One of Darkest Dungeon 2's cleverest enemies started with a Make-a-Wish kid

Darkest Dungeon 2 - Gaunt Chirurgeon
(Image credit: Red Hook Studios)

I recently had the opportunity to chat with Sam Burns, who helped create a new and very unusual enemy called the Gaunt Chirurgeon that's currently being developed for Darkest Dungeon 2 in a partnership between Red Hook Studios and Make-A-Wish, and the first thing he told me—because it was the first thing I asked—is how exactly to pronounce the word "chirurgeon."

"It's kye-rurgeon. The 'ch' is hard," he said. "It's an old-fashioned word for a surgeon, doctor type of person."

The name is apt. The Gaunt Chirurgeon attacks his foes with leeches, which inflict minor damage and heavy bleeding—but they also cure diseases that player characters may have contracted during their adventures. This means that under the right conditions, the appearance of the Gaunt Chirurgeon might be welcome—or at least, not entirely bad news.

Sam had been playing the original Darkest Dungeon "on and off" since 2018, but Darkest Dungeon 2 is what got him really hooked. "The sequel, I was all in. I bought it day one. I was in the hospital at the time but I still did it," he said.

"I really liked that game more than the first one so I played that one a lot, and I just naturally started thinking about it a lot and getting these sorts of ideas. I didn't expect to actually get the opportunity to use one of them, but here we are."

That process began in May 2022. Sam has been hospitalized following a leukemia diagnosis when he was 17, and a social worker suggested that he reach out to the Make-A-Wish foundation with his idea. It took longer than expected to get the ball rolling: A few bureaucratic misfires meant that he didn't actually make contact with Red Hook until November, and there was also a minor hitch at the very start of the process. "They thought it was a scam at first," Sam said.

Red Hook Studios co-founder Chris Bourassa confirmed that there was indeed some confusion on that point when Make-A-Wish first reached out.

"This is absolutely the first time we've ever done anything like this, and to be honest, yes, I thought it was a scam when I read the email subject line for the first time," Bourassa said. "Being approached by Make-A-Wish is just not something that you expect—but re-reading the email, and checking the sending address confirmed that it was in fact legit.

I thought it would be fun if there was an enemy with an attack that was annoying to get hit by in some way, but that also cured your disease ... The doctor/surgeon theme sort of evolved around that, and that's how we got to what it is."

Sam Burns, Gaunt Chirurgeon co-creator

"Even as I wrote the reply, I was still not entirely convinced it was real.  We were so humbled and frankly taken aback. The fact that someone would choose to connect with us instead of a more tactile experience like meeting a celebrity is incredibly moving."

Once everyone was sure the request was on the up-and-up, Make-A-Wish introduced Sam and Bourassa, and later studio co-founder Tyler Sigman and designer Erich Kohlweg, through Zoom meetings, where they got down to the business of making it all happen.

"I met with Sam initially for a few hours—his enthusiasm was abundant and contagious!" Bourassa said. "We went through some Darkest Dungeon 2 pre-production art, including storyboards, character designs, and environment studies. We talked about the kind of character he'd like to see in the game, and we explored ways of making it happen. 

"I did some rough designs offline, and we met a second time with Erich, our item designer, and Tyler, Red Hook's design director and co-founder. The second call allowed Sam the opportunity to get answers to all his mechanical questions, review and provide feedback on my sketches, and to begin working on a set of items that would support his character."

Early concept of the Gaunt Chirurgeon and his items (Image credit: Red Hook Studios)

Sam's idea was for a "support enemy" that doesn't do much direct damage to players, but instead bolsters the other enemies in the fight. The twist is that it will also cure diseases on player characters, which can be incredibly beneficial. That balance of risk and reward is what makes the Gaunt Chirurgeon so interesting: You can't just ignore it, but you might not want to be in too much of a hurry to kill it, either.

