Thursday, July 31, 2008

Utterly disappointing Sushma Swaraj

I don't usually blog about politics in spite of being an avid follower of politics since so much is written about it anyway. But I couldn't resist this one.

After the recent bomb blasts in Bangalore and Ahmedabad, Sushma Swaraj of the BJP said in a press conference that the blasts were a tactic to divert attention from the 'cash-for-vote' scandal. She was referring to the bribery allegations against the Samajwadi Party and the Congress during the vote of confidence in the parliament.

Now, this is one of the most ridiculous statements I have ever heard. Does she really mean that the Congress and Samajwadi Party planted those bombs? Has she gone mad? Does she think people are really going to take her seriously?

To what level are politicians going to stoop in the quest for power? And the BJP, a party I had once admired, has shown hitherto unseen signs of desperation to come back to power.

Especially Sushma Swaraj. Ever since the Congress won the last general elections, she has really lost all sanity. She first said she would shave off her hair if Sonia Gandhi became Prime Minister and now this.

Grow up, Sushmaji!

Wednesday, July 30, 2008

In search of the perfect dosa

It is very difficult to make good idlis. It is very difficult to make bad dosas.

While it is difficult to make bad dosas, making a really good dosa is not all that easy.

A lot of things are important. The composition of the batter, its consistency, the time for which it is allowed to stand, the type of 'tava' used etc. etc. etc.

Coming to the composition, everyone says their's is right. It is mainly a mix of rice and pulses. The pulse used and the proportion again varies from person to person. Some people add 'poha' or fluffed rice and claim this makes the dosas light and airy.

The right consistency is very important. Too thick and it becomes like an 'uttapam'. Too thin and it is difficult to cook.

If the dosa batter is not allowed to 'rise', the dosas become more like leather instead of being light and fluffy (ever wondered how a thing so thin can actually be fluffy?).

There are many variants of the dosa. Plain dosa, which is the pure and simple vanilla dosa. Masala dosa which is a dosa with a potato/raw banana dry curry, Mysore sada and Mysore masala which have a red chutney that is smeared on the dosa and so on.


Pretenders have recently started listing "different types of dosas". A little investigation reveals, however that all they are doing is to use the humble plain dosa and top it with different toppings. Cheese dosa = Plain dosa + cheese, Palak dosa = Plain dosa + spinach. Please. These are not pizzas, for heaven's sake!

There are a few places that make really good dosas. In Chennai, Murugan Idli Shop's ghee roast dosas with about a kilogram of ghee per dosa are very good. The dosas at Woodlands and Sukh Sagar in Mumbai are also fairly good.

The prize, however goes to 'Dasa', a restaurant that had branches in Chennai and Hyderabad. The dosas there were truly heavenly. They had just the correct texture, color and taste. The butter they used made the dosa really tasty. They were never too heavy. Light, fluffy and truly a treat for the tongue. You could easily polish off three in one sitting and still ask for more. Your stomach would say 'Stop' but your tongue would say 'More'!

Unfortunately, really unfortunately, Dasa has closed down. Oh! what a loss that was, my countrymen!

Monday, July 28, 2008

Arogyasree update

I just learned that the Arogyasree program of the Andhra Pradesh government has been extended to cover anyone who requires dialysis. Earlier, the program covered only those who could not afford dialysis treatments. This was done by covering only people who had white ration cards.

I have mixed feelings about this.

I would have prefered coverage being extended to more dialysis for the poorer lot. The current coverage is enough only for two 4-hour sessions every week. This could have been increased to cover three 4-hour sessions. The rich can afford dialysis. They don't need any coverage.

But I'm not going to complain at this point because I feel this is a good start and am actually surprised that this kind of a program is there in the first place.

The government needs to do this for a while and it will then realize the best kind of coverage to offer. So, let's not crib about flaws in this system. The intent is good. They will surely make progress.

Sunday, July 27, 2008

Cost of daily nocturnal almost the same as thrice a week in center in India

I completed 2 years of daily nocturnal home hemodialysis sometime in June this year. I have been maintaining all the bills of my medical expenses so that I could track how much I am spending on this.

I recently did an analysis of the costs and came up with some startling results.

The current cost of one 4 hour dialysis session at a hospital is about Rs. 1250. So, if I did 3 sessions a week, I would require about 13 sessions in a month which would cost me about Rs. 16,250 per month.

