In this tale, a pediatric neurologist’s frustration with administration over a new MRI grows until catastrophe highlights the consequences of budget decisions.
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.
Dr. Camilla Rizzi was a pediatric neurologist specializing in seizure disorders and she was grumpy. For the third time this week, the aging MRI had to be taken offline because its coils were overheating. The last session’s images were essentially useless piles of broken data, and the patient would have to be dragged through the whole process again. She knew that it was only a matter of time before the machine quenched because of heat and blew off enough of the liquid helium to halt it for weeks or potentially forever. At a replacement cost of over $30,000 for the helium, even if the magnet coils were undamaged, it would be the end of the machine. Each time the machine started getting hot, it meant taking it offline, and that meant the tiny little wriggly patients and their parents had to go through the whole scheduling and prep process again. Since her little patients all lived with moderate to severe seizures, delays of any kind were potentially disastrous.
Camilla had been lobbying for 3 years for a new MRI machine, but every time she thought it was close, the administration had turned her down, delayed it, or offered too little to even get a secondhand machine. Her nemesis in this regard was Mr. Percival ‘Pulli’ Roat (MBA, MAcc). Percy, as he hated to be called, did not believe that pediatric neurology was a good investment. He listened with half an ear whenever Dr. Rizzi was doing her annual song and dance about their leaky roof, their broken plumbing, or their dreams of a new MRI. For all the wailing about little kids with seizures and their case histories, when he looked over the department’s revenue and profit profile, they ranked down at the bottom with women’s health, psychiatry, and primary care. There just wasn’t profit there to justify a new MRI. Now, if they had been cardiovascular surgery, orthopedic surgery, or even neurosurgery, and catered to a wealthier customer base, a new MRI would be a worthwhile investment.
The pediatric neurology team, or “neuropeds” as everyone called them, and their MRI were housed in a two-story red brick building adjoining the main hospital complex. The administration block looked directly over the flat-roofed neuropeds building, and this had given a few of the directors a really good idea. Since the neuropeds roof overlooked the hospital’s artificial lake, and had an unimpeded view of the city and the river between them, it would be a really great location for a BBQ and entertainment area. It would need some construction work to clear away obsolete rooftop equipment, relocating the HVAC units, and creating a walkway between the rooftop and the second floor of the Admin wing, but Percy knew contractors who could make this work—and budget lines he could squeeze for the funds. As part of the deal, neuropeds could have their restrooms updated and what he had in mind would no doubt fix the leaks in the roof.
Camilla was outraged but had to swallow it because antagonizing Administration would not get her a new MRI machine. She tried to see the bright side of Admin turning her roof into a place for the brass to have sundowners and flirt with each other’s guests. She counted off the benefits on her fingers. The restrooms would be made less squalid, and in fact the ones on the second floor would be almost regal. The roof would stop leaking every time they got heavy rain, and that would stop the second floor exercise room from smelling like old feet and mushrooms. The parking would probably be neatened up, so the glitterati on the rooftop garden wouldn’t have to be inconvenienced. Finally, when she went on her yearly budget pilgrimage to the admin conference room, she would be able to walk straight across the new elevated walkway.
At the next team morning meeting, she broke the news. There were weary sighs about the MRI yet again not making the cut, some eye-rolling at the news of the rooftop entertainment space, and some grimaces of resignation that a few of their daily peeves would get fixed as a side effect.
“What’s the opposite of an adverse effect?” the radiologist had wondered aloud.
“Placebo?” offered the tech.
“Bribe?” suggested the nurse.
Camilla looked around the tiny room at its Sesame Street murals, the washable stuffed toys on the shelves, and the boxes of crayons on the table, and she sighed. Then she brought her thoughts back to Earth and started the review of the schedule: which patients would be getting contrast media via IV, which ones needed light sedation because they would get dysregulated and freaked out in the MRI, and which were coming in for EEG sessions. The meeting ran like a cross between a busy restaurant kitchen and an orchestra: doling out tasks, bargaining, making compromises, and ending in harmony and a solid overture. Dismissed, they scattered to get things moving.
For the next 2 months, they coped with construction as the place crawled with contractors. There were no parking spaces for neuropeds staff because there were trucks, compressors, piles of rubble, and occasionally a large crane as the rooftop was cleared, the HVAC equipment was moved, and the walkway was erected. Finally, the parking lot slowly emptied, and much fancier contractors arrived to tile the rooftop, install glitzy plumbing on the second floor, and add the BBQ fittings. Once they all tidied up and evaporated, leaving a parking lot with fresh paving, new paint, and decorative edgings, movers arrived with patio furniture, statues, and decorative outdoor carpeting. Camilla and her team went out onto the rooftop and were quite astonished at the transformation. In addition to two glistening and formidable gas BBQs, upmarket furniture, and umbrellas, the flowering pot plants and statuettes gave their roof a definitive upmarket look. “Oh my god!” blurted the radiologist, “there’s a goddamn big-ass refrigerator in here!” She had opened what had looked like a cupboard built into the tile-topped island between the two BBQs. The rooftop entertainment space truly was like something out of a Better Homes & Gardens competition, and lounging on one of the patio swing sets, one might think this was some hedge fund manager’s penthouse spread. Standing at the west wall, the view really was quite something. They could just see the river beyond the hospital pond, and beyond the river, the city skyscrapers sparkling in the afternoon sun. Camilla made some mental calculations and concluded that for the cost of this little paradise on the roof, she could have bought a rather nice 1.5 Tesla 16-channel MRI machine, and she felt like vomiting or setting fire to the fancy furniture.
