An orthopedic surgeon becomes a trailblazer in transgender health. When her work is jeopardized by management’s profit-driven decisions, she takes a bold stand.
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.
Barbara was a real-life Barbie Doll. Matching the popular trope, she was tall but not gawky, slim but not skinny, curvy but not too curvy, and, of course, she had long wavy blonde hair that reached to the bottom of her shoulder blades. She drove a white Corvette with a soft top and red leather seats, and she turned heads as she drove by.
If there was one thing Barbie knew about life, though, it was that it had teeth and claws—it could bite you if it liked, or drag you down with its claws. At the age of 28, she had been riding on the back of her boyfriend’s motorcycle when they were hit from the side by a drunk driver in a black Camaro. It had been a lazy autumn afternoon, with the sun lit up the crimson and leaves on the trees lining a meandering boulevard, and they were two blocks from a barbeque with friends to celebrate an engagement. There was a cooler bag with two bottles of chilled sparkling wine in the left-hand pannier of the bike and gifts for the lucky couple in a velvet bag in the right. Barbie had no memory of the chromed bumper that crushed her right calf, or of hitting the top of the windscreen with her hip, and she was unconscious by the time her body hit the concrete surface behind the car and did not feel her right thigh bone splinter. She had vague dreams in which memories cryptically surfaced. She had disconnected images of being lifted into an ambulance on a scoop stretcher and fluorescent lights passing as she was wheeled into an ED, then a crowd of faces peering down at her.
That was 5 years ago, and she was still a Barbie who drove a Corvette and wore her image well, but now she walked with a cane and a limp. Life had taken a bite out of Barbie, but she was damned if she would let it drag her down. The experience had shaped her direction in medical school, and as an orthopedic surgeon, she was very familiar with both ends of the scalpel, so to speak. Barbie worked at a 300-bed hospital in an area that used to be sparsely populated, but forward-thinking planners had created a complex that added a shopping center and office tower to the end of the hospital, plus a liberal arts college at the other end of the shopping complex. The was a small rose-tinted window in the roof that let in sunlight and, at noon on the day of the summer solstice, illuminated a brass statue of Asclepius, the Greek god of medicine and healing. Under the shopping level, a subway station connected the building to the commuter rail system, and blocks of apartments and parks surrounded the complex. It was an almost idyllic work environment, and having the college and shopping center in the same complex were the pinnacle of convenience. The 100-foot escalator that connected the hospital and office block to the shopping levels was a masterpiece in vertiginous engineering. The descent through levels of hanging ornamentals and foliage was a memorable experience, even for those who did not suffer from a fear of heights. The college also brought a regular supply of medical students and young patients with mainly uncomplex medical needs. The arts courses and youthful population also brought a higher representation of people going through an awakening of sexuality and gender awareness. Barbie was seeing far more patients starting or undergoing gender-affirming care, and especially, hormone therapy, than her peers in other facilities.
Barbie had grown to be somewhat of a leading expert in the unique considerations that transgender patients have regarding joint and bone health: an increase in fracture risk and perioperative risks including infection and clotting. She had immediately become aware of immense gaps in the research concerning orthopedic care of transgender patients and the need for further study. She had started a pair of studies on these issues and was steadily closing in on a point where her team could publish their first paper, describing the risks, issues, and opportunities in the care of the transgender orthopedic patient population. While it couldn’t be said that she had a spring in her step every morning when she ascended the escalator to her office in the hospital building, she certainly limped faster as a result. However, success breeds more than one offspring, and one of those is the attention of investors. A group of investors had taken note of the hospital’s success and bought out the previous owners, who were all aging and keen to parlay achievement and fame into money and a luxurious retirement.
The new owners had paid by means of a leveraged purchase and thus were keen to cut costs and boost profits to service the investor and bank covenants in the funding agreements. Their first step was to cut service lines that were the least profitable: women’s health, psychiatry and behavioral health, and substance use clinics, for example. They were also reluctant to fund research unless there was a clear profit to be made from the results: studies in improving flow and throughput in cardiac surgery, for instance. This put Barbie on a direct collision course with the new management, and although she pushed back hard, she was no fool as far as her position was concerned. Faced by a doubting and disinterested row of white male faces, she knew that pushing the matter much further would just invite them to shut her part of orthopedic surgery down. They had wobbled their heads at the surgical numbers for orthopedics, half pleased, half dismissive, and they could easily reach the conclusion that the service line was as much trouble as it was worth.
The thing that irked Barbie the most was not these slick and uncaring money types, but rather the unctuous and oily staff who latched onto them like slippery little leeches. Josh, for example, had always been an irritating squirt whose little “gotcha” questions in the past about “catering to the weirdo patients” were usually just ignored or batted back by the clinical staff with enough disdain to shut him up for a while. With the new management, the little tick had become braver and more brazen, and management had empowered him to find ways to cut costs. His delight in killing policies or services that helped the less affluent patients made Barbie’s stomach turn but delighted management. He ran through all the policies and programs that various unit heads had put in place over the years, and one by one, Josh delivered recommendations to kill them. Once he had torched every project, program, or policy that tried to soften the burden on people of color, LGBTQ+, or women living with low socioeconomic status, Josh turned his attention to the research projects.
Where the new management had been merely reluctant to fund new studies that were less profit-oriented, Josh was eager to terminate even those already underway. Barbie had bitten her lip during the meeting in which Josh announced, with glee, which research projects were to be terminated with immediate effect. The meeting had erupted into a tornado of name-calling and fury by over a dozen people whose projects, some nearing their end after several years of work, were suddenly terminated. Some tried to explain how this would be a slap in the face to participants, or blow up the theses of many doctoral students, or threaten joint programs with other institutions. Josh rebuffed them with a dismissive retort about profitability. Several research leads stormed out after hurling a biting remark, and Barbie and two others stayed on in the hopes of arguing him out of this drastic action. It was in vain, and Barbie’s entreaty to at least let her finish her study was met with derision. “You are nuts to think I won’t kill a study whose sole beneficiaries are a bunch of …” Burning with resentment, Barbie turned on her heel and left before he could finish his sentence—and before she punched his smarmy little face.
News of the meeting spread like a forest fire through the hospital and college, and while staff were aghast, management was thrilled… so thrilled, in fact, that they offered him a more elevated job in the head office where he could play grim reaper on a broader canvass. It was this context in which gloating, carrying a box of his personal belongings, and grinning like someone who had won first prize in an ego competition, Josh found himself descending the escalator for the last time. So full of joy was he that he didn’t register that, two steps behind him, was a blond woman with a cane and a limp whose clenched jaw signaled something quite different than respect or awe for his elevation.
When it came, the prod in the small of his back from a rubber-tipped cane was impressively energetic, but he had little time to register it as he tumbled head-first down the elevator. By the time he came to rest, 40 feet of rolling and flailing down the serrated steel steps had left him with a broken arm and collarbone and a truly encyclopedic array of gashes. Hooting in pain from a mouth filled with blood and broken teeth, and a face littered with cuts and tears, Josh rose unsteadily and pointed a trembling and torn hand at Barbie. The effort unbalanced him, and after futilely trying to grab the handrail with an arm that was broken in two places, his foot went into his cardboard box and slid out from under him. He made a noise that sounded like a seal barking through a mouth of salt water and tipped over the side of the escalator in a rather pleasing and acrobatic way. His landing on the brass statue of Asclepius 50 feet below was much less elegant but utterly terminal.
