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.

Morty was the administrator of the mental health department in a large non-profit hospital system. He utterly detested being called “Morty.” He was punctilious about his appearance, and his tailored suits, Italian shoes, and expensive haircuts satisfied a burning need to be chic, but utterly failed to obscure the fact that Morty was more comical than cultured. The overall impression that Morty left on the clinical staff was of a somewhat short and pudgy busybody, fussing about and making life harder. He was more a little round leaky teapot than the sleek missile he imagined himself to be. Morty did not have an inclination for care delivery; in fact, he was decidedly uncomfortable with patients overall, and psychiatric patients in particular. He was unnerved by illness. Prosthetics and wheelchairs made him wince internally. Morty viewed the administrator job as a steppingstone to being in the c-suite and ultimately on the board. It was amongst the board members that Mortimer D. Bundy felt at home, with the polite small talk, the annual statements, the clean, orderly, and predictable cocoon of well-dressed people and walnut paneled board rooms.

Dr. Monica Starkman knew all about Morty getting in the way. As the chief of psychiatry, she was on intimate terms with every way that his budget cuts and cost trimming and performative decisions impeded the delivery of quality care and staff satisfaction, from cutting the number of staff parking spots to trimming the building maintenance budget. She didn’t mind that he wanted the financial numbers to look as good as possible, or even his naked ambition to be a board member, but it just grated on her that he did so to the detriment of patient care. She had objected when he moved and reduced the size of the patient waiting area and changed the location of the entrance. She had patiently explained that having a separate entrance for patients with mental health issues was stigmatizing, and that she needed the bigger waiting area to safely accommodate patients who might get anxious sitting too close to one another, or in wheelchairs or using mobility aides. His indifference left her puzzled and hurt, but she would have been furious if she had known his true reason: he simply didn’t want to be anywhere near her patients, whom he regarded with distaste. He didn’t want them agitated in the main entrance, he didn’t want to see any homeless, ragged-looking patients in the waiting area that had intersected with his route to his office, and he didn’t want to risk himself or potential financial donors being accosted in any way by unusual people with possibly unpredictable behavior.

Morty’s influence on staffing had created an even bigger problem, though. Dr. Starkman’s staff-to-patient ratios had gone from uncomfortable to unsafe, and her team of psychiatrists, psychologists, and patient care workers were often seeing so many patients that they were starting to experience quality and safety issues. She had tried to be the champion for the inpatient unit nurses, who said chronic understaffing was making life dangerous for both patients and nurses alike. In addition to begging administration to investigate the chronic understaffing of clinical staff, she had authored articles on the subject, and she regularly protested the chronic understaffing of nurses and other staff on the in-patient unit. As the holder of several NIH grants and author of numerous scientific publications, she had clout, but just not enough. Her entreaties were politely heard, and her petitions on behalf of the nurses were acknowledged, but they were ultimately dismissed in favor of financial metrics.

A recent event had become a rolling nightmare. One of the overworked therapists had fallen asleep during a patient session. He had been mortified and had immediately reported the lapse to his supervisor, and then apologized to the patient, but the damage was done. The patient had been understandably stunned, hurt, and distraught, had taken a photo and tiptoed out of the room. When she shared the image of the sleeping therapist with her online support group, the reaction was explosive. From there, it had rippled across social media. The local news channel picked up the story, Dr. Starkman was interviewed and spoke of the problems of understaffing, and then a celebrity put the image out on Twitter. The tweet racked up millions of views and the entire staff was on edge.

One might suppose that an embarrassment of this nature would unlock some funding to fix the underlying problems, but one might be mistaken. Instead of a Lean Six Sigma event to find root causes, identify solutions, and rapidly evaluate one, Morty used the event to punish the department and to further cut its budget as a penalty. Morty had always felt that the mental health department could operate on a smaller budget; after all, they didn’t need expensive equipment like radiology, or need special tools and rooms like surgery, or even deal with broken bones and open wounds like emergency medicine. In Morty’s reckoning, psychiatric care didn’t need much other than chairs and a few couches. Marty made staff enter the department through the north fire escape door and removed the staff coffee machine. Looking over the nursing slots and building maintenance staff, he thought he could see more ways to cut costs and increase profitability. The maintenance team knew better than to tell him that there were already plenty of complaints about mold in the basement, leaking pipes, and crumbling steps.

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Dr. Starkman tried to calm things down, but patients, and not just psychiatric ones, sometimes have a mind to complain, and complain they did. A group of psychiatry outpatients, some in wheelchairs, started a sit-in and crowded passageways. They congregated and milled about enough to make their point clear, but just not enough for security to intervene. Perhaps, the chief of security had thought to herself, if Morty hadn’t cut their budget, they might actually have had enough officers to deal with the crowding. It was not clear how the rumor started, but word got to the protesting patients and others that it was Morty who was to blame. It was a hot and muggy afternoon when the group had spotted Morty. “That’s him!” an elderly patient in a wheelchair had yelled and proceeded to scoot his way towards Morty. With his face pale, Morty fast-walked back toward the security door that separated his citadel from the clinical area, but the little band was gaining on him. The wheelchair occupant was within mere feet of the red-faced and sweating Morty, when Morty had slipped away to the side, shoved the south fire-escape door open, and heaved it shut behind him.

Standing on a slick concrete surface, slippery with mold from a dripping fire hose, Morty’s smooth-soled Italian shoes slid away as if he were standing on ice. Grabbing furiously for the handrail didn’t save him from falling, but added a spin to his descent, and Morty took a steep swallow dive down the flight of concrete steps, landing with a thud and a crunch as his head twisted under the weight of his body when he came to rest at the bottom of the stairs. By the time the staff and security had quieted the protestors, and realized that he had disappeared, Morty’s body had already started cooling, no longer concerned with budgets, performance indicators, or promotions.