Chirurgeon

The **Chirurgeon** is a Gaunt mini-boss in Darkest Dungeon II encountered at the Chirurgeon's Table.

## Description

The towering Chirurgeon is a curiosity among the Gaunts. While he is inarguably the most physically imposing and powerful of them all, he is seemingly far more interested in being left to his own gruesome devices rather than roaming the roads to haunt travelers. Nevertheless, if the heroes seek him out, he takes both saw and leeches in hand when confronted.

However, even in combat, the Chirurgeon almost seems benevolent - albeit horribly misguided. His skills, both supportive and offensive, all seem to be performed with the aim of treating whatever maladies he perceives his companions to have. Indeed, these treatments occasionally prove fruitful, with *Leucotomy* both healing and buffing his Gaunt "patients," and *Bloodletting* actually succeeding in curing Diseases on heroes. However, others prove catastrophic - while *Trephination* and *Trepanation* do indeed both cure negative tokens on his allies and enemies, respectively, they also cause significant damage for each token removed, and to the heroes' sane minds, *Trepanation* is an extremely  stressful experience.

Never far from his side, the Chirurgeon's trademark leeches seem to share a genuine bond with the pernicious physician - or they simply see him as a particularly resilient source of food. Whatever the case, the Chirurgeon seems to value them highly, and shows the most humanity when he is inches from death, scrambling to keep his leeches safe rather than preserve his own life.

Despite his intentions, it is clear to any sane mind that the Chirurgeon causes far more harm than good to the world's living inhabitants - putting him down may in fact be a kindness, as the work the Chirurgeon has tasked himself with will never end.

## Strategy

The Chirurgeon is, first and foremost, a support boss; he spends most of his turns buffing his allies or debuffing his enemies, and will only rarely resort to attacking the heroes directly. While not a terribly difficult encounter, it can be dangerous if proper care is not taken to prevent the fight from getting out of hand.

While the Chirurgeon's critically low DOT resistances may suggest the use of DOT skills to kill him easily, caution should be used as he has a unique buff from the Appalling Apron he wears that directly counters DOT. At the start of his turn, he takes a single tick of damage from every DOT on him and then gains a small  Regen buff before removing all his DOT. Note that he won't gain any more Regen from having more than 1 DOT, nor is the heal affected by the amount of DOT he has. What this means is that heroes who rely on DOT to deal damage, such as Plague Doctor, Flagellant, Yellowhand Highwayman, or Venomdrop Grave Robber, will have their effectiveness drastically reduced. You can still brute force your way through the Chirurgeon with DOT, as he does take a single tick of damage before the DOTs are cured, but a more effective strategy with a full DOT team can be making use of either Plague Doctor's Cause of Death skill or Flagellant's Sepsis skill on either the Exanimate or Scourge paths to deal all DOT damage stacked on him at once before he can cure it.

Even so, heroes who deal high direct damage, such as Leper, Hellion, or Grave Robber, will be better at putting the Chirurgeon down.

An interesting note about what teams are best in this fight is the unique place Negative Tokens have in it. Two of the Chirurgeon's skills serve the function to deal damage to a target in order to remove negative tokens. *Trephination,* the version used on his allies, deals only a small amount of damage per negative token, while *Trepanation,* the version used against heroes, deals significantly greater damage, one point of Stress, and can Crit, causing significantly greater damage and even greater Stress. Skills that give heroes negative tokens such as Jester's Finale, Grave Robber's Pirouette, and all of Leper's damaging attacks, will cause the Chirurgeon to focus them when he attacks.

*Trepanation* can deal extremely high damage at times when a hero has a lot of negative tokens, but it goes from extremely dangerous to potentially lethal when a hero is taken to Death's Door. If not resisted, the two  Weaken tokens applied on entering Death's Door will mark that hero as a valid target for the Chirurgeon to use *Trepanation* on them with his next action; hoping to cure their Weaken tokens, but having a good chance of simply killing them outright instead. If bringing that hero out of Death's Door isn't feasible, finding a way to at least remove the Weaken tokens can keep them reasonably safe from the Chirurgeon until they can heal.

More importantly, though, is *Trephination,* the version of the move he uses on his allies. Since the damage dealt by this skill bypasses defensive tokens, using debuff skills such as Occultist's curse skills, Plague Doctor's Disorienting Blast, or Runaway's Smokescreen (especially when upgraded) to stack several negative tokens on a single target can cause the Chirurgeon to deal significant damage to it when he cures them. Keep in mind that this will still leave the enemy at full strength for their next attack; your debuffs are typically only worth however much damage the Chirurgeon deals to the enemy upon curing them, but it is still an effective strategy to distract the Chirurgeon while dealing with his allies.

