Saturday, December 10, 2016

A million shades of grey



I had written about this topic back in 2008. Every individual is very complex. It is impossible to classify someone has completely black or completely white. Everyone is somewhere in between - a shade of grey.

Despite realising this, I find myself (and others around me) bucketing people into either black or white. If someone has done something bad, I immediately assume that he is a bad person. If someone has done something good, I immediately assume that he is a good person.

The truth however is that it is merely the action that was good or bad, not the person himself or herself. All of us do good things and bad things. We tend to be less generous of others than we are with ourselves.

This colours our perspectives in very biased ways. If someone whom we have classified as 'bad' does something good, we look for some selfish motive behind that act. On the other hand, if someone we've classified as 'good' does something wrong, we explain it away by saying he or she might have had some compulsion.

We must try to separate the actions from the individuals.

Some people go to another extreme and generalise entire communities, religions and countries in this manner. If they've come across a few individuals from a community doing something, they will generalise and assume that the entire community is like that. At this point, the principle of collective justice is inevitably invoked. For the actions of one person in the community, the entire community must be punished!

In reality, it was one action from among many other actions that caused us to perform this classification. How dangerous this kind of classification can be?

Friday, December 9, 2016

Why am I a huge fan of Peritoneal Dialysis?



I often get asked which type of dialysis is better - Hemodialysis or Peritoneal Dialysis? That question really has no standard answer. It's like asking someone which flavour of ice-cream is the tastiest? It depends on the individual. Some prefer Hemo while others prefer PD.

If you asked me which I prefer personally, I would unabashedly say PD. Why am I such a lover of PD?

I honestly hadn't heard about PD until after my failed transplant in 1998. When I was researching the internet, I actually stumbled across the term by chance. This says a lot about the way medicine is practised in India. "Kidneys are failing, get a fistula made" is the mantra here. When I read about PD for the first time, it almost seemed too good to be true. I decided to ask my doctor about it, half-expecting to be told that it was not available in India or that I wasn't suited to it. Imagine my excitement when he said that I could definitely go for it.

The next six years on PD, as I keep saying to many people I talk to, were the best during my life on dialysis.

There are many reasons I liked PD:

  • Less diet and fluid restrictions: I was not asked to restrict anything. I did four exchanges a day compared to many PD patients who do only three exchanges these days. This was a welcome relief from the severe diet and fluid restrictions I was asked to observe while on HD.
  • No needles: Who does not hate needles? The very thought of two thick needles in my arms is even today,  a huge put off for me. The best part about PD was that there was no need for needles.
  • No thrice weekly hospital visits: PD is almost always done at home. The whole effort of going to a hospital thrice a week for about five hours each time was physically and mentally draining, not only for me, but also for my family.
  • Independence: I did my exchanges and exit site dressing myself. This was very different from HD when you showed up at the hospital and surrendered completely to the centre staff. In PD, I had complete control. This does put a lot of responsibility on you. Some people like this, others don't.
  • Freedom to travel: On HD, I can travel only to places where there is a good centre. Also, five hours at a hospital, every alternate day, does not appeal to me on a holiday! With PD, I could travel easily. All I needed to do was to order the PD fluid bags to a place close enough to where I was travelling. The rest was a breeze. 
I was told later that PD worked best when you had some kidney function remaining. I had zero kidney function during my entire PD tenure. It worked beautifully for me. I think the big difference was that I did four exchanges. That is probably why it worked so well for me.

If there was a way for me to go back to PD today, I would close my eyes and take it.

Thursday, December 8, 2016

Why is the new blood donation technique invented in 1977 still not being used?

A new blood donation technique that was invented in 1977 in India is still not being used. I am not sure why. Lot of the challenges we face today have been overcome in this invention:

  • No pump needed to draw blood, blood can flow against gravity
  • Blood from multiple donors can be mixed together and then donated to one recipient
  • No screening required for viruses etc.
  • No anti-clotting agents needed
We should popularise this technique. I am sure many other applications of this are possible. For example, currently, pumps are needed to pump out blood from a dialysis patient's arm. This is just one of the many areas where this can be used.

Here's a video that first demonstrated the technique: (note that there's an audio that plays in the background that says "Yeh sirf kahaani nahi" which undoubtedly proves that this is not just a movie but reality)


Tuesday, December 6, 2016

My non-dialysis day



I dialyse six nights a week, for seven or eight hours each night. No, I am not in a dire condition that I need so much dialysis. I dialyse so much because it allows me a good life. I am able to lead a pretty normal life. I don't need so much dialysis. I choose so much dialysis.

