December 6, 2020


(c) J. Singh, 2016

It was a simple life in rural Punjab. Narinder grew up in a small village in a remote area, several hours drive from the nearest town. Being the only child, he was doted on by his parents, and he was very close to both of them. There were only a few hundred people in this small village, and everyone knew each other. Early every morning, before the dawn, Narinder’s family would rise, bathe, say their prayers and then begin the work of tilling the soil and tending to the crops that were their livelihood. Narinder’s father taught him all about irrigation, crop rotation, how to plant, how to care for the plants, and what needed to be done for harvest. Not only did Narinder’s family feed their own village, they also sold their crops to other, neighboring villages and even some of the towns.

Narinder had never been to the big city. He had heard a lot about it from friends and relatives as they excitedly recounted their adventures to him. But it didn’t sound at all appealing to him. The big city was congested, polluted, and dangerous. He liked the simplicity and openness of village life. No rigid travel schedules, no smoke to choke his lungs, and no fear of anyone stealing his bags or bicycle. The air was fresh and clean, and the people were friendly and trustworthy.

“Narinder, yaar!” it was his best friend, Ramesh, gliding towards him on his rickety old bicycle. “Want to go running by the canal?”

Narinder considered the remaining chores he had, and didn’t think he had enough time to go play and complete his chores before nightfall. Ramesh knew what was in his mind.

“Do them later!” he urged.

“I won’t be able to finish,” Narinder argued, “there won’t be enough time.”

“I’ll help you, we’ll do it in half the time.”

This argument seemed convincing enough to Narinder, and so he agreed and they both set out for the canal.

Narinder and Ramesh would spend the days playing in and around the village, and talking about their dreams for their future. Ramesh wanted to see America, maybe even live there one day. He was enchanted with the images he saw in movies of the tall skyscrapers and the fast cars. Narinder was interested in creating something, being an innovator, making something that had never existed before. He wanted to be an inventor, perhaps, or an entrepreneur.

And so the days passed, one season blending into the next, until the day came when Narinder’s mother fell seriously ill with an unknown malady. They called for the local doctor, who with his admittedly limited medical training acknowledged that she was suffering from an illness that would not just go away by itself.

“She is running a high fever,” the doctor said, “I will consult with my colleagues at the medical center in the capital city, but I am very sure that she will need medication to resolve this issue.”

The doctor did as he had promised, and he returned the next day with the diagnosis. His face looked grim.

“This is not a common ailment,” he explained, “but it is not rare, it actually happens with some degree of frequency, we tend to see it more so in the larger cities. We are not sure why, it might be due to the larger population density. There is a treatment that is very effective, but it is administered in a series of injections, and I have neither the injections nor the vials of medicine here with me. If I send for them, it will take weeks for them to arrive. The best option is for you to go into the city and purchase the medicine yourself. I can write a prescription for you.”

“Tell me what is needed, I’ll go,” said Narinder.

The doctor wrote down the name of the medicine along with the other necessary medical equipment such as syringes and bandages.

Narinder’s mother didn’t want him to leave. She grabbed his hand, and kept shaking her head.

“Papa is here with you,” he reassured her, but she was adamant.

Once outside the house, he sat down and cried. But he knew that he must get the medicines, so he wiped away his tears and began walking. That’s when Ramesh came riding by on his old bicycle, ringing the bell as he approached.

“What’s wrong?” he asked, seeing Narinder’s countenance.

“Nothing yaar,” Narinder replied, “I have to get this medicine for Mama, but she doesn’t want me to leave her. She was grabbing hold of my hand, but if I don’t get this medicine for her, she won’t get better.”

Ramesh looked in the direction of Narinder’s house.

“Where do you have to get them from?” he asked, taking the slip of paper from Narinder’s hands and reading it carefully.

“I’ll check the town first, if they don’t have supplies then I have to go to the capital city,” Narinder rubbed his eyes.

“And it’s just this medicine and these supplies, exactly as written here?”


“Okay! Stay with your Mom. I’ll be back by tomorrow, if not then the day after!”

“Hey, wait, what!?” Narinder looked on in surprise as Ramesh suddenly pocketed the slip of paper and raced away on his bicycle, waving behind him as he left. Narinder ran a few steps after him but he was already too far ahead.

He looked on in silence as his friend rode his bicycle hard and fast along the only road that led out of their small village.

True to his word, Ramesh returned the day after the next, with all of the required supplies and medicines. He handed them nonchalantly to Narinder outside his house. Narinder received them with both hands as feelings of gratitude washed over him.

“How much did they cost?” he asked, “I’ll tell Papa, he’ll get the money.”

Array yaar!” Ramesh gave him a look, “it’s medicine!”

Ramesh wouldn’t accept payment. He didn’t even want to talk about how much it cost. He refused to listen to anything Narinder had to say, and quickly stopped all talk of it and resumed their focus on other topics as if he had done nothing.

Narinders mother recovered quickly once she received the treatment, and was soon on her feet and back to her normal self. The whole family, and Narinder in particular, was very relieved and grateful.

Time passed, and Narinder and Ramesh eventually completed secondary school. Ramesh gained admission to the Engineering College in the neighboring city, which was five hours away by bus. And Narinder began attending a different college. They still kept in touch, but only saw each other once in a while. And as they progressed in their studies at the different schools, their lives gradually drifted apart.

