Dr. Kenzo Tenma is a young Japanese doctor working at the Eisler Memorial Hospital in Düsseldorf during the 80s. A highly accomplished brain surgeon, he appears to have everything on his plate: a promotion in the offing; the favor of the director of the hospital, Heinemann; and Heinemann's daughter, Eva, as his fiancée. However, Tenma grows increasingly dissatisfied with the political bias of the hospital for treating patients, and seizes his chance to change things after a strange massacre brings the twins Johan and Anna Liebert into his hospital. Johan has a gunshot wound to the head and Anna keeps muttering about killing, and Tenma decides to operate on Johan instead of a prominent politician who arrived afterwards. Johan is saved, but the politician dies. Tenma loses all his social standing and Eva as a consequence. However, Heinemann and other doctors in Tenma's way are mysteriously murdered, and both children disappear from the hospital soon after. The police suspect Tenma, as he benefits greatly from this turn of events, but they have no evidence, and so can do no more than question him.

At this point, the story advances to nine years later. Tenma is now the Chief of Surgery at Eisler Memorial Hospital. However, he is about to come face to face with a sociopath - a sociopath that he helped save.

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