On the other hand, my current treatment modality gives me at least 7 hours of dialysis daily (except Sundays). I have the convenience of choosing my timings. I don't waste waking hours on dialysis. I feel much better. I have no diet and fluid restrictions. And my other side effects like Restless Leg Syndrome, Left Ventricular Hypertrophy etc. etc. etc. are a lot better.

And guess what this treatment cost me? Rs. 17,753 per month!!!

Isn't this great? I got much much better dialysis and I spent almost the same!

Not many people do nocturnal home hemo in India. This is a pity. People must realize the great benefits it offers and the cost is actually almost the same! Doctors must encourage this modality and recommend this to people.

I must really thank my doctor, Dr. Girish Narayen for suggesting this to me. It was really a godsend.

Friday, July 25, 2008

Bad usability, Dettol

Anyone who is making anything for consumers needs to keep usability in mind. This applies for every single product. Bad usability means dissatisfied customers. Software professionals usually learn this the hard way.

But what I'm writing about today is not about software. It is about a commonly used product - Dettol liquid soap.

I use Dettol liquid soap a lot. Now, it comes in a plastic container that has a nozzle at the top which when pressed dispenses a little liquid soap. The volume of liquid soap in the plastic container is 135 ml.

Earlier, every time you completed using the contents of the container, you had to throw away the container and buy a new one. This was a waste because the plastic container could easily be reused. Someone obviously realized this and Dettol liquid soap started becoming available in refill packs which you could buy and empty into the plastic container with the nozzle and then use.

But, guess what the problem is?

The refill pack comes with 200 ml of the liquid soap. Whereas the container is meant for only 135 ml.

I never checked the volumes either on the refill pack or the plastic container. The first time around, I was happily emptying the refill pack's contents into the container and suddenly the liquid soap overflowed from the container.

I assumed that the refill pack would have the same volume as the original container. Some smart ass at the company that makes Dettol decided that the refill pack should have 200 ml and no one ever thought through the implications.

I checked the two volumes and realized this. So, now every time I buy a refill pack, I have to empty out a part of it and there is always a little bit left which I have to either throw or wait till some liquid soap is used up and then fill the remaining into the container.

A little thought is all that is required for good usability. This is true in software as much as it is in real life.

Wednesday, July 23, 2008

The South Indian Thali

What could be more satisfying than the South Indian Thali?

In its standard avatar, it is a delectable combination of about 3 puris, rice, a dry vegetable, a vegetable with gravy, sambar, rasam, dal, curd, a chutney or pickle, a papad and a sweet.


The beauty of the meal is that it is filling but doesn't make you feel uncomfortably 'full'. It is completely satiating but does not induce lethargy.

There is one special aspect of the curd. It is perfectly 'set'. This means that they put the milk to be curdled in the small bowls in which they are served. This causes the top surface to be perfectly smooth. The curd is not first prepared and then served out in a bowl.

I have always been a fan of the thali. There are many variations of course. Some omit the sweet. Some don't serve puris. But the basic concept remains the same in a true blue South Indian thali.

The old Taj Mahal hotel near Manju cinema on Sarojini Devi Road in Secunderabad serves really good thalis. And they are a steal at about twenty five rupees! The same taste over decades. Nothing has changed at all - except of course, the price. Which, if you adjust for inflation would be constant too!

Tuesday, July 22, 2008

The height of exaggeration!

The trust vote in the Indian parliament has been won. Manmohan Singh has emerged winner.

This morning however, in the swimming pool, there were three ladies, one of them, the doctor who returned from the US recently. They were discussing the trust vote and the possible implications on the share prices and the price of gold and silver.

The discussions went on to the amount of money being offered for an MP's vote. Now, I have been following this story closely. There were reports of Rupees 25 crores being offered and a couple of reports of Rupees 35 crores.

The doctor asked the intently listening ladies, probably about 20 years younger and who knew as much about politics as they did about the stock market, and yet insisted on discussing both, "Do you know how much one MP is being offered?"

My ears cocked with interest.

"3600 crores!"

I almost drowned.

Monday, July 21, 2008

Does Arogyasree cover PD?

Bill Peckham asked this pertinent question in his Blog Report a couple of days back.

A little history first.

Peritoneal Dialysis (PD) has often been given step motherly treatment by some doctors in India. Hemodialysis is always the treatment of choice for them. Without much reason, I must say. It was never offered as an option to patients. No one ever educated them on the choices available and the advantages and disadvantages of the different modalities.

Your kidneys failed? You need dialysis? Let's get a HD access. It was that simple. I did not even know there was any other modality till about a year after I started hemo.

