Sunday, September 30, 2012

What a birthday!

On 28th of September, I celebrated birthday number xx. God, that number makes me feel sick! So, I masked it. Anyway, in what has now become a routine, the NephroPlus folks barged into my room at midnight as I was undergoing dialysis. They brought cake and played the guitar and sang for me!

I went to three of our centers in the city one by one and they had the cake cutting ceremony at all three centers!I was planning to go only to the headquarters but the other centers would have none of it. One of them threatened that they wouldn't leave the center until I came! At the other center, they were upset that I was spending only a little time with them! They almost locked me up in the cabin to prevent me from going anywhere else!

I went out for lunch with my fellow-directors at NephroPlus to Indijoe's. Dinner was with the family at  my favorite restaurant, Little Italy.

All in all I had an unbelievably great birthday! Honestly, when people shower so much love on me, it is quite humbling. I feel really touched. Mohsin, one of our technicians once remarked, "Khuda ne aapki kidney le li, lekin uske saath itne chahne wale diye!" (God took away your kidneys but gave you so many people who love you!) This makes me wonder. If I did not have kidney disease, would I have got so much love? Well, I really don't know. But truth be told, I would prefer healthy kidneys over all the love! hehehehe....

Here are some pictures from the day:

NephroPlus team at my house at midnight when I was on dialysis

NephroPlus Founding Team at midnight

Banjara Hills Center pics:





NephroPlus Directors

ESI Sanathnagar Center pics:



With Mohsin, Lead Tech at ESI center

Family Dinner at Little Italy:


With nephew Naman


Sister-in-law Anjali made my favorite Mishti Doi garnished with a lotus flower!


On the left: My grandmother, Dr. (Mrs.) G. Fernes, my mother, my father. On the right: my niece Nidhi (making the face), Naman and Anjali



Thursday, September 27, 2012

I miss writing software!

The last serious work I did in software was a project for the Jain Dialysis Trust where their coupon distribution system was automated. I remember I had deployed the software and reached their office a little late on the day it was about to be used. I wasn't very worried because it was tested thoroughly by Ankur, my former colleague from Effigent (and a brilliant tester). As I entered their office, I noticed patient beneficiaries carrying papers that seemed familiar. A closer look revealed that those papers were coupons generated using my software! I was so thrilled. It felt really great! I almost had tears in my eyes!

For months, the trust did everything manually. Writing out coupons by hand, painstakingly collating data into registers, tallying cash against the coupons. Now everything was automated. The coupon distribution system that would involve 10-12 different people could now be handled by 2-3 people in the same amount of time! This whole project was coded by me! I never felt so ecstatic! Software gives you this kind of high.

I gave up my career in software to a full time job at NephroPlus in October last year. I have not done any coding for about a year now. I miss it!

There are things I did not like about software - the deadlines, the hurry to get something out there even if it was not perfect, the tension that comes with a production app having problems and so on. But the high you get when you see something that you have produced being used by users and actually making a difference like it did in the Jain Dialysis Trust project is unparalleled.

Even in my career in software, the period that I worked for Grene was most satisfying. My work at Effigent was mostly managerial. Managing teams of people writing software. Managing software teams never gave me the high I got from coding! My work at Grene was pure coding. I was the only developer on iOS and WebObjects. I was the only guy working on what I was producing. I thoroughly enjoyed that work. Of course, most software jobs would not be like that (unless of course, you are Jayadeep!). You generally work in a team in which you write a small part of the whole product. In Grene and the Trust projects that I did, my code was basically the whole code! So, I guess the satisfaction was that much more!

Wednesday, September 26, 2012

Politically, these are depressing times

For the first time in ages, we saw the government do things right. The measures they have taken to revive the economy, the way they did not bow down to Mamta Bannerjee's dictats, the Prime Minister's speech are all things that should have been done much earlier. But then, by now we are used to the Congress doing things that are "too little, too late".

However, the series of scams with no parallel in the country's history, a trademark of Congress regimes, has left little doubt on how they are going to do in the next elections barring a dramatic change in the way this government functions.

Unfortunately, what is the alternative?

The NDA looks like it is in a terrible mess. Nitish Kumar has already given enough indication that his allegiance is up for grabs. Narendra Modi is at once the BJP's biggest asset and its biggest problem. Project him as PM and they will lose out on Nitish and many others as well. Without Modi as PM, there is no one who has the charisma and capability to win a general election. And then there is L K Advani who is still threatening to run for PM.

This leaves us with the horrible prospect of a third, fourth or what-have-you front cobbling up a majority which has no single big party calling the shots and will be about as stable as the joke of a government we had run by the likes of Deve Gowda and others during the period between the Narasimha Rao and the Vajpayee governments.

Unless the Congress shows extraordinary courage and takes some bold decisions which bring the country back on track and acts really tough on the corruption issues dogging the country today and brings to book the culprits (which looks extremely difficult given the people alleged to be involved) or the BJP gets its act together and decides on one leader and projects him or her starting immediately so that the nation respects their leader like it did Atal Bihari Vajpayee, the next general election is going to end in an unmitigated disaster.


Tuesday, September 25, 2012

The trouble with doing things every other day

I take 30 mg cinacalcet every other day. It is a very useful drug to bring the level of Parathyroid hormone (PTH), a very important hormone in the body whose chief function is to control the level of Calcium in the blood. I need to test the level of PTH in my blood regularly to figure out whether I need to modify any medication doses.

The trouble is I take cinacalcet every other day. So, it seems like the level of PTH might be going up and down depending on whether I have taken the drug or not. I am not sure of this. It just seems that way. There should be a few hours in the day after taking the drug when the level of the drug in the blood should be higher than otherwise. Which means the level of PTH should be lower during these few hours than otherwise. How do I figure out when I should be drawing my blood sample to ensure that I get a correct reading of my PTH level?

Similarly, I have recently started dialyzing with a high flux dialyzer every other day. I use a low flux dialyzer otherwise. High flux dialyzers give much better clearances and are also good at removing the so-called middle molecules which are known to cause severe problems in long term dialysis patients. Now, I draw my blood samples for regular tests every month. Should I draw the sample on the day I have dialyzed with the high flux or the low flux?!

Samples drawn after the high flux dialysis are bound to contain less toxins than those drawn after low flux dialysis!

I really have no clue about the answers to these questions.

If, on the other hand, I was taking cinacalcet every day or was dialyzing with the same dialyzer every day, there was no problem because every day is like any other day. Drawing blood on any day would give you the same result.

Any suggestions?

Monday, September 24, 2012

Writing for myself versus writing for people

I once mentioned to Srinivas that I write whatever I write on this blog for myself. Because I enjoy writing. I don't care whether people read or like what I write. I write purely for myself.

Yesterday, when I published the survey, he appeared surprised because the survey was a way to gauge people's reactions to my short stories. He asked me why I was interested in knowing whether people liked my short stories when I wrote simply because I enjoyed writing and I wrote for myself.

This set me thinking. What he pointed out was true. Why did I want to know what people thought of my short stories? Wasn't it enough that I enjoyed writing them?

Creative pursuits are often meaningful only when appreciated.

Though a painter might enjoy painting stuff, he will probably feel completely satisfied only when people who view the painting appreciate his work. A musician might enjoy composing a piece but he will derive much more satisfaction if his composition is heard and applauded by an audience. Similarly, though it is true that I thoroughly enjoy writing, I feel really good when someone leaves a comment on one of the posts or when I see the hit count on this blog increasing.

