Part 9: Episode 2-2: The Pacemaker

Episode 2-2: The Pacemaker

I've been ragging on this episode a bit, and I'm going to be doing it a lot more, but a pacemaker operation is a pretty sensible addition to the game.



Wilkins: Yes, you'll be performing an exchange operation to upgrade the one currently inside the patient. You'll also be performing the pre-op examination on her.

Markus: Why us and not a cardiologist?

Wilkins: Because I believe you two are better suited to perform the operation. A team of specialists will be available to assist you, but I doubt that will be necessary.

Valerie: It seems they're expecting a lot of us, but you wouldn't know it by the way the staff treats us.

Wilkins: This can be considered as a preparation phase for the actual operation.

I guess he might mean the one on him. If not, I have no idea.

Wilkins: An appropriate pacemaker has already been selected. You'll be implanting the same type I'm currently using.



Our patient, Chloe. An operation in the second chapter in which you implant a device to make a little girl's heart correctly while dealing with cardiac arrests happening periodically(you don't know about that last part, but it's happening)? Seems a little familiar. If you don't know/remember, this is the exact same setup as an operation in Second Opinion/UtK, except tat operation featured an artificial heart valve.

Valerie: You'll be fast asleep the entire time. It'll be over before you know it.

Chloe: But what if I wake up? Will it hurt?

Valerie: I promise you that won't happen. You'll stay asleep, no matter what.

Chloe: If it's gonna keep me asleep, how will I wake up? Will I be asleep forever?

Valerie: Well… um… you'll wake up because you'll get hungry?

I'm not really certain what part of "we'll stop giving it to you" was considered beyond a child's grasp, but anyway.
Markus: Chloe, you heard your heart isn't doing well, right? Right now, you're okay because doctors put a machine in you that helps your heart. But we found out that machine isn't working like it should. So if we don't put in a new machine, your chest is going to hurt. You don't want your chest to hurt, do you?

Chloe: …No.

Markus: Alright then. The operation is going to be tomorrow. Let's both do our best.

Elena: C'mon, Chloe. Let's go back to your room. Don't worry, there's nothing to be worried about. You'll be better real soon.

Valerie: Opening up a child's chest for the second time. As a doctor, I know I shouldn't be fazed by it, but it's still heartbreaking.

Markus: This operation has nothing to do with the professor's orders. Let's just concentrate on doing our best for that kid, okay?



A new minor character her. I suspect but am not completely certain of his name, so screw it, I'm calling him Andy arbitrarily.



New character number 2 is named Dr. Chen.

Chen: I'm sorry, but we didn't find anything wrong when we examined you.

Andy: That medication I used before seemed to help. How about some of that?

Chen: Dr. Vaughn, can you please help me explain to this patient?

Markus: Me, Dr. Chen?

Chen: He won't listen to reason, and I refuse to write him a prescription. He's just pretending to be in pain because he's addicted to painkillers.

Andy: What? Are you calling me a liar? Forget it, I'm out of here!

And so, he stumbles off to get drugs somewhere else/die/learn diagnostic medicine.

Chen: What does he think this is? A street corner? He was wandering around, so I offered to help him. The first thing he said was "I need drugs."
Markus: How did he get in?

Chen: I don't know, but I should report him to security. By the way, Dr. Vaughn, I heard that you're conducting a pacemaker procedure today.

Markus: That's right. Since I'm the new guy, I've got no choice but to follow orders.

Chen: I suppose that's true. Well, good luck. If all goes well, I'd like to ask you to be my assistant.

Markus: I'll do my best to live up to those expectations.



Your heart has a natural pacemaker that uses chemical impulses to regulate the rate at which it beats. As you probably know, an artificial pacemaker uses electrical impulses to simulate this when there is some problem with the natural system. The idea was kicking around from the late 1800s, but it wasn't until 1958 that one was actually implanted in a person, and that one failed within hours. Modern ones last much longer, but still need to replaced every so often, too, as they run on batteries. This is usually pretty simple, and doesn't even involve removing the leads, but the operation we're about to do does involve removing them and is a huge pain.

Elena: Let's begin the conference for little Chloe. Your objective for this operation is to replace the patient's pacemaker. First, you'll have to stop the old pacemaker, then remove it and insert the new one.



Elena: This patient will require great precision and will put a great deal of strain on the patient's body. Please proceed with the utmost care.

Markus: Of course. This is a very serious operation.

Valerie: She's only a child, so even the smallest mistake could be fatal.

She's not joking.

Elena: Well, good luck, you two.

In Second Opinion, I used the Healing Touch to complete this in, I think, seven in-game seconds. This time, my stupid desire to balance surgeon choices mean I can't, because I'll be using…



Valerie.



Speaking of Valerie, I wasn't aware of this, but apparently her Healing Touch also restores vitals by 10 when it ends, giving you a little bit of an edge if they were low when you activated it.

OPERATION VIDEO

Viddler Backup



This is your greeting almost immediately upon getting in. This time, you aren't allowed to use a defibrillator.



Instead, you need to do this little timing minigame to kickstart her heart. Or something. Timing is important for your score, but it's not hard to succeed at this, but there are a few reasons to be careful.

Basically, the heart will start fibrillating every little while, and usually will fail right after, forcing you to redo the minigame. Sometimes it's a false alarm, and you won't have to do it. Either way, if you try to do ANYTHING while the heart is starting to fail, you get a miss. Vitals always drop down when a flatline comes, meaning that restoring them is a waste of time. If you get a miss, they'll drop to dangerous levels. If your finger slips and you make TWO mistakes(which will happen) you'll basically lost immediately.

If you use Markus, you should just HT right off the bat and save yourself some pain. Valerie's isn't very useful.



Alright then. To remove the pacemaker, you take out each lead by gelling the end, cutting it out, draining the blood, and yanking the lead out. After that, you have to grab the chord itself and remove it, not forgetting to suture the incision you made. When both leads are gone, you can remove the pacemaker.



Time to install the new pacemaker. First, you place it and its leads with the forceps. Then, as shown here, you use the ultrasound to find the holes from earlier so you can re-open them and insert the new leads. Keep in mind that you can't make the cut without pressing A to reveal the spots, and trying to reveal them which the heart is fibrillating means a miss. This is extremely annoying.



Cut, drain, insert, suture. Before you can suture the second one, you'll have to deal with one more flatline which occurs automatically. With that done, you can finish.



Try playing with another person to make this operation more fun. One of you will screw up and you'll devolve into screaming at each other, like all good multiplayer games.



OPERATION END



The last bonus is for minimizing the number of times you had to massage the heart. Speed in completing the operation, timing when you're massaging, and using Markus are all helpful for that.



This isn't really that bad, considering.



Valerie: This is the machine we put inside you during the operation. It's helping your heart beat.

Chloe: Wow, cool! That's what's inside me?

Valerie: It runs on electricity, so there are a few things you need to be careful about. Elena will explain the rules to you, so listen carefully, okay?

Chloe: Did you see it!? Isn't it cool?

Elena: Yes, it certainly is, but don't get carried away just because you feel better, okay? Now, the pacemaker that's inside your chest is like a new friend. And it's going to be with you for the rest of your life.

The chapter ends here, denying us an explanation of why a small child should stay away from MRI machines. Next time: We still don't operate on the professor.