I used to skip dialysis on Sundays earlier. The tech, Jayaram, who used to come home to help with my dialysis had his weekly off at work on Sundays and so, that felt like the right thing to do. It wasn't any scientific decision. It just happened. When Jayaram left because his day job was keeping him too busy, I got a couple of folks from NephroPlus to help with my dialysis.

Somewhere around that time, I decided to change my weekly night off to Tuesdays. Why Tuesdays? Well, I was swimming at a pool that was closed on Wednesdays. What has that got to do with my dialysis weekly off?

Honestly, I am about as non-compliant as they make dialysis patients these days. On a good day, I put on at least 3 litres from morning to night. On a bad day, don't even ask. So, when I skip a day, the fluid weight gain is at the very least 5 litres. I find it a little uncomfortable to swim with too much fluid inside me. Play the fool in a pool - sure. But not rigorous swimming.

So, if I continued with the Sunday dialysis weekly off, I would miss two days a week for my swimming - Wednesdays, because the pool was closed and Mondays, because I was fluid overloaded (sort of).

By coinciding these two days by not dialysing on Tuesdays, I needed to skip only one day in the pool.

Today is Tuesday. My weekly day off from dialysis. I am feeling good today. The thought of not having dialysis seems appealing. No, it's not that I hate dialysis. My regular dialysis keeps me healthy and allows me to eat and drink whatever I want and however much I want. But still, one day off gives me a nice feeling. I have me to myself. No machine, no needles, no timing.

Today, I actually made some progress on my new short story. I have been having writer's block. I don't claim to be some great writer and all to be able to justify calling it a block. But I have just been unable to write more of the story I'm working on currently. I have been stuck at the same point for months!

Why couldn't I take two nights off if I liked it so much? I tried it. I didn't like it. I felt too constrained. I had to watch my fluids too much. And that's the worst feeling anyone can have, IMHO.

So, I will let you go now. Just wanted to share my joy of not having dialysis today. See you soon!

Friday, November 25, 2016

Are humans inherently selfish?



A few months back, a discussion broke out during lunch at work on altruism. Some of my colleagues insisted that humans are inherently selfish and people who engage in altruism are actually doing it not out of some genuine desire to help people who are needy but to make them feel good about themselves. I felt that might be the norm but there are still some people in the world who help out of a genuine desire to benefit those who need it.

When it comes to human behaviour, I believe it is too complex to classify easily, especially by using generalisations.

I have seen a lot of people, especially those who donate to religious causes who insist that their name be displayed prominently among the list of donors because they have donated a larger amount. Some would even decide the amount of money being donated based on how visible the news of the donation is going to be.

Sadly, my religion, Jainism has also become prey to this culture of vulgar displays of generosity. It is more important to many people to be seen doing charity rather than actually being charitable. The sangh and the clergy encourage this as well. It serves their purpose well.

Another fashionable trend that has started is for people to donate in their late parents' memory. The parents' name is displayed rather than their own. It's almost as if people wouldn't get to know who has actually spent the money.

No right thinking individual can condone this kind of conditional charity. It would be interesting to see how things change if for just one year, a decision is taken that all donations would be anonymous.

However, the topic at hand is the more subtle kind of altruism where people don't get the publicity that I have talked about above. They may donate anonymously. My colleagues argue that even this is with a selfish intent of 'feeling good about themselves'.

Even if this is true, I wouldn't mind this kind of 'feeling good'. At the end of the day people can feel good about themselves in whichever way they want to. Some people feel good by spending on themselves, while others may feel good by spending on the needy. At least in the latter, someone who really needed the money or the resources (arguably more than you did) has benefitted.

The point I'm trying to make is that first kind of people (who spend the money on themselves) are more selfish than the second kind (those who spend the money on the needy). And all this is assuming that those who donate are doing it only because they feel good about themselves. As I said before, human emotions are too complex to categorize in this manner and it is difficult to say with any certainty how they play out in the end.

Thursday, November 17, 2016

Utopia



I awoke this morning at the usual 5 a.m. I gently put my NxStage System One in rinseback mode and then once the blood had made its way back into my body, removed the needles and disposed off all the used up consumables.