Only recently has PD been gaining any popularity. I did PD after my transplant failed because I knew about it through the internet and I asked my doctor if I could do PD.

Now, the doctors probably did not discuss PD because of the cost involved. At one point, the cost of PD (Four 2 liter exchanges daily) was roughly twice the cost of HD (thrice a week in-center). For most people the cost of Hemo itself was too much to bear, given the woefully inadequate medical coverage. Most people had to pay their own medical bills. Hemo gave you the ability to live with kidney disease. Why spend more on PD?

Quality of life? What quality of life? You have kidney disease! That you are able to live is a big thing in itself! Stop complaining about quality of life!

Fortunately things are changing. And I think one thing that is contributing to this is the decrease in the average age of the CKD patient. Which of course, is not a good thing. But as an unintended consequence, patients are now asking for options. They want to know what the different treatment modalities available are and many of them have access to information through the internet. So, things like quality of life are being considered important.

Moreover, the cost of PD has now come more within the reach of many people and is not that high compared to Hemo.

Coming back to Bill's question, PD is not covered by Arogyasree. For now, in the realms of kidney disease, only transplants and hemodialysis are included. But as I said before this in itself is a very good start.

Sunday, July 20, 2008

Trip to Pragathi Resorts

(Disclaimer: I do not have anything to do with Pragathi Resorts and this article is not intended to publicize the place. It is merely an account of a fun-filled day we had there.)

Finally, we made it to Pragathi!

From weeks, we've been planning to go. Someone would send out an email about 4-5 days before the day we wanted to go. Invariably some people would be ready while some people would have other stuff to do.

This time, on Saturday, I quickly called a few folks and checked if we could go on Sunday. Wonder of wonders, many people agreed. A few did not due to other engagements. But we were 6, so we thought that's good enough to go.

Sunday morning came. And before you could spell V-A-C-A-T-I-O-N, we were on our way to Poorna Tiffins for a sumptuous breakfast of hot idlis soaked in ghee. From there we headed out, in two cars for Pragathi Resorts. Amrik, Murli and me in one car and Kartik, LN and Thrinath in the other.

The journey lasted a little more than an hour. My jaws and mouth were aching by the time we got there because of laughing too much. Amrik carries this virus with him which can really cause these symptoms. So, beware!

We bought the entry tickets and went in.

Pragathi Resorts is a vast expanse of greenery. The place is full of lush green foliage, small ponds, fountains and some beautiful animals. The best part of the resort is the huge swimming pool which has slides, fountains and a 'bucket blast' which periodically throws a huge amount of water from the top at great pressure! There is a DJ who plays great loud music for a few hours on weekends by the pool.

A view of the pool

We ambled around for some time and then settled down in chairs next to the pool and chatted for a while.

Around 10:30, we decided it was high time we got into the pool. We quickly changed and dove in. Thrinath and I were the only ones who knew how to swim. Amrik pretended he could swim with not much success. He had these new swimming goggles from the US and in the end it only protected him from the sun!

Kartik, on the other hand, acknowledged that he could not swim but was really aiming to master the fine art by the time we got out of the pool. Again, not much success!

We started off by playing this game where everyone picks a guy at random. And then hits him with a ball! After we tired of this, we did the slides, a 'bucket blast' thrown in every now and then for good measure. We then played Volleyball for some time.

By this time, the DJ had started the music. The atmosphere was electric. 50 odd people in the swimming pool and under the fountains dancing to the latest chart busters. And mind you, the quality of dancing was uninspiring to say the least. It was just people having fun.

After about four hours in the swimming pool, we got hungry and came out of the pool, changed and went to the restaurant where lunch was arranged. The quality of the food left much to be desired. The spread was good but the food was not tasty.

We had a few drinks and then decided to leave.

I was quite dehydrated for some reason. I had probably lost a lot of water during the hours in the pool directly under the sun. While waiting for our cars at the reception area, I actually fainted. My friends lifted me up and we then got into our cars and headed out.

All in all, apart from the hiccups in the end, it was really a fun day.

Friday, July 18, 2008

The system

I have recently had to deal with 'the system'. Well, what exactly is 'the system'?

To me, it is a loosely defined collection of irrelevant and unnecessary people and procedures whose purpose is ostensibally to make sure things work according to established norms and mechanisms but in reality, it is a source of incessant and horribly frustrating roadblocks in getting your work done.

Phew!

To get a relatively simple transaction done I have gone through so much pain and frustration that I have probably mentally aged about three years in what we usually call three days.

