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.
Dr. Ebenezer Bankmore was the well-heeled CMO of a successful for-profit hospital system. He had gone to “the dark side,” as some might say, and had drifted far from his undergraduate aspirations of saving lives and improving health. The metamorphosis from an eager and inspired medical student to a phlegmatic and mercenary businessman had been a long journey, studded with significant milestones that spoke to disillusionment and disengagement. In his final year of medical school, he was puzzled by the assertions of a dual MBA and medicine professor who extolled the virtues and described the necessity of regarding medicine as primarily a business. The sentiment surfaced with renewed emphasis and far more salience when he graduated with an accumulated $310,978 in student debt.
A pivotal moment in his passage to the dark side was the experience of being sued for malpractice by a patient’s family, who in their grief and pain believed strongly that their loss and anguish could only be explained by the negligence of the attending physician. The legal argument that he could have “done more” for his patient swirled in his head for weeks after the case had been settled, insurance paid out, and premiums were adjusted. At some level, and despite his feelings and his lawyer’s response, there was some element of truth to the claim. Was it not true in every case that “something more” could always have been done? There was something mechanically businesslike about the process and its ramifications. More was always better, and Ebenezer had learned to perform defensive medicine.
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The shift in his mode of medical practice had unexpected and reinforcing effects. Increased RVUs, more tests, and additional referrals resulted in greater payment, increased visibility with management, and an expanding circle of ever-more grateful specialists. It was not long before the visibility of his performance metrics and chatter on the golf course among specialists and facility management resulted in promotion. Instead of just being a physician, he was now a manager, one who quickly infused the practices of his subordinates with defensive and profit-seeking changes. Out with generics and in with higher-priced medications. More testing. More referrals. More surgeries. More, more, more.
Another pivotal moment for Ebenezer was the first time he decided to use an increase in staffing budget to employ a billing specialist rather than another physician. It had come to his attention, spurred by participation in a medical business conference, that they were “leaving money on the table” when it came to billing insurance, Medicare, or (reluctantly) Medicaid. Within 6 months, the three medical coding and billing admins that he could hire for 23% less than a new physician had generated more profit than two new physicians. The bonus he received at the end of the year was bigger than all previous bonuses combined, and Ebenezer was head-hunted by a for-profit hospital system that was ever watchful for rising talent.
His transition to the dark side was almost complete.
If adding billing admins was more profitable than adding incrementally more physicians, wouldn’t the corollary also be true? He wondered. After a few sessions with the CFO and a bevy of analysts, he soon had, on paper at least, an answer. Cutting the three lowest-performing physicians and replacing them with a team of eight medical coders would apparently reduce overhead costs by several thousand a month while increasing profits by nearly a million. All the metrics that counted would climb sharply and their loss exposure and malpractice insurance costs would be 7% lower.
On a drizzly October Thursday, Dr. Melissa Freeman, psychiatrist, Dr. Margaret Mills, endocrinologist, and Dr. Katy Copeland, OB/GYN, were informed blandly by HR that they were “superfluous to requirement.” They could still attend the corporate Christmas bash in December, they were informed, but would be required to remove personal effects and hand in their badges by the end of the day. From his expansive corner office on the seventh floor, Ebenezer could have seen Melissa Freeman walk to her car in a daze, and then hunch down in the driver’s seat and cry explosively for 15 minutes, but he didn’t. He was instead reviewing profit projections and examining a recommendation by the analysts to close OB/GYN services and expand anesthesiology. It was all about the RVU ratios versus malpractice insurance. His transformation was complete.
Herman was a nurse, bachelor, and an apothecary. His dabbling in herbalism had grown from its roots in his teenage years to a paying hobby and a way of life. His cola toffee was delicious, but it was his herbal throat lozenges that were most popular. Every winter, he would sell, at a purely nominal price, lozenges made from honey, treacle, ginger, and lemon oils, and eucalyptus oils specially imported from a supplier just west of Moogara in Tasmania. This year, he had experimented with making eggnog for the Yuletide season. The problem was grittiness caused by the nutmeg and cassia, which was unpleasant and left unsightly sediment. Herman found that grinding them finer just clogged the strainer and they lost their flavor quicker. It was a quandary, and he was nervous that his promise to provide some of the eggnog for the company Christmas party might be an embarrassing flop.
