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.

Nurse Betty was ugly and a little slow, and she took great care to appear that way. She was, in truth, naturally brighter and more aware than average. She was slightly taller, healthier, fitter, and slimmer than most of her peers. Her face was more symmetrical, her skin smoother, and her hair glossier, fuller, more manageable. If she had a fault, it was that she was slightly distant, a little manipulative, and she viewed her surroundings and others as part of a big natural experiment that she could tweak if she liked.

As a pretty, witty, and curious nursing student, Betty had quickly realized that her body attracted jealousy and unwanted attention, and caused men to be underfoot wherever she turned. She learned to camouflage her body. She also realized that getting good grades meant being typecast and attracted yet more jealousy. These things threw her life out of balance, and Betty liked balance. So she learned to keep her grades secret, and didn’t tell anyone but her closest friends when she was accepted into a master’s program for nursing.

Betty enjoyed the balance of theoretical study and practical application, although taking on both studies and her nursing duties meant zero social life outside work and barely enough time to sleep. She found that the computer science units were fun and that she had a knack for it. The module on cybersecurity in healthcare was an eye opener; she was shocked to find out just how vulnerable many ancillary hospital systems were. As an example, the instructor showed them how a previous employee had reserved an executive parking spot by culling a user code and password for an unsecured list.

Now, as a full-time nurse on a surgical ward, Betty’s daily makeup routine included adding blotches to her skin, making her lips look narrower, and giving her face a subtle asymmetry. Where many clinicians bought form-fitting scrubs and elegantly practical footwear, Betty wore baggy uniforms and hideous Crocs. The social distance she curated had three beneficial results. Hardly anyone sniped at her, she didn’t have to endure constant pickup lines, and she had mental space to observe others. The latter was very useful for delivering high quality patient care and having time to reflect on her studies. It was also useful for people watching.

Watching the interactions between other people at work in this way allowed her to see social networks. She could see who was bullying whom, who was cozying up to whom, and, of course, who was sleeping with whom. Lately, she had detected a refinement in her appraisal of sex partners. The CMO was clearly bonking the HR director, the unit nurse manager was obviously on bedroom terms with one of the anesthesiologists, and one of the new nurses was quite plainly having various levels of intimacy with three physicians and dangling a fourth. What Betty had recently noticed was a relationship of similar attachment level between three surgeons and two medical device sales reps. Their relationships were as intense as sex, but it felt qualitatively different to Betty. The relationships were also more networked than the love dyads and even the one polyamorous group of three down in accounting. The relationships between surgeons were strong but somehow distant, and those between surgeons and sales reps were intense but guarded in a way that none of the sex bonds in other social networks were. Betty was intrigued.

Over the next few months, Betty maintained a heightened awareness of this odd social network, and then she felt a sudden disturbance in it. One of the surgeons was alarmed. Betty could sense his fear as clearly as if she had sniffed a swab soaked in iodine. She could see the alarm spread in the network like a contagion. It spread slightly between the surgeons, strongly between two specific surgeons and one specific rep, and then weakly between the reps. The level of alarm surged, ebbed, and then surged before abruptly abating. After the event, it felt like the ties became stronger, although more guarded. Two months later, she saw it happen again, and this time when she poked around in the EHR system, she found a possible link. The alarm had started in both cases when there had been a readmission due to surgical complications and ebbed again after surgery. She had no proof, but after a third event, and carefully sifting through the records, she had a pretty good guess as to what was going on. In addition to the medical records, she had noted lifestyle enhancements amongst the surgeons compared to their peers. Putting her computer training to work, she accessed the unsecured parking history records, and noted the changes over time in the cars that the sales reps had registered. The surgeons and sales reps were clearly doing something sneaky that was putting loads of money in their pockets. Since the sneaking factor was so high and there were panics attached to readmissions, Betty guessed that they were either using counterfeit implants or taking on patients that didn’t meet criteria. Further delving in the data shifted the weight towards fake implants, and the implications threw Betty’s world into imbalance.

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What to do, though? Betty knew she could be a queen spider in a web of blackmail and could squeeze all of the participants for money. However, in her recollection, blackmailers usually got murdered in movies, and extortion was also a felony that could attract a 20-year sentence. It would also cause potential harm to patients and not repair the vertigo she felt over the imbalance between care goals and behavior.

Being a practical person, Betty put her skills and observations to work. She collected the evidence and her conclusions together and set about a plan of action. Firstly, she sent an anonymous email to the legal department, detailing the liability risks to the hospital. Secondly, she called the anonymous compliance hotline and detailed the issue and listed times and cases. Lastly, she anonymously emailed the supply chain director with details of the info she had accumulated on the sales reps’ shady activities.

Within a week, hospital security had revoked access for the sales reps involved, and the purchasing department had downgraded the ratings of the device firm. The surgeons were placed on administrative leave and a bevy of auditors were crawling all over their records, while quality & safety staff scoured their past surgical cases. Seeing things working as they should, Betty sighed. Her universe was back in balance. Behavior would be back in alignment.