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 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.
Erica became a nurse largely because of her feet. They were, in her words, freakishly large feet. Even for her six-foot frame, her feet were slightly beyond the norm.
When Erica graduated high school, the traditional business attire for women included skirt, stockings, and of course, heels. Heels in her size were hard to come by, and her choices seemed to be limited to low-heeled Mary Jane’s that looked like forlorn boats or kinky stripper heels. There were no Christian Louboutins or Manolo Blahnik’s in men’s size 13.
With her school friends heading off to entry-level, skirt-and-heels jobs in banking, insurance, or law, Erica found, to her delight, that not only did nurse uniforms involve comfy washable shoes, but also stipulated scrubs. No skirts, stockings, or stilettos in sight.
What Erica sought was a career that was bigger than herself—one that involved helping, attention to detail that mattered, and work that made a difference in people’s lives. At the end of any long workday, Erica had a sense of purpose and a feeling that where her friends mostly had jobs, she had a vocation. Their job stories were about being a dollar short or over on the till, a memo that was misfiled, or a paper cut. Her job stories were about anguish and joy, pain and relief, life and death.
Jack was a hacker and had been since his teens. It started at school when he defeated the school website security and discovered quick and easy rewards from stealing and selling staff personal details. The $200 he got for the staff records was more than what any of his classmates made on paper routes, working a till, or bussing dishes at a diner. H4ck3rJ4ck3r, as he called himself on online forums, was all about the money.
After he graduated high school, Jack did odd IT jobs, mainly call center work, helping with transitions to offshoring, doing IT work during mergers, and decommissioning IT systems of failed businesses.
It was somewhat unstable work, and besides selling off data he gathered from the failed businesses, Jack supplemented his income with hacking previous employers and customers, and especially vendors or manufacturers of goods or services that got up his ire. There was the big box store that sold him a TV with a faulty remote control. A plumbing service had overcharged him for unblocking his drains. A car service had ripped him off, and he was sure that the place that did tires and mufflers had switched his tires. He broke into their systems and stole personal data.
Hacking to nab client or staff details was relatively easy, and victims seldom realized they had been hacked. Mostly their staff and clients would see more spam emails, some would see unfamiliar charges on credit cards, and a few would discover their identity had been used to secure a loan or open an account. Sometimes a hack got him only 15¢ per record, and sometimes it was a bonanza with a $12k payout.
Jack’s girlfriend had been mortified when he let slip that her jade necklace had been bought with the proceeds of hacking an elder care facility. “Do unto others …,” she had suggested. Jack had retorted that “Yeah well, they already did unto me.” Kelsey pointed out that while he might feel the facility short-paid him for a website, the old granny whose details he sold, didn’t. “Tough,” said Jack, and suggested that in this world, you can only rely on yourself, and it’s everyone for themselves.
Kelsey suggested the proverb that if you live by the sword …
Jack snorted, “Yeah well, nobody ever actually dies from being hacked.”
“Maybe you will be one of the first?”.
“Oh, I would love to die from a hack, that would be the best.”
The relationship didn’t last long after that. Kelsey couldn’t get over how mean he had proven to be and broke up with him. Jack proved her point by selling her details and a few nude pics for the price of a new illuminated keyboard. Years of poor diet, lack of sleep, and sparse exercise had given Jack prediabetes, high blood pressure, and heart arrhythmia. One hot and sticky day at the local PC shop where he sometimes worked part-time, he fainted while packing out new stock. He recovered in a few minutes and figured it was not worth an ER visit, but after a panel of blood tests and a lecture about greens and exercise, his primary care physician ordered up an MRI, “just to be sure.”
As is sometimes the case, the MRI revealed additional issues. Firstly, he had bell clapper deformity, which made him a prime candidate for testicular torsion, but more acutely, he had an inguinal hernia. There was a small amount of tissue, perhaps a part of the intestine, protruding through a weak spot and into his scrotum. “Feel here” the radiologist had invited, and guided Jack’s fingers to where he felt a generous lump that definitely wasn’t meant to be there. Jack felt nauseous at the thought and sensation, and his head spun.
Not a dire emergency, his primary care doctor explained, but something that needed surgery and a short hospital stay.
