It was a tough life but neither of them complained. Both of them found their work extremely satisfying and intellectually stimulating. The hospital was beginning to do well financially as well. They could see that their efforts were bearing fruit. Having your own hospital, catering to hundreds of patients every month and making some money in the end gave them a sense of achievement, of having done something, of drafting a success story that few could boast of.
Dr. Som saw close to fifty patients every day. People came from Rajahmundry and towns and villages close by. He understood the plight of some of the poorer patients. They barely had money for the commute. The hospital was not yet empanelled with the state government’s health insurance scheme, Aarogyasri. Despite that, due to the superior quality of care, many patients came here even though they could barely afford the cost.
Dr. Som was sympathetic to them. He appreciated the fact that they came to him even though they could have gone to another hospital that was empanelled under Aarogyasri and got treated free of cost. Sometimes, he waived off part of the treatment cost for those who could not afford it but needed the quality of care Narayana Hospital offered.
A patient had come to see him from Samarlakota one afternoon, a place about 50 kilometres away. He was in bad shape. He needed dialysis urgently. It was a case of late detection of kidney disease. For years, the symptoms had been building up. As is often the case in places with inadequate medical facilities and awareness, people realise they have kidney disease when it is too late to do anything to save and preserve kidney function.
Dr. Som told the patient that he would need to get a temporary access for dialysis until a permanent one - an arteriovenous fistula was made. He would need dialysis immediately. He was asked about the cost of the entire treatment. Dr. Som told him that the initial cost would be about five thousand rupees including the temporary access and one session of dialysis. The permanent access would cost about Rupees 7,500 but he could get it all done free of cost under the Aarogyasri scheme if he went to a hospital that covered it.
The patient chose to get the temporary access and the first session of dialysis done at Narayana as he was in a bad shape and did not want to prolong the agony by going elsewhere at this stage. Dr. Som put in a catheter in the jugular vein that would enable the patient to get a dialysis session immediately. Dr. Som decided to waive off the charges of the temporary access and charge only for the dialysis. He made a note to that effect in his file and sent the patient's wife to the billing section.
In the meantime, he started preparing for the minor procedure which was typically done in the dialysis unit itself.
By the end of the day the patient had undergone his first dialysis session.
Dr. Som was in his chamber when he got a call over the intercom from Vasudha. Vasudha wanted to come over to discuss something. Dr. Som knew what was coming. He called her over.