This is one of a collection of stories that are like “Final Destination” meets “The Monkey’s Paw” (W. W. Jacobs, 1902). As such, they are tragedies more than either mysteries or horror, and would appeal most to readers who enjoy the inexorable pull of a story arc that leads to doom. In each story, a protagonist makes a wish that comes true with fatal results for someone, often the person making the wish. Nothing supernatural, but just how things work out. (Or is it?) The technical details surrounding the fatal (or near-fatal) event are drawn from real cases in the US OSHA incident report database or similar sources and are therefore entirely realistic, even if seemingly outlandish. The plots draw lightly from cultural beliefs around actions such as pointing at someone with a stick or knife, wishing in front of a mirror, or stepping on a crack.

Art Bollinger III had a secret. After all, Art was a hospital concierge; he knew everybody’s secrets. One of the many undocumented tasks that he routinely carried out was buying gifts for the wives, girlfriends, and mistresses of the senior management team, the board of directors, and some of the luminaries and visiting guests that management had identified as VIPs. He also booked hotels, obtained hard-to-get theatre and sports tickets, secured tables at the best restaurants, and ensured unchallenged entrance to the most exclusive nightclubs. Less savory services that Art fulfilled involved arranging things that you might easily guess, but which, happily, he was seldom called on to provide. Art had some rules about stuff like that, and everyone was sure to stay on good terms with him.

None of these things, however, related to the secret that Art kept very close to his chest: the fact that, for several years, he had been fighting cancer. Nobody other than his oncologist knew that he was battling ovarian cancer, or even that he had ovaries at all. At 55, Art cut a distinguished but streetwise figure who was firm, efficient, and capable, and he was under no circumstances planning to change that to an image of a dying and increasingly fragile person. So far, the cancer and treatments that he could afford did not affect his two hobbies too badly, but he was beginning to feel that change. Ballroom dancing was becoming too strenuous, and tango was out of the question, but he could still do a tidy waltz or two. Though he was also still able to indulge in hobby electronics and building remote controlled models, his hands had started trembling, and holding a soldering iron was becoming difficult, too. He hated admitting it, but Art was keenly aware that his life was slowly crumbling away, and without something near miraculous, he was headed for a steady downward spiral.

Gary was a health insurance claims adjuster, and like you might guess, enjoyed things being neat, tidy, and squared away. His desk was spartan and efficiently arranged, and his numbers were consistently the best in the office. He was not motivated by greed and had no time for the intrigues of bonus schemes and reward programs. Gary routinely overachieved not because he was offered a percentage of savings but because he followed the rules to a T, applied them tirelessly, and was grimly efficient at his job. He took no pleasure in denying claims if they didn’t exactly meet all criteria, nor did he reduce claims because he had any issues with patients or providers. He did so because he could, the provisions allowed him to, and because that was his job. Gary could always spot the slightest, most arcane, least challengeable means to reduce the amount the firm needed to pay out. If a CPT code was wrong, Gary would sniff it out and deny a claim. If there was a cheaper code that fitted the description, he would apply it. If there was a way to run out the clock and reduce or deny payment, he would do it. Gary wasn’t the sort of person to break his neck over things, either, and so he did it all calmly, quickly, and quietly.

Dr. Narjust Florez was exhausted. As an oncologist, she guided patients either up the trudging climb to remission, or down the steady spiral the other way. By the time patients were referred to her, cures were very seldom quick or easy, but she had a solid track record. While the job of treating patients had its good times and bad, medicine itself was not even half of her daily job—the rest was mainly hand to hand combat with administrative tasks, such as the hospital’s cumbersome and erratic EHR system. After a full patient panel each day, she was usually wrestling with the EHR until late at night, adding patient notes, searching for clinical trials, or, worst of all, writing justifications to insurers for drugs, surgery, or palliative care, arguing, pleading, and cajoling with them for hours on end.  Writing notes was a logical part of patient care and good practice. It helped avoid mistakes, clarified thinking, and saved time in the long run. Searching for clinical trials felt productive, and there was always a chance of pulling a lucky match that worked out well for the patient. However, trying to justify, re-justify, and argue about justification, just for a treatment to be paid for, seemed like such a grinding waste of time. There were endless hours spent sending faxes, writing emails, and waiting on hold just to secure prior authorization for a necessary treatment, but then there was also the torture of repeating the whole process again whenever the insurance company decided to refuse the payment anyway.

