Sunday, June 29, 2008

The mental aspect of a physical illness

I was diagnosed with renal failure in July 1997. This was a purely physiological disease with no mental ramifications whatsoever. But when I introspect, I find that there have been some unmistakable mental symptoms.

For example, I am not as confident about myself now as I was in the summer of 97. Back then, I had just completed my Chemical Engineering, won the gold medal in fact, US I20 in hand, visa just stamped, ready to take on the world. Nothing could come in my way. I was sure of a bright future. I was good.

Now, when I think of myself then, I find such a big difference. Now, I am full of self doubt. I am not sure of myself. I am not positive about my future. There are problems and I'm not sure how I will overcome them. In many aspects. I'm not sure how my health will turn out. I'm not sure how my career will shape up.

Its not that I'm depressed all the time. I'm depressed only rarely. Which cannot be uncommon in someone with a chronic illness. But my self confidence has reduced considerably over the last eleven odd years.

Also, earlier, I thrived in company, among friends, in a group. Nowadays, I enjoy periods of solitude. Well, I do still enjoy company but I never enjoyed being alone earlier.

Why might this have happened? Honestly, I have no idea. Its not as if I 'blame' myself for this.

Do others with chronic illnesses face this? I wonder.

Friday, June 27, 2008

The Architecture Mafia

Yesterday I wrote about the Process Mafia. There is another breed of software professionals. They are the Architecture Mafia.

I have always believed that simplicity is the key to good software. I read the three rules of good software design somewhere:

1. Keep it simple
2. Keep it simple
3. Keep it simple

Whenever we design software, we should do so in the simplest manner that does the job. Unfortunately, there are architects who do just the opposite. They will introduce unnecessary layers in the architecture to impress their boss, show off their knowledge and win brownie points with the customer. The customer of course, never realizes what he's getting into.

The end customer wants a solution that works. He couldn't care less if you use the next big thing in web technologies or good old C. He wants the job done. And it should be easy to maintain. These are the main things most customers care about (or should care about).

But the architecture mafia don't get it. Their biggest failing is that they are unable to live up to their ability. Instead of keeping it simple, they try to use technologies that have just been introduced into the market, need a few years to stabilize and are very raw.

This leads to a large number of problems. You don't have enough people in the company or even in the market who know the technology. There isn't anyone senior enough who knows the technology inside out. And heaven forbid, if the technology fails to mature, the customer is doomed. There will never be anyone to fix problems that will inevitably crop up later in the life cycle of the application.

While architecting the application and designing its components, unnecessary but fancy stuff is introduced for no reason whatsoever other than to look good on paper. That it will make life miserable for every individual associated with the project down the line does not strike.

I don't claim to be an expert. But I do have common sense. And keeping it simple makes a lot of sense to me.

Thursday, June 26, 2008

The Process Mafia

In the software industry, of which I am a part, 'process' is a heavy word.

Everything must have a 'process'. From development to testing to design to hiring to visiting the loo, everything must have a 'process'.

Now, having a process is not bad. In fact, it brings a lot of order to an otherwise chaotic ensemble of myriad components.

There is a problem however. Whenever 'process' overtakes common sense, a disaster is in the making.

Processes are there to help in streamlining activities in an organization. Processes are really invaluable in predicting the outcome of a project, in helping to notice possible slippages early in the cycle and in ensuring continuity in the face of attrition among many other benefits.

Many people unfortunately treat processes as the end rather than a means to the end. And these are mostly managers. The kind who know less than a fuck about technology. For them it is more important to fill in your status report for the day than to finish off the critical bug that you are on the verge of fixing and you have just hit upon the breakthrough algorithm that legends are a part of.

Managers need to understand that processes are enablers, pretty much like themselves.

A manager who does not enable his team to complete the work at hand is not doing his job. A manager who is more particular about the endless meetings and reports his team must prepare is not doing his job. A manager who does not remove every obstacle in his power that is preventing his team from performing is not doing his job.

