Saturday, January 26, 2013

Things I hate about the big, fat Indian wedding

We have one going on in our family. My dear cousin Malay is getting married. The trouble is almost everyone realizes that there are things about the wedding that are antediluvian but nobody feels like changing anything.

Take the gifts given by the two sides to each other. There are gifts not only for the bride and the groom but also a lot of 'important' people on either side. The gifts are not so much out of love as they are about 'looking good'. The most ridiculous part about gift giving is that the gifts are all displayed for everyone to see and then - hold your breath - the list is announced in front of the elders of the society! How pathetic is that? Why make a public spectacle of this?

Another thing that is evident in most traditional marriages is the absolute supremacy of the 'boy's side'. India is a hopelessly male-dominated society. Marriages make for one of the most vulgar displays of this domination. The 'girl's side' is supposed to behave in a completely servile fashion. Every wish of anyone in the 'boy's side' is supposed to be their command! Though, in some families, the extent of servitude is decreasing, the mindsets are still the same.

One of the most disgusting aspects of weddings is the tendency to show-off. 'X spent this much on a wedding, so I must spend at least twice that much!" or "Y brought the baraatis by a chartered flight. I must do so too!" This kind of competitive celebration is really sad and totally unnecessary.

Relationships have become so commercial. I often wonder how a husband and wife can live happily together and with true love for each other after the shameless and utterly disgusting negotiations that go on in the name of 'dowry'. And it is shocking that in this day and age, so many educated people still practise this horrendous tradition. It had all become so institutionalized that the woman, who has been through so much at the time of her 'dowry' negotiation would not hesitate to do the same to another woman when she has a son and it is time for him to get married!

Thankfully, in our community, the practise of 'dowry' has been entirely done away with. But it is really high time the other antiquated traditions are also abolished.

Thursday, January 24, 2013

Some basic professional behavior

However intelligent you are, however efficient you are, I believe that you must have some basic professionalism in your day to day work. Without this, a lot of people could be put off and your unprofessional behavior may overshadow your intellectual genius.

When I look around me, I find these are some of the things I expect while working with people:

- Punctuality: Basic punctuality is one of the mot important attributes of professional behavior according to me. If you have agreed to be somewhere at a particular time, you bloody well be there at that time. Most of the time at least. All of us get delayed once in a while. There're a lot of things that could cause this - traffic, oversleeping, getting delayed at an earlier meeting etc. However, there is a big difference between once-in-a-way delays and regular, consistent delays.

On those rare occasions when you do get justifiably delayed, I consider it important to let the person or people you are going to meet know with a brief apology. Not doing this, in my humble opinion, is the pinnacle of unprofessionalism.

- Responding to email: Email is something that is meant to be responded to within a reasonable amount of time. You don't have to respond immediately but you should really respond within probably 24 hours unless it is a holiday. Not responding to email could mean so many things. You don't consider the topic important enough or worse you don't consider the person important enough.

Not responding to email can leave many things hanging in the air. To make sure I respond as soon as possible to email, I follow a simple rule. I keep the email in my Inbox until it has been 'dealt with', which means I either respond to it or make an Action Item and put it on my To-do list or both. It then goes into a folder meant for emails related to the topic. That way, anything in my Inbox means I have things to take care of. If the number of emails in my Inbox goes beyond what fits in one screen without scrolling, I become very uncomfortable and restless!

- Phone calls: We all get calls when we cannot take them. What do you do in that case? Ignore them? Call back? It is ok not to take calls when you are in a meeting. It is actually very unprofessional to take calls during meetings unless it is really urgent! Texting, equally so. What about the call itself? If the call is from a person I know, I would definitely call back once I am done with the meeting. If it is an unknown number as well, most of the time I call back unless it is from a number that looks like a tele-caller's!

I find that basic professional behavior goes a long way in making work much smoother and a pleasure. Some unprofessional people can completely ruin your day and make delays in getting things done very frustrating. It is never too late to change. All it takes is intent.

