It was very important. He had been waiting,  for quite a while, to have a knee surgery and that was the letter of the famous surgery-bank checks. When a person is waiting for a long time, they get a bank check and with that bank check  they can have that surgery in the private sector.
Era molto importante. Da un po' era in attesa per un'operazione al ginocchio, e quello era la carta per il controllo chirurgico. Quando stai molto ad attendere ricevi un controllo, e con quella carta puoi fare l'operazione da un privato.