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.

Charles B. Holloway was not a very healthy man, and he was constantly surprised that he was still alive and partially kicking. At 54, he was the older of two brothers by a grand total of 3 years, 2 months, and 7 days, and not a day passed without him crowing about it to his brother, one Christopher K. Holloway. Chris was not very much healthier than Charles, but he never let a day pass without mentioning it to Chuck. Chris had heart irregularities, for which he took digoxin. Chuck had recurring bouts of bronchitis that sometimes became pneumonia. Chuck also had frequent episodes of pink eye, sinusitis, middle ear infection, and strep throat. Chuck took very many medications.

Chuck and Chris bickered like only an old married couple, or bachelor brothers, can. Chuck disputed his brother’s claim of being the chess champion in fifth grade. Chris maintained staunchly that Chuck cheated at Monopoly. Things may nonetheless have worked out fine had it not been for Rebeca Correia Cavalcanti (nee Carvalho), and the fact that their father had been a first-class ass. Chuck and Chris had met Becky at bingo, and they had fallen over each other in response to her Brazilian accent, exotic looks, and perfume. Rebeca was 5 years younger than Chuck, in good shape, and vivacious compared to any of the rest of the bingo and bridge crowd. A grim rivalry grew between the brothers after that first meeting 2 years ago.

Their father, Hank, had done them the immense disservice of encouraging competition between the boys. He had believed it would help “build character” and prepare them for the world. In practice though, all it did was make them bitter, suspicious, and scheming. The boys grew up convinced that life was unfair, hostile, and sneaky, and when Hank died, he left a parting shot that underlined the rivalry and focus. The estate was not prodigious by any means, but it wasn’t insignificant either. Hank left all his stocks, bonds, and cash to Chuck, and his two-story house and its contents to Chris, with the proviso that they could not be sold, and that Chuck had a right to live there should he so wish. The house was appraised at $285,000 and the financial instruments at $5,000. It caused an immediate state of pandemonium between Chuck and Chris, and it took the boys over 20 years to arrive at a truce of sorts. Chuck lived on the upper floor of the house, Chris in the lower, and they watched each other like hawks to ensure that neither gained an advantage.

Rebeca liked both brothers but saw neither as a long-term prospect for romance or partnership. They were fun and attentive for going bowling, dining, or playing bingo, and outdid each other to be helpful and polite to her. Their constant rivalry was amusing in the beginning, but they both seemed to be getting way too serious and competitive, and she was starting to pull back from them a bit. Unfortunately, when she pulled back, both brothers took it as a sign that the other was gaining ground, and their rivalry ratcheted up. Chuck “forgot” to tell Chris about a joint date to go bowling, and as a reprisal, Chuck’s car mysteriously had two flat tires and caused him to be a no-show for movie night. Rebeca became increasingly alarmed at the toll it seemed to have on their health. When Chris had chest pains during one of these joint dates, she decided to stop going out with both of them.

Chuck had been sick again. He was frantic over Rebeca saying she didn’t want to go out anymore and he blamed Chris. Chuck was running a fever, and as he explained to their family doctor, his throat was like old, cracked sandpaper, and swallowing was like trying to force down rusty razor blades. He further stated that he had occasional bouts of nausea after meals. There was certainly redness and irritation going on, and given Chuck’s past medical history, the doctor had prescribed the macrolide class antibiotic azithromycin. In her notes, the doctor had also written that Chuck seemed just a little confused, and had repeated himself several times.

Dr. Josh Trebach was in his tenth hour of a twelve-hour ED shift when Chuck was brought in. It was past 10 PM and Josh had missed any chance at food when he was called to bay five, where a male patient was complaining loudly to the infusion pump about vomiting and diarrhea. Chuck tried to focus on the man in the white jacket and wondered out loud what sort of restaurant this was, but stated flatly that he was not hungry, and anyway, everything either shot right out of his bottom or came right back up as soon as it reached his gut. “In and out, in and out!” Chuck proclaimed alternately to Josh, the nurse, and the infusion pump. Collecting a good medical history from Chuck soon proved to be out of the question, and while the nurses got an IV line in and started collecting a trace from the ECG, Josh had a quick word with the lady who brought him in. Somewhat agitated and struggling to keep her Brazilian accent from taking over, Rebeca explained that Chuck had been sick recently with a sore throat. “Red pills!” She rummaged in her bag and produced a tattered, half-empty box of antibiotics.

“He was taking them for a throat infection, but he has always been very sick,” a slightly disheveled older man several seats from her piped up. Josh turned and looked at him, puzzled. “I’m his brother,” Chris explained, and went into detail about Chuck’s history of various ear, eye, and throat infections. Josh thanked them both and returned to the ED while mulling over the odd tableau he had just witnessed. The brother’s emphasis on past illness seemed stilted, forced, hurried. There was also some sort of tension between the brother and what seemed to be the patient’s girlfriend. Josh shook his head and reviewed the clinical picture. The symptoms overlapped with some that might come as a result of a really bad strep throat, but didn’t line up well. The role that azithromycin played in this, if any, puzzled Josh, as did the symptoms. This didn’t look like sepsis, complications of strep, or even adverse effects of the antibiotics.

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Back in the ED, Josh stood beside Chuck and reviewed the data. The cardiac trace looked too slow for someone in distress, and there were rhythm irregularities that worried him. In a lucid moment, Chuck was able to answer a question: What was he seeing? The slight blurriness might have just necessitated a new prescription, but Chuck was seeing flashes, and confidently stated that the white card Josh held up was yellow. Josh looked again at the abnormally high potassium levels and changed tack. He ordered a test on the blood already drawn, added an order for digoxin-specific antibody fragments, and sent a call for the police.

The next morning, Chuck’s symptoms, including his confusion, were mostly gone, and he was on the discharge list. Chris, on the other hand, had woken to a knock on the door by the police. It did not take long to piece together the facts showing that Chris had been poisoning Chuck with his digoxin over their long-standing rivalries that had been brought to a head by competition over Rebeca.