Sunday, August 31, 2008

Peace through religion

A lot of individuals are deeply religious. They go to the place of worship regularly, perform fasts and rituals with great sincerity and are very particular about following certain principles related to their religion.

Some people however do these things with a motive. It is either fear of divine retribution if these rituals are not performed. Or it is the lure of material benefits that accrue by performing these rituals.

For example, if I do not do this ritual, I will be punished. Or if I do this ritual I will be rewarded by 'God' with this.

Well, to each his own. But I do not subscribe to these lines of thinking.

The 'divine element', whatever form it takes cannot have passions that mortals have. This 'force' cannot be pleased or angered by us doing or not doing certain things. These are misconceptions that have been foisted on the laity of different religions by the powers-that-be.

For me, religion is intensely personal. Rituals are a means to be at peace with myself. Because I feel 'pure' before, during and after them. For me rituals are not a way of pleasing any 'God' or getting material benefits. They are not even a means to cure me of my health problems.

The entire experience of religious rituals is a cleansing of my mind. To be at peace with myself.

Saturday, August 30, 2008

Three days and counting...

I posted a few days back about a scare I had when I tried to start my dialysis treatment myself. The problem I had did not deter me from trying it again.

I started my treatment myself the next day, and the next, and the next! Last night was the third day in a row without any issues!

I'm really happy.

I do take my brother's or father's help a little. There are some things that are risky to do alone and until I figure out and get comfortable with ways to do them myself, I don't consider that a problem.

It does take me longer though to start dialysis than the tech. But I guess speed is not an issue. Once I get more comfortable with it, I will get faster.

The feeling is amazing. The independence this gives me cannot be described.

The only thing is I need to be very meticulous. One small slip and I could have trouble. Not life-threatening for the most part but a major pain. Alarms, delays and the possibility of losing a little blood.

Let's hope things go on like this!

Friday, August 29, 2008

What is it about Effigent?

Effigent was started in September 2000. We are almost eight years old. There were two primary unstated objectives - to build a commercially successful company riding on the Mac market and to build an organization where people grew with the organization and where they enjoyed working.

We are still a little away from achieving the first objective. We have definitely succeeded in the second.

I have seen people treat this company as their own. They would genuinely feel for the company. They would celebrate the successes of the company and be sorry when we had setbacks. They would not create a tantrum when salaries were delayed. These were the true believers in the company.

I created this video and showed it to a gathering of Effigent folks during the farewell to the consulting team which was bought over by another company. Quite honestly, the video is not at all great. It is quite bad technically.

Inspite of this, people were visibly moved. The video was then shared with a lot of people who have left Effigent in the past. I have received many emails that tell me how they miss Effigent and that they have never got the environment that Effigent provided.

What is it in Effigent that works? Why do people miss the environment that Effigent provided?

Is it the CEO Obul's easy-to-approach demeanor? Is it the relatively flat organization structure? Is it the consistency with which we have taken on inexperienced people and provided them an opportunity to learn? Is it the tremendously fast growth? Is it the college-like atmosphere? Is it the lack of rigid policies? Is it the freedom that people got?

I really do not have an answer. Maybe it is a combination of all this.

Whatever it is, I can proudly say that I am a part of a company which people are sad to leave. When some individuals have tears rolling down their cheeks on seeing a video that captures moments from the history of the company, the management of the company has done something right.

Maybe we are not owners of a bank account that is bursting at the seams with cash. Maybe we are not yet financially where we would have liked to be by now. But the goodwill that we have earned is a great achievement in itself. How many companies today can boast of this kind of success?

When the consulting team has now moved to another company as part of a deal, I feel sad. Sad that we could not share our success with them the way we would have liked to. I miss them so much. The morning meetings, the ML meetings, the rush of a deadline. I really loved my team. It is very unlikely that I will have this kind of a bond in any other company.

There's something in the DNA of Effigent that facilitates this. There's some inexplicable quality in the air that encourages this. I want to know what this is. Because I want to make sure it never goes away.

Really, what is it about Effigent?

Thursday, August 28, 2008

Take a chill pill Jeetu bhai!

The Jain 8-day annual festival called 'Paryushan' has just started.

Among other rituals that are performed as part of this festival is the daily evening 'pratikraman'. This is a ritual where a lot of Jains gather and perform a kind of 'pooja' where some verses are chanted, people meditate and recite some religious songs.

It is supposed to be a highly introspective one hour and the main purpose is to repent for the sins committed during the day.

What happens is that there are inevitably a few children who also come for the 'pooja'. Now these kids don't obviously realize the significance of the ritual and are there mainly because their parents want to induct them into religion at an early age.

During the rituals they sometimes go overboard and make a lot of noise.

Now, there is a 50-something year old person called Jeetu bhai who is very learned. He has an extremely short temper. He blows his fuse at the slightest provocation! He cannot tolerate the kids disturbing the proceedings. So, he keeps yelling at the kids when they make a noise.