Irrelevant procedures, unnecessary formalities, useless forms to fill. And shock and horror, I wasn't even dealing with the government!

The last three days of my life have been totally wasted.

Why, why why? Why do simple things have to be made more complex?

And though I have not been dealing with the government, this complex web which we call 'the system' is there because of the government. The government HAS to really get out of things it does not need to be involved in.

Focus on more important things. Medical care, for example.

Thursday, July 17, 2008

Rajiv Arogyasree

I have got some more details about Rajiv Arogyasree, the unique medical care program started by the government of Andhra Pradesh.

I was never a fan of this government but this program is one reason I am going to actually start thinking about supporting them.

In the renal community, until now, this program was available only for transplants. But starting today, apparently, the program covers dialysis too. Which for me, comes as a huge surprise! A huge pleasant surprise!

The government is going pay up to Rupees ten thousand towards dialysis treatments for patients who have a white ration card. A white ration card is basically an indicator of a poor economic condition. So, if such a person, who obviously cannot afford any medical care and would have otherwise died because of the inability to afford dialysis can actually survive!

Rupees ten thousand will get him or her dialysis about twice a week which is an EXCELLENT start.

The way they've set it up is that the government has tied up with an insurance provider and pays some premium and the provider takes care of the medical expenses. Or something like that. I still have sketchy details.

But I was so excited to hear this that I could not wait to post. I am trying to find out more details.

This is a great beginning towards health care for all. It is a big shame that so many people die because they cannot afford medical care. We just have to do something about it. This scheme should be replicated in all states in the country as soon as possible. If Andhra Pradesh can do it, I'm sure the others can too.

Tuesday, July 15, 2008

Money versus Passion

'There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.'

- Shakespeare in 'Julius Caesar'

Often in life we are faced with a choice. On the one hand is the promise of great financial reward. On the other is uncertainty financially but intellectual bounty.

It is really difficult to choose between the two.

Money is a very important thing in life. It allows you the freedom to do things you like. It allows you comforts that can otherwise be treated as luxuries. It gives you a good life. I am at a stage in life where I do not need to worry about existence. I am pretty sure I will be able to earn enough, whatever I do, to be able to live a basic life. What I'm referring to here is to be able to afford luxuries. For example, to have the option of taking good vacations, to be able to build or buy a house with a swimming pool, to be able to settle down in Switzerland etc.

On the other hand, life can be difficult to go through doing something that is not intellectually stimulating. You can carry on for some time but after a while, it can become a drag. Our work is what we do for the most part of our waking day. It has to be interesting. Whatever the amount of money your job gives you, it will become a real pain after some time if it is not what you like doing.

There are dozens of examples these days of people having left lucrative careers to do something they like even if it is not even fractionally as rewarding in terms of money.

Many of us need to make such a decision sometime in our lives. And the consequences of that decision stay with us for the rest of our lives.

Monday, July 14, 2008

State sponsored medical care

In India, the state does not provide medical care for citizens. Many countries do.

I have seen 2 known people die because they did not have the money for dialysis. This is a shame.

In a country like ours where the population is so huge, is state sponsored medical care really an option? It all depends on what the priorities of the government are. It really requires the issue to be thought through. For instance, which is more important - education or health care? I would of course say it is health care. If you are not alive, what will an education do for you? I'm sure opinions will vary though.

Treatments like dialysis are really quite expensive and not everyone can afford them. Should we allow people to die because of this? I know a few organizations that offer subsidized dialysis. This might be a good start but the reach of these organizations is minuscule.

I recently heard of a government scheme called 'Rajiv Arogyasree'. Now, I don't know the details about this scheme but I have learned that many people have been able to get a transplant because of this scheme.

Maybe we need to start somewhere and have some kind of scheme which is:

1. Government sponsored
2. Only for people who cannot afford medical care
3. For life threatening conditions

This can be gradually be expanded to make it more far reaching.

I do realize that the logistics of implementing even such a basic program are mind-numbing. But it is high time we made a small start in this regard.

Sunday, July 13, 2008

As the clock strikes seven...

In our company, when the clock strikes seven, a lot of things change.

Different genres of music start emanating from various corners of the office. For some reason, it is all right to play music after seven. During the day you have heads fixed with ear phones. After seven, the computer speakers are used instead.

