The descent of Herbert J. Walker into bankruptcy, homelessness, and despair was smooth, efficient, and relentless. On a Thursday morning at 10:45, 3 weeks before Christmas, Herb lost his job. From the moment Herb was informed that the Fellowship Ebenezer Hospital was closing, events followed as smoothly as clockwork.

His immodest 3,300 square foot McMansion house with a lake view and bordering the nineteenth hole of a private golf course ceased to be his within 3 days. His job as VP of marketing had come, and gone, with substantial perks. The home loan, platinum credit card, car lease, and club membership were part of his comfy package, as well as a sizable overdraft facility and box seats at almost every notable ball game in the state.

In the space of 3 days, the bank management went from obsequious to predatory, and Herb looked on with stunned disbelief as his interest rates for mortgage, revolving credit, and car loan all flipped from 3% to 23% and the bank called them all in. It didn’t take long for Herb to realize that his burn rate, even at low-price long-stay motels and the cheapest apartments around, was going to deplete everything he had within a few months. He sold almost everything he had except for a 2011 Mercedes Sprinter van and a Rolex watch his wife had bought him for his 50th birthday. He had bought the van thirdhand when hiking and touring seemed like a way to spruce up “us time” with his wife. After their divorce, he abandoned further work on turning the van into a tourer but never got around to selling it.

Herb had spearheaded some rather clever campaigns to destroy potential competitors in the region, and largely through his lobbying efforts on the golf course and well-targeted re-election donations, the Ebenezer was eventually the only hospital for miles. Through his efforts, they had cut several low-performing specialties and had built out a medical coding team that was expert at squeezing the most out of Medicare and Medicaid through creative and adventurous coding. Herb’s presentations to the board were peppered with phrases like “crushing competition,” “breaking them,” and “sucking out the fat” in federal programs.

Larger forces were at work, though, and there was a recessionary backdrop and high unemployment. When the state turned down federal funding for the Affordable Care Act, the Ebenezer suddenly found itself in a squeeze. To make matters worse, state funding for women’s health was cut, and referrals from the two reproductive health clinics dried up when they closed. The final straw was increased pricing in the self-insured marketplace that resulted in fewer visits, and also a drop in elective procedures due to the unemployment spike. The investors behind the Ebenezer decided it was worth more in asset sales and tax write-offs than as a running concern.

Herb sucked his thumb and tried to focus. His nail had torn and folded back when he struggled to get the house key off the ring. It didn’t bleed much, but it hurt like the devil and reminded him that he would lose his health insurance at midnight on New Year’s Eve.

So, that settled the bankruptcy and homelessness of Herb’s situation, but it wasn’t until his live-in girlfriend, Cindy, had left town that Herb felt despair. She had been his personal assistant and cheerleader, and his affair with the young and bubbly Cindy had been the final nail in the coffin of his marriage. Herb had seen her as a new beginning, but Cindy had not seen Herb as a soulmate of any description. When her position was eliminated at the Ebenezer, it took her less than an hour to get a gig in San Diego, and less than 3 to book a flight, pack a bag, and call a taxi. Cindy traveled light and carried little physical or emotional baggage. By the time Herb had surfaced from the initial shock of being laid off, and before the financial implications had fully developed in his mind, Cindy was gone.

His contacts in the industry had further bad news. The market for marketing was in the doldrums, and he could expect an 18-month wait to get the next position. They also warned him that he might have to settle for a lower position with a much smaller package.

Herb moved into the van to cut costs. It had almost all the basics fitted out, and except for shower and toilet, he could be self-sufficient. He figured he could stretch existing money twice as far living in the van, although that meant moving every 14 days to a different campsite or RV park. Twice as far still wouldn’t get him anywhere near 18 months though, so he started looking for interim jobs.

Herb started with high expectations, looking for Interim Director/Manager jobs, but soon realized that those were all quickly snapped up by ex-CxOs. He tried marketing and sales manager jobs, but out of 2 dozen applications, he got only one interview. They had made it pretty clear that competition was stiff for these positions, required current experience with the latest customer relationship management tools, and paid 90% on commission. At 10% base pay for 3 months while Herb built a sales pipeline, he would be basically earning minimum wage. They didn’t call him back anyway, so the point was moot.

What Herb eventually did find, after 2 months of searching, was an early shift job at a bakery. It paid slightly more than minimum wage and would give him his afternoons free to continue his job hunt and develop his social network on LinkedIn. The work itself was physically demanding and started at 4:30 AM, sanitizing the kitchen and hauling 50lb bags of flour from the storage room up a flight of stairs to the kitchen. His primary job was preparing dough each morning, starting with loading and running a pair of 20-gallon mixers.

Living in his van was cost effective, but it had a downside. The campsites were not always available, and Herb was sometimes required to practice “boondocking”—overnighting in parking lots of all-night shopping malls, fitness centers, or high-traffic areas. Noise, lights, and frequent loud voices or motor vehicles made uninterrupted sleep nearly impossible. It also sometimes involved people banging on the side of the van, and sometimes the people were police, enforcing county regulations against vagrancy.

This morning, Herb arrived at work after a fitful night in which he was boondocking. A police cruiser shooed him along at midnight, and it took him another hour to find a suitable parking spot outside a nightclub. With the noise and fears of being rousted again, he never fully regained sleep. Wrestling a 50lb bag of flour into each mixer woke Herb up fairly well, and he was plenty alert while adding the required yeast, grains, and warm water. Once the mixers were running though, Herb was just watching them turning, monitoring for spills or dry spots. The churning dough was almost hypnotic.

Herb dozed off for less than a minute and was jolted awake when a lump of dough as big as a cabbage fell out of the closest mixer and landed on his foot. In a panic, Herb used a wooden paddle to wrestle a tower of dough back down into the bowl. With one last shove, Herb got the runaway dough back under the turning dough hook. He glanced around quickly to see if anyone had noticed and felt relief wash over him. In that moment of inattention, one of the upper limbs of the dough hook slipped under the metal band of his Rolex, and before he could reach the cutoff switch, the high-torque motor effortlessly pulled Herb off his feet and across the rim of the heavy-duty stainless-steel bowl. His coworkers reacted quickly to Herb’s shrieks of agony as the hook twisted his arm around and around the shaft, but not before it shattered his forearm bones and upper arm in a dozen places. The sounds of his bones snapping and grinding rose above the hum of the machines.

With the Ebenezer closed, the nearest emergency department was over 80 miles away. Although the local volunteer ambulance crew were willing, poor funding meant that they lacked key knowledge and equipment. While they could deal with putting in an IV line and treating Herb’s excruciating pain, they did not know what to make of the petechial rash spreading across his chest and neck, or his panting breath. Herb’s heart rate continued to speed up, he developed shortness of breath, and showed signs of confusion, but the crew lacked an intubation kit and PEEP valve for the bag-valve mask, and they would not have known that they needed them or how to use them anyway.

 With 30 miles yet to go, Herb became lethargic and his mental confusion progressed into coma. Despite continued efforts by the crew, Herb had a series of seizures and died a few miles past the empty hulk of one of the competitor hospitals he had helped to force into closure a year before.