Now, I don't really blame the kids. Its great for them to have come for a religious ritual in the first place. And their disruptions are by no means serious enough for the hullabaloo that Jeetu bhai creates.

Jeetu bhai must really take it easy.

Tuesday, August 26, 2008

A scare

For a long time I had not done my cannulation (putting in the dialysis needles into my arm) and started dialysis. The dialysis tech who comes to help was doing everything. I had learned the whole process and was doing a lot of it myself for a while. But then I would be tired after work and would not get down to doing anything at all and would let the tech do the whole procedure.

Yesterday was Monday and I needed good dialysis since I had not dialysed the previous night, it being a Sunday. I called my tech around 10:15 in the night to check when he would be coming. He said he would take about half hour more.

A thought occurred to me. How about doing everything myself?

So, I started off. Prepared the bicarbonate solution. Primed the tubes. Priming is a process by which the dialyser (artificial kidney) and the tubes that connect the needles that pull out the blood from my arm and push it back after passing it through the dialyser are cleaned with sterile water.

Once this was done, I cannulated myself and connected the tubes to the needles. But by mistake I connected the venous line to the artery instead of the arterial line. Blood is supposed to come out of the artery and go into the tube. But no blood was flowing.

I then realized my mistake and disconnected the venous line and connected the arterial line. But this caused a lot of air to go into the system. Air in the system is a strict no-no. I however had not realized this.

As the blood was drawn from my artery and passed through the dialyser and was about to be returned to my vein, the machine sounded an alarm. I then noticed the air in the tubes. I started panicking. I tried to tap on the tubes to get the air into the venous chamber which acts like a cushion for extra air. But to no avail.

Just then, to my great relief, Jairam, my dialysis tech arrived. I explained the problem to him. He asked me not to worry and did a few things by which the problem was resolved.

It was a little scary but I am undeterred. I plan to do it again tonight. Let's hope things turn out ok.

Sunday, August 24, 2008

Cheating myself!

I am on a fluid-restricted diet. Which means I need to drink less fluid. I need to drink less water.

That is because my kidneys are not working. A very important function of the kidney is to remove the excess water from the body. So, when the kidneys don't work, the excess water builds up inside the body causing different complications.

Now, to avoid drinking too much water unwittingly, people like me are advised to measure the water we drink. So, what I do is to drink from the same bottle. I fill up a one liter bottle with water and always drink only from that bottle. That way, I always know how much water I have drunk.

When the bottle is getting empty I know I have drunk close to a liter. If its getting empty around morning, I know I have to slow down. If its close to night, I know I've been a good boy.

Now I have found a way to cheat. Cheat myself, if you will!

I usually drink from the same bottle. But let's say when I go for a swim, there is a water dispenser near the changing rooms. I drink about a quarter of a glass from that. Now, that did not come from my bottle. So, that's ok. It does not count towards my fluid intake! I can drink as much as I want. The bottle will not get empty early!

Unfortunately, my body is not as smart as my brain! And the water actually does go into my blood! Can you believe it? The water that I drank from the dispenser and not from my bottle goes into my blood! How could that possibly happen?

Saturday, August 23, 2008

Long winded wedding rituals

Well, I'm no expert at this since I am not married. But I have seen with great disdain the cumbersome rituals that are a part of Indian weddings.

Weddings are supposed to be fun. But what happens eventually is that the immediate family of the bride and groom have to undergo such a lot of pain that at the end of it all they are quite relieved!

Another problem is that weddings are scheduled at weird times. Why? Because the 'muhurat' was arrived at at that time. Now, it is so difficult to have a wedding at these times. I can find 100 couples who have got married at a 'non muhurat' time who are totally happy and 100 couples who have got married at the 'muhurat' time and are unhappy.

Why then do we worry about the 'muhurat'?

Also, the number and complexity of the wedding rituals is mind boggling. I suspect this trend is a conspiracy of the 'pujari' brethren in order to increase their clout and 'dakshina'!

I remember a cousin sister's wedding. The engagement was the previous day. The 'pujari' made the engagement last about 2 hours. A few of us got together after the engagement and scolded the 'pujari' for this. We threatened him with dire consequences if he made the marriage ceremony last too long.

The next day, the marriage ceremony was wound up in 90 minutes!

Friday, August 22, 2008

Akbar on living life in third person

Akbar Pasha wrote about living life in third person here.

A really amazing post.

I have experienced living life in third person in the past for a few minutes each time. Unconscious of the fact that there was a term for it and people discussed and wrote about it!

The experience was quite disconcerting. Its like the person in you, and you, are two different individuals. You look at the man in the mirror and treat him as someone else and then look at his emotions, his feelings, what he does. Its really strange. Try it.

After a few minutes of living this life, I would immediately come back to life in first person because it was very uncomfortable to imagine.

I believe all of us might have experienced this unknowingly at some point.

