The Agreement at Clivemore Hospital
âCome inâ, Doctor Burgos said. He was a Doctor, but it had been years since he had spent any real time with a real patient. He was the Senior Director of Hospital Operations at Clivemore Regional Hospital, a sixty-year old, three hundred bed hospital, fifty minutes North of downtown Baltimore, and today was the day he was hiring his replacement: a younger Physician named Echols who was standing in the office doorway, composed and slim, wearing a blue suit and dark tie.
âCongratulations by the wayâ, said Doctor Burgos, âI havenât formally said that to you since you accepted our offer, but I have been following our process since your first interview. Itâs the board that hires you, but itâs my job to seal the deal, so to speak. And soon, it will be your jobâ.
Echols stepped in while Dr. Burgos pushed up his glasses, smoothed his suit and did something that the young Doctor Echols did not notice.Â
âThank youâ, said Echols, âIâm happy to join the teamâ.
âYou knowâ, said Dr. Burgos, âIn addition to your resume, it was your handling of the Havenfield suit that made this job yours. That filthy business must have been hardâââon you, your wife and your family. But you persevered, didnât you?â Echols was about to respond, but instead paused. It wasnât a question.
Burgos opened a folder on his desk and continued.
âI have your job offer in writing, as well as a few additional documents for you to sign. Youâll report to Dr. Johnathan Pitwell, our CEO. He liked youâ. Echols grinned in reply and began to initial and sign documents as Burgos chatted on.
âI remember when I interviewed with him. We talked about our wives love of cooking. My wife, she lovesâââwell, she loved to cookâ. The Doctor paused, then continued with their business. âYour base salary will be $250,000 per year, with guaranteed annual bonus, ten percent minimum. Cell phone, car allowance, family plan, pretty typical stuff. Youâll have a reserved parking space. Itâs not in the letter, but youâll just take mine. Yes, initial here. And there. Great. This next letter covers standard malpractice, all of that. Initial there. Great, now sign here, and I sign there. Good. And these copies are yoursâ.
Dr. Burgos gathered the paperwork together, tapped them against the top of his desk and set them aside. Then he reached over to another small stack of papers and slid them in front of Dr. Echols.
âNow, this one is our confidentiality agreement. It is fairly lengthy, and the majority of it is standard. Yes, initial there. Sign there. Thank you. Now...â Burgos hesitated. âThereâs one more.â
The Doctor paused and then reached into a drawer of his desk and brought out a single sheet of paper. The paper seemed faded and stiff and Burgos continued, holding the delicate piece of paper between two fingers as if it might break.
âThis next page. I go over this page with everyone. You will too. Youâll have toâ.
At this point, Burgos almost laughed, but then didnât. He hadnât meant to laugh, heâd meant to breathe. He leaned backward into the leather of his chair and spoke.
âItâs strange. Iâve had this job for thirty seven years. A long timeâ. A long time without his wife. âAnd now someone else will have to do this. Explain page six of the agreementâ. Echols nodded back, whatever impatience he had was now replaced by a curiosity.
âHow much do you know about Clivemore Hospital? The history. Its beginningsâ. Burgos paused but didnât wait for Echols reply. âNo, you donât knowâ, said Burgos, âYou couldnât. I didnât. But Iâll tell you now what you need to knowâ. He took another deep breath.
âOn the books, Clivemore Hospital opened February fifth, 1972. But in truth we were treating patients almost a decade before that. Patients from six neighboring clinics, and three regional penitentiaries. Most of our funding came from the state back then, so we did our part with prisoner treatment, therapy. Surgery. Fairly pedestrian work with the occasional trauma or serious event. One of the prisons had a maximum security wing, and it was there that they did executions. One of these executions concerns the agreement we have today. The one in front of you. In 1968, there was a prisoner. His name is Ian Darling. Was Ian Darling. He was a murderer. Sentenced to die for killing six people. Four of them his own family. The other two were people, neighbors who heard the screams. Came to help. Something like that. He also maimed two guards, almost killed a thirdâ.
The Doctor paused again, watching Echols listen, watching him process.