It was a cold morning. I was wondering whether I should put on a sweater but then decided against it. I made my way to the kitchen and put the water to boil. I decided to have the Rohini Premium Black Darjeeling this morning. One and a half teaspoons. Five minutes to brew. I chuckled to myself thinking about the irony of having Darjeeling tea in the midst of the Nilgiris! I took my steaming cup and went towards the backyard. I opened the door from my living room and took out my easy chair and placed it on the platform just above the grass. I settled in with my cup. I could see the moist air emanate from my mouth as I breathed out. I could actually feel the sips of tea going down all the way from my tongue through my throat and then right down my gullet, invigorating and warming my entire body. What would I do if there was no tea in my life?

I then did my usual ten-minute meditation routine and then wrote for about an hour. I had started writing this book within a week of moving to Coonoor. In the past three months, I had completed about half the story.

As the sun started rising, I realised I had begun to feel a little hungry. I had some cornflakes and then got ready and went to the community swimming pool. The heated pool in this part of town was absolute bliss. About 40 minutes of swimming and I was feeling so nice. The best part of the pool was a waterfall at one end where you had hot water gushing with force on your head.

I came back home and had a breakfast of Idlis. I then headed to the Coonoor NephroPlus centre. I checked on all the guests who had come in for dialysis, had a Skype call with the centres scheduled for today and then got about my daily emails and other tasks for the day. We were planning to submit four abstracts for the upcoming World Congress of Nephrology and the data was coming along just fine. I caught up with my Hyderabad team on some stuff and then went back home.

Traditional Gujju lunch and a nap later, another cup of Darjeeling black and then back to my book. Fiction gives you so much freedom. You give your characters the traits you want to, no restrictions imposed by actual people! You make things happen. You add a twist where you like to. No constraints! I am excited thinking about what the response would be! Of course, it may turn out to be a dud. But I wouldn't mind. I enjoyed the journey.

By around 6 p.m., I began to feel tired. My mind was exhausted. I munched on some berries. How I loved berries, in all colours and sizes. Not that I needed to watch my potassium since I was on daily dialysis but they did have low potassium. If there was one thing I missed when I was in Hyderabad it was berries. I watched some television. Modi was in the thick of campaigning for the 2019 election. I wondered if he would win. I think he did a good job overall. But was he as good as people thought he would be? That may be up for debate.

A light dinner followed. Some fresh bread with herbs and butter, homemade pizza - only Margherita (toppings were still overrated). I went through my Pocket and Flipboard apps and read some good articles.

I was soon back beside my companion for the night - my faithful NxStage machine. I was so grateful that I had access to this beauty. Just a few years ago, I had honestly no hope of being able to get one. But then suddenly it all changed. Indian health-care became dramatically different. It brought access to the latest and the best. With it, came the little NxStage machine. The lesson for me from all this was - never give up hope.

These thoughts lulled me into deep sleep in a few minutes.

Wednesday, November 16, 2016

Inflammation, inflammation!

It's been a long time since I blogged! I have been having pain in my left knee from about a month now. It gradually increased over time and about a week back, it became really bad. I could barely walk and when I did, I was in a lot of pain. The pain is worst when I sit for a while and get up and then reduces if I stand for a little while.

I consulted an orthopedician who got some X Rays and then an MRI and said I have some inflammation in that area and some fluid has accumulated and formed what is known, rather colorfully, as a Baker's cyst. When I first heard the term I wondered whether it was related to something that formed in bread when it was baked! Wikipedia put it down, disappointingly, to the cyst that was named after the doctor who discovered it and went by the last name Baker!

I was asked to take an NSAID called Indomethacin. Now, usually NSAID are prohibited in people with kidney disease because they can harm kidney function. But since my kidney function is already at 0, they were okay with me taking it because there was no lower the kidney function could go. Talk about a silver lining!

The drug has made it possible for me to walk, although with a slight limp. The pain has reduced significantly. However, I still have moments, especially when I get up after sitting for a while, when the pain is bad and I need to stand for a minute or so before attempting to walk.

In the recent past, I have had inflammation quite a lot. It was in my wrist at first and the same drug would relieve the symptoms in three days. Now, it's the knee. I wonder why I am so inflamed! I had read that dialysis is a very inflammatory process. So, it must be the long term dialysis.

I do hope I get better in time for my holiday this weekend! So looking forward to it!