In the name of processes managers must never stifle creativity. This is the bedrock of good software. Processes surely help in creating good software. Only help. Processes by themselves will never create good software.

Sunday, June 22, 2008

To transplant or not

I visited my nephrologist yesterday. Apart from the regular discussion, I discussed the transplant and the immunosuppression. I told him about the call and that we needed to be ready this time around.

There are a lot of issues associated with my transplant. First of all, the association of Calcineurin Inhibitors like Cyclosporin and Tacrolimus with recurrence of HUS. There was a research paper I found on the internet from the Mario Negri Institute in Bergamo, Italy, an institute that has been doing a lot of work on HUS.

The paper said, "On the basis of these data, renal transplant should be considered an effective and safe treatment of ESRD for patients with STX-associated HUS, but considered with extreme caution in patients with non-STX forms."

Obviously I have the non-STX form. Life has to be exciting, right?

So, for me, a transplant should be considered with 'extreme caution'.

Another complication is my WBC count. It has been consistently low. Which hampers my ability to fight infection. And infection is a big risk when I will be on immunosuppression.

Now, I also have an enlarged spleen. My nephrologist felt that there was a possibility that some parts of my blood were getting sequestered in my spleen and this could be a cause of the low WBC count. So, he thinks we should consider the possibility of doing a splenectomy (remove the spleen) before going for a transplant. But he's not sure.

The spleen by itself has a big role to play in the immune system that helps fight infection. So, if you remove the spleen you are again reducing the ability to fight infection.

So, all these things need to be considered. And then there is the dragon too. Which makes the whole equation more fun.

We are however pretty much decided on the immunosuppression. We've pretty much decided on using Sirolimus, MMF and Prednisolone.

My nephrologist is however not sure about the course to take with respect to the spleen.

To conclude, yesterday he said we should go ahead with the transplant (after taking a decision and possibly some action on the spleen). But he warned, we should be fully prepared for rejection or recurrence of HUS. And then not take any "over enthusiastic" steps in case there was a sign of losing the kidney. Basically give up without too much of a fight because it would increase the risk of other complications.

Which is not a whole lot encouraging.

I am now going to go and meet Dr. V.S. Reddy, the nephrologist at the center where I will be undergoing the transplant to discuss this.

Let's see what he has to say.

Friday, June 20, 2008

The Stars

In every field, in a team or in a group of people, there is always a star performer. Well, mostly.

This is the person who has the amazing ability to take the lead, take the initiative and actually do things. This is the person on whom the manager or the boss can depend upon. In fact, this person can take the manager's place in his absence.

These are the stars of the team. People look up to them to show the way. People expect them to have solutions to problems.

One thing that I have noticed is that seniority has nothing to do with it. It could be that senior people are the stars but it is not a rule. Often, some junior individual also takes on this role.

This is true at work but is also true in other spheres of life.

I have seen these 'stars' at work, in sports, at college events and even in a group of sadhus (monks)!

In fact what prompted me to think about this is the group of sadhus that is currently in Secunderabad for the recently concluded 'deeksha' ceremony which I wrote about here.

Now, the Jain monastic order gives a lot of importance to seniority. Every junior monk has to bow before a senior monk. Now, there is a lot of reason there. But, quite often, a junior monk shows a lot of promise and takes on (and is encouraged to take on) additional responsibilities.

This is the case with Muni Veetragyashvijayji. He is one of the junior monks in the group but he is the one who is seen shouldering a lot of responsibilities given by the Acharya (who is the head of the group). In fact, the recently initiated Kandaswamy became a disciple of the 'muni' despite there being other senior monks in the group.

This can sometimes give rise to differences within a group. But, this should be handled very carefully by the manager or the head. He or she should try to minimize the resentment which is bound to be there among the senior members. Often senior members are mature enough to understand this but this is not always the case.