If I was truly writing only for myself, then I would not publish it on a public blog, right? So, I guess, I do not write only for myself. I write for people to read. I hope people appreciate what I write. I hope what I write interests them and intrigues them enough to keep coming back.

Sunday, September 23, 2012

How Facebook saved my life

Life? Well, no, not exactly. But read on...

A few days back, right in the middle of Paryushan, I felt feverish in the evening after the pratikraman. When I checked, it was 100.4 degrees. I took a Dolo 650 mg and got on to dialysis. The next morning, though the temperature was normal, I felt weak and had aches all over. I decided to take the day off.

I sat at home and slept and watched episodes of "The Big Bang Theory" that Rohit, my colleague at NephroPlus gave me. I felt a little better by the evening. I got on to Facebook and posted the following: 

"Spent the day at home. Had fever last evening and was weak-ish this morning. Spent the day seeing four episodes of The Big Bang Theory and sleeping! Feeling much better now."

Guess what? This post got 6 likes, 10 comments and I got call from a friend! I was so thrilled! One of the comments was from Adil Asim, a friend from school who I have not met or spoken to for the last what - twenty one years??! This is what Facebook can do!

It feels really nice. Some people criticize the interactions we have on Facebook calling it artificial and what not. I couldn't agree with that. Facebook gives me moments like these where it feels nice to know that people whom I barely interact with in real life have written a "Get well soon" message for me. 

Its not like I do not have problems with Facebook. Their privacy features suck. I also get bugged by people who suddenly log on to their accounts after days and post like a gazillion pictures that have gyaan inscribed on them probably posted by someone else on their timeline or that they have received in their email as a pathetic forward. Gyaan once in a while is ok. Not when it is in a flood all of a sudden that clogs your timeline with crap. Good thing is you can block all this and some poor unsuspecting souls have received that treatment from me over the last few days. Serves you right!

Saturday, September 22, 2012

Short story survey

I just concluded my second short story yesterday. I wanted to know if you liked the short stories or you would rather I stick to simple non-story based posts. Please take this short survey which will help me decide. Thanks!

Friday, September 21, 2012

No stranger bond - 12

(This is the last part of a short story No stranger bond. You can find the full story here.)

The next morning when Sharada awoke, she found the nurse smiling excitedly. She pointed to the urine bag. It was half full! Sharada had started passing urine! The nurse said that she had passed about 450 ml of urine since last night. Sharada couldn't believe her eyes! She burst out crying. The nurse patted her head and said that she had won the battle!

There was jubilation all round. Dr. Bhalla rushed to the KTU as soon as he came to the hospital. He immediately called Bala and Masih and told them the good news. Everyone rushed to the hospital.

Shuja was also informed and he thanked the almighty for setting things right. He felt very relieved that things were falling in place, finally!

The kidney function picked up very well. Within a week she was totally normal. Both Shuja and Sharada were moved to special rooms where they could be with their family. They would have to eat healthy food. They were encouraged to drink a lot of water, a departure from the severe fluid restriction they were put on before the transplant.

Shuja was discharged from the hospital with instructions to come back to see Dr. Bhalla every other day to begin with. Sharada was kept for one more week and closely monitored to look for any abnormal signs. Thankfully, there were none. She was also discharged and asked to come back every other day.

Epilogue

It was the second anniversary of the transplant. Shuja, Masih, his wife Miriam and their kid Junaid had come over to celebrate the occasion at the Subramanyam's residence. Bala and Madhu also had a kid by then called Prathima.

Sharada was wearing the sari Shuja had gifted her before their transplants. She had made the payasam, the sweet that broke the ice and made this swap transplant possible.

Miriam had also made some Vegetable Biryani. Of course, this biryani had regular vegetables and the leaching was not required! Sharada also made some idlis with coconut chutney though idlis were traditionally a breakfast dish. She wanted to commemorate the fact that she could now happily eat something she had missed for so long.

Sharada told the two families present about the dream she had the day before her kidney started functioning. "Believe it or not, I know my husband had something to do with this."

No one was quite sure on how to react to this. They moved on to something else. They started recounting the fights Sharada and Shuja used to have in the dialysis unit. There was no rancor, of course. Laughter filled the house as Shuja and Sharada sparred, in a mock-serious tone as to whose fault the fights really were!

Thursday, September 20, 2012

No stranger bond - 11

(This is the eleventh part of a short story No stranger bond. You can find the full story here.)

Dr. Vinay Bhalla was worried. It was about 48 hours after the surgery. Sharada Subramanyam had passed no urine. Masih's kidney in her refused to kickstart. Many times, transplanted kidneys afflicted with Acute Tubular Necrosis (ATN) take weeks or months to recover. Dr. Bhalla did not want that to happen because in that case Sharada would have to go in for dialysis until the kidney recovered. He hated to have to tell a transplant recipient and his or her family that they would need dialysis.

Bala and Masih were soon told about Sharada's condition. There was panic all around. After all these obstacles, finally the transplant had happened. And if both Shuja and Sharada's transplants did not succeed, it would be a great tragedy. Yes, Shuja would go on to lead a normal life but it would be with a constant feeling of bitterness.

Sharada wondered why the urine bag next to her was empty. She asked the nurse attending to her. The nurse said she should ask Dr. Bhalla when he came. Sharada felt her heart turn leaden. She could easily sense that something was wrong. Yet, she kept hoping that Dr. Bhalla would have an explanation. The Gayatri chants became more rapid and impassioned.

Dr. Bhalla came to the KTU the next morning. As soon as entered, Sharada asked him, "Why is the urine bag empty?"

"Hello Mrs. Subramanyam, don't worry about it. It is a very temporary thing. It is called Acute Tubular Necrosis or ATN and you should be totally fine in a few days. Really, don't worry. Many kidney transplant recipients get this problem but I assure you, it is only a temporary thing."

Sharada felt a little relieved but she was still unsure.

Shuja was also told about Sharada's condition. He felt scared and then felt tears running down his cheeks. This was not fair. This was supposed to be a swap. How can my new kidney work and her's not work? He started praying hard as well.

Bala and Masih were discharged from the hospital the next day.

Madhu came back that evening to check on Sharada. She had already talked to her thrice since morning on phone and reassured her that everything would be ok. Sharada had started to show signs of being disturbed by the non-functioning kidney. She started asking questions like, "What if the ATN does not go away?" and "What if I have to go back on dialysis?"

Those were questions that Madhu had no answer to.

Madhu found Sharada in a grim mood. Through the glass window she could sense that Sharada was quite depressed. They used the phone to communicate. Madhu updated her about Shuja, Bala and Masih and said that everyone was praying hard for a speedy recovery. Sharada told her that she was getting tired. "How much more do I have to bear Madhu?"

Tears ran down her cheeks. Madhu told her she would have to be strong and this would be the final obstacle.

Madhu went over to meet Dr. Bhalla. She wanted to discuss what the plan was. Dr. Bhalla said they were planning to do a biopsy the next day. This would help ascertain the cause of the non-functioning kidney. Madhu was worried at the mention of a biopsy. She was wondering how Sharada would react. "What about the fluid and toxins that are accumulating inside her?" she asked.

That was the big question they would have to answer.

Getting a few dialysis sessions after a transplant is medically not really that big a deal. There would always be acute conditions which would settle. However, the mental impact is huge. You basically got a transplant to get away from dialysis. Now, after all the drama associated with a transplant, if you still need to get dialysis, even if for the stated "few days", you feel really bad.

This was what both Dr. Bhalla and Madhu were worried about.

"We'll see", said Dr. Bhalla.