âOn the day of his executionâ, Burgos described, âIan Darling presented with labored breathing, chest pains, and ended up collapsing in a prison hallway. He lay there for over an hour before they transported him here to Clivemore in full arrest. Iâm sure they hoped heâd die there in that hallway. But he didnât. He died here. In open heart surgery. The Coronerâs report stated Ian Darling died from abdominal complications resulting from defect of the pericardium, and resulting mediastinitis. In truth, they cracked him open and let him die there. On the table. They were all there that night. Surgeons. Staff. Guards. Even the Warden watched. It was his executionâ. This time Burgos watched the young Echols, who could not hold his gaze. Instead, Echols looked down at the Confidentiality Agreement searching for some answer that would not come from that stale piece of yellowed paper.
âYouâre wondering what this has to do with you. I did too. And so will everyone you tell this to when you do this job. Your job. You will have to tell this story to everyone we hire at Clivemore. Everyone. Whether it is a Doctor or a Janitor. It is part of your job. The most important part. You will tell this story and you will have the person you tell this story to sign our agreement. That piece of paper. Everyone who has been hired at Clivemore since August 3rd, 1978 has signed that piece of paper. That very oneâ.
Echols looked again at that piece of paper. He hadnât really noticed before, but now he did. It had hundreds of signatures on it. Some were in print, some cursive, some in pencil, some pen. Some signatures were faded, others new. They overlapped, they were sideways, on the margins, anywhere that could fit a name there was a name. Echols looked up.
Dr. Burgos leaned forward and laid a pen in front of Echols.
âBecause since the day he died Ian Darling has, and will haunt this hospital, and each and every one of us in it, unless we sacrifice one heart from one patient each and every year, on the anniversary of his deathâ.
At this, Dr. Echols just stared. His expression froze for a breath, as he accepted what he just heard.
âThis is not a jokeâ, Burgos declared. âI know it is disconcerting, but please understand that this is real. It is happening. It is fact. Separate yourself from what you knew when you walked into my office and process this one truth. There was an Ian Darling, there is an Ian Darling. We do not know why this happened, but it did and does. And now we do this at Clivemore. Every year. We remove one heart from one patient, and we give it to him. We place it on a table, in the South Wing, in the room where he died, and at 2:14 AM it is gone. We are all a part of this. And now you are tooâ.
Echols sat back and managed a stare. A stare that eventually broke into a smirk. A silent reaction of incredulity, bordered with an anger. Dr. Burgos did not react. Instead, he repeated what he had said.
âThis is real, Doctor Echols. We do this. You will do thisâ.
At that moment Echols cellphone vibrated. A call was coming in. He glanced at the number and silenced it. He exhaled. âItâs my wife. Should I tell her this? This truth you say? This idiocy? Iâm supposed to be calling her with good news. Now I guess Iâll be calling her to say I declined your offer; thereâs no job honey, no job because I said No to those lunaticsâ.
Burgos sat silent for a breath and then said, âYou will be calling her with good news, Doctor. You will. We want you here. We picked you for good reason. After the Havenfield suit, you were untouchable in Washington, untouchable everywhere some might say, but we knew you were right for Clivemore. You would fit in. And you will. Youâre here. This will pass. You will understand us, you will sign this agreement and you will join Clivemore. You need not think of this but once a year. In fact, most of this business will be handled without you. But you must know. You must sign. We learned that decades ago. It took years to know what to do, what he wanted. He told us in his way. First by taking them himself. Hearts. From our staff. And from theâââthe families of our staff. At that point, the previous Director of Clivemore involved the Police. But that, well âŚit had its consequences. It led to tragic outcomesâ.
Burgos stopped for a breath and he composed himself. âOnce we knew what he wanted, we tried to keep this obligation to a select few here at the hospital. We thought that was best. But it was not. We quickly learned that everyone must know. Every employee of this hospital must know what we do, and must sign that agreement. It keeps a peace, Doctor. Without it, and I know you have yet to comprehend everything I am telling you, but without it, we all face a certain kind of Hell. A Hell, Doctor. Those are my words. Others call what we do here something else. Each of us has his or her own views of our mortality on this Earth, and our place in it. But I have no other words to describe it, and once I embraced that Hell, it offered a kind of comfort, a peace. Three hundred and sixty four days of the year this peace helps me not to think of Ian Darling. But on one day, that one day a year I must think of him, and I do. And I do so, so he will not think of meâ.