The air smells of samosas after seven. People are generally hungry by now. Lunch was a good five hours back! So, every evening a little before seven, the office boys go around collecting money for the samosas and then bring in piping hot samosas from the corner halwai. There's a rumor that the Balaji Badrinarayan Mithai Bhandar sells 75% of its samosas to Effigent!

After seven, there are long queues for a game at the Table Tennis table. The unemployed in our office play TT at odd times like 11 a.m. and 4 p.m. The more useful ones play after seven to give their mind the much needed rest after a hard day's work.

The general air takes on a more relaxed hue. People are more jovial (unless of course there's a release that day!). There's a lot more camaraderie than usual. You might even see a developer and a tester, otherwise sworn enemies, laughing together!

Shooing a fly

Recently, a fly sat on my laptop screen.

Guess what I did?

Instinctively I started moving my mouse pointer with my mouse to shoo it instead of my hand!!!

Tells us how ingrained the computer has become in our lives.

Saturday, July 12, 2008

The dawn that wasn't - Epilogue

How did I get this disease?

Was it due to the vaccines? Many others took them. Was it due to the antibiotics and pain killers I had taken a month or so before I got this? Nothing that dozens others haven't taken in the past.

I had had a disease called ITP (Idiopathic Thrombocytopenia Purpura) in my childhood which was treated successfully with steroids. Could this be linked to the current disease? Possibly.

Medicine has made a lot of progress undoubtedly. But we continue to grapple with the human body and its mysteries. There is still a humongous amount of knowledge that waits to be discovered.

Having a chronic disease is painful. For the body and the mind. Not knowing how and why it struck is more painful. What was the event that triggered this? How I yearn to know this!

I have written this series not because I am depressed or sad. It is just for people who want to know more about the process and events that one has to go through with such a disease.

I have taken this disease head on. Researched the internet. Found out all I could. Talked to the doctors. Talked to the specialists. I think I have done a good job dealing with this disease. I work full time. I work harder than anyone in my family.

I have not let the disease overpower me. I know of people who groan and moan about their condition. I don't. I live my life as fully as possible.

Am I always cheerful? No. With this kind of a problem, it is natural to feel sad or helpless at times.

I ensure that it remains only a part of my life. I ensure that it does not become my life.

Friday, July 11, 2008

The dawn that wasn't - Part 5

When I came to, I felt a sore in my throat and was coughing a little. I found myself in the Transplant Care Unit lying on a bed. A nurse was there in the room. I was dying to know what had happened during the surgery. General anesthesia literally takes away time from you. It was a gap in my life. A blackout.

"Sister, how did the transplant go?"

"It went very well. You are perfectly fine!"

"Thank God!", I thought to myself. I asked her about the sore in my throat. She said that was ok and it was due to the ventilator that was used.

I was peeing gallons through a catheter by now and they had also put me on IV fluids.

For the next few days, the routine continued. Blood tests, visits by the nephrologist and the surgeons. I was slowly started on a liquid diet, then moved to semi solid and then finally solids.

After about 9 days of the transplant I was moved to a private room. All this while, my blood tests were all normal.

On day 11 post transplant, the nephrologist, Dr. Dakshinamurthy, second to Dr. Shastry, came to my room in the morning.

"Your creatinine is a little high. I have asked for a repeat test."

I was scared. This should not happen. Maybe its a mistake. Let's wait for the repeat test.

A few hours later, I learned that the repeat test showed the same value. Now what?

The docs returned after a while. The decision was to give me a massive dose of steroids to try and force the kidney to behave and get a biopsy to find out what exactly was happening.

Steroids were given on 3 successive days. No change.

By the 20th day post transplant, my creatinine almost touched 10. Dialysis had to be started. This was a big mental setback. For me and my family.

The biopsy report was out by then. Recurrent HUS, they concluded. Cyclosporine was stopped immediately.

I was back on regular dialysis.

They tried different things to try and bring the kidney back. Nothing was working. My biopsy slides were sent to different doctors and specialists in India and the US. Nothing useful came out.

After about a month of the transplant, during a dialysis session, Dr. Shastry came to my bed and said, "We must give up now."

That was the verdict. It did not come as a great surprise to me. But that was the end of it. Officially.

Epilogue

Thursday, July 10, 2008

The dawn that wasn't - Part 4

An important part of a transplant is the post surgery medication. This involves a set of medicines including immunosuppresants and steroids. Basically these medicines prevent rejection of the new organ by the body.