Sharada watched TV for a bit and then fell asleep.

Sharada had a disturbed night. She had a weird dream. She saw her husband come to the KTU and gently caress her stomach where the new kidney was placed. He told her that everything would be ok. She got up and hugged her husband tight and said, "You left me to deal with all this. This is not fair." Her husband patted her head and said, "Trust me, everything will be ok."

Wednesday, September 19, 2012

No stranger bond - 10

(This is the tenth part of a short story No stranger bond. You can find the full story here.)

The next morning, all the four were wheeled into the Operation Theater (OT) area. This was a huge area that had large pre-operative and post-operative areas, some rooms for the doctors, the actual Operation Theaters and some changing rooms. They did not see each other that morning. Each of them was changed into an OT gown and made to lie on a bed. The nurse came and did some final checks of Blood Pressure and Pulse. The anesthetists also did a final check of different parameters on the case sheet - a file that had their entire history.

Each of them was then given a line through which they could infuse any medication that might be necessary. The final moment then arrived. They were transferred to a stretcher and moved into the actual OT - where they would actually be performing the surgeries. Four different teams of doctors had gathered, one in each room. There would be at least one urologist and one anesthetist in each team and a host of others. There would also be a cardiologist on standby in case they needed support.

Sharada saw the lights of the area above her as she was being moved to one of the main OTs. She saw many faces looking at her. Finally when they reached the surgery room, the OT staff asked her to get on to the operating table. She was continuously chanting the Gayatri Mantra.

Meanwhile, Shuja was having a similar experience. He was taken to another OT. The OT staff asked him to move to the operating table. He was continuously praying as well.

The OT staff then put a mask on Sharada's nose and mouth and asked her to take deep breaths. In the other OT, the staff there also put a similar mask on Shuja's mouth and asked him to take deep breaths.

Shuja opened his eyes. Everything was blurred around him. He looked around him. It was quite calm. He was wondering where all the OT staff were. There was one nurse sitting quietly in a corner. Seeing him open his eyes, she came to him and asked him how he was feeling? "I am feeling all right", replied Shuja. His throat pained. He felt very thirsty. His throat felt totally parched. "Can I have some water?"

The nurse took some water in a teaspoon and put it in his mouth. "You can have just a little now."

"Where am I? I was in the OT, right?"

"Yes, you were. Your surgery is over. You are now in the Kidney Transplant Unit where you will recover from your surgery."

Shuja couldn't believe it. It was almost as if he had just closed his eyes and started taking deep breaths a few moments ago! In reality it was more than twenty four hours!

Shuja asked the nurse how the surgery went. The nurse pointed to the bag tied to his bed. It was half filled with something that looked like urine. Shuja's new kidney was producing urine like nobody's business! Shuja couldn't help smiling on seeing that despite all the soreness he felt in his stomach.

In the meantime, Sharada also woke from her surgery. She also ran through the same confusion as Shuja about the time. However, sadly, Sharada had no urine bag to see. Her new kidney had not started to work. She had no clue however. She was coming to terms with the loss of a day. She asked the nurse how the surgery went. The nurse said, "Everything is fine."

Dr. Bhalla and the surgeons came to see her after a while. They asked her how she was feeling. She said she was feeling quite sore. Dr. Bhalla smiled and said, "You will be just fine Mrs. Subramanyam."

Bala and Masih had also recovered from the anesthesia by then and were in their respective rooms. Dr. Bhalla sent for Madhu. As Madhu entered Dr. Bhalla's room, he looked quite tense. The Chief Surgeon who had actually placed Masih's kidney in Sharada's stomach was also there.

Dr. Bhalla broke the news to Madhu. "Shuja sa'ab is doing fine. His new kidney is functioning really well. However, Mrs. Subramanyam's kidney has not yet started functioning. Now, please don't be alarmed. We suspect this to be a condition we call Acute Tubular Necrosis. Many transplant recipients get this condition and most of them recover completely. She is stable however and we will be watching her very closely."

Madhu was stunned. She did not know how to react. She did not know what to make of this. Dr. Bhalla advised her not to tell Bala until he had recovered fully from the anesthesia and was confirmed to be completely stable.

Madhu made her way back to the room. She tried hard to behave normally. Bala, still groggy from the anesthesia did not notice. Madhu went to the Kidney Transplant Unit where they kept transplant recipients after the surgery. Through a fixed glass window, she could see her mother-in-law. Sharada was asleep, oblivious of the non-functioning kidney.

Tuesday, September 18, 2012

No stranger bond - 9

(This is the ninth part of a short story No stranger bond. You can find the full story here.)

"Please take some more", said Shuja as he passed the biryani to Sharada, "all the vegetables are leached!" The Subramanyams had come to Shuja Mohammad's house for dinner. "Oh, we dialysis patients! Imagine having leached vegetables in a biryani", burst out Sharada. They all had a hearty laugh.

"Luckily we both have our dialysis tomorrow, otherwise all the water this biryani is going to cause us to drink will surely kill us!"

"Totally agree Sharadaji", said Shuja, "but soon all this is going to be a thing of the past!"

"Oh, how badly I want a transplant, Shuja bhai. I want to be able to eat coconut chutney with my idlis again!"

"And I want to be able to be able to eat - forget it", Shuja stopped midway realizing any mention of meat would not be appropriate in front of this "pure vegetarian" lady. "I would love to be able to have a full glass of sherbet on Eid. Oh how I miss the fragrance of sherbet!"

Their children let the parents do the talking. How relieved they all were! It was a mystery how it all came about. They were not bothered though. As long as it would all turn out fine in the end.

Dr. Bhalla was ecstatic! The first swap transplants were both doing very well. It had been more than a month and it was very gratifying to see them so happy. And then he got to know that Shuja and Sharada had also agreed to the swap. He was thrilled that the new software they had procured would help another set of patients get rid of dialysis. It was the perfect marriage of technology and medicine!

The date of the transplant was fixed. There was about a month left. In the meantime, the four people involved would need to undergo a last set of tests.

A week later, the Subramanyams invited Shuja and his son over for dinner. Shuja gifted a nice sari to Sharada. Sharada decided she would wear it on the first monthly anniversary of their transplant surgery. Sharada had prepared a sumptuous South Indian spread - all low salt and low Potassium!

As the date of the transplant neared, the two families were on tenterhooks. After all this effort, they were hoping everything would go well. Dr. Bhalla put together a team of the best available surgeons and anesthetists. He got most of the people who had done the first swap transplant.

About a week before the surgery, to Shuja's and Sharada's surprise, Govind Patel and Shomik Bhattacharya, the two men who had the first swap transplant came to visit them at the dialysis unit. They stood between the two beds and Govind Patel said to them, "It is amazing to be able to do this. For both of us, it has been nothing short of a miracle. We had really given up hope. But when we were told by Dr. Bhalla about the possibility of a swap, we were so excited. It was like a new life!"

Shomik Bhattacharya added, "We had heard about your fights! We never thought you would be able to reconcile. It is really great the way both of you made up."

Shuja immediately gave the credit to Sharada, "It was all thanks to the payasam!"

Sharada smiled.

The day finally came. Shuja, Sharada, Masih and Bala got admitted into the hospital. Shuja's relatives had come to Delhi for the transplant to look after them for a few weeks after the transplant. The surgery was scheduled to happen the next morning. That evening, they all gathered in Shuja's room for a final meeting before the surgery. The duty nurse allowed this exception. They were all totally tense. What would tomorrow bring for them? The transplant surgery for one patient was complicated enough. Here they were doing two simultaneously. They left things completely to God and wished each other luck.

