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.

Betsy was small, nervy, and slim to the point of being skinny. She was also a psychiatrist at a magnet hospital who was blind and black.

Years before, as a last-year medical student, Betsy had very little free time for what many students assumed was a normal college life. There was no time for going to sports events, for hobbies, for joining or attending campus drives or clubs, and no time for making friends or socializing generally. When other students were going to parties, joining marches, or supporting protests, the medical final year students, and especially Betsy, were hitting the books hard. Like many other medical students, the grinding workload and rushed pace made Betsy feel a deep sense of isolation from her family and previous friends. Because of the tight schedule, heavy workload, and intense competition, she had missed birthdays, engagements, weddings, and even a divorce and a funeral. The study load doled out by lecturers, faculty expectations of medical students, and the students’ own internalization and self-policing weighed on Betsy like a big lead blanket of melancholy. When other students were meeting new people, falling in love, or having their hearts broken, the medical students were getting to know a cadaver, becoming intimate with its internal parts, and taking apart its heart. Medical students were, however, still human, and in the face of nagging, teasing, and even scolding by her roommates about “living a little,” Betsy grudgingly agreed to at least show up at a party they were organizing. It was to be a turning point in her life and a dramatic shift in her career path.

Cliff was an anthropology student. He had recently come back from a gap year hitchhiking around the world, seeing out of the way places that only a young hitchhiker can reach, trying exotic ethnic dishes, and sleeping over in places that few of his family had even heard of. He had loads of interesting stories and told Betsy about local ambulance services that used old pickup trucks at best, with usually only an auto-rickshaw to pick up patients. He had even seen a pregnant woman brought into the hospital in a wheelbarrow. Betsy had enjoyed his company and snuggled up when the evening chill, plus the effects of two glasses of wine and an 18-hour workday, began to make her sleepy. They had kissed briefly, but then Betsy crashed, and only woke at 3 in the morning when the cleaning crew turned up the lights and began vacuuming the floors and tidying up.

Betsy had gone back to her residence with a crick in her neck, sleeping like a log until 5:30, when it was time to get ready for a normal Saturday morning as a medical student: a quick jog while reciting names of metabolic processes, followed by a shower, breakfast while reviewing notes, and heading to a study group to prep for a cadaver session in the afternoon. Like most medical students, she was often a little dehydrated, malnourished, and sleep deprived, and simply didn’t notice a slight increase in her temperature. With finals approaching, Betsy was feeling exhausted. She had a furious headache and seemed to be a lot more clumsy than usual. By the next morning, Betsy was admitted to the ICU and put in a medically-induced coma.

Dr. Susan Nasif O-Adorisio was a virologist at the hospital and was looking at samples taken from the febrile medical student in the ICU. Susan picked up measles fragments in the tissues and drew the link between measles and what looked like subacute sclerosing panencephalitis. Betsy’s kissing partner had been carrying measles and had infected her and several other people on campus before the disease burned out in the mostly vaccinated student population. By the time a firm diagnosis had been made and she was out of the ICU, Betsy had lost 90% of her vision, and the news was mostly grim. Although they had prevented any further damage to her brain, and she was otherwise recovering well, there was little chance of restoring her vision, and her vision had dropped from a severe loss to a total one. Betsy was having auditory effects, too, and routine, everyday noises sounded like voices to her. It was initially alarming, but in the same way that she came to terms with navigating a sightless world, she got used to an opening door sounding satisfied, the coffee machine sounding eager, and her shower sounding like a chorus of slightly angry old women. Many devices and machines seemed to be calling to her, imparting little messages. The campus bus murmured to her that she should watch her step, and she plainly heard the security latch swear at her every time she left the building. The entire medical faculty was highly invested in helping Betsy, but there were limits to what could be done. Continuing her intended study path in neurosurgery was no longer viable, but with a lot of discussion, favors, and luck, Betsy switched from neurosurgery to psychiatry.

