# The Case of the Stacked Deck Show: Adverse Events · Lead: Dr. Tracy Grant · Draft 1 > **This is the script.** The build is `podcast-stacked-deck.html`, generated from this file. > Write here; the build is disposable. Run-sheet and production notes live in the > build only. > > Format: `##` opens a scene · `>` is a sound cue · `**CAPS**` is a speaker · > everything else is speech · blank line between paragraphs · `*(beat)*` inline. --- ## COLD OPEN — 0:20 > a desk fan, steady · a playing card flicked into the blades · another **TRACY (V.O.)** Four arms. Two clinics. One list. And six months of me feeding a deck of cards to a desk fan, one at a time, trying to work out what was wrong with it. > — music sting — **ANNOUNCER** Adverse Events. From the case files of Dr. Tracy Grant, who writes the protocol, and Connie Chase, who makes it happen. **ANNOUNCER** The story you are about to hear is fiction. Any resemblance to your last study is purely coincidental and entirely predictable. **ANNOUNCER** *The Case of the Stacked Deck.* --- ## SCENE ONE — THE OFFICE > the fan, slower · a door · a clipboard signed **CONNIE** Courier came. Sealed, signed for, initialed twice. From a Mr. Miser. **TRACY** Randy. **CONNIE** Randy Miser. *(a beat)* Somebody in that family had a sense of humor. **TRACY (V.O.)** Randy Miser. Two states over. A man I have never met and would not know if he sat down on me. Which is the whole point of him. A stranger deals, and we just play the hand we've been dealt. Allocation concealment. Cheapest rigor in the business, and it costs a stamp. **CONNIE** Where do you want it? **TRACY** Drawer. **CONNIE** The drawer that locks, or the drawer that's got a lock on it? > a beat **TRACY** The one that locks. > a drawer, pushed shut **TRACY (V.O.)** I'd asked Randy for blocks of four. Four arms, four cards to a block, so the groups stay even at every interim look. He said fine. Randy says fine to everything, which at the time I mistook for agreement. **CONNIE** Oh — the specialty clinic's sending four more Thursday. Then nothing till the twentieth. **TRACY** Of course they are. **CONNIE** They come in bunches, that place. Always have. **TRACY (V.O.)** Which I complained about at the time, to anybody who'd hold still. > — music bridge, four bars, then under — ## SCENE TWO — THE INTERIM LOOK > no fan · rain at a window · a cup set down **CONNIE** Finally getting crisp out there. Don't you love the fall? **CONNIE** Brought you a hot — well. A coffee. From the machine on four. **TRACY** You went to four? On purpose? **CONNIE** Hey, at least it's consistent. Predictably cold, right from the spout. > the door **TRACY (V.O.)** Six months in, you take an interim look. Not curiosity. Protocol. Somebody has to make sure we're not hurting anybody. > pages, set down one at a time Table one. Four columns, A through D. Forty-odd apiece. Age, even. Gender, even. Every column telling the same story. Severity. Five point nine. Six point oh. Six point seven. Six point one. > a page turned back Six point seven. Same as the look before. And the one before that. Now, randomization is the one thing in this business you are never supposed to have to think about. It's a coin. A coin does not develop opinions. I read that table four times, on the theory that a fifth might fix it. > — music bridge, two bars — ## SCENE THREE — THE INVESTIGATION > the fan back on · a filing cabinet · a telephone **TRACY (V.O.)** You start with the machinery, because the machinery hasn't got feelings and can't be insulted. Was the deck truly shuffled? Or was it the shuffling they do at a wedding. Feet going every which way, yet nobody's moved one square foot in twenty minutes. Except my nephew Donald, who can't seem to stay with one partner long enough to say hello… > a beat · then a handset lifted · dialing · a machine picking up · the beep **TRACY** Randy. Tracy Grant, QUARTET. I need somebody to tell me that sequence is clean. Humor me. > handset down **TRACY (V.O.)** He'd called back before I got in the next morning, which tells you everything you need to know about Randy Miser. > an answering machine clicking on **RECORDED VOICE** Tracy. Ran it again. Sequence is clean, dated the third of March, and I still have the code. *(beat)* It ain't the list. > the machine clicking off **TRACY (V.O.)** Scratch one. Second suspect: the tape measure. Maybe severity itself was walking on me. Different rater out at the specialty clinic, different afternoon, different private notion of what a six looks like on a bad day. > a filing drawer · folders going down on a desk So I pulled the ratings and set them against each other. Concordant. Boringly, beautifully concordant. The measurements were on the level and they had alibis. Which meant the imbalance was real. And a real imbalance in a randomized trial is a thing with no business existing. Like a draft in a sealed room. Like hot coffee from the machine on four. > rain · the fan Which left a third suspect. And I sat there a good long while before I'd let myself walk all the way up to it. > — music bridge, two bars — ## SCENE FOUR — THE DECK > the fan · a deck squared on a desk · one card flicked into the blades **TRACY (V.O.)