Medical Fiction: Ugly Betty and the Scales

This is part of a collection of stories that resemble the encounter between “Final Destination” and “The Monkey’s Paw” (WW Jacobs, 1902). As such, they are tragedies more than mysteries or horror, and would appeal most to readers who appreciate the inexorable pull of a story arc that leads to doom. In each story, a protagonist makes a wish which comes true with fatal results for someone, often the person making the wish. Nothing supernatural, but just how things work. (Or is it?) The technical details surrounding the fatal (or near-fatal) event are taken from actual cases in the US OSHA Incident Reporting Database or similar sources and are therefore quite realistic, even if they seem far-fetched. 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 bit slow, and she took great care to look 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 shinier, fuller, easier to comb. If she had a flaw, it was that she was a bit aloof, a bit manipulative, and saw her surroundings and others as part of a grand natural experiment that she could alter if she wished.

As a pretty, witty, and inquisitive nursing student, Betty had quickly realized that her body attracted jealousy and unwanted attention, and caused men to be underfoot everywhere she turned. She learned to camouflage her body. She also realized that getting good grades meant being typecast and drew even more jealousy. These things threw her life out of balance, and Betty loved the 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 degree in nursing program.

Betty enjoyed the balance between theoretical study and practical application, even though undertaking both study and nursing duties meant zero social life outside of work and barely enough time to sleep. She found computer units to be fun and she had a knack for it. The module on cybersecurity in healthcare was an eye-opener; she was shocked to discover how vulnerable many auxiliary hospital systems were. As an example, the instructor showed them how a former employee reserved an executive parking spot by selecting a user ID and password for an insecure listing.

Now, as a full-time nurse on a surgical ward, Betty’s daily makeup routine involved adding speckles to her skin, making her lips look tighter and giving her face a subtle asymmetry. Where many clinicians bought form-fitting scrubs and smartly practical shoes, Betty wore baggy uniforms and hideous Crocs. The social distancing she organized had three beneficial results. Hardly anyone shot her, she didn’t have to endure constant lineups, and she had mental space to observe others. She was very helpful in providing high quality patient care and 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 him to see social networks. She could see who was bullying who, who was getting close to who, and, of course, who was sleeping with whom. Lately, she had detected a refinement in her appreciation of sexual partners. The CMO was clearly fucking the HR director, the nurse in charge of the unit was obviously grieving with one of the anesthesiologists, and one of the new nurses was obviously having varying levels of intimacy with three doctors and hung a fourth. What Betty had recently noticed was a similar level of attachment relationship between three surgeons and two medical device salespeople. Their relationships were as intense as the sex, but they were qualitatively different from Betty. Relationships were also more networked than love dyads and even the only polyamorous group of three in accounting. The relationships between the surgeons were strong but somehow distant, and those between the surgeons and the sales people were intense but guarded in a way that none of the sexual ties in other social networks were. Betty was intrigued. Over the next few months, Betty maintained a heightened awareness of this strange social network, and then she felt a sudden disturbance. One of the surgeons got alarmed. Betty could feel her fear as clearly as if she had sniffed an iodine swab. She saw the alarm spreading through the network like a contagion. It spread lightly between surgeons, strongly between two specific surgeons and a specific rep, and then weakly between reps. The alarm level increased, decreased, then increased before suddenly decreasing. After the event, it seemed that the bonds grew stronger, although more guarded. Two months later, she saw it happen again, and this time, while digging through the EHR system, she found a possible link. The alarm had gone off in both cases when there was a readmission due to surgical complications and ebbed after surgery. She had no proof, but after a third event, and carefully going through the records, she had a pretty good guess of what was going on. In addition to medical records, she had noted lifestyle improvements for surgeons compared to their peers. Leveraging her computer background, she accessed unsecured parking history records and noted changes over time in the cars that sales reps had recorded. The surgeons and sales reps were clearly doing something sneaky that was putting a lot of money in their pockets. Since the sneakiness factor was so high and there were readmission panics, Betty guessed that they were using counterfeit implants or taking patients who didn’t meet the criteria. Further analysis of the data shifted the weight to fake implants, and the implications threw Betty’s world into an imbalance.


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What to do, however? Betty knew she could be a spider queen in a blackmail web and could pressure all participants for money. However, according to his recollections, blackmailers were usually murdered in movies, and extortion was also a crime that could carry a 20-year sentence. It would also cause potential harm to patients and not fix the vertigo she felt about the imbalance between goals of care and behavior.

Being a hands-on person, Betty put her skills and observations to work. She gathered the evidence and her findings and developed an action plan. First, she sent an anonymous email to the legal department, detailing the liability risks for the hospital. Second, she called the Anonymous Compliance Hotline and detailed the issue and listed the times and cases. Finally, she anonymously emailed the director of supply chain with details of the information she had accumulated on the sales reps’ shady activities.

Within a week, hospital security had revoked the affected sales representatives’ access and the purchasing department had downgraded the device company’s ratings. Surgeons were placed on administrative leave and a multitude of auditors went through their records, while quality and safety staff went through their past surgical cases. Seeing that things were working as they should, Betty sighed. His universe was once again in balance. The behavior would be back in alignment.

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