F.A.T.E.: Algorithms of Despair

The pharmacist’s words struck with the sting of cold steel—sharp, sudden, impossible to brace for. “Denied.” Just that, delivered in a monotone so flat it might have been automated, as if my hope was nothing more than a line on his script. The injustice of it echoed in my chest. I pressed him again, while the sterile tang of rubbing alcohol clawed at my nostrils. Beneath it all, that familiar, suffocating pressure began to coil inside me—the same dread that always crept in when the tumor threatened to reclaim its hold.

I clung to the edge of the counter. My frustrated tears went unnoticed by the person rushing me to leave for the next customer. Everything around me dissolved into a watery haze. The neat rows of pills behind the glass melted into indistinct shapes, as if the world itself was slipping out of focus. Across from me, the pharmacist’s face was a mask, unmoved by the storm inside me. This scene most probably played out in front of him several times a day, every day.

“Why?” I managed to choke out. My throat felt raw, as though the word had clawed its way out.

His sigh felt dismissive and nonchalant. He curtly stated, “Your insurance denied the claim.”

“How much is it without insurance?” I whispered.

He showed me the price on the receipt, without talking $1938.63 for thirty pills.

I shook my head. Long-term disability maxed out my credit cards. I'd starve without the food pantry. The house was barely fifty degrees, as the heating bills were too much.

Despite being labeled experimental, the drug was reducing the tumor's size.

The woman next in line with the squeaking cart glared at me, her impatience sharp enough to cut. To her, I was a roadblock, a burden. My savings were gone, devoured by this merciless disease. To the world, I was nothing—just a ghost clinging to a life no one valued, discarded like trash.

Corporations had adopted AI for claims validation, software designed to cut costs and jobs. The ripple effect of their greed reached me here, in this suffocating pharmacy line.

Life’s worth wasn’t measured in compassion but in numbers—cold, calculated algorithms deciding who deserved to live. No human had denied me; a system built by lawmakers and economists had. It rationalized the impossible, reducing lives to financial equations and governments’ strategies for saving money.

And here I stood, waiting, begging for someone to see me.

It had been two days since my last pill, and the emptiness clawed at me, sharper with each hour. Nights were the worst—silent and endless, leaving nothing to distract me from the ache. Like a sunburn, I could almost ignore it during the day, but at night, it pulsed deep, raw, and relentless. Lying awake, desperate for relief, I longed for sleep that never came. Each minute dragged on, and I wondered if anyone could truly understand the loneliness of this pain.

The cold air bit at my skin as I shivered, trudging to the car. My old vehicle, a reflection of my crumbling life, sat waiting. I hesitated, fingers hovering over the icy door. Selling it might cover one month of medicine—just one. The thought was so absurd it almost made me laugh, though bitterly.

Shaking, I slid into the driver’s seat, my face streaked with hot tears I didn’t bother to wipe away. Crying was useless. Nothing changed. The system had abandoned me when I needed it most. I thought of those smiling families in insurance commercials, promising care and security. We’ve got your back. You’re in good hands. Lies. All of it—just marketing and empty promises.

I sat there for what felt like hours, the cold seeping into my bones, the tears drying on my face. Eventually, I started the car and drove home, the world outside a blur of headlights and shadows.

Opening the door, I tried to calm myself with wine. Finding the phone, I dreaded what would come next.

The phone felt heavier than usual, a prelude to the call I dreaded. I took a deep breath, dialed the doctor, and was met with an automated message.

The robotic voice rattled off options: Press 1 for billing. Press 2 for prescription refills. Press 3 for medical records. None of them fit. My finger hovered over the keypad, hesitant. I just needed to talk to someone—anyone—who could help.

Seconds dragged like hours until finally: “Press 5 to speak with a medical assistant.” Relief flooded me as I pressed it, only for the line to click and deliver the dreaded message: “All of our assistants are currently busy. Please hold.”

The hold music began—a tinny, grating loop that set my teeth on edge. I leaned back, staring at the ceiling as the minutes crawled by. My mind wandered to the office’s commercials: smiling doctors, cheerful staff, patients at ease. What a cruel joke. The truth was this: an endless wait, a faceless system, and the creeping fear that no one would ever pick up.

When the assistant finally answered, her voice was rushed, clipped, as if she were juggling a dozen other calls. “How can I help you?” she asked, her tone making it clear that she didn’t have time for pleasantries.

The assistant’s words still echoed in my ears: “I’ll need to transfer you to someone else.” Before I could even form a protest, the line clicked, and the hold music returned, that same grating, tinny loop that had already worn my patience thin. I closed my eyes, gripping the phone so tightly my knuckles turned white. My jaw clenched as frustration bubbled up inside me, hot and sharp. This is what it’s come to, I thought bitterly—begging for help from a system that doesn’t care.