They went back to their respective rooms eagerly awaiting the new light that was about to enter their lives.

Monday, September 17, 2012

No stranger bond - 8

(This is the eighth part of a short story No stranger bond. You can find the full story here.)

"I don't even want to talk about it!" said Sharada as Bala and Madhu sat down that evening after dinner to talk about the conversation Dr. Bhalla had with them that afternoon. Sharada had been unusually quiet the whole day. She did not come out of room after her nap. Madhu went and called her late in the evening. She was lying on her bed thinking.

Bala said, "Amma, don't take any hasty decision. Think about it. Think about your life without dialysis. No diet and fluid restrictions. No needles. You can lead a normal life."

"I don't want a normal life, Bala. Not if it has to come by begging before an arrogant old man!"

"Amma, you're being unreasonable! Nobody is going to beg before anyone! It is a simple swap!"

"I don't want to have anything to do with that fellow, do you hear? Also, have you thought for a moment? I am a Brahmin who hasn't touched non-vegetarian food throughout my life. How can I take a kidney from someone whose staple food is the flesh of animals! This discussion is over."

"Amma, wait! You're being silly, now!"

Sharada stomped out of the room.

Masih was not having an easy time either. "No way!" was Shuja's response when Masih broached the topic.

"I would rather die than accept a kidney from that woman's family! You know what kind of a woman she is. Her son would also be like her. We should not get into any kind of arrangement with them. It will only lead to a lot of problems."

Masih protested, "Abbu, we don't have to have any arrangement with them. Our arrangement will be with the hospital. You treat it like you are getting a kidney from me. What difference does it make to you? They will be taking a kidney from me and they will be putting a kidney into you!"

Shuja said, "Masih, the kidney that is taken from you would not be going into me, right? That is the whole problem!"

In the next few days, many times, both the kids would bring this up with their parents. Neither of them relented.

A few weeks later, Dr. Bhalla, on his usual rounds of the dialysis unit came to the beds of Shuja and Sharada. He was visibly excited. "You know I mentioned that there were two such matches that we found? The other match was between Govind Patel and Shomik Bhattacharya, both our patients. They agreed to the swap between Patel's daughter and Bhattacharya's wife! Their transplant is happening tomorrow!"

Both Shuja and Sharada did not show any emotions. But inside, both of them felt a sense of regret. Why did my match have to happen with his son? Why did my blood have to match her son?

After about a week, they got to know that the swap between the Patel and Bhattacharya families had gone perfectly well and all the four people involved were doing fine.

Another week went by. This week saw Shuja and Sharada doing a lot of thinking.

One morning, as both were about half way through their dialysis, Sharada called out to the technician. He whispered soemthing in his ear.

The technician burst out into a huge smile. "Sure, madam!" he said and reached out for her bag. He pulled out a packet that had a bowl. Sharada signalled with her head towards Shuja.

The technician took the bowl and offered it to Shuja. "Payasam, from Sharada ma'am for you sir!"

Shuja looked at Sharada. She smiled and nodded. Shuja asked for his bed to be raised. The technician helped him with the packet and bowl. Shuja took one spoon of the payasam. It was the sweetest thing he had ever had and the sweetness for not only due to the sugar.

Sunday, September 16, 2012

No stranger bond - 7

(This is the seventh part of a short story No stranger bond. You can find the full story here.)

"Hello Shuja sa'ab. Hello Mrs. Subramanyam. How are you? Hello Madhu. Hello Masih. How are you?" Dr. Bhalla smiled.

Shuja and Sharada were quiet. Masih and Madhu managed a smile.

All four of them were really nervous.

Dr. Bhalla began, "I wanted to share something with you."

"Yeah, get the hell out of here, you two!" Shuja expected Dr. Bhalla to say.

Dr. Bhalla continued, "I am sure by now all of you know that a kidney transplant offers the best quality of life in patients with kidney failure. Whatever you do, dialysis simply cannot match the benefits of a transplant. Medically and even personally as well. Even in terms of longevity, transplants offer the opportunity to live much longer lives compared to dialysis."

"Now, if you remember we had taken samples of your blood when you joined us and we took samples of your relatives' blood as well. We do that as a protocol at this hospital. We immediately check on the possibility of a live related donor transplant and then plan accordingly. However, I am sorry to say that  your relatives are a poor match for both of you."

"We have already placed your names on the cadaver transplant list16. However, the waiting list for a cadaver transplant is fairly large and the number of cases we get suitable to be cadaveric donors too low to offer a realistic chance for you to get a kidney using this route."

"Now, there has been an interesting development recently. There is a software that has been developed in the US where they match different blood samples to look for possible matches. So, what this means is you feed in the data of blood samples of a large number of people who could be potential donors and potential recipients and the software tries to match these samples."

"What this does is - it opens up a large number of possibilities. For example, let's say, a person who needs a kidney has a relative whose blood does not match the patient for a transplant. But it matches some other patient's sample. And if that patient's relative's blood does not match that patient but matches the first patient's, then you have the possibility of doing a swap transplant. That is both the relatives donate their kidney to the other patient. That way both the patients get a kidney and there is no money exchanged and no favor felt either."

"You understand this, up to now?"

Shuja had no clue about what the doctor was saying. The rest understood.

"So now, coming to the interesting part." Dr. Bhalla continued. "Our hospital has been one of the fortunate few in the country to be able to get this software. It did cost us quite a packet but we thought a lot of people could benefit and we finally got it a couple of months back."

"We have painstakingly entered all our patients' data into the software. A few days back, this exercise was completed and guess what? We found two swap possibilities among our patients and their families. One of those possibilities is if Masih, you donate your kidney to Mrs. Subramanyam and Madhu, if Bala donates his kidney to Shuja sa'ab!"

There was a stunned silence in the room. No one could believe what they had just heard.

"Think about it, all of you. There is no hurry."

"Sure, Dr. Bhalla", Madhu responded. They all got up and left the room. They got into their respective cars and left the hospital.

There was complete silence on the way home. No one uttered a word.

Who would have thought that this match would ever happen? Why would this happen? Would the bickering couple make peace in order to live a normal life? Ah, the delicious ironies of life!

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16 - Many times, especially after an accident or other shock to the body, a person can become 'brain dead'. This means that the brain is irreversibly dead and the heart and other organs are kept alive by artificial means (a ventilator). Once this artificial support is removed, the heart and other organs would also stop working. So, if the organs are removed before withdrawing the artificial support, these organs can be used to potential recipients like dialysis patients who could get a new lease of life. This kind of transplant is called a cadaveric transplant and many hospitals that have a cadaveric transplant program have a waiting list where people are registered and whenever an organ becomes available through this means, the person at the top of the waiting list gets the organ.

Saturday, September 15, 2012

No stranger bond - 6

(This is the sixth part of a short story No stranger bond. You can find the full story here.)

On the day of their next session, once both sessions had started, the technician came and told both Shuja and Sharada somberly, one by one that Dr. Vinay Bhalla had asked both of them to come and meet him along with their family members immediately after the dialysis session. The technician had no clue about what the doctor wanted to talk to them about.

It was pretty obvious to both however. It had to be about the fights they were having. Sharada grew worried. What if Dr. Bhalla asked her to leave the unit and go elsewhere for dialysis? She couldn't go anywhere else. This unit was so close to her house and it was convenient for Bala and Madhu to pick and drop her as well. What could she do now? The damage has already been done. All because of that old man! Why did he have to come to this unit at all?