Cyclosporin is the most commonly used immunosuppresant. Unfortunately, in Hemolytic Uremic Syndrome (HUS), cyclosporin is suspected to cause recurrence of the disease in the transplanted kidney. Well, no one can say for sure. But there have been studies that have found a link between cyclosporin and recurrent HUS. Again, there have been studies that demonstrated that there was no link.

So, its extremely important to get the choice of immunosuppression right. I did a lot of looking up on the internet and took printouts of all the articles to Dr. Shastry.

After a few days, I went to him to discuss this. He asked me what I thought we should use. I was a little surprised. When your doctor wants to know what you think on such an important decision, it could mean that he wants to involve you in this. It could also mean something else - he does not know. And that can be a heck of a lot worrying.

Anyway, we decided that we would use cyclosporin. Because of inconclusive evidence to suggest the contrary. I was a part of that decision.

My mother and I got admitted to Kamineni Hospital a day before the surgery was scheduled.

I had dialysis that day. I was thinking happily that that was my last dialysis. I would never have to undergo the pain of the 2 thick needles in my left arm.

My doctor thought I would have a sleepless night and gave me some sedatives. I slept quite well.

Finally, the morning of the transplant came.

I was wheeled into an Operation Theater, my mother into the adjoining one.

The two main surgeons (a husband and wife pair) started working on us. Before the surgery, a ventilator was put through my mouth to ensure proper breathing since I was given general anesthesia. Within a few hours, my mother's kidney was transplanted to me. No, mine were not removed. This is a popular misconception. Almost always, during a transplant, a third kidney is put into the recipient and it is not a replacement. Almost instantaneously, urine is produced to signal functioning of the new kidney.

When the surgery was complete, I was moved to a transplant care unit. There, the doctors suddenly realized that I was not recovering from anesthesia. There was panic all round and the anesthetist was summoned urgently. They tried a cocktail of drugs to get me out of the peaceful slumber I slid into. Since this could potentially cause cardiac issues, a senior cardiologist and a group of other specialist were called in.

Seeing all this commotion, my family was terrified. The entire pantheon of different religions was invoked. Mantras were chanted incessantly. About a month back, I myself had seen another transplant recipient go into this stage of 'not recovering from anesthesia'. I had seen the group of doctors lean over his body trying hard to get him back. They did not succeed.

I was luckier. Within an hour or so, I came out of my stupor. Still unconscious but stable.

Part 5

Wednesday, July 9, 2008

The dawn that wasn't - Part 3

In September 1997, my doctor decided to try a course of steroids. So, I started taking Prednisolone.

My kidney function started improving. The gaps between dialysis sessions could be increased. My urine output also increased dramatically.

At that point, one Sunday evening, I went out with my family. It started raining quite heavily. By next morning I had caught a bad lung infection (infections are easy to catch while on steroids) and had to be admitted. The infection was treated but my renal function declined and I was back to square one.

During this entire period, we would hear from different people about different alternate therapies. I tried almost everything. Each therapy would come with its own set of diet restrictions. Nothing worked.

My hopes of a cure from this problem would be greatly increased. And then within a few weeks gradually disappear.

Around November 1997, someone anonymously sent us a newspaper clipping that featured a businessman in Bombay called Dr. Gupta (not a medical doctor). He apparently chanted a mantra given to him by a 'sadhu' (ascetic) many years back into a glass of water. People with kidney diseases who drank that water everyday apparently were cured of their kidney ailment.

We were all very excited. This looked like a godsend. The anonymous letter. The aura of a mantra. The promise of liberation.

I left for Mumbai in December 1997 and stayed with another aunt and her family. Every morning I would go to Dr. Gupta's office and drink the charmed glass of water.

I will never find out the truth about that 'treatment'. All I know is that it did not work for me. After 2 months of drinking the glass of water (I enjoyed this part though!), my creatinine showed no sign of reducing and my urine output showed no sign of increasing.

After a few weeks of this trial, the t-word started being discussed.

A transplant was, after all acknowledgment that there was no hope for reversal. That we had given up on the week that Dr. Girish Narayen had promised.

By March 1998, we had all reconciled to a transplant and started the process of a live related donor transplant. My mother was going to donate. In the meantime, Dr Girish Narayen had to go abroad and put me onto Dr. J. C. M. Shastry who was one of the senior most nephrologists in the country.

The whole process lasted a few months. Finally, we decided on November 11th, 1998 as the date of the transplant.

I was extremely anxious. Was this the beginning of a new dawn? Were all my troubles finally going away? Will I never need dialysis again? Were fluid restrictions going to become a thing of the past?