Camilla adopted a new approach to lobbying for her MRI. Each time a patient had to be rescheduled because the MRI started overheating, she left Percy a message. If more than one patient got rescheduled, she would detail each and the knock-on effects. A delay in the morning typically shifted anywhere up to a dozen patients, so sometimes her messages took several minutes. She also started texting him updates, especially when weekend work was involved. If that didn’t work on his nerves, she had decided to start paging him and interrupting his rooftop soirées to update him on scheduling changes every time the MRI had to be allowed to cool down. If that didn’t work, she reflected, maybe she should retire or hurl him bodily from the roof.
The pestering certainly was getting on his nerves, and Percy was not in a good mood these days, even when the numbers looked good. His voicemail was always brimming with messages, and that woman was calling in from random extensions, so he could never be sure who it was from until he listened to it. He felt in his bones that any day now she was going to start stalking him and corner him in the elevator or during socials to harangue him about schedules. He was starting to get acid reflux again, and he was having nightmares about crows and ravens squawking at him about machines. When one of the neuropeds patients died, he had been invited, summoned even, to the morbidity & mortality briefing, and had to endure her passive aggressive insinuations and snide remarks. That night he dreamed of a row of cold corpses of children, standing around his bed and pointing at him, while a sleek and glossy crow murmured “budget, budget, budget.” He woke up screaming in a cold sweat that took a hot cocoa toddy to ease.
It was nice to be on the rooftop with amiable colleagues for the office Valentine’s Day party, but Percy couldn’t relax for fear that that woman would appear. While others took in the sunset painting the fountain in gold and edging the trees in bronze and crimson, Percy was distracted. He couldn’t even find solace in the winks and smiles his PA gave him or spare a thought on the silky underwear he had bought her for later. Drinks were poured and ice cubes tinkled against crystal, while steaks, kebabs, and brats hissed and whistled on the BBQ. Happy chatter from well-oiled administrators, department heads, and distinguished guests and donors filled the evening air, while below them, trouble was brewing. The neuropeds team was treating their 20th patient of the day, and things were unraveling. It was a difficult case, they needed to be quick without rushing, everyone was tired and more than a little frayed – and the MRI was especially loud, which was not a good sign. Camilla took the tech aside where it wasn’t so noisy and got the rundown. “It’s getting hot … worse than usual.” Camilla had to balance this carefully, as this was a patient who couldn’t wait. His seizures were becoming life-threatening, and the parents were not wealthy, so sending them to another hospital was not a strong option. As she was thinking over the options, the tech popped out again. “Doc, we need to abort.”
Then the sound of music and laughter drifted down from the rooftop. Camilla took the stairs to the rooftop three at a time, and startled faces swiveled as she burst through the doorway. “You, Percy the Pug, get your sad carcass down here to see how your penny pinching is harming our pediatric patients!” Camilla was shocked at her own tone, and the probably career-ending words that just leapt out of her mouth. Before she had time to reflect, she had propelled Percy down the stairs and into the magnet room. The thumping and popping noises from the MRI were almost deafening.
“This machine is dying!” she yelled at him above the racket. While he was standing there bewildered, the tech screamed at Camilla and grabbed the child from the MRI tunnel. “Quench!”
The team was focused on the child first and foremost, and the nurse was checking that he had not been hurt from being plucked out of the MRI, nor burned by touching the MRI walls on his way out. In the meantime, the tech was frantically trying to bring the MRI down gently. Nobody noticed Percy still standing on his own in the magnet room.
With a roar, the machine performed an emergency quench and helium gas started surging down the vent tube. The guests on the rooftop would have seen a fine display of the whole contents of the helium vessel being vented to the outside air in a giant and entertaining plume of white but for the fact that contractors had closed the vent tube. Not knowing what it was, and thinking it to be some unused relic, they had cemented it closed and bricked it up. Down in the magnet room, the intense heat had boiled away the helium, the helium had nowhere to go, and the internal coupling to the vent tube burst like a grenade, showering the room in metal shards. The concussion of the stainless steel tube bursting knocked Percy off his feet, and in a few seconds, the entire room disappeared in a bank of dense white fog as the helium gas poured out of the MRI.
It was only 2 minutes before confused partygoers were staring down at the neuropeds team assembling in their evacuation spot on the newly rejuvenated parking deck. The team did a head count and checked that the little boy was still stable and calm, his parent accounted for. They called emergency services and went through the checklist again.
Even though this was all done quickly and efficiently, it was of no use to Percy. He had been rendered unconscious within 10 seconds of all the oxygen being displaced by helium in the magnet room and went into cardiac arrest in another 20.
Two floors below, the people still happily sipping chilled chardonnay and eating flame-roasted kebabs, Percy’s cold blue body lay dead still and his Valentine gift of red undies remained unopened in his jacket pocket.