Shuja was more calm about it. He believed he had done no wrong. If Dr. Bhalla asked him about it, he would tell him confidently about each incident. He would even ask the staff of the unit to corroborate. I am not going to let an old hag spoil my life. I will protest. I have done no wrong. I am quite clear about this.

Sharada called Madhu and told her about the meeting. Shuja also let Masih know that he would need to spend some more time after the session.

After the session as the four of them waited outside the unit for Dr. Bhalla to become free, Masih and Madhu started talking.

"Why don't we resolve this right here?", Masih suggested to Madhu. "That way we can tell Dr. Bhalla that we have settled the dispute and promise him that nothing needs to be done."

Madhu agreed. "Yes, definitely. We are all comfortable here. Why spoil things?"

Masih counseled both his father and Sharada. "See Abbu, see Aunty, maybe both of you have some differences. However, you are both mature adults. You must realize that going to another unit is going to be very difficult for both of you. And it is also going to be very difficult for your families. You are now used to this unit, the staff, Dr. Bhalla. Do you really want to go to another unit?"

There was no response. Both looked away.

Madhu explained to Sharada, "Amma, forget about the problems we would have. Think about your convenience. You are so happy here. We don't know what kinds of technicians we will find in other units. I have heard such horrible stores about people getting infected with strange diseases and all."

Masih said to Shuja, "Abbu, you have had enough problems, right? Do you want to suffer more? You are grown up now! You cannot fight like kids!"

Shuja responded, "Ok, so what do you want me to do? Beg for forgiveness for no fault of mine?"

Sharada was shocked. "No fault of yours? What do you mean by that? Along with your kidneys, you have lost your brains also, old man!"

Shuja couldn't imagine what he had just heard. He shouted back, "Lost my brains? And you have lost your character. At least I have that intact!"

Sharada screamed, "What? What did you just say? You called me characterless?"

Madhu yelled out, "Stop it! You will fall sick! You should not get so excited!"

Sharada said, "You heard what he just called me? You heard? Never in my life have I been treated like this. Oh God! What have I done to deserve this? Why did you not take me away also with my husband?"

Masih pleaded with his father to keep quiet. Shuja could not let his anger go so soon however. He said angrily. "God has no place for a woman like you! The Devil would however willingly take you!"

Sharada gave up. She started crying inconsolably.

Masih begged his father to keep quiet.

All the patients and their attenders in the room watched the fight intently wondering how it was going to end. Masih and Madhu felt totally helpless.

Just then, Dr. Bhalla rang the bell and his secretary came out of his room and said, "Mr. Shuja Mohammad, Mrs. Sharada Subramanyam?"

Shuja and Masih went in first. Sharada wiped her tears and Madhu helped her into the room.

All four of them were tense. What would Dr. Bhalla tell them? Surely it wouldn't be anything good.

Friday, September 14, 2012

No stranger bond - 5

(This is the fifth part of a short story No stranger bond. You can find the full story here.)

One morning as Sharada entered the dialysis unit, she saw Shuja getting dialyzed on her usual bed. She saw a new patient on Shuja's bed. She seethed with rage. She called out to the technician in-charge and asked why Shuja was on her bed. The technician tried to calm her down and explained that they had an emergency that morning which they happened to take on Shuja's usual bed. Shuja had come earlier than her and asked to be dialyzed in the closest available bed to his usual - Sharada's usual bed.

Sharada was furious. How dare he take my bed? The technician requested her to get dialysis in another bed. Sharada angrily walked to the other bed. She was upset for the whole session. Shuja realized what had happened. He did not care though. It was not his fault.

As she was leaving after her session finished, Sharada went over to the lead technician and told him sternly, "Don't give my bed to anyone else, understand?"

"Yes ma'am", the technician replied.

The next session both were on their regular beds. The dialysis unit had a television set for every patient. The only problem was they did not have headsets. They however had an unwritten rule that the volume should be at a level so that you can hear but at the same time not disturb the other patients. Sharada switched to a Tamil channel that was showing some devotional songs and increased the volume  so that it would disturb Shuja. Shuja was watching the news. He realized what the old lady was trying to do. He ignored it for a while. Sharada increased the volume even more.

Shuja called out to the technician and complained. The tech requested Sharada to reduce the volume. Sharada refused. "There is no rule about TV volume!"

The tech looked at Shuja helplessly. Shuja decided to take things into his own hands. He increased the volume of his television set as well. Sharada increased the volume of her set even more. Shuja did the same. The technician was wondering what to do. The noise in the usually peaceful dialysis unit was becoming unbearable. The other patients were all getting disturbed as well. The cacophony had by then woken up all patients.

Just then, thankfully, Dr. Bhalla entered the unit. Both Shuja and Sharada instantly muted their TV sets! The technician burst out laughing. Dr. Bhalla asked him why he was laughing. The technician shook his head and said, "Nothing, sir!"

Most dialysis units take in patients in order of their arrival. First come first served kind of a thing. Shuja generally got there before Sharada. The techs would prepare Shuja's machine before starting to prepare Sharada's machine keeping this in mind.

One morning, Sharada planned to get there earlier than usual. Shuja's machine was already ready. Her's was being readied. She checked her weight and went and sat on her bed. In the meantime, Shuja walked in. Since his machine was already ready, the tech went over to Shuja's bed to begin his dialysis. Sharada asked him why he was doing this? She pointed out that she had come before him.

"Yes, ma'am, but his machine is already ready."

"Why did you make his machine ready when I came first?"

"Ma'am, usually he comes first, that's why!"

"I don't care. I came first. My dialysis should start before his."

Shuja stepped in. "My machine is ready. What difference does it make if my session starts first?"

"It is not a question of what difference does it make. I came first. So my session starts first."

Shuja did not think it worthwhile to argue further. He told the tech to start her session first.

Sharada got even angrier. "Who are you to tell the technician what to do? I don't need your kindness! You start his session first!"

The technician started Shuja's session first marveling at how life makes old people behave so much like kids.

Thursday, September 13, 2012

No stranger bond - 4

(This is the fourth part of a short story No stranger bond. You can find the full story here.)

"Wheelchair!", shouted Masih at the entrance of the Gangabai Memorial Hospital. Three months had quickly passed since Shuja Mohammad was wheeled into the casualty. Shuja's fistula had matured11 by then and he was now on regular thrice weekly dialysis sessions. Masih would drive him down and then wait until the four hour session would be completed and then drive him back. Masih somehow managed to convince his boss that he would make up for the lost time by working late.

Shuja had overcome the initial frustration associated with being diagnosed with kidney disease. He was slowly settling into the dialysis routine and diet and fluid restrictions. He had also come to terms with the fact that he would be dialysis dependent for his entire life. He would spend a lot of time reading the  Holy Quran and in prayer.

Sharada Subramanyam came in the same shift and days as Shuja. They would always be in neighboring  dialysis machines. Patients often get used to certain beds and machines in units12. This happens for no particular reason. The machines are almost always the same. The beds are also the same. However, patients still feel comfortable dialyzing in their usual beds.

Call it a strange co-incidence or call it a quirk of fate. Shuja Mohammad and Sharada Subramanyam both of whose lives were going to get so entangled in the coming weeks happened to have their 'usual' machines next to each other.

For the first few times this happened, neither noticed the other. They would come for the session, get their dialysis and go back home. Both would have complications from time to time13. Nothing major though. They were generally compliant. A little cramp here. A bit of hypotension there. Nothing that couldn't be managed comfortably.