Echolsâ cellphone vibrated again. And again. âItâs my wife againâ.
âGo ahead, answer herâ, Burgos replied. Echols picked up and started to talk, but the person on the other end must have cut him off. âWait, slow down honey. Whoâs there, whoâs knocking? No, I donât. Honey, slow down. Thereâs no oneâââIâm still at the hospital. What does he want?â
Then Dr. Burgos spoke calmly, but directly to Echols. âTell me what she is saying, Doctorâ.
Echols gripped his phone. âHoney, calm down. Honey. Ok. Jesus. Call 911 on the house phone. Yes, do it nowâ.
âTell me what she is saying Doctorâ, said Burgos, almost demanding now.
âSheâs saying someone is at the doorâ, Echols described, âSomeone is pounding on the doorâ.
Burgos leaned forward. âCan she see him?â
Echols stood up. âCall the Police, honey. Call them now. Iâm coming, Iâm coming right now. Iâm on my wayâ.
Burgos, still seated, directed a request at the departing Echols. âDoctor, sign the agreementâ.
But Echols wasnât listening. He was straining into his phone, pleading to his wife. âWhat?! Honey, run. RUN. Take the phone upstairs and lock the bedroom door, Iâm comingâ. Echols gripped the knob of the locked office door, trying to shake it open. âOPEN THIS!â he shrieked.
âSit down, Doctor, and sign the agreementâ, Burgos demanded.
âWhat the hell are you talking about?â Echols yelled. âFuck you and your agreement. Open this door!â
âSign it, Doctorâ, Burgos stated loudly, âItâs himâ.
But Echols wasnât listening. âPatty, run. Run upstairs. Are they on their way? Patty?!â
But Patty was screaming. Screaming for help, screaming for her life, her wails of terror tinning through the tiny phone. âPatty!!â
Burgos slid the agreement forward at Echols. âSign it, Doctor. Sign or he will kill her. He will kill her like he killed my wife. I didnât want to sign, I didnât sign and I left this room and I went home and I found her ripped in two. He tore her open and her heart was the heart he took that year. We decide here, Doctor. The elderly. The addicted. The lostâ.
âPATTY!â Echols screamed.
But Burgos went on. âWe decide whose heart he gets, not him. Not him. Donât let him choose. SIGN. Sign and it will stop. Sign and he will leaveâ.
âPatty!â Echols cried. âGive it to me!â Echols lurched forward, snatched a pen and signed the Confidentiality Agreement.
âPatty?! Patty?â Then there was a crying. A sobbing sound came through the phone, even Burgos could hear it. Echols collapsed back in his chair, gripping the phone. âPatty, oh Christ. Are you Ok? Youâre Ok. Jesus, honey. What? What did you say?âââSay that again. What do you mean? Slow down. A man. A man came in and⌠He was a what?â
Echols slowly brought his eyes up to stare at Dr. Burgos and repeated what his wife had told him. âHe was a prisoner?â
Dr. Burgos leaned forward from his chair, gripped the Agreement between his fingers, opened a drawer of his desk, then placed it within.
âHeâs gone now, Pattyâ, Echols said to his wife, trying to calm her even though his own voice shook. âIâm on my way. Wait for the Police andâââI donât know, I donât know what to tell them. Tell them what you told me. Iâm sure they, they will try and, I donât know, to try and find him. The prisoner. But youâre Ok. Theyâll be there. Iâm coming. Iâm coming now. I have to go, honey. I have to goâ. Echols clicked off his phone and stood up, his brow sweating, hands trembling. He gasped and then spoke quietly, barely above a breath, barely able to meet Burgosâ eyes.
âShe says a man, a prisoner she said, broke down our door andâââshe ran upstairs. She said heâââshe said he reached through the floor and he grabbed her and he pulled her through the floor back downstairs. He grabbed her and heâââhe tore her shirt open and he had a scalpel, and thenâââhe just disappeared. He was there, on top of her, straddling her, staring at her, about to kill her. And then he just wasnât. He was gone. Heâs goneâ.
Dr. Burgos stood up from his desk, slowly crossed the small office, and unlocked the door.
âWelcome to Clivemore, Doctorâ.