In our company, we had the example of Rajesh Naidu who was quite a junior guy but was extremely capable. We gave him a lot of responsibility. Some seniors in his team were a little unhappy but we handled this and thankfully, did not have too many problems.

Thursday, June 19, 2008

Kandaswamy takes Jain 'deeksha'

Recently, in Secunderabad, a 'deeksha' ceremony was performed. Kandaswamy from Tirunelveli, Tamil Nadu was initiated into the monastic order by Acharya Rajyashsuriji.

The whole celebration spanned over 8 days and had various ceremonies and 'poojas' culminating in the 'deeksha' ceremony on Monday, the 16th of June.

Why does an individual voluntarily give up worldly comforts and take on a life of hardships and difficulties?

Jain monkhood is literally a path strewn with thorns. No vehicles, no footwear, severe penance, no use of electricity.

In Jainism, the ultimate quest is that of 'moksh' - freedom for the infinite cycle of birth and death. That is what every true Jain strives for. Not money, not good health, not success and fame. The quest is only for 'moksh'. Any prayer, ritual or act of 'dharm' without the goal of 'moksh' in mind is meaningless. Rituals performed for self-aggrandizement are discouraged.

True Jains always wish that their deeds result in a pure soul rather than worldly comforts.

'Deeksha' is a means to this end. It is a major step in the quest for a soul unblemished by 'karma'. It is the first step towards achieving a soul that is pure, that is in its true form. When the soul gets rid of all its karma, it attains 'moksh'.

Monday, June 16, 2008

Crap-avathaaram!

I saw Dasavathaaram yesterday. I wish I hadn't. I haven't seen a movie this bad in a long time.

Now, let me start with a disclaimer that I don't understand Telugu and that this was a Telugu film but then I've seen many Telugu films and enjoyed them. So, there!

Touted as the most expensive film ever made in India in which Kamal Haasan plays ten roles, Dasavathaaram ends up as a waste of time, effort and money. The basic idea of a film, that of telling a story is forgotten. It is more a mash up of ludicrous characters who are juxtaposed on film to show off the wizardry of computer graphics than to do justice to a story and script.

The characters are burlesqued to ridiculous extents. And why oh why did Kamal have to do all the voice overs? The voice for the tall fair guy from the van in the accident scene is so irritating that I almost shouted out asking him to shut the fuck up.

The songs are very average except the first one.

I sat through the second half only to see how the tsunami was filmed (I had read somewhere that the tsunami 'brings it all together') and regretted it. The graphics that were talked about so much were very artificial.

All in all, it was an extremely disappointing film.

Saturday, June 14, 2008

Another 30-something Indian on dialysis

Thanks to Bill Peckham, who posts a CKD blog report every once in 3-4 days, I found Samiir Halady, who is a 35 year old guy living in Mumbai on dialysis.

After reading his blog, I found out that Samiir is on hemodialysis and goes for treatments twice a week. He works full time. And loves to trek.

I really want to find out more about him. How does he manage fluids? Where does he get the energy to trek? How did CKD come about? Is he on a transplant list?

Though I am in touch through forums with other folks on dialysis, this is the first time I have come across someone from India with a similar age as mine and a blogger at that!

I am trying to find out more about him.

Thursday, June 12, 2008

Is good intent good enough?

Well, no. You need to have the capability to back up good intent. In any endeavor, you need to actually deliver and for that good intentions are not usually enough.

Let me give you an example. At work, I know a few people who are very sincere, very enthusiastic and eager to do well. But they are unable to back it up with results. Tch, tch. Doesn't help.

I have utmost appreciation for their attitude but I'm afraid, they are not effective at delivering things as needed. Successful people are, to borrow from Joel Spolsky, people who are smart and get things done.

Good intentions are important. But that's not all.

I feel a little sorry for these people. I want them to do well. I really want them to succeed. I like them for their attitude. But I cannot trust them with important work and that's sad.