Akbar's posts are so different from mine. I write about the more mundane things in life - dosas, swimming, work etc. while Akbar's posts are so profound. I am always excited when I know that he has written a new post. And I say "Yes" to myself and quickly open the blog URL in a new window. He writes very rarely but it is clear that a lot of thought has gone into it.

I must confess that I was inspired to start blogging after reading Akbar's blog.

Going further in the article, Akbar talks about moving to living life in 4th person. Now, that was too much for me. As it is, third person psyches me out. I don't even want to try fourth person!

Thursday, August 21, 2008

In search of the perfect shrikhand

What would Gujarati food be without shrikhand?

Shrikhand, for the uninitiated (and the unfortunate, I must add!) is thickened, sweetened, flavored curd (yogurt).

Now, that definition does not convey even a tenth of what shrikhand actually is! But, in plain English, that's what it is.

Shrikhand is prepared by letting curd hang in a cloth and let most of the water dribble out. May take a few hours. This process is so important. Let it stand for too long and it becomes too thick. Take it out too soon and it is too thin. The consistency is an extremely important aspect of shrikhand.

Once this is done, sugar is added and flavors that give it its rich taste and odour are added. Kesar (saffron) and elaichi (cardamom) are the most widely used. Chopped almonds and pista are usually used for garnishing.


Variants of shrikhand include fruit shrikhand (diced green grapes alone, pomegranate alone or a mixture of different fruits) and amrakhand (mango flavoured shrikhand).

There are many places in Hyderabad where you can get good shrikhand. But my favourite is Panchratna Dairy which has branches in Koti and Prenderghast Road, Secunderabad.

There is one place in the lane opposite the Venkatramana theatre in Kachiguda which makes amrakhand to die for. I forget the name. Will update the post when I remember.

Tuesday, August 19, 2008

Donkey versus Scientist

Sometimes you need a donkey. Sometimes you need a scientist. Never make the mistake of using a scientist when all you need is a donkey.

The donkey is the guy who will do as he is told. Do this, then that and then that. This, that and that will get done in exactly that order. Without a mistake. Good donkey.

Now, imagine if you have a scientist. You tell him the same thing. Do this, then that and then that. The scientist will first analyze this, that and that. He will try to understand why you told him to do these things in that particular order. He will wonder if there was a way he could do it more efficiently. He will ponder. He will mull. It will be a week before he starts off on this. And there is a very high probability that you will not get what you wanted in the first place.

Ah! the ingenuity of the human brain!

Sometimes you just want people to do as they're told. Not apply their mind. Because you've already thought it through. Why bother those cells? I've done my home work. JUST DO AS YOU'RE TOLD!

But no, there are some people who love to exercise their brain when its most not required. And they mess up totally.

So, take it from me, sometimes donkeys are better than scientists!

Monday, August 18, 2008

Social Networking Blackmail

I have received a few emails that border on blackmail from the new social networking sites that have started coming up after the phenomenal success of orkut. The emails are on these lines: (Sandeep is a fictitious friend and XYZ, the name of a fictitious site)

------
Hi Kamal,

Sandeep has invited you to be his friend on XYZ. Click here to accept the invitation or Sandeep may think you don't want to be his friend.

Thanks,
The XYZ team
------

Excuse me, what do you mean by Sandeep may think you don't want to be his friend?

This is ridiculous. Covert blackmail. If I don't go and become a member of the site, Sandeep will think I don't want to be his friend?

I am already a member of Orkut and I don't think I want to become a member of any more such sites. I'm sure Sandeep will understand that.

This kind of stuff can fool the more gullible folks out there. But no sir, not me!

Sunday, August 17, 2008

The three mistakes of my life: Chetan Bhagat

I just finished reading Chetan Bhagat's third novel. I had read the first two a few months back. And was waiting to read this one. I finally ordered it on Rediff and it was delivered about a week back.

The book is vintage Bhagat. Indian setting. Young characters. Liberal use of the f-word. Light reading.

The book is about three friends who start a cricket shop in Ahmedabad.

Govind Patel is the quintessential Gujarati businessman who would prefer to run his own business even if it meant making less money than working for someone. Ishaan is a cricket fanatic who believes in giving back something to the game by coaching youngsters passionate about it. Omi is the son of a Hindu priest and is worried that he will have to follow in his father's footsteps.

The book goes through the travails of the three guys through particularly difficult times including the earthquake and the post Godhra riots.

An important character is Ali, a child prodigy whom Ishaan calls "a national treasure" for the game of cricket. Another character is Vidya, Ishaan's sister with whom Govind has a relationship.

The book ends after a gory scene where the boys fight a bunch of political thugs belonging to a right wing Hindu party during the Gujarat riots.

However, people who liked the first two novels will like this too. Simply because it conforms to Chetan Bhagat's style.

Saturday, August 16, 2008

Clearing the air

I recently got accused of things I never did. And it hurt. I had two options - ignore the whole thing and get on with life or clear the misconceptions.

Ignoring the whole thing initially seemed like the easier option. I did not have to bother to explain. There was no risk of further misunderstanding. I had to simply forget about it and move forward.