The music was excruciating. I watched the clock, each second an eternity. I was overwhelmed by anger, helplessness, and confusion. How could something so important—so vital—be reduced to this endless cycle of waiting?

And then, the music stopped. For a moment, I felt a flicker of hope, a fragile thing that barely had time to take root before the cold, the empty sound of a dial tone crushed it. Click. Gone.

“Shit!” The word burst out of me, sharp and loud in the quiet room. I slammed the phone down on the table, my hands trembling with a mix of anger and despair. My chest felt tight, my breath shallow, as if the walls were closing in around me. I wanted to scream, to throw the phone across the room, to do something to release the pressure building inside me. But instead, I just sat there, staring at the phone, the silence around me deafening.

I automatically redialed. "911 for emergencies," the monotone robot repeated. Gritting my teeth, I forced myself through the process.

Finally, I reached the voicemail. “Please leave a message. If it is after 3 p.m., your call will be returned the next business day.” The words hit me like a punch to the gut. I glanced at the clock. 3:07 p.m. Of course. Of course, I’d missed the cutoff.

I let out a bitter laugh, the sound hollow and humorless. What was the point? I left my name, number, date of birth and I hung up, the weight of it all settling over me like a heavy blanket. My head throbbed, my chest ached, and my hands felt numb as I set the phone down on the table.

The room felt too quiet, too still, as if the world had stopped moving. I stared out the window, watching the sunlight fade as the shadows crept across the floor. The day was slipping away, and with it, any hope I’d had of finding a solution. With the darkness came the cold. Another night of bundling up in layers of clothes and a blanket while dealing with the growing throbbing pain that had been unleashed without the pills I had taken for years.

“Denied.” The word pulses behind my eyes, a bitter ache that medicine used to dull but now only sharpens. I clutch the remote like a lifeline, searching for numbness in the flickering blue glow of the TV. The news drones on—robots, smart cities, promises of progress—stories meant to soothe, but to me, each headline feels like a quiet accusation. Are our lives really getting better, or is that just what they want us to believe?

A billionaire’s voice, slick and untouchable, seeps through the speakers: AI will soon devour jobs, he says. Security, purpose, gone. The words coil in my gut. Is this the new order, the first echo of surrender to machines? I wonder—do you feel it too, that cold dread creeping in, the suspicion that the world is slipping out from beneath us? Are we meant to bow to algorithms, to beg for scraps of meaning, or will we simply disappear, erased by progress that abandons us at the roadside?

Sharp pain. Nausea is curling in my gut. Sleep’s not coming—not tonight. The TV blares, but it’s just noise. I barely hear it. My mind’s stuck on them, the ones who are supposed to help.

Rushed voices. Hold music. Dial tone. Voicemail. Over and over, like some sick joke. How many times do you have to beg before someone sees you? How many times do you have to fight just to be treated like a person?

I’m invisible to them. The system shrugs and looks away. They built a future for someone else, left me in the waiting room—denied, dismissed, forgotten.

And the question claws at me, keeps me wide awake: What do you do when the people you counted on decide you don’t matter?

The pain was this bad the first time too—back when my vision blurred and I stumbled into the hospital, scared and hoping someone would listen. I should’ve known better.

A hot shower chased away the deep chill I was feeling. Ghostly tendrils of steam blurred my reflection as I stood before the mirror. The image was burned into my mind; there was no forgetting it. I was met by the gaze of a stranger, a living ghost.

My skin, stretched taut and pale, felt as paper-thin as it could be against my bones. My collarbones and ribs were sharply defined beneath my sunken chest. My appearance was alien, as if sculpted by a heartless, cruel force.

I touched my scalp—just a few stubborn patches of hair left, clinging after radiation burned the rest away. The scraps that remained felt alien, as if they belonged to someone else. Would it ever grow back? Would I?

My face was gaunt, eyes sunken, cheeks hollowed. I leaned into the mirror, searching for answers in a stranger’s reflection. The doctors warned me—hair loss, fatigue, weight dropping off. But nothing prepared me for watching myself unravel, piece by piece.

The bathroom was silent except for the slow drip of water. I wrapped a towel around my shoulders, but the cold still seeped in. Fragile. I felt breakable, unsure if I’d ever feel whole again. I held my gaze, daring myself to look away—but this was me now, like it or not. A new day brought new hope.

I tried to call the insurance company again. I prayed most of the night when the nausea was overtaking me, that today would be better, today I would get to the bottom of why I was denied.

“Yes, hello. Listen, I need my medicine, and your company said it was denied.”

The girl was polite. I don’t think she was in the US, though, as her accent made me think it might be in the Philippines.

"Yes, I can see here that your claim was denied. Don’t worry, let me check further and see how I can assist you with this.

“Who denied it and why?”

