Spoiler: Major spoilers!! I've played it 3 times. The surgeon dies every time. The other 2, the anesthetist and nurse presumably, are optional. I agree with you about the decision. When people tell me Joel is evil and made the wrong choice, I ask them if they would kill an innocent person to cure a real world disease like AIDS or something. Remarkably, some say yes and some say no, but they don't think either choice makes the person "evil." That's the brilliance if the ending, IMHO.