, that is, it wasn't so good that it would reliably be mistaken for a human. However, it did appear to demonstrate complex behavior, though it was all smoke and mirrors, so to speak.

ELIZA was designed by Joseph Weizenbaum, and the program simulated a psychotherapist. It would interact with the user mainly by recognizing patterns in the user's statements, and rephrasing them as questions, and similar tricks.

You, too, can play with such a program: go to your desk in your office, then click the computer monitor. There you go! When you get bored, just click the monitor's POWER button to go back to your desk.

SECRET: You can type "DEBUG" to the computer and get a useless list of numbers. This seems to have been used for tech support, but may have been used only by the programmers.

SECRET: You can type "CREDITS" to the computer to see the credits to the game!

There's another semi-secret regarding computers: look at the one on Dr. Skelton's desk. (Dr. Skelton's office is to next to yours, to the left.) The monitor will have a message that appears either to be a typed note or an e-mail (yes, they had e-mail back then), the body of which shows what he thinks about your progress.

The message is always to Dr. David Lindstrom, who was the chief surgeon in the original Life and Death game.

If you click the plant in your office, it will say "Water me, please!" There is no way to do so, however.

Finally, this isn't a secret so much as a bug: if your computer's clock is set to the year 2000 or later, dates in the Hall of Fame will look funny. For instance, furrykef got in the Hall of Fame for a subdural hematoma operation and the date on it is 11/19/103. Yup, it's a minor Y2K bug! Other dates in the game will appear normally because the year is written with four digits.

Questions and answers[]

Q: Will the game run too fast on my PC?

A: No. However, if you're playing the game with an emulator, the emulator may run it too fast; consult your emulator documentation.

Q: When does the game end?

A: We don't yet know.

Q: Who is Dr. Skelton?

A: Doctor Ryan T. Skelton is the chief neurosurgeon. He's the bearded guy.

Q: Is it spelled "Griffin" or "Griffen"?

A: Griffin's name is spelled "Griffin" in most of the game, but it's spelled Griffen in the Operating Room.

Q: Where is the Hall of Fame?

A: In your office. There are four certificate-like thingies on the wall above your desk; the top one is blank and the other three are names and dates of people who perfectly completed various operations, including Dr. Skelton, and, if you get good (and lucky) enough, you! Note that the Hall of Fame will retain records of deleted surgeons.

Q: I got into the Hall of Fame twice for a subdural hematoma [or whatever], but my name only appears once.

A: That's because you can only have your name up there once. If you get into the Hall of Fame and your name is already there, the old entry stands. Note that it's the name that matters: if you delete your save file, then add another surgeon with the same name, and the second surgeon gets into the Hall of Fame, he won't be added because the old entry with the name still stands.

Q: I want to delete my save file and start over, but it's the only one and I can't delete myself. How do I do it?

A: Easy. Create a second name, sign in, and delete your other name with it. If you wish, you may exit, re-enter, and put your name back where the old entry was, and then delete the temporary name.

Q: What's that telephone number in that "blank" space above the Hall of Fame?

A: We're not sure. Perhaps it was the phone number for the Software Toolworks?

Q: Does the cafeteria serve any purpose?

A: Comedy relief, but it also helps illustrate conflict between possible assistants (though one of the messages claims Kahn and Schmidt got into a fight, and they're not supposed to be rivals). You'll also get some ribbing if you visit just after botching an operation. "Practice is an art... and boy, does your art need practice!"

Q: Does the morgue serve any purpose?

A: Only to remind you of your previous incompetence. :)

Q: The patient died and I don't know why.

A: Pay attention when Dr. Skelton yells at you, and you will. ;) Any death in this game can be prevented if you pay attention to what's going on. If your patient dies, it's your fault: don't blame your assistant for not warning you, when you should keep an eye on things. Find out what went wrong (the good doctor will usually tell you), and don't do it again.

Q: I did the aneurysm procedure properly as far as I can tell — I got the clip on it and it matches the picture — and after closing, Dr. Skelton says I didn't clamp off the aneurysm! What gives?

A: This is a common problem, it seems. We don't know the cause or the solution yet, but there are people who have done it successfully...

How to kill your patients in Life and Death[]

Just for the heck of it, I decided to give you many many ways you can kill your patients in the game Life and Death 2. So scrub up, put your gloves on, and pay attention. I will add more deaths the more I play.

Ways to kill your patients with misdiagnosing[]

  • By not referring the patient to a psychiatrist when the patient is addicted to morphine
  • By not performing surgery on patients who have a subdural hematoma, a brain tumor, or an aneurysm

Killing patients with imaging equipment[]

  • By putting patients in the MRI machine when they have a pacemaker
  • By putting patients in the CAT scanner when the patient has allergies

Killing patients before incising the patient[]

  • By injecting lidocaine or atropine when it isn't needed
  • By mixing nitroprusside and dopamine