Part 4

Tuesday, July 8, 2008

The dawn that wasn't - Part 2

By evening the nausea had worsened and I started throwing up. We were wondering what was happening. To rule out anything serious, we went over to our family doctor Dr. Kirit Parekh. My aunt, who is a doctor was in the loop by then. They decided to get a few tests done.

So, we went to the lab and I gave some blood samples.

The next day, the reports came. The doc at the lab was known to my father and my aunt. He asked me to wait outside and called my father and aunt in. I was a little perplexed.

When they came out, I asked them what was happening. They said there was some problem with my kidneys. Aha. So? They said we would need to see a nephrologist. Sure. My creatinine was 7 at that time.

I had no clue what that meant. Well, I knew that my kidneys were not working. Something temporary, I thought. Some medicines would do the trick.

We fixed up an appointment with a nephrologist, Dr. Girish Narayen recommended by Dr. Parekh.

When we went to meet him, he saw the reports and asked for some more tests. He also asked me to restrict my fluids to a liter a day. I remember wondering if 1 liter was easy to restrict to! He also said that I would need a kidney biopsy. I remember my aunt reacting with shock when she heard that. I again had no clue as to what that meant.

I was asked to be admitted to the hospital. The journey from there to dialysis was short. A few days I think.

I also got a biopsy which confirmed Hemolytic Uremic Syndrome.

I was continuously told that I had Acute Renal Failure. The kidneys had suddenly shut off. And just as suddenly they would revive and start working. I had to simply wait. In the meanwhile, they would give supportive treatment.

During every dialysis session, I would ask my doctor about when the kidneys would revive.

"Its very close now, Kamal. Maybe another week."

"You said that last week too"

"Yes, I know but its difficult to predict this accurately."

The routine went on.

"Another few days"

"A little more time"

"One more week"

That week never ended.

Part 3

Monday, July 7, 2008

The dawn that wasn't - Part 1

(This series describes the run up to kidney disease, the diagnosis and my first transplant)

11th July 1997, Chennai, India

"Counter Number 4, please", the magical words of the Consular Officer at the US consulate! No questions asked. He just looked through my papers and said this. This meant I was being given my student visa for pursuing my master's in the US. "Thank you sir!", I said and rushed over to the queue at counter #4 to pay the visa fee.

As I was leaving the consulate building, there was an extra bounce in my step. I was extremely happy. This was the end of a long journey. A journey that enabled another journey. I would go to the US to study. Great opportunities lay ahead.

I saw my father at the gate waiting anxiously to know what happened. I signaled with a thumbs up sign. He was relieved. The tension that accompanies the whole visa approval process not only engulfs the candidate but his immediate family as well. It is a big step in an individual's life. One that dictates the next few years of and possibly his entire life.

We celebrated that evening by going to my favorite restaurant in Chennai called "Dasa". Some relatives in Chennai joined us.

The next day, we headed for Hyderabad.

13th July 1997, Hyderabad

My brother Prasan had given a small ad in the local newspaper to celebrate another event - my winning a gold medal for topping my college exams! So, a few people called and came home to congratulate me for that rather than the visa!

I started preparing for the move to the US. The first thing I needed to do was to learn how to cook. Guess what I started off with? Dal Bati! Probably one of the most complex dishes! I explained to my mother that though I was learning the whole dish, I could actually make it in parts or try it on a Sunday!

14th July 1997

I went to the Institute of Preventive Medicine. I had to get vaccinated for Hepatitis B, Typhoid, Measles, Mumps and Rubella. This was a standard thing which everyone who was going to the US did. I got the vaccines. I was told that there could be some fever as a side effect.

Towards evening, I did get feverish and took it easy.

I started planning a small party for a few friends to celebrate the gold medal and the visa. The next morning I went to my college where I was scheduled to meet up with a few friends and plan the party and invite the guys. I was feeling a little queasy and attributed it to the vaccines.

However, unknown to me, there were some changes that were taking place inside me. These changes did manifest in external forms. But I had no clue on what was happening. My blood cells had started breaking. My platelet count started decreasing and my nephrons, the building blocks of my kidneys started failing.

I went ahead and booked my tickets for the US.

Part 2

Sunday, July 6, 2008

The travel bug beckons

I'm itching to travel.

Its been a long time since my Goa trip and I need to do a short trip soon before the itch becomes unbearable!

What are the options?

I'm looking at a weekend trip to Rajahmundry where the resplendent Godavari flows but my friend LN (short for Lugalapu Nagasrinivas) from Rajahmundry advises me not to go before September to enjoy the most.