This time, Dr. Florez had run out of tricks, pleas, and alternatives. The patient had waited until a bit too late, the referral process had taken a bit too long, and the insurer had been a bit too good at raising delays. Mr. Bollinger’s ovarian cancer had spread. There were some promising experimental drugs, but the costs were high, and insurance wasn’t going to cover them. Dr. Florez tried to reason with the insurance company yet again, and after submitting additional justification and documentation, she waited on hold for 30 minutes before the claims representative finally spoke with her. Gary was unmoved, however, and calmly pointed out that treatment for ovarian cancer was covered by ICD codes C56.1-9. He patiently explained to her, as if she was a particularly slow 8-year-old, that these codes only existed under the female subsection, and therefore could not be applied to Mr. Arthur Hephaestus Bollinger III, since his forms clearly identified him as a male. Try as she might, the insurance had a legal point, the right to stick with it, and no incentive to shift their view.

Art considered his options. The discussion with Dr. Florez had been a blur, and all he could remember was that there was no curative path left, that the cancer was unstoppable without the drugs he couldn’t afford, and Dr. Florez’s face as she struggled not to burst into tears while giving him the news. He still felt stunned; sitting at home on his old sofa, he couldn’t stay focused, so he began to channel-surf, anxiously waiting for sleep to sneak up on him. Idly watching a documentary on farming and the logistics of food, he suddenly got an idea. It was clear, breathtaking, and preposterous, but he knew exactly what he needed to do.

Art started by writing several letters. He first wrote to Dr. Florez, thanking her for all her support. He wrote to a few friends, explaining his situation. Finally, he wrote to the insurance company, giving them a big raspberry. He then packed a picnic basket, looked up a few things, checked a map, and made some notes.

At 10 PM, Art went to his workshop and spent the next two hours building a little project. The following morning, he called in for paid time off, and then called a retired friend to go to the store downtown with him. At the checkout, the clerk eyed his odd collection of items: a hand truck, a pack of BBQ lighters, and four 50-pound bags of finely milled white flour. The clerk cracked a joke about their haul. “You guys making lotsa pizzas or something?” Art and his friend loaded the goods into the back of the hospital van he had been using to run errands the past few days and drove away.

Art backed the van up to the loading dock in the basement parking of the insurance building. The new office park had not yet reached full occupancy, and amongst the empty buildings and remaining vacant lots, the insurance building itself was a big looming structure. It was not too much trouble to defeat the lock of the service bay under the main elevator shaft. Art pushed the hand trolley up the slight ramp and into the service bay, moving one bag of flour at a time. He had to pause each time to get his breath back; it took nearly 2 hours to move all four bags underneath the first elevator. By the time Art finally got everything tied and secured, he was exhausted, in pain, and his hands and legs were shaking badly.

After resting for an hour, Art finished with the rest of his work, and then, using the maintenance panel, sent the elevator to the 11th floor. The space above him now felt like a cathedral, disappearing high in the vaulted distance above. He cleared a space, rolled out a small blanket, and unpacked the picnic basket. He placed a small vase at the edge of the blanket, inserted three chrysanthemums and a small bottle rocket, and poured himself a glass of red wine. Art snacked and sipped his wine and reflected on a life that was filled with events. Some had been ugly and alarming, and he acknowledged those memories and let them go. Some were tender, joyful, or uplifting, and he greeted those memories warmly, inviting them to linger with him. At 3 AM, the witching hour, he picked up the remote control, walked to the maintenance panel, and made a selection on each before returning to his picnic. Art heard the elevator far above, making its way to the 13th floor, and he took a last bite of stilton cheese on a slice of Melba toast. Art breathed evenly, quieting his thoughts, and lit the fuse on the little rocket.

It was 3 months before crews finally demolished the last of the insurance building and hauled away the rubble. The explosion that had ripped through the building core had weakened it structurally and blown out the fire doors on every floor. The resulting fires had roared unopposed through the building, and by the time the fire department had got it under control, the building was a blackened husk of broken concrete, twisted metal, and minor traces of furniture and documents.

Gary was one of many who lost their jobs when the insurance company folded, but the rumors about the ultimate causes of the fire ensured that he was one of the few that didn’t immediately find new work. After 3 months of unemployment, Gary tripped on the hem of his pajama pants one afternoon after three dry martinis, fell down the stairs, and broke his neck. Gary would never deny another claim.