Photo Credit: Ulianna

In this medical fiction tale, a weary nurse confronts her ruthless brother, leading to a reckoning that resolves years of family conflict in a fateful twist.

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 that appeal most to readers who enjoy the inexorable pull of a story arc that leads to doom. The technical details surrounding the 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.

It was a Christmas to remember, a Christmas to forget, and the most uncomfortable time of the year for Edith R. Pugliese, chief nursing officer at St. James Hospital. As the only daughter, Edith had always felt it her duty to host her family’s three big annual gatherings: Independence Day, Easter, and Christmas. So did her father and two younger brothers, but this time was different—in a life-changing way. 

The Pugliese family had a long and proud history in medicine. It had always been assumed that Edith would become a nurse and her brothers, Bruce and Bradley, would follow the paternal line as surgeons, like their father, grandfather, and great-grandfather before them. Bruce and Bradley, however, had other ideas. Much to their father’s irritation, Bruce pursued a career in finance, while Bradley managed three years of medical school before abandoning it to become a poet.

Edith’s childhood had been a constant balancing act. As the older sister, she often mediated between her domineering, opinionated father, her quiet, arts-loving mother, and two brothers with opposite temperaments. Bruce was mercenary—the one who would snatch someone else’s leftover slice of pie from the fridge—while Bradley seemed to crumble under even minor stress. If Bruce was the chair that was too hard and Bradley the one too soft, their parents were disconnected players who occasionally made home life more chaotic. Edith had always been the fixer—retrieving Bradley’s toy that Bruce had commandeered, quieting them both before Father confiscated it or Mom surreptitiously bought Bradley another.

After their mother’s death from an undiagnosed heart condition, Edith, then just sixteen, became the family organizer, mediator, and soother of souls. Those responsibilities stuck with her even after she entered a nursing program and moved into adulthood. When Bradley dropped out of medical school, it was Edith who absorbed Father’s uncomprehending rage. When Bradley contracted hepatitis from sharing needles, it was Edith who ensured he received the right antivirals, monitored his weekly Interferon shots, and kept him alive. She held Bruce’s hand through his many self-inflicted romantic failures and supported Father through a late-career depression. When difficult family crises arose, Bruce and Bradley always scattered, leaving Edith to dig in and fight through the mess.

Thirty years later, Edith had reached the top of her profession. Becoming the chief nursing officer of St. James was a hard-earned triumph, yet her family’s reaction was underwhelming. Father dismissed her role, mumbling about “uppity nurse managers,” Bruce didn’t seem to know what a CNO was, and Bradley, stoned as usual, likely wouldn’t have known the difference between a CNO and a hole in the wall. Edith celebrated with friends instead, treating herself to dinner and a show downtown. At fifty, she had expected life to settle down. Instead, it only became more complicated. Without children of her own, she somehow ended up sandwiched between caring for an irritable, increasingly confused father battling encroaching dementia, supporting Bradley financially through eviction threats, and cleaning up the fallout from Bruce’s latest romantic catastrophe. It was exhausting, and at times, she could have cheerfully murdered one or all of them. Father’s pompous irritability, Bruce’s heartless attitude, and Bradley’s neediness overwhelmed her at times.

Edith’s family members had also progressed in their careers, which had created another dimension of tension. 

Father had become a surgical consultant of sorts after retirement from the hospital, and they’d recognized him with a ceremony and a medallion for his contributions before gently nudging him out of the door. 

Bradley hadn’t advanced much in terms of position, but he’d been awarded a “poet laureate” title that came with a nice ceremony during the annual college poetry event and a prize of $1,000. He seemed exuberant, and Edith was glad for him.

Bruce’s rapid career ascent had taken a darker turn. After stints as a CFO at a finance firm and then as a venture capitalist, he joined a private equity firm. He now wore bespoke suits, drove a ridiculously expensive car, and lived in a palatial mansion. His gleeful accounts of “streamlining” companies and “releasing” thousands of employees disgusted Edith. His attitude toward the working class had devolved—they were now “worthless” and “parasitic,” he said. 

The cruelty Bruce described so cavalierly was about to get very personal for Edith: Bruce’s firm had set their sights on buying a number of hospitals, clinics, ambulance companies, and other providers of medical services and supplies. They intended to vertically integrate them with their insurance company to form a captive customer base and then list the combined group on the stock exchange. Naturally, the integration also involved combining similar departments and functions, and streamlining. With Bruce leading the effort, his group had just bought Edith’s hospital, and despite his casual assurances, it quickly became clear that “streamlining” meant they planned on slashing services and specialties that were “less profitable” and reducing staff to a bare minimum. Edith would be required to rank-order her nurses using arbitrary “performance” metrics, then force them to re-apply for their jobs. Evaluating nurses by how many “relative value units” they could generate revolted Edith, and the performative cruelty of making her nursing staff “sing and dance” for their jobs infuriated her.

Venting her frustration to Father and Bradley solved nothing. Father had just sniffed and talked about “real clinicians” and “progress,” while Bradley muttered something vague about “late-stage capitalism.” Neither seemed to understand that Bruce’s platitudes about “value” translated into real people losing their jobs. Edith found herself struggling to juggle their indifference and Bruce’s heartless ambition, all while trying to maintain fragile family harmony during the holiday season.

It had been freezing cold and drizzling all week, but Christmas morning arrived with a rare inch of snow on the ground. The family gathered at Edith’s house, and for a brief time, the mood felt festive. Everyone seemed to be trying their best to be pleasant: Bradley read a heartfelt poem he’d written for the occasion, Bruce smiled over his wine, and even Father seemed filled with good cheer. But as the drinks flowed, so did unfiltered truths.

Bruce, his tongue loosened, let slip the devastating details of his personal plan for Edith’s hospital: women’s health, family medicine, psychiatry, and pediatrics were on the chopping block, and two-thirds of the nursing staff were earmarked for layoffs or reduced hours. Edith was enraged. Years of pent-up resentment erupted as she turned on Bruce, pointing out how his opulent lifestyle was built on the misery of others. Father stormed off to watch television, Bradley burst into tears, and Bruce shot back a vicious, juvenile insult: “You can take your stupid low-rent family events and stick them.”

They continued their vitriolic exchange as Bruce grabbed his coat and scarf and headed through the narrow front hallway, Edith hot on his heels.  Bruce slammed open the front door, stepped out onto the icy steps, and then turned to deliver a cruel parting shot: “You’ve always been a tedious, servile, low-value person. I’m outsourcing nursing next—it’s cheaper, and I won’t have to deal with useless nurses and their frequent tantrums and costly demands.”

It wasn’t a big push. Edith barely touched him. In her heart, she had wanted to kill him. Her hands moved toward his chest, but by the time her fingertips brushed his expensive cashmere sweater, she had regained her composure and was considering making peace, whatever that might look like. Bruce, however, had seen the momentary murderous glint in her eyes. He flinched as only instinctive cowards do, and his feet slid on the icy surface. He overcorrected with a wild gyration and, arms flailing uselessly, his feet shot out from under him. Gravity did the rest. Bruce fell backward down the steps, his head colliding with the concrete like a cannonball.

Snowflakes drifted down in perfect silence, glittering in the Christmas lights. Edith stood frozen, haloed by the falling snow, as faint strains of “Silent Night” floated through the frigid air from a neighboring house, and Bruce’s soul slipped silently away.