Then one morning, Shuja had a terrible bout of cramps. About three hours into the session, he yelled out, "Sister, cramps!" The staff on duty found that shout quite scary. It was not like Shuja. Three of them instinctively ran towards him. The lead technician immediately stopped the ultrafiltration and started infusing saline. Shuja was crying out in pain. Masih rushed in hearing his father's voice. The techs requested him to wait outside. One nurse started massaging his feet and calves, areas where the cramps can be felt most severely. About 100 ml of saline14 was administered. The cramps did not subside. Shuja was in terrible discomfort. Another 100 ml of saline was pushed in. No relief.

The techs made Shuja sit up. It often helped to cause blood to travel to the lower limbs. Another 100 ml of saline was also infused. Shuja was held up by three technicians. After another five minutes of excruciating pain, the cramp finally subsided. All the patients were looking at Shuja with eyes filled with empathy. Many people face cramps now and then on dialysis. What they had seen that day was an extreme bout.

Once Shuja had settled back in his bed, Sharada asked him, "Abhi accha hai?" Shuja looked towards the female voice he had heard and responded, "Haan." Sharada continued in Hindi laced with an unmistakable South Indian accent, "I had similar cramps once about 5-6 months back. They just wouldn't go. They pushed in almost half a liter of saline. Only after that did it become any better. I would have rather drunk half a liter of water. Imagine receiving that much fluid through the veins! What a waste!"

"Hmmm", Shuja nodded.

Sharada asked him, "Have you noticed any change in your appetite recently?"

"Yes, I feel quite hungry these days."

"That's it! Your dry weight15 has probably gone up! So what these technicians are seeing as fluid weight which they are trying to remove is actually your dry weight going up. Ask them to remove less fluid from next time."

Shuja had no clue about what the old lady was saying. Dry weight, fluid weight, what was all this?

He remained silent.

Shuja was getting a little irritated. Why did this old lady have to talk so much? As it is I have had these horrible cramps. I could really do with some peace.

Sharada continued about how she dealt with the problems she faced during life with dialysis. Shuja stopped reacting. Sensing this, Sharada stopped after a while. She was wondering why this old man was so rude.

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11 - AV Fistulas take time (four to six weeks typically) to mature before they can be used. This is to make the veins large enough to effectively pump out the blood and pump it back in to give effective dialysis.

12 - Dialysis units have a series of dialysis machines arranged in a line with a bed or a dialysis chair next to each machine for the patient to sit or lie during his or her session. In countries such as the US, most units have chairs - recliners rather, while in India, most units have beds.

13 - Dialysis is generally quite a violent process. Blood is pumped out and passed through an artificial kidney. A lot of biochemical changes happen during this process. Toxins and water are removed at a very rapid rate, much higher than the rate at which they are removed from the blood naturally by kidneys. This causes many side effects, some more perceptible than others. the most common complications are cramps in the legs and hypotension or low blood pressure (both caused due to rapid removal of water from the body).

14 - Saline or Normal Saline is a solution of common salt in water used to treat cramps and hypotension rapidly.

15 - Dry weight is the weight of a dialysis patient assuming all the excess fluid in the body has been removed. The amount of water to be removed during dialysis is calculated by subtracting the current weight of the patient from his or her dry weight. For example, if a male patient has had 2 liters of water and other fluids between two dialysis sessions, his weight would be 2 kgs more than his dry weight. Typically, the technicians would target to remove about 2 liters of water during the dialysis sessions. Dry weight changes are not immediately recognizable. So, if a patient's dry weight has gone up, it is typically construed as fluid weight and is targeted for removal during dialysis. This causes the actual water in the blood and muscles in the body to be removed causing cramps!

Wednesday, September 12, 2012

No stranger bond - 3

(This is the third part of a short story No stranger bond. You can find the full story here.)

Shuja saw himself crossing a street. There was suddenly a lot of vehicles honking away from all sides. The drivers were yelling at him. He was confused. He did not know where to go. He started taking hurried steps towards one side. Suddenly he saw a huge lorry coming really fast towards him. He was trying to run but his legs were not moving. The lorry was not stopping. He was about to be hit by the lorry. He raised his hand and shouted, "Nahin!"

Shuja awoke from his dream in a start. He was sweating profusely. Masih, who was sleeping in the attendant's couch in the room of the Gangabai Memorial Hospital, also was woken by the shout. "What happened, Abbu?"

"Nothing, just a bad dream."

"Ok, would you like to have some water?"

"Yes."

Masih went over and poured out a small quantity of water for his father. He remembered what the doctor had told him that evening when he went to meet him. "Only one liter of water a day."9

He got his father to lie down again and try and get some more sleep. He checked his watch. It was about 4:30.

Masih was quite worried. Dr. Bhalla had told him about his father's condition. Shuja Mohammad had chronic kidney disease. He probably had symptoms for some time now but he had ignored them. That morning, as he was sipping his tea reading the morning newspaper in his apartment in New Delhi, he collapsed. His son and daughter-in-law rushed him in their car to Gangabai Memorial Hospital where he was taken to the casualty immediately. A few hours and tests later, he was found to have a Serum Creatinine of 10.2! He needed dialysis immediately. He was taken to the dialysis unit where a femoral catheter was inserted and dialysis was started.

That evening Masih met Dr. Bhalla. Dr. Bhalla explained that his father would need dialysis for some time. Dr. Bhalla also told him they would also need to create an arteriovenous fistula for the dialysis. This would be a small surgery which they would plan after a few days of dialysis. Masih did not like the sound of all this. It looked like some major problem.

Sharada Subramanyam woke up as usual at around 6. She quickly had her bath and went over to the kitchen. She had decided to make idlis that morning. Cooking came easily to this Tamil lady. She had learnt the ropes from her mother. She loved to cook and feed her husband when he was alive. Even after her husband had passed, she did not let the loss diminish her love for cooking. Her son and daughter-in-law, both complete career people were ardent fans of her cooking and loved the keenness with which she would use only the correct and the best ingredients and churn up one South Indian delicacy after the next. Madhu did the basic stuff but let her mother-in-law do things she enjoyed.

Idlis were Sharada's strength. "It is easy to make a good dosa but it is equally easy to make a bad idli!", Sharada would tell anyone who cared to hear.

That morning she gathered the boiled rice that was brought from Chennai ("the Delhi rice just doesn't cut it!") along with the urad dal and put them in the wet grinder. Many South Indian families had settled for the mixer-grinder to prepare their batters. Not Sharada. She strongly believed that the wet grinder had an equally important role to play in the making of a good idli as the quality of the rice itself.

One thing Sharada hated though was that she couldn't eat the coconut chutney that she made to go with the idlis. She had to make do with sambar and that too with such less salt that it took away half the pleasure of eating the idli. The excess potassium in the chutney could actually kill Sharada10. Despite this, Sharada would make the coconut chutney for Bala and Madhu and they relished it totally. Idli mornings were happy mornings in the Subramanyam household!

Shuja Mohammad woke up around 8:30 that morning. He found Masih reading the newspaper. The nurse came to give him a sponge bath. He declined. Masih understood. Dr. Bhalla came to see him at around 10. They asked him the plan for the day. "Complete bed rest", Dr. Bhalla said. "Tomorrow, we will give him another dialysis. We will need to do some more tests and then plan for the fistula surgery. Once the fistula surgery is done, we will send you home."

"It is all a money making tactic", complained Shuja once the doctor had left. "Let us go home right away. I am feeling totally all right. Just a little bit of weakness."

Masih replied, "Let us not be in a hurry, Abbu, now that we are already here, why be in a rush to go back? Let us do the tests and then make sure you are totally all right and then go."