While the Chirurgeon's self-defense skill, *Bone Saw,* may deal heavy damage along with a hefty five-point bleed, it will only be used if he has no valid targets for *Bloodletting, Trepanation,* or *Trephination,* so having a negative token anywhere on the field, either on the Chirurgeon's allies or on your heroes, can distract him from performing this dangerous procedure on your heroes.

The Chirurgeon's other unique buff, provided by the Spiked Skullcap he wears, gives him +15% bonus CRIT versus targets who are bleeding. The buff's other effect, that inflicts 1 Bleed to an attacker whenever the Chirurgeon is hit, along with the many other sources of Bleed in the fight, from Woodsman, Ghoul, or Patients (and Patients debuffing heroes' Bleed Resist), as well as the Chirurgeon's own *Bone Saw* attack, mean that it's very difficult to avoid Bleed entirely during the fight. As such, it's very likely that the Chirurgeon will benefit from his +15% CRIT bonus more often than not; having Block tokens on your frontline heroes to prevent a *Bone Saw* crit from taking someone to Death's Door very quickly is advised. Bringing either combat items or skills like Plague Doctor's Battlefield Medicine or Runaway's Cauterize to cure Bleed when needed can also be very helpful.

*Bloodletting* is the Chirurgeon's rarest skill, and is sometimes the main reason why you would choose to fight him in the first place. *Bloodletting's* main purpose is to cure diseases on heroes, and it will *always* be used if any hero has a disease, and only against that hero, applying a moderate Bleed as well as two stress in addition to curing the disease. Notably, while *Bloodletting* is unaffected by Block, due to dealing no damage, it *can* be Dodged, causing the disease on that hero to remain uncured, meaning the Chirurgeon will use *Bloodletting* against them again on his next turn. While you often want the disease to be cured on your heroes, this (as well as Guarding the diseased Hero) can still be a somewhat effective way to distract the Chirurgeon from using his other skills for a few turns.

The last thing that is important to note about *Bloodletting* is the debuff it applies: -20% Damage. This is a separate, stacking debuff that's unique from Weaken tokens, and, importantly, while it can be resisted, the debuff *lasts the entire battle* if not*.* If you approach the Chirurgeon with the intent of curing diseases on one or more of your heroes, keep in mind that it's very likely that those heroes will be moderately weakened for the remainder of the battle. In addition, almost all the Gaunts (bar Widow and the Chirurgeon himself) have a chance to Disease on one or more of their attacks, meaning it's possible to gain new diseases to be cured with *Bloodletting* *during* the battle. The disease chance on these attacks is usually very small, except in the case of Patients, who have a 25% chance to disease with their version of the *Chomp* attack, meaning contracting repeat diseases is somewhat likely when faced with one or more of these enemies. Since *Chomp* exclusively targets the frontline ranks, which typically contain the main damage dealers in most teams, the damage debuff from *Bloodletting* sticking even just once on those heroes, let alone twice, can have a huge effect on the pace of the fight.

## Trivia

* The Chirurgeon uses most of the unique items that can be obtained as a reward for defeating him.
	+ The Appalling Apron and Spiked Skullcap are both worn on his person and provide the same respective buffs that they do as equippable trinkets.
	+ The Trephine Bur and Orbitoclast are used by him in combat both to treat his Gaunt allies and to "treat" heroes.
	+ The contents of his ubiquitous bucket of Leeches can be rewarded in the form of an inn item or a combat item.
	+ The Bone Saw is used as his last-resort procedure on heroes.
	+ The Physicians' Guild Seal is the only unique item drop that does not appear anywhere in the battle.

* Patients, the champion version of Lost Souls, exclusively appear in battles with the Chirurgeon.

* Trepanation appears to be the antithetical counterpart of Indiscriminate Science.
	+ While Indiscriminate Science removes positive tokens and heals per token removed, Trepanation removes negative tokens and deals damage per token removed.

* Leucotomy provides a unique buff to Carrion Eaters, despite them not appearing in the fight naturally. This is because they can still spawn via the Corpse Light Infernal Flame.

* Both the Chirurgeon's visual design and battle mechanics were created in collaboration with a Darkest Dungeon fan via the Make-a-Wish foundation.
	+ The first batch of items based on the Chirurgeon, which included the Appalling Apron, Spiked Skullcap, Bone Saw, and the Leeches inn item, were released in the *Void Between Us* update on December 12, 2022, with the Chirurgeon himself, along with a promotional render and concept art being revealed a month later on January 26, 2023, with plans announced to add him to the game following the game's full release.
	+ Initially, the Chirurgeon was planned simply as a basic support unit for the Gaunt faction, but upon the reveal of the *Chirurgeon's Table* update, was revealed to have become a true mini-boss with his own node, rewards, and mechanics, and was added to the game on August 18, 2023.

1. ↑ https://www.darkestdungeon.com/news/red-hook-partners-with-make-a-wish-foundation-new-fan-designed-monster-and-items/