Since he had no health insurance, Jack was forced to sell his life insurance and 401k to pay for the hospital. Selling in this case was more like pawning than simply cashing in. A third-party group took ownership of the policy for a short period and gave him a bundle of cash. The deal was that they would let him buy it back again a few months later but at a sturdy interest rate. Jack figured a few good hacks and he would recover his policies with cash to spare. Heck, he might even hack the insurance loan crowd. They seemed a bit shady and deserving of a bit of attention from H4ck3rJ4ck3r.
Jacks’ surgery went well, and the attending went through his chart and said that all things being equal, Jack could be discharged the next morning.
At 3:16 AM, things got somewhat unequal, and Jack’s heart stopped. Despite heroic efforts by the crash team, Jack was called at 3:48.
Erica was puzzled. Being somewhat a stickler for detail throughout her 40 years of being a nurse, she had noted the drug levels in the IV auto drug dispenser in room 5 north 17c: the inguinal. She noted drugs in, levels, and drugs administered, and they didn’t balance. Pulling the log from the dispenser, she could see exactly which fluids it thought it had dispensed, but these didn’t tally with how much her records said was in the machine when she had stocked it, and how much was left in it.
Knowing that Erica was very seldom wrong when she said a death didn’t sit right, an autopsy was requested. The autopsy didn’t find anything specific, but there were things that tallied with the missing drugs. Few people would have been suspicious with just the autopsy results or with just the drug discrepancy, but the two together felt like something to Erica.
Erica asked the device vendor to run a full maintenance test on the unit and to check its calibration. While she waited for that, she requested data for the 18 months since the hospital had started using auto dispensers. In the meantime, Erica had other patients, other duties, and other priorities waiting for attention.
The data arrived 2 days later, and Erica pulled it into her R statistical package. There was indeed a correlation between use of the auto dispensers and death. Patients on them tended to die at a higher rate than those who weren’t. Not a cut and dried case though, she thought, because maybe sicker patients are on autos. Erica sent off a query to friends and colleagues at other hospitals in the region.
Bryan, the vendor service manager called her to set up a meeting the next day, which gave Erica pause for thought. They didn’t usually want to visit so quickly. He came with Frieda, his top technician, and they looked worried. “We have puzzling results,” he started and handed over to Frieda. The auto dispenser tested ok, and calibration was within specifications, but there was something wrong with the log and with the software version level. The log had a little gap, and the time intervals were off. It was as though someone had snipped out a piece of time, and then pasted in another piece, but slightly askew. The software version number was between levels. It wasn’t a whole increment and not any version they had ever put out.
“What do you make of it?” Erica had asked them. “The device was hacked,” Frieda shuffled some printouts and looked up directly at Erica, “and I think this was deliberate.” Frieda had brought her PC and had written a diagnostic app to identify units that had signs of tampering. She excused herself and went to examine other dispensing units they had on site.
Erica called in the deputy chief medical officer, nurse director, facility IT manager, and security chief, and she and Bryan briefed them. Erica outlined what was known and laid out all the facts; the unexpected death, missing drugs, autopsy results, and the evidence of tampering.
Frieda returned, looking distraught. Five of the units she had tested showed evidence of having been hacked. Three of the ICU’s 12 units had been tampered with, as well as two of the 18 step-down sub-ICU units. Worse still, while she was connected to an ICU unit, she had seen tampering in progress, and had recorded it while the nurses physically disconnected the IV and switched to manual infusion. Someone had tried to kill a patient right in front of her.
In the following weeks, the investigation spread to other hospitals, and the number of deaths associated with hacking had climbed to more than 70. Working with the police department and hospitals, investigators discovered that all the deaths were related to one common element. All the patients involved had sold their life insurance in the 18 months prior to death. Someone had been killing them for the insurance payouts.
Erica looked at the revised coroner’s report on Jack, the inguinal hernia case. Death was attributed to homicide by persons unknown and resulted from intentional tampering with hospital equipment for the purposes of financial gain. His ex-girlfriend, Kelsey, would have been unsurprised. Live by the sword, die by the sword, she would have reiterated. Cause harm by hacking, die by hacking—the equation was balanced.