Masih had done a lot of research on the internet that morning. He had realized that his father was seriously sick. Kidney disease was now a reality he would have to live with lifelong.

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(Acknowledgements: Jayadeep Thum for suggesting footnotes to explain terms that may not be obvious to those unfamiliar with dialysis. I have also updated the first two parts with footnotes.)

9 - Dialysis patients need to restrict their fluid intake because since their kidneys are not functioning, the excess fluid is not being removed from the body. Typically, most patients are advised to restrict their fluid intake to about a liter per day.

10 - Potassium is one of the toxins that the kidneys remove. Though potassium is essential for muscles like the heart to function, too much potassium can cause the heart to beat too fast and when the quantity of potassium becomes too high in the blood (typically when the kidneys are not functioning), the patient can also die. Coconuts are sources of high potassium and dialysis patients are not allowed to have even a little coconut due to this.

Tuesday, September 11, 2012

No stranger bond - 2

(This is the second part of a short story No stranger bond. You can find the full story here.)

Sharada Subramanyam finished her session and was out of the unit by around 12:30. Madhu came to pick her up in time and drove her to their house which was about ten minutes away.

In the meantime, the old man that was brought in to the unit regained consciousness. He was bewildered. Where am I? He looked around and soon realized he was in a hospital. What is that pain in my thigh? He reached for that stinging pain he felt in his upper thigh. Immediately, a nurse signalled him not to touch his thigh. It was actually a femoral catheter6 used to draw blood for dialysis.

"That is an injection. Please don't touch it. We will remove it very soon."

The old man was trying to recollect how he got there. It was all a blur. All he could remember was that he was reading the newspaper sipping some hot tea. He vaguely remembered reading about some firing. He had become very angry. He tried to strain his memory. Nothing. He fell back asleep.

Sharada had her lunch. She hated every morsel. There was barely any salt7. She said to herself, "Imagine me making such crap!" The only saving grace was the payasam she treated herself to after the meal. Luckily she was not diabetic8. Imagine being diabetic on dialysis, she often thought. After her meal, she took her morning Blood Pressure medications with a sip of water. On dialysis days, she was advised not to take her Blood Pressure medication before dialysis as that could cause the Blood pressure to fall too low in which case removing the excess fluid accumulated between treatments would be difficult.

She went to her room to take a nap. Dialysis left her drained and she needed a good two hour nap to regain some semblance of energy after her sessions.

The old man at the unit was now fully awake. He asked the nurse quite agitatedly what was happening. He wanted to know what happened to him and how he got here. He suddenly noticed a known face enter the dialysis unit. It was his son! "Abbu, how are you feeling now?" asked Masih, the old man's son in Urdu.

"What happened to me? Why am I here?"

"You are fine now Abbu. You had fainted at home this morning and we brought you here. They are doing some treatment and we will go home soon."

The nurse took the young man aside and said, "He cannot go home now. He has to get admitted. His kidneys have a prob - "

Just as she was explaining the situation to Masih, the old man started coughing. The nurse rushed to his side with a small steel stray called a kidney tray to allow him to bring out some sputum. The old man continued to cough and then suddenly threw up. Masih was worried. Kidney problem?

The old man felt horrible. It was like his insides were revolting. The nurse cleaned his mouth with a wet piece of gauze. She said this was normal and there was nothing to worry. This was his first dialysis so this was expected.

"What is his name?"

"Shuja Mohammad"

"Age?"

Masih thought for a bit and said, "About 55".

"Ok, please wait outside. We will call you when the dialysis is completed."

Masih told his father that he was waiting outside and that they would go home soon.

After a while, Dr. Vinay Bhalla came to the unit and came straight to Shuja Mohammad's bed. He looked at his file and then went over to examine the patient. He made some notes in the file and told the nurse to call the patient's family.

Masih was summoned inside. Dr. Bhalla explained to him, "Your father has a kidney problem. He might need some more dialysis. We will also need to do a few tests. You should admit him in the hospital as we need to monitor him closely and diagnose the main problem."

Masih nodded gravely. "Is there anything seriously wrong?"

Oh how I hate that question! Dr. Bhalla thought to himself. What do you answer to such a question? Is it serious enough that the guy will not survive? No! Is it as simple as a cough or a cold which would be treated with some medicines and he would be fine in a week? No! His kidneys are failing and he is likely to be dialysis dependent for the rest of his life unless of course he gets a transplant. Now I don't know whether that can be classified as 'serious'.

"No, not serious. Don't worry", Dr. Bhalla said as he walked out of the unit.

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6 - Femoral catheter is a thin catheter inserted into a vein in the upper thigh. Femoral catheters are typically used for dialysis to draw out blood from the patient and send it to a dialysis machine to clean it of toxins and excess fluid. Femoral catheters are typically used for short durations, from one day to a few days until a permanent mechanism to perform dialysis like an AV Fistula is ready.

7 - Salt is one of the toxins kidneys remove. Though salt is essential for the human body to function, excess salt can be very harmful for the body. Since the kidneys are not functioning salt can accumulate in the body and cause things like high blood pressure and excess thirst. Dialysis patients are asked to eat very little salt - sometimes as little as 4 grams per day. Most healthy people eat more than 8 grams of salt per day.

8 - Diabetes is the biggest cause of kidney failure. Many dialysis patients are diabetic. The problem is having kidney failure has one set of diet restrictions while being diabetic imposes another set of restrictions. That is why, diabetics on dialysis have it really hard as they need to follow both sets of restrictions!

Monday, September 10, 2012

No stranger bond

(This short story is entirely a work of fiction.)

"17th July, 2011. Today is going to be a special day!", Sharada Subramanyam thought to herself as she got out of her bed and started going about her daily routine. She was unusually cheerful. There was an extra bounce in the sixty-six year old's steps. There weren't many days like this though. She was on dialysis for about four and half years now.

She went to the kitchen and started straining the drinking water and filling the containers. Her daughter-in-law Madhu joined her after ten minutes or so and scolded her for getting started without her. "You really shouldn't be doing all this alone, amma! You know we allow you to do small chores around the house so that you feel as normal as possible but you shouldn't take undue risks."

"What risks, Madhu? When appa was alive, I used to do much more! You people have really spoilt me."

"There is no point telling you, I know. What time is your session1 today?"

"7:30"

"Bala will drop you off and I will pick you up as usual at around 12. I am thinking of making cabbage curry with chapathis and rice and drumstick sambar. Is that ok?"

"Perfect. You know I am ok with anything! Ask your fussy husband!"

"Yeah I know, amma", said Madhu as she smiled in appreciation.

Madhu was a huge fan of her mother-in-law. She couldn't help admiring how well she handled herself. Fate had dealt a cruel blow to her not once but twice over. Her husband, Subramanyam Ganeshan was diagnosed with chronic kidney failure at the age of 54. His doctor had managed to keep him off dialysis for five years with medication and strict diet control. However, soon after, the kidney function had deteriorated drastically and he had to be put on dialysis. Sharada Subramanyam was determined not to let the disease get the better of her husband. She nursed him and catered to every demand this disease made of them. After about four years of endless visits to the dialysis center and the concomitant side effects of kidney disease2, Subramanyam Ganeshan succumbed to a heart attack at the age of 63.

Sharada was devastated. For decades her life had revolved around her husband. She was married to him when she was 16. Life for a woman from her background meant - the husband. Everything was done keeping the husband in mind. From the time you woke up when you started thinking about what to cook for breakfast to the time you slept only after he slept - pretty much every breath you took was dictated by the husband. It was almost a devotional relationship.