"Diseases are like these permanent nasty status effects that you can get through a lot of different ways. And normally enemies are the ones inflicting it, not removing it," Sam explained. "So I thought it would be fun if there was an enemy with an attack that was annoying to get hit by in some way, but that also cured your disease. When I told that to Chris, the doctor/surgeon theme sort of evolved around that, and that's how we got to what it is."

Sam's work on Darkest Dungeon 2 is being implemented in two parts: In-game items, which arrived in the December 2022 update, and the Gaunt Chirurgeon itself, which will be added in a post-launch update.

"Items don't take that much development time but an enemy does because it has to be modeled and rigged and animated and textured and all that," Sam said. "It takes a lot of work and they didn't have the time and resources to squeeze that into their roadmap at the time."

In fact, the plan at first was only to make the items: Sam said Red Hook initially told him that the developers just didn't have time to invest in creating an entirely new character. Instead, the idea was to create a character "theme" and then build some items based on that.

"I was like, okay, cool. That's great. That works for me, because I was totally on board with anything," Sam said. "But when we actually started working on it, Chris, and then later Tyler, were like, hang on, we actually really like this idea. We're going to see if we can make this work and put it in the game for real."

The Gaunt Chirurgeon (Image credit: Red Hook Studios)

Sam acknowledged that his wish might seem a little out of the ordinary—"You hear about Make-A-Wish kids traveling or seeing a celebrity or something, not making a zombie man for a turn-based RPG"—but Make-A-Wish America said that game-related wishes are becoming more common, and that they're being embraced by the games industry.

"It's safe to say that between mobile devices, the console market, and online gaming, the videogame industry has exploded," a Make-A-Wish spokesperson said. "In turn, we have seen an uptick in influencer wishes, including gamers. The gaming community have been incredible supporters of our wish kids."

I was somewhat surprised, under the circumstances, to hear that while Sam is a huge Darkest Dungeon fan, he isn't interested in Darkest Dungeon mods—and as much as he enjoyed working with Red Hook to bring his idea to life, he's not particularly interested in pursuing game development as a career, or even a committed hobby.

The cancer didn't kill me, [but] it threw a wrench into any sort of post-high school plans I had. So I'm just sort of here for the moment. Still working things out. But at least I'm better now.

Sam Burns

"I'm not a modder," he said. "I rarely ever act on any of my ideas, I just like thinking about them in my spare time and maybe writing them down if I feel like it. But I don't mod. To be perfectly honest, I don't actually like Darkest Dungeon mods very much.

"[Game development] has always interested me but I don't know if I'd want to do it as a career. I haven't thought that far ahead. I tried stuff when I was younger, like more kid-geared stuff. It was kind of fun. I did like it, but I just don't know if that would be a career I want."

Sam's open-minded approach to the future is understandable given his illness. He's beaten cancer, although he will remain in treatment until early 2024, but it changed his life in ways he couldn't have imagined when he was younger.

"Clearly the cancer didn't kill me, [but] it threw a wrench into any sort of post-high school plans I had," he said. "So I'm just sort of here for the moment. Still working things out. But at least I'm better now."

And that really is the best part of the story. Darkest Dungeon 2 is set to go live on May 8 on Steam and the Epic Games Store. The Gaunt Chirurgeon will be added to the game in a post-launch update.

Andy Chalk

Andy has been gaming on PCs from the very beginning, starting as a youngster with text adventures and primitive action games on a cassette-based TRS80. From there he graduated to the glory days of Sierra Online adventures and Microprose sims, ran a local BBS, learned how to build PCs, and developed a longstanding love of RPGs, immersive sims, and shooters. He began writing videogame news in 2007 for The Escapist and somehow managed to avoid getting fired until 2014, when he joined the storied ranks of PC Gamer. He covers all aspects of the industry, from new game announcements and patch notes to legal disputes, Twitch beefs, esports, and Henry Cavill. Lots of Henry Cavill.