Clearing the misconceptions seemed more difficult. Make the effort to meet with the individuals. Explain my view point. What would the reactions be? Would it help at all if the individuals were firm about their perspective?

I thought about it for a while. I also took the advice of some trusted friends. And decided to clear my name.

So, I went over and discussed the situation. I explained my point of view. I explained why what I was being accused of was ridiculous. Why it made no sense for me to do such a thing. I explained that my integrity was of prime importance to me.

They saw my point and agreed. And were sorry that I had to go through this.

In the end, I felt so relieved that this was sorted out. And all it took was two half hour conversations.

I have found that this really helps. Not talking about things often leads to some untruths being construed as true. Instead, bringing them out in the open can help solve a lot of issues.

Thursday, August 14, 2008

Kabhi alvida na kehna

(This is an email I wrote to my team yesterday, when they moved over to another company as part of an acquisition. I was scheduled to move too but some last minute changes prevented that from happening.)


My dear VCA team,

It feels odd writing to you like this. I am more used to writing to this group to announce a working Saturday or to give a stern message about Junit tests!

Anyway, I hope you are all settling down in your new surroundings. Life in Cyber Towers must be quite different from that in Parklane! No garbage bin outside office, clean lifts, pretty girls and more.

As for me, I am already missing you all badly. I walked into office on Monday morning not quite ready for an empty third floor. It took some time to realize what had happened. Well, the reality is slowly sinking in.

I guess I need to accept that life is all about change. For better or for worse.

Some of you might feel a sense of betrayal on my part because I have been saying I will be moving with you all. Believe me when I say that the change in plans was almost a last minute change due to circumstances beyond my control.

I am sure you will all rock and make sure the VCA project is taken to completion. You now have some great support too.

Few things -

Ramana, are SWATONE-4983, 4985 done? For some reason, these 2 kept getting postponed!

Thrinath, how is the orders page coming along? I'm sure you'll do such a good job that the VCA staff will keep creating orders even without customers just to be able to use the orders screen!

Tarun, please be careful about the check ins!

Kiran, great work with sync.

Sriram, continue to rock with generic search!

Veerababu, make sure Ramana runs the correct version of the security scripts!

LN, you were doing most of the management even when I was there. Thanks so much for making my life easier!

Ankur, your joining the project really made a huge difference. Thanks!

Vijay, it was great working with you. Too bad it lasted only so long.

I would like to thank all of you for the great time I have had since I joined the project in January this year. If I have hurt anyone, please forgive me, it was not intentional.

In parting I would like to say:

Chalte chalte mere ye geet yaad rakhna
Kabhi alvida na kehna, kabhi alvida na kehna.

Thanks
Kamal

Wednesday, August 13, 2008

How a routine helps

I have realized the importance of a routine in the past few months.

I have to be careful about the amount of fluids I consume during the day. Since I am on daily nocturnal home hemodialysis, I don't need to worry as much as someone on the more common thrice a week in center dialysis but due to my mental frailties, I find that I do need to worry a little!

On weekdays, when I am at work, I find that I have a set routine. This routine helps me have less water during the day. I have pretty much fixed times when I have water or other fluids. For example, after I get to office around 9 in the morning, I finish off checking my email etc. and then have about 200 ml of Darjeeling tea.

Around 11 in the morning, I have a snack, usually made of oatmeal followed by about 200 ml of water. Then I have some water after lunch. And so on.

So, this way, the amount of water I have is fixed. More or less.

However, during the weekends, there is no routine and I tend to go overboard sometimes because of this.

Another good way of controlling the amount of fluids is to drink out of one bottle. So, I always know how much I am drinking. If I finish the bottle, then I fill the same bottle again and drink out of that. I find this also helps.

Controlling fluid intake is the toughest part for people on dialysis. Following some simple rules helps make life much easier.

Tuesday, August 12, 2008

Jaisa sang vaisa rang

This Hindi maxim is so true. It means that we are strongly influenced by the company we keep. We tend to do and think the way people around us do and think.

Of course, this may not be true for all. Some strong people might not actually get influenced by people around them. But many of us are not that strong and are easily swayed by people around us.

For example, if I am with people who have a couple of drinks socially, I am tempted to do so too. And I feel a little bad that my medical condition does not allow me to. If, on the other hand, I spend a few hours in a religious discourse or discussing religious things with a 'sadhu', the next few hours, even after the discussion has ended, will be spent on spiritual introspection.

Many times I feel that I am straying from the 'right path' because of insufficient time spent on 'good things'. I was very different during my 'healthy' days. I was deeply religious. I was also fairly involved in religion during my PD days.

Undoubtedly, hemo has taken a mental toll. For some reason, my mind is not as spiritual as before. Why has this happened?

Do I need to spend more time with spiritual people? I really like the time I spend with them. Its only the initiation that is the problem. Taking the first step towards them. Finding time for this.

