The black-and-white document listing last week's layoffs at Hutcheson Medical Center is nothing if not systematic.
Job titles and ages run down the 15-page spreadsheet, along with boxes below two categories: "Selected for termination program" and "Not selected for termination program."
Which box the X goes in means everything, especially if you're Renee McNulty.
As a night pharmacy nurse, she saw cancer for more than a decade at the Fort Oglethorpe hospital. She cursed it, attacked it, treated it.
Now she has it.
McNulty noticed a soft lump on her jaw that came and went, occasionally protruding against her right tonsil.
"Everything was kind of shifting," she said.
Testing last year indicated a desmoplastic small round cell tumor, an aggressive form of cancer with a three-year survival rate of 15 percent.
"My 9-year-old asks, 'Are you going to be around when I'm grown up?'" McNulty said. "I tell him I'm trying."
Much like cancer, cost-cutting can be brutal. Hutcheson laid McNulty off last week along with 57 other full-time employees, some of whom have never worked anywhere else. Another 17 part-time workers also lost jobs, hospital officials said.
Sixty percent of those terminated were 55 or older, hospital records show.
FULL-TIME POSITIONS CUT
Activities aide: 1
Applications manager: 1
Certified RN anesthetist: 3
Cardiopulmonary tech: 1
Dietary aide: 2
Distribution tech: 1
Employee health nurse: 1
Environmental service aide: 4
Gastrointestinal lab tech: 1
General ledger accountant: 1
Guest relations representative: 1
Human resources generalist: 1
Instrument tech: 2
Licensed practical nurse: 5
Lead person: 1
Maintenance tech: 1
OB scrub tech: 1
Operation room attendant: 1
Operation technician: 2
Phone operator: 4
Patient care tech: 1
Patient financial access representative: 1
Radiologic technologist: 2
Registered nurse: 4
Team leader: 1
Source: Hutcheson Medical Center
Hospital officials said the cuts allow them to "increase financial stability" to the tune of $3.4 million annually.
The layoffs came three days before Hutcheson's leaders voted to adopt a management agreement with Erlanger Health System of Chattanooga, which will inject a $20 million line of credit into the ailing Fort Oglethorpe hospital.
When Hutcheson's financial problems grew acute last year, the hospital sought new management teams. It defaulted on a $35 million bond and continues to lose $1 million a month.
It remains to be seen whether more layoffs are coming.
"I don't know if the first round of employee reductions is sufficient to get us to the right level or not," Erlanger President and CEO Jim Brexler said Thursday. "I know it's a personal issue and a lot of people are concerned about it. ... I honestly can't comment one way or another on that issue."
In August, Hutcheson evaluated its 900 full-time and part-time employees, deciding who was expendable based on overfilled positions and shifts. Those with least seniority were fired, human resources director Ella Cowden said.
When McNulty, 46, was told to return her nurse's badge, she was a month removed from medical leave and in the midst of chemotherapy sessions.
"That had nothing to do with it," Cowden said. "Of course not."
Even before the Hutcheson/Erlanger agreement was approved last week, employees felt that an outside suitor would rescue their hospital.
Chattanooga's largest health care organization, Erlanger Health Systems, submitted a management agreement in October.
Three of Hutcheson's four decision-making boards unanimously approved the agreement April 3, and the final one, the Hospital Authority of Walker, Dade and Catoosa Counties, voted yes Wednesday.
Brexler said he expects Erlanger's board of trustees to approve the agreement Wednesday.
Trustees from the authority and Hutcheson Health Enterprises Inc., the hospital's nonprofit parent company, denied that the layoffs were part of the deal with Erlanger.
"That would surprise me," said Hutcheson Health Enterprises board Chairman Jim Forrester.
Cowden said officials set the date for the layoffs in February. She said she didn't know if other reductions would follow.
Employees received two weeks' severance pay that officials said included unused vacation time. In comparison, former CEO Charles Stewart, who took the job in 2005 and resigned in February, received a $69,000 bonus during a fiscal year in which the hospital lost millions.
But McNulty has something else in mind: her five children. The other day, her 9-year-old asked what it's like not having hair. Another called from Georgia Southern University, so worried about his mom that he checked himself into the student health clinic.
"I want to have things ready," she said, tearing up after a 40-minute interview. "I want to keep this family moving forward."