Dr. Kenzo Tenma is a talented neurosurgeon. He works at Eisler Memorial Hospital in Dusseldorf, Germany, where he is highly respected by his colleagues for his surgical skills.

After finishing a successful six-hour surgery, Dr. Tenma is congratulated by his coworkers and told to go home and rest. However, as he prepares to leave the hospital, he notices a grieving family in the waiting room. He asks a nurse about them, and she explains that the father of the family, a Turkish laborer, was brought into the hospital around the same time as Dr. Tenma’s patient. However, whereas Dr. Tenma’s patient survived, the Turkish laborer died during his operation with Dr. Becker. Dr. Tenma laments what a “shame” that is before departing.

The next day, Dr. Tenma is awoken by his fiance, Eva Heinemann. He is exhausted from work, and she playfully accuses him of forgetting about their planned date. The television in the background announces that Mr. Liebert, an East German foreign trade advisor, has just arrived in West Germany as a refugee, along with his family.

When the next news story comes on, Eva encourages Dr. Tenma to watch, as it is about the patient he operated on: a famous opera singer named Rosenbach. During a press conference, the Eisler Memorial Hospital director—Udo Heinemann, Eva’s father—proudly declares that Rosenbach will very likely make a full recovery. The newscaster remarks that the hospital has become well-known for its skilled neurosurgery department and that high-profile cases help strengthen Germany’s reputation in the medical world.

Eva congratulates Dr. Tenma, telling him that if he continues to follow her father’s directions, he will soon be named the Director of Surgery at the hospital. This pleases Dr. Tenma, who is grateful to Dr. Heinemann for giving a Japanese man like himself the chance to live and work in Germany. Eva also tells him that Director Heinemann is impressed with Dr. Tenma’s thesis and that he plans to publish it under his own name. Dr. Tenma is initially reluctant to allow Director Heinemann to take credit, but Eva seduces him into agreeing to it.

The next day at work, Dr. Tenma is confronted by Dr. Becker, who mocks his status as the “Director’s favorite pet.” He warns Dr. Tenma that hospitals are also political and that Director Heinemann is using Dr. Tenma’s skill as a surgeon to advance his own career and enhance the reputation of the hospital. Dr. Becker asserts that “there is power in being used,” and encourages Dr. Tenma to use Director Heinemann—as well as his relationship with Eva—to his own advantage as well.

As Dr. Tenma goes about his hospital rounds, he is confronted by the Turkish family from the previous day. The man’s wife angrily accuses him of skipping over her husband in favor of Rosenbach, even though her husband was brought to the hospital first. Dr. Tenma recalls that he was originally supposed to perform the Turkish man’s surgery, but Director Heinemann stopped him at the last minute, citing an emergency situation. Dr. Becker performed the operation instead, but the delayed treatment—combined with Dr. Becker’s inferior skills—led to the Turkish man’s death.

At dinner with Eva later that evening, Dr. Tenma is distracted by thoughts of the Turkish man and his family. He laments that had he been in charge of the surgery, he likely could have saved the man, but that he ultimately just did what the director told him to do. An irritated Eva tells him that “not all people’s lives are equal.” This sentiment shocks and distresses Dr. Tenma.

The narrative then shifts to a crime scene: Mr. Liebert, the East German trade advisor, has been killed, along with his wife. The police find the family’s twin children, a brother and a sister, alive. However, the boy is in critical condition.

Back at home, Dr. Tenma receives a call on his pager informing him that he has a new patient.