Without spirituality, my mind becomes shallow. Empty. Without any sense of purpose. I really must change.

Sunday, August 10, 2008

In search of the perfect Dal Baati Churma

Dal Baati Churma is quintessential Rajasthan. A delicious, rich, flavorful dish, a whole meal in itself.

It is basically composed of three things, as the name indicates - dal, baati and churma.

The Dal is actually a mix of 5 pulses - tur dal, chana dal, green moong dal, yellow moong dal and masoor dal. Some people also add a little tomato puree. Spices and ghee add the necessary flavor.

Baati is essentially a wheat dumpling. Made out of whole wheat and cooked in a tandoor oven. The more indulgent cooks fry the baatis in ghee. But the purists believe a baati can only be made in a wood fire oven! Fry it or bake it, there's no escaping the ghee in which you soak it. Before eating, the baatis are usually soaked in a bowl of ghee!

Churma is a mixture of fried wheat and a sweetener (jaggery or sugar) garnished with almonds. Jaggery adds its own flavor while sugar does its job in a rather unobtrusive way.

'Gatte ki subzi' is a good concomitant. It is basically fried gram flour ('besan') dumplings in a gravy. Some people also add a salad of cabbage, tomato and cucumber. While some also have 'Panchvati sabzi' which is a mixture of green tomatoes, capsicum, ridge gourd, peas and cucumber, cooked and flavored. Green pudina chutney also adds to the taste.

So, you see, how rich and complete the dish can be.
This is a dish that many people acquire a taste to. Many people do not like it the first time they have it. But have them eat it 2-3 times and then they are hooked for life!

I recall a funny incident revolving around the dal baati. This dish is not very commonly eaten outside Rajasthan. So, many people do not know about it. As it happened, my cousin brother was getting married to a girl from Mandvi, Gujarat. A group of about 50 people were coming to Hyderabad for the wedding.

Dal Baati Churma was the on the menu for the first meal they were to have in Hyderabad after a grueling 36 hour journey to Hyderabad. The tables were laid. The guests took their seats in anticipation of a sumptuous meal.

The waiters started serving the baatis, the dal, the churma and the other accompaniments. None of the guests knew about this dish. So, assuming the baati to be a kachori, started eating the baati plain and were a little surprised at the bland taste! Some others were waiting for puris or rotis to be served. The embarrassed hosts had to explain to them that there were no puris or rotis and the dal baati had to be eaten just like that!

I haven't been to Rajasthan more than a couple of times and both times have been before I discovered dal baati. I'm sure the best dal baati churma is available somewhere in that state.
Among places that I have been to, 'Dhola ri Dhaani' in Hyderabad makes really good Dal Baati Churma on Sundays.

Saturday, August 9, 2008

Six years of normalcy - Peritoneal Dialysis - Epilogue

That was the end of PD for me. Six years of near normalcy. Too bad it had to end. I had to now go back to hemo. I went and met Dr. Girish Narayen who asked me not to worry. He recommended that I do daily home hemodialysis.

The six years I spent on PD were by far the best during my entire time with kidney disease. And I am also including the last 2 years or so of daily nocturnal home hemo.

The whole process of hemodialysis is so violent. Blood is drawn out of the body and passed through a machine. PD, in contrast is much less risky as a process. There are concomitant risks of infection which can sometimes be fatal. But if all the procedures are strictly followed and you steer clear of tsunamis, PD can be really good!

I do not have as much freedom even now as I did when I was on PD.

I am a travel freak. With PD, I could travel unfettered. No worrying about getting back home in time for my hemo session. I could carry my bags with me or have them delivered to a close by place. And then I could stay there for as long as I like.

Now, I can go to a place for more than a couple of days only when there is a dialysis center there. Even if there is a center there, they will not do nocturnal. I can only get 4 hour sessions. And they will not do at night.

In the circumstances, nocturnal hemo is great. But PD was better for travel.

There was however one problem with PD. I could not swim! The risk of infection was too high.

So, there. Everything has a good side and a bad side.

But if you asked me what I would have preferred, I would say PD.

Friday, August 8, 2008

Six years of normalcy - Peritoneal Dialysis Part 5

At that point it was decided to remove the PD catheter, give the whole area some rest, let the infections be totally cured and then put in a new catheter. I would need to go back for some time on Hemodialysis after all. Dr. Girish Narayen's experience had helped.

So, back to the operating table. The PD catheter was removed. And I was back after more than six years on what I hated the most in life - hemodialysis. Back to the needle jabs, back to the diet and fluid restrictions. But I took solace in the fact that this was a temporary phase and I would be back on PD soon.

We waited for a couple of months and then planned the re-insertion of the new PD catheter. Another surgery. Except that at the end of the surgery, the pain was unbearable. Usually, they give you a lot of pain killers and once the effect wears of, there is pain but fairly well controlled by oral pain killers. But this time, for some reason, on the way back home from hospital, the pain was so bad, I was actually crying with pain. Once we reached home, I took some strong pain killers and the pain reduced.