On the other hand, you have the capable guys. With loads of attitude, albeit the wrong kind. They have the ability to do whatever is required. And do it fast. But you need to pamper them, praise them, mollycoddle them. Only then can you get the work done. These guys couldn't care less if the work doesn't get done if they don't contribute.

Great attitude with great capability - a killer combination. But difficult to find.

Sunday, June 8, 2008

The call

It was midnight last night when my cell phone rang.

I had fallen asleep about half an hour back while waiting for my tech, Jairam to come and start dialysis. We've changed the cannulation sites and so he's been doing the cannulation for a few days now. I had called him around 10:30 and he said he would be late because he was caught up in the hospital.

I answered the phone half asleep. It was Jairam. Was he not going to come tonight? I was about 3.5 above my dry weight and I could pull off another day. It would be good if he did not come. I could have a comfortable sleep.

"Bhaiyya (brother, in Hindi as he calls me), we've just got a cadaver and the blood group is O positive. Will you be interested?"

I had recently registered at the Krishna Institute of Medical Sciences (KIMS), Secunderabad for a transplant. I had initially broached the subject with my nephrologist, Dr. Girish Narayan and he said that we should now try another transplant. I had my first in November 1998 and after 11 days of normal function, Hemolytic Uremic Syndrome (HUS), my original disease had recurred causing the transplanted kidney from my mother to fail.

For a few years, I did not even think about another transplant but for the past few months I have been getting a little fed up of dialysis and started wondering if I should try again.

Dr. Girish Narayan asked me to register at KIMS since they have a large number of transplants happening. So, I went and met Dr. V. S. Reddy, the nephrologist at KIMS and discussed everything. I completed the necessary formalities and got onto their list.

Immunosuppression was going to be tricky. Cyclosporin, the most commonly used drug can cause recurrence of HUS. Both Dr. Girish Narayan and Dr. V. S. Reddy were going to do some research on the internet and then decide on the regimen for me. I was going to pitch in with my own findings.

When I registered I enquired about the statistics and calculated that I should not expect a call for atleast about 5-7 years. So, I took the research bit easy. I guess so did the doctors.

I was shaken out of my partial slumber with a mental jerk. A kidney for me! I was flooded with a thousand thoughts at the same time. No more dialysis. No more worrying about fluid. But wait a minute. What about the immunosuppression? That was not decided yet. I could not use cyclosporin. Last time I got a transplant, cyclosporin caused recurrent HUS.

I called Dr. V. S. Reddy and confirmed that he had not had a chance to check on the immunosuppression either. Both of us decided then on the phone that we should not go in for the transplant now.

Shucks! What an opportunity lost!

But I guess in these circumstances this was the right thing to do. Why take a risk when we are unsure?

At the same time, I'm not sure when I will get another chance.

Saturday, June 7, 2008

It's a boil! It's a wound! No! It's a fistula, man!

I have a fistula in my left upper arm. I have so many people staring at it that I get a little uncomfortable at times.

Now, fistulae generally are a little gross to see. Mine has the arterial vein dilated like crazy. That makes it even worse.

Generally, my shirt or T shirt sleeve covers it but when a small part of it is visible and if I stretch my arms above my hand, pretty much the whole fistula is visible. Reactions to the involuntary exhibition of this prized possession have ranged from a worried "What happened?" to an inquisitive "What's that on your arm?"

An answer like "Its an arterio venous fistula used for dialysis" usually ends the conversation with a mild "Ok" to hide ignorance of most of that.

When I go swimming, I spray a wash proof aerosol spray to prevent water from getting in. And then I cover it with a wrist band. I'm still undecided whether the wrist band attracts more attention then if I had left it bare.

People have asked me in the pool about it and I have given the same answer. I've been advised not to swim if it was a boil. A boil that big? Give me a break!

