Doris, a woman battling a dire diagnosis, takes matters into her own hands during a medical conference attended by the insurance company CEO.

This medical fiction tale 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.

Sitting in the tight middle seat, reluctantly sharing elbow space with the passengers on either side, Doris fumed. It was bad enough that it had taken an hour to clear security, which forced Doris to trot to the gate. But now she sat wedged between the man with the suffocating aftershave and the fidgety teen with a seemingly unending supply of electronic gadgets, the retrieval of which from pockets or bags apparently required a great deal of squirming and bumping. She also missed her dogs.

The poisonous glance that Doris shot at the youngster for spilling her tea went completely unnoticed by the distracted and self-absorbed boy as he rummaged for his Bluetooth earphones. He had hoped the middle seat would be taken by someone hot, but with his luck, he ended up next to some panting old lady with clammy elbows. He got a good playlist going, stole a look at the legs of the woman pushing the snack trolley, and was soon immersed in a first-person shooter game on his PC. Had he known what was on her mind, he might have paid more attention to the old woman beside him whose intentions exceeded anything in his game.

Doris was on this flight to deal with a personal matter. Her diagnosis had come after many unpleasant and invasive tests. Then, just when she thought there was finally some end to this saga, it all got very much worse. There was a drug, the doctor had said with some degree of hope in her voice, but there were issues. Clinical trials had recently completed and the drug was waiting for approval. That meant, she had said with a hint of doubt in her voice, that joining a clinical trial was no longer an option. But approval by her health insurance had also been declined because the drug was “still experimental.” The reasoning was sound at an academic level, but infuriatingly unhelpful. Since the drug was not yet approved, they couldn’t cover it, but it also couldn’t be bought privately. This dance continued for months while the symptoms continued to unfold and blossom. The mild night sweats had become pillow-drenching and had extended their scope to include being clammy all day. The sensitivity to movement grew worse, and the body aches steadily ratcheted up from passing twinges to a constant ache.

Doris was understanding but growing impatient. She and the doctor played tag team with the pharmaceutical company, the FDA, and the insurance company. Between them, they envisioned a dozen scenarios, projected several endpoints, and tracked her condition closely.

At last, the drug was approved, the manufacturer was ready, and it was now just a matter of insurance. Her daily calls to the insurer yielded little progress, but she now knew all the contacts there by name, and they were growing confident that coverage was imminent. Doris played out the scenarios with her doctor. There was still time, and the prognosis was not all bleak. If she started the course within the month, there was still hope for almost full recovery. Some of the damage was now irreversible, but she could still live a full life.

In the scenario of a 3-month delay, the picture was somewhat bleaker, but still workable. There would be more damage, less recovery, and it would be slower. Not a full life, but a manageable one. The 6-month scenario was bleak. There would be some recovery, but she would need a degree of assisted living, and the likely quality of life was not a pleasant topic. Doris planned for the first two scenarios and was undecided on whether the third scenario demanded accommodation or an exit plan.

Her trip was to attend a medical conference at which the insurance company CEO was one of the keynote speakers. His topic was on how to maximize profit amidst the growing proliferation of expensive precision medicine drugs. Doris had circled that event in her conference program in red pen. The conference was crowded, but she had paid the additional gold-member fee to get a room at the hotel adjoining the conference center and bought the extra pass to gain access to the closed sessions with the speakers, as well as the fancy dinner. Having studied the conference material and the floor plans, she had selected the three best alternative: the hotel, the VIP dinner, and the keynote addresses.

When he arrived at the conference center, Doris tailed the insurance company CEO. She often got close enough to hear the brief exchanges between the conference staff, the CEO’s personal assistant, and occasionally His Royal Highness himself as he curtly issued gruff instructions and commands. The opening keynote speech was too complicated; just too many people milling about and the PA was always in the way. Doris favored the dinner over the final keynote speech, but there were more unknowns, and the way the PA clung to him was a problem. But then there was a little tense exchange between the CEO and PA loud enough for her to hear. Gone were the sweet tones; he was clearly irritated with his bouncy PA. He had left his special reading glasses at home, and he blamed her. There was a quick instruction to have a spare couriered to reach him by that evening, and the PA had scurried off to make things happen. Doris was about to take this opportunity, but as she got within two steps, a fellow executive pushed in front of her, and they were soon booming congratulations at each other as a throng of hangers-on pushed Doris out of the way. With that option gone, Doris returned to her room after visiting a bookstore on the shopping level.

The dinner was also a bust. The VIPs entered through a different door, and they sat on a dais well away from the rest of the attendees. Because of a visiting dignitary who had not been on the published list, the place was also littered with security. After the dinner, Doris tailed the CEO and PA to his room, and waited in case there was an opportunity once the two were done with their evening entertainment. After 30 minutes, the PA emerged. With freshly applied makeup, but hair and clothing still in need of a slight adjustment, she walked past without glancing at Doris.

When she knocked in a businesslike manner, Doris announced an “urgent package delivery” and gave the name of the PA. The CEO all but yanked open the door and stood there in slippers and a silk bathrobe, holding out an imperious hand.

“Well?” he demanded.

“Sign please,” Doris said evenly, holding out a small clipboard and a pen.

As he reached for them, Doris contrived to release it just before he had it, and in the moment that he was distracted and both his hands and his attention were occupied, she stepped in and thrust the sharpened steel pipe up into his abdomen just below the rib cage. As he collapsed, she shoved him backwards, and he landed on the carpeted floor in front of the open bathroom door, eyes wide in an uncomprehending stare.

“That,” she whispered into his ear, “is what you get for my drug not being allowed for a year after approval.”

Doris closed his room door, hung a “Do Not Disturb” sign, and took a cab to the airport.

“Such a lovely conference,” she told the driver, “but I accomplished what I came for, and I miss my dogs.”