So, I was now back on PD. I started manual exchanges gradually. For some reason however, the efficiency of the dialysis had reduced. The amount of water that was being removed was much less than required. While this was being investigated I had to do a few sessions of hemodialysis so that I was properly dialyzed. So, I was doing both hemodialysis and PD for a while.

This was a complex problem. We did not know how to handle it. Why was the efficacy of the dialysis reduced? It was most probably due to the adhesions that had formed in the peritoneal cavity due to the large number of surgeries I had.

I had often come across the name of Dr. Georgi Abraham on the internet in the context of PD. I decided to go to Chennai to consult with him on this. We met Dr. Georgi Abraham in Chennai's Triple M hospital. Dr. Abraham seemed like a very concerned, affable person. He analyzed all the evidence and then suggested that we try Extraneal solution instead of Dianeal solution. Extraneal solution was another type of PD solution and he thought we might be able to get a better clearance with this solution.

Extraneal was not yet being used in India. But I managed to get a few bags through Harish Natarajan of Baxter. I tried Extraneal solution but this did not make any difference to the clearance. I was still unable to get enough dialysis.

We decided to go back and discuss this with Dr. Georgi Abraham.

"Mr. Kamal Shah". "Yes". "Please go in". It was my turn to see Dr. Georgi Abraham. This was a crucial meeting. We were going to ask him if we could remove the catheter and wait for a few more months. Would the adhesions clear out and would I be able to go back on PD again. This was more like a judge pronouncing his verdict. And I was really anxious. How would this meeting end? Will there be hope for the future? Or will it be back to hemo? I could take a few more sessions of hemo if there was the promise of returning to PD later. All this was running through my mind as I entered Dr. Georgi's room.

"Good evening doctor."

I settled down and explained to the good doctor how the extraneal had not worked. He listened intently. I then asked him the question.

"Can we remove this catheter and wait for a few months, maybe even a year, and then can we expect the adhesions to clear out and is there a hope that I can go back to PD?"

"No. This will not happen. The adhesions will not clear out. You will need to go back to Hemodialysis."

There it was. The verdict was out. Plain and simple. Like a dull thud.

There was not much I could say.

Epilogue

Thursday, August 7, 2008

Six years of normalcy - Peritoneal Dialysis Part 4

In December 2004, a few friends and I planned a trip to Mahabalipuram in South India at a beach resort. We reached on Christmas night. The next morning, the tsunami struck (you can find a more elaborate account of this here).

My catheter and exit site were completely in the filthy water that the tsunami brought with it. I took strong antibiotics immediately and for the next few days. There was no immediate problem.

A few months after this incident, one morning, while cleaning my exit site, I noticed some puss around it. My exit site was infected.

I quickly called the Baxter Clinical Coordinator, Venkatramana. He came over and examined the exit site. I went over to Dr. Girish Narayen and he put me on antibiotics and I was asked to do the exit site dressing twice daily. We also sent the puss to the lab for a culture.

I had no fistula at this point. Dr. Girish Narayen suggested that I get a fistula made in case we needed to do hemodialysis at some point. I thought that would be an overkill. I mean, why would I ever need to go back to hemodialysis? This was a small infection and we could take care of it. But I went with Dr. Narayen's advice.

Dr. P. C. Gupta, an amazing person first and then an excellent vascular surgeon was to do the fistula. I was wheeled into the Operation Theatre (OT) for a surgery that was expected to take about an hour at most. I was awake during the surgery. Dr. Gupta and his assistant surgeon were working on the fistula on my upper left arm. I was following their conversation and after about an hour, the conversation sounded like they were about to wind up. However, the conversation suddenly became a little worried and they sounded a little perplexed.

I was wondering what the hell was going on. After a few minutes Dr. Gupta said, "Mr. Shah, there is a small problem. The vein seems to be blocked and we're not getting a good flow. We will need to connect this to another vein and this may take some more time." There was nothing more I could say apart from "Ok doctor."

What was supposed to take one hour finally took about three and half hours. My family outside the OT were by now panicking. What was going on? When the surgery was finally completed, they were told about what had to be done. So, I finally got a new fistula which, at that point, seemed totally unnecessary to me. I could not have been more wrong.

The exit site puss culture identified the bacteria as the dreaded pseudomonas aeruginosa.

I had attended a medical conference on Peritoneal Dialysis about a year back sponsored by Baxter. Usually such conferences are attended by doctors and technicians. But I knew one of the senior executives in Baxter, Harish Natarajan. He offered to allow me to attend to learn more about what's new in the PD world. I had attended a session on infections and I remember the speaker mentioning that infections due to the pseudomonas family of bacteria are hard to eliminate completely.

The exit site infection was however controlled within a few days. But unfortunately, that was not the last I had heard from the deadly pseudomonas.