The phone grew heavier against my ear, the hold music a drill boring straight into my skull. My fingers hammered the counter—frantic, useless. The empty pill bottle glared at me, label half-peeled, as if mocking how badly I needed what it once held. The doctors knew I needed it. My body screamed for it. But here I was, trapped, waiting for some faceless system to decide if I deserved relief.

“Ahh, Fate denied it. We can appeal it. Let me see,” the voice on the other end finally said, as if this was just another Tuesday for them.

“We need a list of the medicines you have tried. There are others that might work. Have you tried them?”

“Ma’am, I have had several doctors, and they put me on this one after others didn’t work. Can my doctors call Fate and talk with her?”

I didn’t understand the laughter on her end.

"No ma’am, Fate is not a person. It’s an acronym that stands for Final Assessment and Treatment Engine. It’s an AI computer system that gathers information from several sources, including white papers, about the subject. If the system says you need to try a different medicine, that’s the reason why your claim was denied. But the good news is that, according to FATE, there’s a generic version of the medicine that you should try first. I’ll go ahead and fax this to your doctor so they can review it.”

I couldn’t respond; my language would have been so unladylike. I would have been ashamed of myself. Why is a computer playing doctor, making life and death decisions on cost?

I finally muttered, “What if it doesn’t work?”

“There is an appeal process, ma’am, but all other options must be exhausted before insurance will cover that drug.”

By the sixth day without my medicine—and just three days after starting the new one, the kind that never worked before—the pain clawed through my body with a ferocity I’d almost forgotten. Each breath felt like swallowing fire. I gripped the edge of the kitchen counter, my vision swimming with black spots. I was alone, terrified, and so weak I could barely hold up the phone. My fingers fumbled at the screen, desperate to dial 911. The room spun around me, the cold linoleum pressing into my cheek as I slid down, my last thought a silent, pleading hope that someone—anyone—would answer and help before I disappeared into the darkness.

The ambulance took me to the nearest hospital, where I drifted in and out of consciousness.

The world around me was a haze of sterile white and muted beeping. The faint scent of antiseptic clung to the air, sharp and clinical, as if it were trying to scrub away the humanity of the place. I blinked against the fluorescent light overhead, my body heavy, my mind swimming somewhere between sleep and wakefulness. And then I saw him, the doctor—standing at the foot of my bed, his face half-hidden behind a clipboard, his expression unreadable.

“Doctor,” I croaked, my voice raw, as though it had been dragged across gravel. “The pain… It’s so much less now. Did you give me the medicine I needed?”

He glanced up briefly, his eyes meeting mine for a fleeting moment before returning to the chart in his hands. His silence stretched, taut and uncomfortable, like a string about to snap. Finally, he spoke, his voice measured, clinical. “The tumor has grown and is pressing on the part of your thalamus, which is like a relay station for sensory information. The words hit me like a slap, cold and stinging. “What do you mean?” I asked, my voice rising, cracking under the weight of disbelief. “It was working.”

He sighed, a sound that seemed to carry the weight of a thousand conversations just like this one. “We’re moving you to a rehab facility,” he said, his tone flat, as though he were reading from a script. “There, you’ll have two choices.”

“Choices?” I repeated the word tasting bitter on my tongue. “What choices?”

He hesitated, his fingers tightening around the clipboard. “You can keep trying the generic brand,” he said, his voice softening, almost apologetic. “Or… we can give you a morphine drip. You’ll drift away. Peacefully.”

“Drift away! What about surgery?”

He barely glanced at me before dropping his gaze to the clipboard, rifling through pages printed with endless columns of numbers and jargon—meaningless, impersonal, like the folded leaflets crammed into pill bottles. My fate, reduced to statistics and formulas, he barely bothered to explain. When he finally looked up, his eyes were flat, indifferent, as if I were just another checkmark on his to-do list. “Statistically, you would not make it off the table alive.”

The words landed with a dull finality. I wanted to scream, to shake him, to make him see me—not a data point, not a risk calculation, but a person who needed help. Instead, I sat there, my hands clenching the scratchy hospital blanket, boiling with helpless rage as he retreated back behind his numbers, my future already decided by a spreadsheet.

“You’re telling me that a machine decided my life isn’t worth saving?”

He didn’t answer. He didn’t need to. The silence spoke louder than any words ever could.

F.A.T.E. sealed my destiny cold, unfeeling verdict delivered by algorithms and circuits stripped of humanity. It wasn't just my right to fight that was denied; it was the fragile hope of being seen as more than a line item on a balance sheet. Somewhere in a sterile office, someone was already calculating the projected number of "write-offs" for today, this week, this month—an entire year's worth of lives reduced to statistics and mortality tables. I couldn’t help but wonder: what’s the insurance company's stock price today? And tomorrow, as F.A.T.E. sharpens its blade to cut even deeper, how much higher will it climb? Was the ROI on F.A.T.E. paying a dividend?