When her husband died, Sharada felt an emptiness that was very difficut to fill. She couldn't figure out what to do with her life. It was as if there was no purpose left in her life. And then, life played a cruel joke on her. It gave her something to think about. It gave her something to deal with. It gave her kidney failure. A few months after her husband passed, she started feeling tired. Her son, daughter-in-law and even Sharada herself ignored it.

A few more weeks passed when her feet started swelling and she started feeling nauseous. Then one day, while working in the kitchen, Sharada collapsed! Luckily, her son and daughter-in-law were at home and they rushed her to the hospital where in the course of some blood tests, it was discovered that her Serum Creatinine3 was a mind-numbing 14.3 - more than ten times the normal!

Dr. Vinay Bhalla was immediately summoned. Bala and Madhu could never forget the expression on Dr. Bhalla's face as he looked up from the reports, examining them again and again to confirm if what he was seeing was indeed true. "This is unbelievable! Your mother needs dialysis immediately!"

A battery of tests and a biopsy4 later, it was confirmed that Sharada Subramanyam had Chronic Kidney Disease as well. It was likely that her kidney function had been declining for more than a year now and due to negligence, the deterioration had become quite rapid.

They immediately inserted a jugular catheter5 as access for dialysis and got her an arteriovenous fistula which would be used after a month or so. During all this, Sharada Subramanyam maintained a stoic calmness about her. It was deja vu for her as she went through everything her husband went through a few years back.

She knew everything about kidney disease. Who in her position wouldn't? Dr. Bhalla sympathized with her completely and tried to make things less difficult for her. But who could take away the complete toll kidney disease has on a person? Who could take away the fact that life changes forever? Changes in a way no one can ever fathom.

Sharada Subramanyam walked into the dialysis unit of New Delhi's Gangabai Memorial Hospital around 7:10 that day and wished the unit staff a good morning. The nurses noticed her in a really good mood. They felt happy for her. Within half an hour her session had started and she fell asleep.

Her morning nap was broken by some strange sounds. As she looked up, she saw about 5-6 hospital staff pull in a hospital bed with an old man into the unit. The man had all kinds of tubes attached to his body and he seemed unconscious. They placed the bed at one corner near a dialysis machine and the techs quickly got to work. They started dialysis on the man.

Sharada quickly went back to sleep. She did not realize that the man who had just entered the unit would change her life in more ways than one. Yes, as she had inexplicably guessed when she got out of her bed that morning, the day was going to be special indeed!

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1 - Dialysis Session. Dialysis Patients typically go twice or thrice a week for dialysis treatments to a dialysis center or a hospital.

2 - Kidney failure usually has many side effects. The heart is the most commonly affected. Since the kidneys are not functioning, dialysis patients are often in a state called 'hypervolemia' or excess fluid in the body. Due tot his the heart has to pump more fluid than it is designed for. This often causes heart conditions such as Left Ventricular Hypertrophy. Many dialysis patients die not of kidney disease but of heart related complications.

3 - Serum Creatinine is a blood test used commonly to measure kidney function. For people with normal kidney function, it is usually between 05 to 1.2 mg/dl.

4 - A biopsy is a special test where a tiny bit of an organ such as the kidney is taken out and studied under a microscope to see the changes that might have occurred at the tissue and cellular level. This helps to make a more accurate diagnosis of the underlying disease.

5 - Jugular Catheter - is a thin catheter inserted into a vein on either side of the neck. Jugular catheters are typically used for dialysis to draw out blood from the patient and send it to a dialysis machine to clean it of toxins and excess fluid. Jugular catheters are typically used for short durations, from a few weeks to a couple of months until a permanent access to perform dialysis like an AV Fistula is ready.

Sunday, September 9, 2012

Starting tomorrow - "No stranger bond" - my second short story

"One thing Sharada Subramanyam hated though was that she couldn't eat the coconut chutney that she made to go with the idlis. She had to make do with sambar and that too with such less salt that it took away half the pleasure of eating the idli. The excess potassium in the chutney could actually kill Sharada. Despite this, Sharada would make the coconut chutney for Bala and Madhu and they relished it totally. Idli mornings were happy mornings in the Subramanyam household!"

"Shuja Mohammad had overcome the initial frustration associated with being diagnosed with kidney disease. He was slowly settling into the dialysis routine and diet and fluid restrictions. He had also come to terms with the fact that he would be dialysis dependent for his entire life. He would spend a lot of time reading the Holy Quran and in prayer."

Sharada Subramanyam and Shuja Mohammad got dialysis at adjacent beds at Delhi's Gangabai Memorial Hospital. "No stranger bond" is the story of these two amazing individuals who find their lives unintentionally intertwined in the strangest way.

This is my second attempt at fiction. I was really happy with the response to the first story - "In you we trust".

I have added a section to the right of the blog where you can find the whole story in a single page rather than having to click on multiple links to go to the successive parts.

As always, I would appreciate your comments - good or bad!

Saturday, September 8, 2012

Wednesday, September 5, 2012

Teacher's Day memories from HPS

Today, September 5th is celebrated as Teacher's Day all over India. At The Hyderabad Public School, Begumpet where I studied, Teacher's Day was huge!

The morning would start with students doing what the teachers did at the Morning Assembly right from the prayer to the announcements. Classes would then begin albeit with a difference. The senior school students would take classes for the junior classes! The teachers would get to relax the whole day! It was after all, their day!

The afternoon would usually see an entertainment program put up for the teachers by the students. This usually included a whole lot of comedy and live music.

I had the privilege of being a part of our school beat group. Our group was hugely popular among the teachers and students alike.

One Teacher's Day, we did Pink Floyd's "Another Brick in the Wall". The song is a little irreverent to teachers but what the hell, this was HPS! Our teachers really enjoyed the song. In fact, our principal, Mr. S. K. Bose was seen snapping his fingers to the song! Here's a You Tube video of the song:


To all my teachers who shaped my thinking, helped me hone my talents and made me what I am: a BIG thank you! Here is a list of teachers I can remember from my school days:

- Mrs. Kanthi Rajan
- Mrs. Korobi Mukherjee
- Mrs. Prabhakar
- Mrs. Swadesh Sridhar
- Mrs. Deepa Chandra
- Mrs. Usha Bhargava
- Mrs. Shanti Sam
- Mr. G. Jayanand
- Mr. Govindrao Deshpandey
- Mrs. Akamma Koshy
- Mrs. Leila Parker
- Mrs. Roopali Mansukhani
- Mrs. Kamala Jagadeeshan
- Mr. M. A. Bari
- Mr. Devadattam
- Mr. Chandrashekhar
- Mr. Krishnam Raju
- Mr. Maruthi 
- Mrs. Suzy John Mathai
- Mr. Ramanachary
- Mr. Punna Rao
- Mr. Srikanth
- Mrs. Nirmala Abraham
- Mrs. Geetha Shyam Sundar
- Mr. Suresh Sharma
- Mrs. Kamala Jagannathan
- Mr. Sai Sunder Rao
- Mr. M. S. S. K. Subramanyeshwar
- Mr. P. Narayan Rao
- Mr. Sathyanarayana
- Mr. Dennis Powell

and one special teacher whom I can never thank enough - my English teacher for five years from Class 8 to Class 12 - Mrs. Marien Oommen. It would not be an exaggeration to say that any success I have achieved in my life is due to her. I got to be a part of NephroPlus only due to my blog and I give the entire credit for my blog to her. Thank you ma'am!