A few weeks later I developed a tunnel infection. The tunnel is the path the PD catheter takes from outside below your skin finally to the peritoneum. An area of my skin above the tunnel had become red and swollen. Sure signs of an infection. I took oral antibiotics again and it looked like the infection was cleared.

The doctors however decided to reposition the catheter because of the recurrent nature of the pseudomonas bacteria. So, I underwent a surgery where the catheter was repositioned. The peritoneal end of the catheter was in the peritoneum itself. Only the outer end of the catheter was repositioned to take another path.

To no avail.

The tunnel infection recurred. The pseudomonas devils had still not given up.

Part 5

Wednesday, August 6, 2008

Six years of normalcy - Peritoneal Dialysis Part 3

Within a few months I had become quite comfortable with PD. The best part was there were no diet and fluid restrictions. I did put on some weight and flab because of all the glucose that was being absorbed by my body from the dialysis solution. I couldn't care less however.

I soon decided to take up atleast a part time job. I was feeling wasted and needed to get some activity for my brain! I took up a part time job with a family friend's software company. I would go to their office in the morning and return in time for my lunch time exchange. After lunch I would work from home.

I strongly believe that I could not have worked had I continued hemo. Well, everyone is different and what is true for me may not be true for others. But for me, I can easily say - PD worked like a charm.

That year I did the unthinkable. I went for a vacation to Kodaikanal, a hill station. This would absolutely not have been possible on hemo because the nearest dialysis center was a 4 hour drive away. One other thing that made vacations on PD possible was Baxter's excellent PD network in India. You could go to pretty much any place and there would be a supplier of dialysis fluid close enough.

I soon took up a full time job. Obul, a friend of my uncle's and I along with a few others started a software company called Effigent. I would do two exchanges at work in a separate room and would work the whole day there.

Things couldn't have been better. My work was good. I had no diet and fluid restrictions. No needles being jabbed into my arms every other day. The only problem was the two exchanges during the day. The morning and the night too were not a problem. It was only the middle two.

I discussed this with Dr. Shastry who suggested that I could consider a cycler. The way a cycler works is that you hook up to a machine at night and the exchanges are performed automatically with shorter dwells (a dwell is the period between exchanges when the fluid is cleansing your blood). That way, you do not have to do anything during the day.

The only problem is that the machine is not portable so you need to do manual exchanges during the day when you go out of town or are away from home.

We did a test called the Peritoneal Equilibrium Test. This test basically determines the rate of transfer of solutes across the peritoneal membrane. The test would indicate whether I was a 'low transporter' or a 'high transporter'. High transporters were more suited to PD using a cycler because the dwell periods were shorter on a cycler and you could get more out in a shorter period of time. Low transporters, on the other hand, are more suited to manual exchanges because the dwell periods are longer and you need the extra time so that more can be pulled off. My test returned a result of 'low average' which did not rule out a cycler but meant I may not get very good dialysis. We nevertheless went ahead with Automated PD at night using a cycler.

During this period, I changed from Dr. Shastry to Dr. K S Nayak, who was known to be a PD specialist. More than that, Dr. Nayak visited a hospital much closer to my house than the one Dr. Shastry operated from.

We did another vacation, this time in Mahabaleshwar, another hill station the next year. I did manual exchanges during this trip.

I was now leading an almost normal life apart from the exchanges at night on the cycler and morning post shower dressing of the exit site. Of course, if I lifted my shirt, to expose my stomach, you would see this cloth pouch tied around my stomach holding a plastic tube. The sight can be quite unnerving to the uninitiated!

A few months later, I switched from Dr. Nayak back to my original doctor Dr. Girish Narayen due to a difference of opinion on the brand of cycler to use.

I had finished about five years of PD by April 2004. I was featured in the 'PD Heroes' section of Baxter's quarterly newsletter.

Part 4

Tuesday, August 5, 2008

Six years of normalcy - Peritoneal Dialysis Part 2

"How much more time is Dr. Georgi going to take?"

"We don't know, sir. He said he is on his way."

It was back to the waiting area. It was the beginning of summer in Chennai and the waiting area had one humble fan. It was a little hot.

PD had given my life back to me. To think I expected Dr. Shastry to refuse to let me try it!

Dr. Shastry came to my bedside that day, many summers back and did the usual examinations. I asked him if I could try PD. "Sure", he said. The next session, the other doctor, Dr. Dakshinamurthy came to me and said that he had arranged for the representative to come and meet me and plan to start PD. I was getting excited. This was exactly what I had hoped for.

The Baxter rep, Venkatramana came a few days later and explained the whole process. I was also continuing my reading on the internet.

Basically, there would be a small surgery where they would insert the PD catheter somewhere in my stomach and then they would train me for a few days in hospital and then once I got the hang of it, I would be able to go home and do it on my own. Now the surgery usually leaves a slightly biggish scar on the stomach. But these days there was an increasing use of laproscopy to do the PD catheter insertion which caused only a small scar. An experienced surgeon from Australia was going to be visiting the hospital in a few days for a transplant of a small girl. They had arranged for him to do my PD catheter surgery too.

