The Agreement at Clivemore Hospital
“Come in”, 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.
“Congratulations by the way”, said Doctor Burgos, “I haven’t formally said that to you since you accepted our offer, but I have been following our process since your first interview. It’s the board that hires you, but it’s my job to seal the deal, so to speak. And soon, it will be your job”.
Echols stepped in while Dr. Burgos pushed up his glasses, smoothed his suit and did something that the young Doctor Echols did not notice. He locked the door.
“Thank you”, said Echols, “I’m happy to join the team”.
“You know”, said Dr. Burgos, “In addition to your resume, it was your handling of the Havenfield suit that made this job yours. That filthy business must have been hard — on you, your wife and your family. But you persevered, didn’t you?” Echols was about to respond, but instead paused. It wasn’t a question.
Burgos opened a folder on his desk and continued.
“I have your job offer in writing, as well as a few additional documents for you to sign. You’ll report to Dr. Johnathan Pitwell, our CEO. He liked you”. Echols grinned in reply and began to initial and sign documents as Burgos chatted on.
“I remember when I interviewed with him. We talked about our wives love of cooking. My wife, she loves — well, she loved to cook”. The Doctor paused, then continued with their business. “Your base salary will be $250,000 per year, with guaranteed annual bonus, ten percent minimum. Cell phone, car allowance, family plan, pretty typical stuff. You’ll have a reserved parking space. It’s not in the letter, but you’ll 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 yours”.
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.
“Now, 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...” Burgos hesitated. “There’s one more.”
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.
“This next page. I go over this page with everyone. You will too. You’ll have to”.
At this point, Burgos almost laughed, but then didn’t. He hadn’t meant to laugh, he’d meant to breathe. He leaned backward into the leather of his chair and spoke.
“It’s strange. I’ve had this job for thirty seven years. A long time”. A long time without his wife. “And now someone else will have to do this. Explain page six of the agreement”. Echols nodded back, whatever impatience he had was now replaced by a curiosity.
“How much do you know about Clivemore Hospital? The history. Its beginnings”. Burgos paused but didn’t wait for Echols reply. “No, you don’t know”, said Burgos, “You couldn’t. I didn’t. But I’ll tell you now what you need to know”. He took another deep breath.
“On 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 third”.
The Doctor paused again, watching Echols listen, watching him process.
“On the day of his execution”, Burgos described, “Ian 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. I’m sure they hoped he’d die there in that hallway. But he didn’t. He died here. In open heart surgery. The Coroner’s 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 execution”. 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.
“You’re 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 one”.
Echols looked again at that piece of paper. He hadn’t 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.
“Why?” Echols asked.
Dr. Burgos leaned forward and laid a pen in front of Echols.
“Because 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 death”.
At this, Dr. Echols just stared. His expression froze for a breath, as he accepted what he just heard.
“This is not a joke”, Burgos declared. “I 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 too”.
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.
“This is real, Doctor Echols. We do this. You will do this”.
At that moment Echols cellphone vibrated. A call was coming in. He glanced at the number and silenced it. He exhaled. “It’s my wife. Should I tell her this? This truth you say? This idiocy? I’m supposed to be calling her with good news. Now I guess I’ll be calling her to say I declined your offer; there’s no job honey, no job because I said No to those lunatics”.
Burgos sat silent for a breath and then said, “You 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. You’re 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 the — the families of our staff. At that point, the previous Director of Clivemore involved the Police. But that, well …it had its consequences. It led to tragic outcomes”.
Burgos stopped for a breath and he composed himself. “Once 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 me”.
Echols’ cellphone vibrated again. And again. “It’s my wife again”.
“Go ahead, answer her”, Burgos replied. Echols picked up and started to talk, but the person on the other end must have cut him off. “Wait, slow down honey. Who’s there, who’s knocking? No, I don’t. Honey, slow down. There’s no one — I’m still at the hospital. What does he want?”
Then Dr. Burgos spoke calmly, but directly to Echols. “Tell me what she is saying, Doctor”.
Echols gripped his phone. “Honey, calm down. Honey. Ok. Jesus. Call 911 on the house phone. Yes, do it now”.
“Tell me what she is saying Doctor”, said Burgos, almost demanding now.
“She’s saying someone is at the door”, Echols described, “Someone is pounding on the door”.
Burgos leaned forward. “Can she see him?”
Echols stood up. “Call the Police, honey. Call them now. I’m coming, I’m coming right now. I’m on my way”.
Burgos, still seated, directed a request at the departing Echols. “Doctor, sign the agreement”.
But Echols wasn’t listening. He was straining into his phone, pleading to his wife. “What?! Honey, run. RUN. Take the phone upstairs and lock the bedroom door, I’m coming”. Echols gripped the knob of the locked office door, trying to shake it open. “OPEN THIS!” he shrieked.
“Sit down, Doctor, and sign the agreement”, Burgos demanded.
“What the hell are you talking about?” Echols yelled. “Fuck you and your agreement. Open this door!”
“Sign it, Doctor”, Burgos stated loudly, “It’s him”.
But Echols wasn’t listening. “Patty, run. Run upstairs. Are they on their way? Patty?!”
But Patty was screaming. Screaming for help, screaming for her life, her wails of terror tinning through the tiny phone. “Patty!!”
Burgos slid the agreement forward at Echols. “Sign it, Doctor. Sign or he will kill her. He will kill her like he killed my wife. I didn’t want to sign, I didn’t 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 lost”.
“PATTY!” Echols screamed.
But Burgos went on. “We decide whose heart he gets, not him. Not him. Don’t let him choose. SIGN. Sign and it will stop. Sign and he will leave”.
“Patty!” Echols cried. “Give it to me!” Echols lurched forward, snatched a pen and signed the Confidentiality Agreement.
“Patty?! Patty?” 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. “Patty, oh Christ. Are you Ok? You’re Ok. Jesus, honey. What? What did you say? — Say that again. What do you mean? Slow down. A man. A man came in and… He was a what?”
Echols slowly brought his eyes up to stare at Dr. Burgos and repeated what his wife had told him. “He was a prisoner?”
Dr. Burgos leaned forward from his chair, gripped the Agreement between his fingers, opened a drawer of his desk, then placed it within.
“He’s gone now, Patty”, Echols said to his wife, trying to calm her even though his own voice shook. “I’m on my way. Wait for the Police and — I don’t know, I don’t know what to tell them. Tell them what you told me. I’m sure they, they will try and, I don’t know, to try and find him. The prisoner. But you’re Ok. They’ll be there. I’m coming. I’m coming now. I have to go, honey. I have to go”. 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 Burgos’ eyes.
“She says a man, a prisoner she said, broke down our door and — she ran upstairs. She said he — she said he reached through the floor and he grabbed her and he pulled her through the floor back downstairs. He grabbed her and he — he tore her shirt open and he had a scalpel, and then — he just disappeared. He was there, on top of her, straddling her, staring at her, about to kill her. And then he just wasn’t. He was gone. He’s gone”.
Dr. Burgos stood up from his desk, slowly crossed the small office, and unlocked the door.
“Welcome to Clivemore, Doctor”.