Being blind had been surprising in many ways. Once she had accommodated to all the myriad ways in which navigating a world built by and for sighted people, and which required extra planning, effort, or care as a person living with blindness, there were things that she could never have anticipated. One of those was the confessional aspect. People talked to her and strangers told her their secrets, so many confessed things: how they had stolen a necklace, cheated a partner, even one who confided that he had robbed a 7-11. White people who would otherwise not have glanced at her other than to furtively clutch a handbag ever so slightly tighter now poured out their hearts to her. Another surprise was just how much she needed to trust strangers. Just getting around required the help, forbearance, and space provided by countless people. Betsy had a suspicion that these two surprises were linked in some way. After college, she found a position faster than she had even dared to hope and discovered an easy group of friends in the church board members. Father Bartholomew was a gruff Irish priest whose ecclesiastical duties included ensuring that the hospital was run according to scriptural lines and operated frugally. He felt a softness for the tiny blind psychiatrist, though, and found himself sharing his feelings a great deal more than he was accustomed to.

Rod was the financial director at the 600-bed, nonprofit hospital. What Rod lacked in ecumenical credentials that were an essential part of advancement in the highly religious environment, he made up for by being frugal with the hospital’s money. Rod had his eye on the CFO position and knew that consistent cost savings and financial discipline were visible to the board. He was not blind to the internal politics of the 13 board members; he knew that his eventual promotion would involve making allies with as many of them as he could and avoiding conflicts with the rest. Rod understood that log rolling for the influential board members was almost as important as making the CFO look good and far more important than keeping the clinical directors happy. Although the hospital vision, mission, and value statements were all about patient care, and the physicians held those reigns, they were essentially a voiceless community in the hospital power ecosystem.

Rod discovered that greasing the gears for financing the pet projects of the power players on the board was far more important to his reward package and promotion prospects than keeping the physicians happy. As a weak constituency, doctors weren’t going to bring home his bacon, but Ms. Gladwell on the board certainly could. Ms. Gladwell had seen a documentary on burnout and was very keen to implement a resilience program. Rod made sure the paperwork and funding flowed like water. Professor Brown was enthusiastic about making sure that nurse uniforms were modest and that their movements were tracked. Ron saw to it that a GPS tracking system for monitoring nurses was at the top of the IT acquisition pile. Father Bartholomew felt strongly about the need to make space for reflection and worship. Rod hastened the paperwork and budgeting to add a chapel and three small prayer rooms. Conversely, he threw innumerable hurdles and pitfalls in the paths of budget requests for a physician’s lounge and new autoclaves. In fact, Rod discovered ample savings by sorting the doctor’s preference list by category and cost and eliminating the top 10% of items in each category. The savings easily paid for most of the board member’s pet projects while reflecting well on the budget. There was a lot of complaining by physicians, but that just proved to the board that they were a discontented bunch who were never satisfied. To the nurse’s complaints about substandard scrubs, Ms. Gladwell was simply peevish that nurses had been so ungrateful about the resiliency training.

Dr. Helen C. Neblett was the nurse executive, and she was tired. She had several nurses out on mandatory resilience training, another nurse had “accidentally” dropped their GPS tracker in the toilet this week, and there was literally a pile of complaints about broken, outdated, or ineffective equipment in her in-tray. Three complaints related to low quality scrubs in the dispensers, four complaints were about the new surgical gloves tearing, and nine were about only one of the two autoclaves working. Knowing that there would be resistance from Rod, she had sought support from other department heads and key personalities. Dr. Betsy Reardon wasn’t a department head, but as their only blind physician and a psychiatrist, she had attracted somewhat of a cult following amongst the staff. In her 5 years at the hospital, she had developed a reputation for being a friendly ear, acutely perceptive, and influential with the board of directors. Helen was sure Betsy would be a great ally in getting Rod to move on the issues.