Surgery day came and went without too much of a fuss and the catheter was in place.

A day after the surgery, I had a lot of sharp stinging pain in my lower abdomen. They said it was the tip of the catheter touching nerve ends in my peritoneal cavity. The pain would go once fluid was infused. But that could not be done till the surgery wound healed.

A few days passed. It was time for the first infusion of fluid. All this while I continued hemodialysis. I had fluid and diet restrictions. I was eagerly waiting for PD to start so that I did not have to bother about restrictions. They started with 1 liter of fluid. I could feel a slightly cool liquid filling within me. It was a rather strange sensation.

After a couple of hours, they removed the fluid. It was colored yellow, pretty much like normal urine. Which was not unexpected at all since this was sort of replicating kidney function! Fresh fluid was infused.

Over the next few days, the volume of fluid was gradually increased. Eventually I was doing 2 liters every exchange. Initially there was a little discomfort in my stomach with the fluid in it. I would actually be relieved when the fluid was removed. But I did not mind it at all. I soon threw caution to the winds where it came to my fluid and diet restrictions! And I wasn't feeling bad at all.

I eventually went back home from hospital and the routine was kind of set. Four exchanges every day - the first when I woke up every morning, the second before or after lunch, the third around 5 in the evening and the last before sleeping.

I had to be very careful about infections. Now, PD involves a catheter that is coming out of the stomach and the chances of infection are very high. So, I had to wash my hands thoroughly before an exchange. Every morning, after a shower, I had to clean the 'exit site' or the point where the catheter came out of my stomach with some povidone-iodine solution and then cover it with gauze and tape it securely.

"Doctor has come". There was suddenly a flurry of activity near the reception of Dr. Georgi Abraham's consulting room. The doctor had arrived. This was the second time I was going to be meeting him. There was still some time however. Five people were to see him before I would be shown in.

Part 3

Monday, August 4, 2008

Six years of normalcy - Peritoneal Dialysis Part 1

March 2006, Chennai, India

"We're here to meet Dr. Georgi Abraham."

"Doctor has not yet come, sir. Please wait. You're the sixth in the list."

"Sixth!", I thought to myself. After he comes, it would be a good one hour atleast. My dad and I settled down in the waiting area on one of the upper floors of the Madras Medical Mission Hospital at Mogapair in Chennai. The hospital was called 'Triple M Hospital" and was one of the centers Dr. Georgi Abraham visited.

As we waited for Dr. Georgi to arrive and pass his verdict on my condition, I reminisced about the last few years of my life. How different they had been from the two years before that. The last six years passed by like lightning. It was an almost normal life.

I could almost see it happening in front of me. March 1999. Kamineni Hospital, Hyderabad's dialysis unit. It had been a few weeks since my graft nephrectomy (removal of the transplanted kidney) because of HUS recurrence. My transplant had failed and the kidney was causing a few problems. So, it had to be removed. I was by then, back on thrice a week dialysis.

I had heard about Peritoneal Dialysis (PD) and also read about it on the internet. This was a modality of dialysis where a catheter is inserted into the peritoneal cavity of the body. The peritoneal cavity has a semi permeable membrane and is surrounded by blood. So, dextrose solution is filled into the cavity by means of the catheter. Movement of impurities and excess fluids in the blood happens through the semi permeable membrane into the peritoneal cavity.

After a few hours of residing in the peritoneal cavity, the now saturated dextrose solution is removed through the catheter and fresh fluid is infused for a fresh cycle of cleansing to happen. The process of removal of the old fluid and infusion of fresh fluid is called an 'exchange'.

It sounded quite promising. Diet and fluid restrictions were minimal. It could be done at home. Many people were able to lead quite a normal life with it.

PD was very rare at that time. About 5% of the patients who needed dialysis did PD. But I had decided that I wanted to try it. I badly wanted to regain my life.

One day, I decided to ask the nephrologist treating me, Dr. Shastry about it. For some reason I was sure he would say no and that would be the end of it. So, I lay in bed, the needles in my left arm, going about the routine of pulling out the impure blood, passing it through the dialysis machine and then returning it into my body, unmindful of the anxiety in my mind.

Part 2

Friday, August 1, 2008

The mysterious Mac mute problem

For a while, I had noticed that suddenly, the system sounds of my Mac would not play. For example, whenever I am chatting with someone on iChat, for every message that is typed by me or the other person, the Mac usually plays a short sound.

At one point, these and other sounds would totally shut off. A restart of the laptop would resolve the problem.

Recently, I figured out that this happened as soon as I muted the sound on my Mac and then put it back on. After this, the system sounds would totally shut off.

So, now I do not mute the sound totally. I just reduce the volume in case I need to do that.

The system sounds are really important because they alert me for different events. For example, if I'm chatting with someone and I start work on an email or a document and the other person types a message I would not know unless the sound plays because the chat window is obscured by the email or document window. The other person would think I am ignoring him!