Why is a fistula needed in the first place? Here's an extract from wikipedia:

"In dialysis, blood is withdrawn from an artery or vein, purified, and returned to a vein. The volume of blood is too great for veins to handle, so a vein must be enlarged. An artery and vein, usually in the arm above or below the elbow, are sewn together, to create a fistula, and arterial pressure eventually enlarges the vein. The enlarged vein can accommodate a cannula or a large needle."

So, a fistula is what makes dialysis possible. I protect it like my life.

Here is a picture of my fistula in all its glory during a dialysis treatment:
You can see the two needles taped securely to my arm almost at right angles and blood in the tubes connected to the needles. I use the buttonhole method which means using the same sites for every treatment. Many people use the step ladder method which means using a different set of sites for each treatment.

Friday, June 6, 2008

Why the portable dialysis machine can't be brought to India

A few friends have wondered why the portable dialysis machine cannot be shipped to India.

There are a couple of reasons.

One, the System One is not yet permitted to be sold outside the US. Aditya responded to this by saying the iPhone is also not permitted to be sold outside the US. But there is a difference. The iPhone costs a few hundred dollars. The System One is probably atleast a hundred times more expensive.

Which brings me to the second reason. In the US, I believe there is a 24 hour replacement guarantee. That is, if something goes wrong with the machine, they will have a replacement shipped to you within 24 hours. Which will be impossible in India. And Indian technicians (however good they might be) will find it difficult to fix the problem without any formal training. Spare parts might also be difficult to get in India.

I had explored this option when I switched to daily nocturnal but it did not seem practical then. Things haven't changed much.

Thursday, June 5, 2008

Trust, where o where are you?

I have recently come across a number of instances where trust has been breached.

A couple of friends lent money to their friends and are not getting it back. They helped when it was really important trusting that the money would be returned. But it did not happen. Questions on when the money would be returned are met with cold responses, lame excuses or plain denial that the money was taken!

Now, the money in question was small. So, it is not that big a material deal. But the issue here is principles. A simple human value. Trust.

Another type of this breach which I have seen is breaking the promise of confidentiality. I confide in a friend about something. I trust him completely. I tell him for whatever reason. For advice, for help or just for the sake of lightening my heart. Whatever. He has no business telling anyone else about this.

I see this happening though. And it pains. The original individual is happily oblivious of what's happening. And the intent here, mind you, may or may not be malicious. Does not matter. The fact of the matter is that there has been a breach of trust.

Some people are compulsive gossip mongers. Any bit of information with the slightest hint of juice and slander and they cannot digest it. They have to pass it to someone.

Women are unfairly accused of being that way. Many men do it too. In fact, there is a joke that goes, "What are the 3 most effective forms of communication?" Answer: "Telephone, Television and Tell-a-woman"!

Monday, June 2, 2008

Telugu - sweeter than honey

Languages have always fascinated me. Think about the way languages have evolved. From nothing to a complete structure of words, grammar and constructs!

When a language sounds sweet to the ear it is all the more appealing.

Among all the languages I have heard, I find that Telugu sounds the sweetest - if it is spoken in its pure form without the corruption that you get with its many dialects.

In fact, the name of the language comes from 'tena' which means honey!

Another language which is considered sweet is Urdu. One aspect of Urdu is it is sweet due to its constructs. Telugu, on the other hand is sweet because of its words.

Repeated efforts on my part to learn to speak Telugu fluently have fallen flat. I have used a book called 'Learn Telugu in 30 days'. This did not work because the emphasis was on writing and speaking Telugu. This became too much for me.

I need to focus primarily on speaking the language and then worry about writing!

I have scoured the internet for some good websites that teach spoken Telugu. To no avail!

The important thing however, is to practise after learning. This is something which simply does not work for me. Everyone speaks to me in other languages. And since my Telugu currently is horrendous I hesitate before speaking it!

iPhone battery update

I had written here that I was having problems with my iPhone battery. My fears were unwarranted. It was something temporary or mistakenly perceived.

My iPhone battery works very well and there is no unnecessary discharging. Phew!