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.

Randy felt rotten.

Randall J. Taylor was a senior administrator at a regional hospital and had risen through the ranks since obtaining his MBA from a leading business school. Randy was very enamored with saying that we should “Uberize medicine,” by which he meant something very clever about demand flows and just-in-time staffing, or “agile workforce,” or something. Actually, nobody was quite clear exactly what he meant by “Uberizing medicine,” other than that he was very enthusiastic and very confident about something or other. In fact, none of the clinical directors or unit managers had the faintest clue what Randy was going on about.

The administration executives, however, held Randy in high esteem because of the way he had cut costs, boosted revenue, and shaken up some of the overhead departments. For example, he had totally reorganized, downsized, and right-sized the quality and safety department. Gone were all the slow plodding types, and in came a brace of eager young (cheaper) faces who were focused on rooting out anything that wasn’t value-added—and by that they meant anything that didn’t bring in money. Randy replaced large parts of the monitoring and evaluation work, the quality and effectiveness metrics, and the mandated goals and objectives. He took the vast metrics data warehouse and slimmed it down from several hundred metrics to two dozen, all of which focused on cost control and revenue recognition. The new measurement system prioritized one thing, and that was money. Randy had Uberized the hospital.

Randy ached in every joint, and his every breath was labored.

The results of the new metrics system were profound. The c-suite rejoiced at the reduction in operating costs, the shrinking of debtor’s days, the climb in profits. The bank balance and billing pipeline had never looked so healthy, and various triggers built into the executive reward scheme were set to deliver a big fat juicy bonus for them all. The clinical leaders were less optimistic. They were pleasantly surprised that they too would be seeing a little productivity bonus, but there had been a growing clamor from the physicians and nurses about lengthy delays in filling vacancies, difficulties in getting new equipment, and endless issues with materials: the scrubs were of lower quality, the personal protective equipment was not up to scratch, and labs took longer because many routine tests were being sent to some new, out of state location. There wasn’t a day that went by, they complained, that there wasn’t a horde of people bitter about some new irritation: too few glove sizes, too many double shifts, too little grip stock of basic materials, too much delay in getting new stock. The latest was the shortage in N95 masks and the total lack of variety in what they had. Staff were reusing masks several times now, where before these were regarded strictly as single-use items. The new masks didn’t fit everyone’s faces well, and while they worked fine for those with cherub-shaped faces, they left gaps on people with skinnier faces or high cheekbones. It was exasperating.

Randy was confused, and he kept trying to ask where he was, but he couldn’t talk. His awareness waned and waxed, but each dip went deeper and each climb grew slower and peaked lower.

The delays in getting masks had eventually become more than just irritating. Some of the medical staff had figured out why there was a shortage and who was behind the substandard masks they now had. Randy’s email box was filling up with courteous but irate questions and entreaties. The cheaper scrubs were often mentioned, but the masks were the leading cause of complaints. They didn’t fit everyone well, they bulged at the sides, the elastic bands pulled loose, they smelled funny. The list was long, and Randy did what any MBA faced with flak about financial decisions might do: He had ignored them. It wasn’t like the doctors or nurses had any say in running the hospital, and Randy didn’t report to the medical departments, so really, ignoring them was easy and went without risk. It did get him thinking, though, that the emails might help identify the more troublesome groups, and maybe food for thought when any cuts were made, or budgets were approved.

Ethel had been feeling lousy, and she was glad that her shift was finally over. She had hustled her tall skinny self around the ED for 14 hours and now she was finally headed home. Her throat was sore, her feet were killing her, and her face ached from the N95 mask. The new masks didn’t fit her well, and the elastic bands that secured it were pulled so tight that the mask left welts that turned into bruises. She winced as she pulled one band down around her neck, relieving that cruel clamping feeling on her cheekbones, and she stepped into the crowded elevator. Ethel was the last in and turned to face the door. She would not have noticed the maskless suit who was now close behind her, but had she known that Randy was the person behind the new range of PPE, she might have considered accidentally stepping on his toes. When the doors finally opened on the first floor, Ethel heaved a sigh of relief, took a deep breath, and gave a little dry cough that fluffed a few hairs that had broken free of her tight bun. She was headed home for 2 days off before she started her new night shift sequence. Her whole body ached to get home, have a long shower, and sleep.

Randy was in trouble. The valves were wide open, but the numbers on the screen kept dropping.

Randy had not noticed the tall nurse in front of him in the elevator, nor had he noticed the minty scent of the lozenge she had sneaked to soothe a throat parched by slight dehydration and dry hospital air. Two days later, when he developed a sore throat and started coughing, he had not connected the two events. He had never considered the pandemic as more than a financial inconvenience, one overblown by a media that reveled in spectacle, hyperbole, and outrage. The financial media focused on logistical turbulence, and stories about toilet paper, and adroitly sidestepped the need to keep spread down.

Clara was at that point, yet again. Every treatment intervention at their disposal in the ICU had been used, every trick deployed, all the team’s combined experience utilized, but the patient was gliding steadily to their end. There was nothing left to do, no magic to perform, no miracle drug to administer. It was now just waiting and watching. The first pandemic cases that ebbed like this had torn at the team. They reviewed each one in the hopes of finding a fault, spotting a lesson, learning some new way to avert more deaths. Now, after 2 years and countless cases, the hopeless cases were just acknowledged with grim recognition. When it was time to start the process of freeing up the bed for a new patient, Clara wearily removed the leads, and spared a quick thought for Randy, who was still, grey, and gone.