Narinder made it a point to always call Ramesh on his birthday. He did so for several years successively, and then one year, during a very hectic day during which he was preparing for his final exams, Narinder forgot to call. He texted Ramesh the next day. The following year, the date slipped by unnoticed. And, like that, slowly they lost touch with each other.

Decades later, Ramesh found himself in the United States of America. He had immigrated there after completing his Computer Engineering Degree, with a job offer from a local company already in hand. He had been married shortly after graduating, and Narinder had attended his wedding. The two friends had met each other with warm smiles and hugs, and Narinder was truly happy for his childhood friend, smiling from ear to ear the whole time.

That was the last time that Ramesh had seen Narinder. Now, settled in the United States, a lot of years had passed. Ramesh had a family, with three children - a fifteen year old, twelve year old and six year old. The oldest two were boys and the youngest was a girl, Shilpa.

It was for Shilpa that Ramesh and his wife found themselves seated in the hospital waiting room on a cold Winter afternoon, feeling tense and anxious. When they were called in to the see doctor, he didn’t have much good news.

“It’s a rare thing,” he explained in his matter-of-fact way, “we don’t see it very often. And while there is a treatment, it is quite involved and rather expensive. And it does involve a series of complicated surgeries.”

Ramesh had a million questions he wanted to ask the doctor, but only managed to ask one.

“Will this treatment work?”

“With this course of treatment,” the doctor replied, a little more hopefully, “we believe that her chances of survival are greatly increased. The data that we do have suggests that patients responded well, and after four months most of them were healthy and back to their normal lives.”

“What will it cost?”

“I’m afraid it is quite costly. It appears that the insurance you currently have does cover a portion of the treatment, but because of how rare this condition is, I would recommend you call your health insurance plan and clarify with them what exactly they will cover.”

Ramesh nodded slowly as if in a daze. When he called the insurance company, he realized why the doctor had made the suggestion. They would only cover twenty five percent of the total cost, and they used some jargon and fine print to absolve themselves of the responsibility of the remaining cost. That would end up being the patients responsibility.

Ramesh already knew that the medical costs would run into the hundreds of thousands of dollars. He would do everything he could to save his daughter, even if it meant that he would be in debt for the rest of his life. He had been saving money for years, and he would apply his savings to this medical situation now, but even if he used all his savings, it still wouldn’t cover even a fraction of the amount owed. He made an inventory of all their assets - house, savings, jewelry, stock certificates, everything. Even if he sold everything he had, he would still be left with a sizable bill.

Ramesh resolved that he would bear the burden of that when it came. He called the doctors office and requested that they make all the necessary appointments for Shilpa.

The first surgery was scheduled in two weeks. They had to drive to the hospital early in the morning to arrive for pre-op preparation. It was 5 a.m. and the first light was just breaking across the dark sky. Ramesh, his wife, and Shilpa were in the car. Shilpa’s brothers were at home, still sleeping.

As he drove past the looming buildings and towards the hospital entrance, Ramesh noticed the large, brightly lit sign of the convention center, which was on the other side of the street. It read “Innovators and Entrepreneurs Conference”, in large bold letters. A week-long conference of the most promising businessmen and rising stars in the world of business and entrepreneurship.

Ramesh was too involved in his own concerns to give it more than a passing thought. He turned onto the road that led into the hospital parking lot.

The first surgery went well, and after a few days monitoring in the hospital, Shilpa was back home on bed rest and strong pain killers. She was smiling, braving the pain and the circumstances she was enduring. Her brothers, who were very protective of her, waited on her hand and foot, and brought her anything she asked for.

Ramesh felt a sense of relief that Shilpa was getting the treatment she needed. But there was also a sense of foreboding dread that hung over his head. Every day, he checked the mail, fearful of seeing that dreaded letter, the hospital bill. Finally, it came. But, it was not the itemized bill for the first hospital visit, as he had expected. It was a summary of all charges for the entire treatment.

This must be some mistake, he thought, and he called the hospital billing department. The woman put him on hold for twelve excruciating minutes, and then came on the line and started asking him some questions - name, date of birth, relationship to patient, patients name, patients date of birth, security verification questions, and then please wait a few moments while I pull up your account. Ramesh gritted his teeth and answered all the questions quietly and politely.

Finally, she had the billing account on her screen and could tell him what the situation was.

“Yes,” she confirmed, “let’s see here, it looks like there are more surgeries scheduled, and yes we also have the doctors visits on the calendar, these are future appointments, for follow-up post-op. The balance is zero.”

“So the current balance is zero?” Ramesh asked, “the rest will be billed after the appointments?”

“Well, normally the billing is done after the visit, yes,” she confirmed, “but there’s a note here, it looks like all of these have already been pre-paid. Which is unusual, because the final amount that is due to the patient is usually not determined until after we get the statement back from insurance. But, yes, it seems like it has been pre-paid already.”

“By whom? When?”

“Umm, let me see. Seems like this was posted on the 3rd. It doesn’t have any names, I don’t see where it’s coming from. There’s an agency name, but no individuals.”

Ramesh thanked the billing lady and then stared down at the statement he held in his hands. It was a long list of procedures and medications, and at the bottom of the fifth page, the total amount which was crossed out with blue ink and the handwritten words “Array yaar, it’s medicine.