Just in time, an inspiration from a dream in which he saw a waterfall and a pond led Herman to the idea of steeping the nutmeg and cassia in warm water with a touch of filtered vodka. The alcohol was preheated and the roasted, crushed nutmeg and coarsely ground cassia were soaked in it and agitated regularly. Then the slurry was added to sparkling spring water and warmed slightly. The aroma was pure heaven and his little cottage was a tumult of scents and fragrances. With that problem solved, and the eggnog promise secured, Herman busied himself with other preparations. There was, however, bad news on the horizon that distracted him. No sooner than he had he set aside the nutmeg and cassia to steep, he got a call from his supervisor. OB/GYN was being shuttered, and although they would keep him in mind for other vacancies, his age and performance metrics suggested that being transferred was an unlikely outcome. After a few days of brooding, Herman shrugged off the bad tidings, put on a smile, and dropped off a jug of his cassia and nutmeg infusion eggnog and a couple of wreaths for the Christmas party. He consoled himself with the thought that karma would eventually circle round and it would be Dr. McScrooge’s turn to have his head on the chopping block. “Well, we’ll raise a glass to that!” his friends had cheered at his impromptu farewell after work.
Dr. Melissa Freeman had thought about leaving town when the company Christmas bash was on, but since she had already bought the components for a Victorian Christmas outfit, and thought it a good opportunity to give Dr. “Chief Grinch” Bankmore a piece of her mind, she decided to attend. Dr. Margaret Mills had decided to change her costume to one festooned with monopoly money and had been eagerly awaiting the chance to publicly denounce the current money-grubbing attitude of management. What were they going to do, fire her? Dr. Katy Copeland, being an OB/GYN and therefore future-leaning, was going in a space-traveler outfit in shimmery silver and pearl fabric. She had a side-arm in the form of a water pistol, guaranteed as “the most powerful water gun on the market,” and she had some ideas on exactly whom she might use it.
Sentiment at the Christmas bash was mixed. There was enthusiastic glee in abundance, to be sure, and on the whole, the costumes showed care and forethought. The only knot in the plank seemed to be the wide birth most were giving to the table at which Dr. Bankmore was seated. Those whose designated seats were at his table seemed to forever be elsewhere, and he was left to sip the fragrant eggnog alone. After two full cups of the delicious, but heady, jug of Herman’s eggnog, Dr. Bankmore was feeling expansive and relaxed. He satisfied his dry mouth with a third cup, taking more of a gulp than a sip, and raised it in greeting to a rather well-dressed Victorian lady who materialized out of the throng. She raised a hand, as if he should kiss it, but then pointed at him, and her smiling face grew stern. “You betrayed your oath to patients, Ebenezer! You were such a promising doctor, but you lost your head. Can you not remember your passion?” She slapped him across the top of his reddening head with her fan, then fixed him with one last glare, turned as briskly as her hoop skirt allowed, and departed with an ominous “Misfortune will visit you, Ebenezer, you slippery toad.”
Dr. Bankmore was stunned and confused, and it seemed like the room around him was twisting, stretching, and buzzing with cackles from a multitude of sprites, gnomes, and talking animals. He wiped his eyes and unsteadily poured another draught of eggnog. “You!” Ebenezer startled at the accusing voice of Dr. Margaret Mills. “Look at you, you money-grubbing plutocrat! You are a giant festering anal gland!” She stuffed Monopoly money in his shirt pocket and threw a handful in his face. The room grew silent and he could swear he heard the sounds of clanking chains. Then the room twisted again, and the swirling figure festooned with money drifted away and vanished. His mouth felt like a desert, and he gulped from his cup.
Dr. Bankmore tried to get up, but felt dizzy and sat down heavily in his chair, pulling the tablecloth with him and tipping the almost empty jug of eggnog. He watched in a distracted way as it rolled, and spun, and shattered in a million sparkling pieces at his feet. He was still staring at them when a jet of icy water hit him full in the face. He flailed wildly at the shock and fell backwards, his breath bursting from him as he hit the floor. “Got you!” a space alien crowed at him and shot him again in his chest. Ebenezer scurried to his feet, stumbling and staggering through an alien landscape filled with twisted and glaring faces, fangs bared, fingers pointing. He bolted from the cafeteria, rushing past astonished partiers, and hurtled into the foyer. When he suddenly encountered a menacing monster with a pulsing nose and red eyes glaring beneath murderous antlers, he lost his footing on the sheer marble floor and slid under the Santa’s sleigh diorama. His slide into last base stopped short when his jaw caught on a crossbar between the skis and the back of his head was trapped by the base of the platform.
The internal decapitation precipitated by his sudden stop was swift and sure in ending both his nutmeg delirium and his plans to further convert patient care into a billing machine.