** There's a deck in my second drawer. Been there since the Halloran fiasco. I flick them into the fan when I'm stuck, which my mother would call a waste and I call thinking. > another card · and another Somewhere around the fourth one, it stopped being a fidget. > the fan switched off · cards dealt out one at a time, four to a round Four hands. Four arms. Four cards to a block. Clubs. Diamonds. Hearts. > a pause · nothing but the room And I'm holding the fourth one before I've turned it over, because there is exactly one thing left that it can be. That's not a trick. That's arithmetic. Nobody out at that clinic is dealing the cards. But they *can* see every card that gets dealt. Three down, and the fourth's got nowhere left in the world to go. So somebody out there could look at the patient sitting in front of her, and know exactly what was coming next, and hold it back a day. Nobody would have to lie. Nobody would even have to decide anything, exactly. > a card set down flat, not flicked There's a woman at that clinic. I've met her twice. She has been enrolling people into studies since I was writing my first aims page in a library carrel. And at eleven o'clock at night, with a fan going, I was building a case against her out of a deck of cards. I would like to tell you I felt bad about that. I did feel bad about that. I kept going. > the drawer · an envelope lifted, and set back · the drawer closing And here's what I could not do. I could not find out whether anybody ever had. Six months. A drawer I picked out because it locked, and a key nobody ever turned. Me included. An office with four desks and a door that stands open because it has always stood open. There's no record of who opened that drawer. There was never going to be one. Nobody writes down the thing nobody thought to watch. > HOLD — three full seconds · rain An innocent explanation and a guilty one leave the same mark on the world. Which is none. > — music bridge, two bars — ## SCENE FIVE — THE RE-DEAL > traffic through a window · the fan, off **CONNIE** You slept here. **TRACY** I did not sleep here. **CONNIE** Your coat's on the chair and there's a jack of spades under the radiator. > cards being gathered up **TRACY (V.O.)** She wasn't wrong about the cards. But somewhere in the small hours I'd quit asking *who*, and started asking *where*. > pages · a pencil I took that table apart and dealt it again. Not by arm. By clinic. Two clinics. One list. And the specialty place — the one that sends the sicker folks, four in a week and then nobody till the twentieth — Every one of those bunches walked into a block of four and came out cut in half. Never down the middle. That's the whole of it. Nobody stacked that deck. We dealt one deck across two different tables and never once stopped to think about it. I'd asked Randy for blocks of four and he'd said fine. I never asked him what he made of two clinics. He'd have told me. That's the part that stings. He'd have told me in a sentence. **TRACY** Connie. It was never a person. **CONNIE** Is that the good news or the bad news? **TRACY** It's arithmetic. **CONNIE** So's that machine on four. Nobody's fixed that either. > a chair · papers squared **TRACY (V.O.)** Two things changed after that, and there is nothing clever in either of them. The next list gets stratified by site. Which is a long way of saying each clinic deals from its own deck, so a run of hard cases at one of them can't bend the other. And the deck stays right where it is. Turns out a lock only tells you nobody's supposed to look. It doesn't tell you whether anybody did. So there's a book beside it now. You open that drawer, you sign for the privilege. Name, date, why. > a drawer sliding shut · a key turning > — music — People think you seal the deck because you don't trust your people. You don't seal it for that. You seal it so that six months on, when the numbers come out crooked and it's eleven at night and there's nobody in the building but you — you can quit asking who, and go find out what actually happened. **ANNOUNCER** This has been *The Case of the Stacked Deck.* --- ## SIGN-OFF — 0:30 > — music up — **ANNOUNCER** Dr. —— appeared as the Voice of Randy Miser. **ANNOUNCER** Adverse Events is brought to you by Software for Research. For those who love discovery more than data entry. **ANNOUNCER** And even though the biostatistician points out that our sample size is one whenever they hear us: this is Adverse Events. > — music out —