Her relationship with Betsy was not all a bed of rose petals, though. Helen sometimes found Betsy unsettling, and Betsy’s habit of personifying inanimate objects and carrying out conversations with them just struck Helen as odd. When she broached the subject of the scrubs, Betsy had been very supportive, agreeing that they were poorly fitting and made of inferior material. Helen was grateful for the validation, but tactfully asked how Betsy could know how the scrubs fitted or what they were made of. Betsy laughed. “I can hear how they crackle instead of having a soft rustle and by the way people move in them!” She explained how she had felt the course, stiff material and poorly stitched seams when one of the nurses had guided her to a table. Surprised, but encouraged, Helen went on to discuss the dire state of the autoclaves. Betsy shared that she has been hearing the autoclave singing plaintively, but now it seemed to be in pain. “I used to hear both autoclaves sighing and muttering, but they are growing increasingly unhappy.” Betsy described how one autoclave gave up and went silent, but she could hear the remaining one begging and calling out for help. Betsy put a hand gently on Helen’s arm, and with an earnest tone, assured Helen that she wished that Rob would give it the help it needed and not have it so overworked. With added emphasis, Betsy said that she thought the autoclave was desperate and could have a crisis sometime soon unless it got attention.

Back in her office, Helen sighed and fired off an email to Rod with a plea to address a list of shortfalls, adding a note from the head of Quality & Safety that provided a risk assessment. She paused, not sure how to involve Betsy without having to get into the metaphysics of how the autoclave was feeling desperate or having a personal crisis. Helen settled on mentioning that Betsy had expressed concern, that the autoclave was in urgent need of repair. That seemed to be a fair approximation without getting complicated.

Rod scoffed. He couldn’t believe Helen had invoked that weird psychiatrist woman in an attempt to influence him. To make things worse, he was pretty sure that Betsy had also run off to tattle to Father Bartholomew. Gritting his teeth, he phoned Helen and agreed to meet her the next afternoon. With any luck, he could let her vent a bit, maybe make a few small concessions, and not make a big official saga out of it or dent the budget. In the meantime, anticipating a need to have something to offer, he looked at the implications of getting better surgical gloves. Helen was pleased at the progress in meeting Rod and made a list of the things she could live with, what concessions she might make, and what was a show stopper for her. The uncomfortable scrubs would be a win, but to her mind the unreliable surgical gloves were a big safety issue for her nurses. She was less sure about the autoclave. To her mind, this was more a medical and lab issue than a nursing problem, and something that could be handled by the medical director and the maintenance department. Betsy’s urgent tone had shaken her a bit, though, so she decided to make that part of the discussion. If the second autoclave gave up the ghost, it would probably inconvenience the nurses as a knock-on effect of canceled or delayed procedures. She added it to her “nice to have” list.

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The meeting started off better than Helen had hoped. Rod had looked at photos of torn surgical gloves that Helen had got from the nurses and cut Helen short halfway through her reading of an email from one of the nurses. “Yes, sure. Clearly a health and safety issue. I’ll shift the purchase order to a different supplier.” He was less committed to changing the scrubs but promised to look into it. “Of course, stiff material and poorly stitched seams,” he dictated to himself as he wrote, and looking up at Helen, “and impedes movement, you say?” Rod agreed to go look at the autoclaves, and as they stood in front of the remaining operational machine, his phone rang. Betsy had indeed been talking to Father Bartholomew about what she heard the autoclave say, and he gave Rod an unwelcome sermon. Helen figured their meeting was over, and since she had achieved everything she had intended to cover, she gestured a farewell to the distracted Rod and went back to her office to wrestle with her scheduling for the next day.

It was 3:46 when Rod stood in front of the autoclave. He had finished the call in a foul mood, mumbling angrily to himself. “Well, I don’t care what that bevy of witches have to say, this machine can damn well wait until the next quarter before I spend a bundle of money on it!” He gave it a little kick for emphasis. At 3:46:12, the latch mechanism on autoclave #2 failed, and with 30 psi of internal pressure resulting in approximately 72 tons of force behind it, the 40-pound door broke loose and hit Rod with enough momentum to make the copious 2nd and 3rd degree burns to his face and body quite irrelevant.