Santosh told me about Talakaveri, the place where the Kaveri originates but it might be too far for a weekend. The description sounded very tempting and I was considering doing that. I would have to dialyse in Bangalore though.

Another option is Vishakhapatnam and its lovely beaches. The weather is also just about right.

Yesterday, Samiir, a fellow dialyzor who goes on these awesome treks invited me over to Mumbai and said the monsoon is a great time to go on treks.

While I plan this, I might as well do a one day trip to Pragati resorts and the lovely swimming pool with fountains, slides, the bucket blast and a DJ in attendance. Short, simple, sweet!

The problem is that currently pressure at work is high and we've been working for the last 3 Saturdays. This makes it impossible to do a full weekend.

Maybe after Release 1.8.16!

Saturday, July 5, 2008

Picasa in Hindi

Recently, while trying to use images to create a greeting card at the superb Greetos, I tried uploading some images to Google's Picasa.

Now, since I have a Gmail account, it signed me in but to my surprise, on Firefox, there were a lot of question marks being displayed. I was foxed! Was it something to do with my Mac?

I then started up Parallels which allows me to run Windows XP on my Mac and accessed the same site. Guess what? The site was being displayed in Hindi! Now, I don't remember ever setting my preference to show sites in Hindi. But I guess, Google, as always, trying to be smarter than required, figured out I was from India by looking at my IP and decided I must want all my sites to come in Hindi.

Now, I have nothing but utmost respect and love for my national language. But, while trying to upload pictures to use in a greeting card, I don't want to grapple with words I don't know the meaning of.

I have no clue what 'asoochigat' means. Or for that matter 'saamagri niyantran'. I could figure out that 'Settings sahejein' means "Save Settings" but only because of the context. "Aapki settings adyatan kar di gai hai" too - "Your settings have been saved". But I would never, for the life of me have been able to figure out that 'adyatan' meant save.

I went and promptly changed my language to English and was then able to get the task done.

Now, Hindi is a beautiful language but for web sites to be usable by more people, the language used should be simpler. New paradigms will need to be defined. We don't need to look for literal translations. For example, many people today first associate a window with something on the computer rather than something in a house!

So, we might need to begin this process for the use of Indian languages on computers.

Are my ears that small?

Are my ears smaller than the average human?

I have an iPhone and I use it sometimes to listen to music and podcasts. Now I have a terrible time with the earphones. My ears pain when they're in. So much that I have stopped using them and listen using the inbuilt speakers.

Now, I would imagine Apple to take care of these things and make sure that the ear phones are comfortable. Which leads me to believe that my ears are smaller than most people. They don't look like that though.

I wonder if other people have the same problem.

Tuesday, July 1, 2008

Eavesdropping in the swimming pool

Those of you who've been following this blog long enough probably know how much I love swimming and that I go for a swim every morning.

The time I spend in the pool is the best time of my day. The cool water, the peaceful morning weather, well, you get the picture.

These days, when the highest temperature during the day is in the low thirties, the number of people in the pool has considerably reduced which has made the swim that much more relaxing. A few weeks back however there were many more people and unless you were careful, you could actually collide with a number of people.

Invariably, there were groups of people who would come together or people who would meet their friends and acquaintances at the pool and strike up interesting conversations. I would be an unwitting eavesdropper.

For instance, there was one gentleman who was a player in the stock market. He would counsel everyone in sight to get an online stock trading account and dabble in shares giving tips on what to buy or sell.

Then there was this lady doctor who had just returned from a long visit to the US. She spun some of the most ridiculous stories on how Splenda had aspartame and should not be used or that there was now treatment for cancer where they can 'block' the bad cells. And whenever she said 'block' she gesticulated wildly with her hand actually showing how the medicines could 'block' the cells!

There were 2 elderly gentlemen who continuously bitched about a third gentleman. And when the hapless target of the bitching was around, they would be shocking camaraderie all around!

And then there was this group of Gujju ladies who would spend more time chatting about things as diverse as recipes for the best summer pickles to the bawdy Gujju play that ran at their club the previous night. They were there more for catching up than for any serious exercise.

It was fun listening to all this and it was not (I swear!) intentional. I mean, what could I have done? Closed my ears? The persons mentioned did not try to speak softly. The words came naturally to my ears.

Anyway, the summer has gone and so have my fellow swimmers. All I can eavesdrop on now is the chirping of the birds and the whooshing of the wind. I am not complaining.