Wednesday, January 23, 2013

A good strategy to manage fluid intake

For me, the biggest problem while being on dialysis was the fluid restriction. Typically, people on dialysis need to restrict their fluid intake to a liter. This includes water, tea, coffee, curd, dal, rasam, ice cream etc. Anything that is fluid at room temperature is counted as fluid. All told, the fluid intake should typically not cross a liter. For people who pass urine, this could be higher.

I find that having a plan on the fluid helps a lot. Rather than drinking at any time, having a plan on when to drink what and how much helps manage this much better. One thing which is commonly recommended is to measure out your allowed quantity of water in a bottle and drink only from that. When you drink something other than water, discard an equal amount from the bottle. Plan your day so that the bottle lasts you till you go to sleep.

Another good way is to write out your fluid plan for each day. Think about what's important for you. Let's say, it is important for you to have 3 small cups of tea - one early in the morning, one at around 11:30 and another cup in the evening, write these three things down. This could probably come to about 300 ml. Put in about 100 ml of water after every meal. The total comes to 600 ml. You still have 400 ml to play with for different things. The key is to fix up the time, the quantity and what exactly you would like to have and write this down and follow it as much as possible.

By doing this, you have no surprises. In case you feel like having a gulp of cola at dinner, you can skip one round of tea. I believe very few things are entirely out of bounds for people who get thrice weekly dialysis. You can have everything in limited quantities provided you plan it well.

If there is something you really relish which is high in potassium, ask your doctor if you can have a small quantity during the first half an hour of dialysis. If you are otherwise compliant and dialyze regularly without skipping the prescribed sessions, you can afford to take some liberties during the first half an hour of dialysis since the dialysis will remove the excess potassium during the treatment. Of course, every individual is different. So, please check with your nephrologist or dietician before doing anything out of the ordinary!

Tuesday, January 22, 2013

Indian dialyzors have problems more serious than adequacy

On the internet, when you browse forums related to dialysis, you see a lot of emphasis on trying to increase frequency and duration of dialysis. When you talk to many patients in India, you realize that the issues are very different. Considering that a majority of dialysis patients do not have access to dialysis treatments, you begin to realize the seriousness of the problem.

Very few people can afford to pay close to Rs. 20,000 for medical treatment. What generally happens is if you are lucky enough to be able to get diagnosed in the first place (yes, a large number of people don't even get diagnosed, they simply die of some 'unknown illness'), you start getting dialysis. You soon realize that this is eating away the entire family's resources. The rest of the family also sees this. The patient starts feeling guilty of this. What will happen to the rest of the family? And it is not like a few dialysis sessions would cure the patient. This punishing disease can only be managed, not cured!

The patient and the family often decide that they cannot continue this forever. They are only being practical. The dialysis treatment is stopped. In a few days to a few weeks, the patient passes.

For those that can afford the treatment, everyday problems like paying for the expensive erythropoietin injections, dealing with the co-morbidities, managing doctor visits, the inevitable hospitalizations once in a way take up so much of the patient's and the family's time and energy, that there is barely any bandwidth for other things.

When I talk to people about doing daily dialysis or nocturnal dialysis, it is as if I am talking nonsense. These things for many are things they don't even want to begin considering. It is too far fetched and impractical. Their immediate problems are more existential, much more fundamental.

It is a pity really. When I get on to dialysis sometimes, in the comfort of my home, I feel so grateful (not to God), just generally grateful that I could get access to this wonderful modality that enables me to lead a close-to-normal life, I feel simultaneously sad that more people are not able to do this. When there is something that can take away a lot of the pain and frustration that dialysis is generally associated with, it is really unfortunate that more people cannot try it.

It is not due to money alone. I know many people who can easily afford the expenses. My monthly medical expenses come to the same as someone who is on thrice weekly dialysis! And I am getting about 40+ hours compared to their 12 hours. It has more to do with the leap of faith in dialyzing at home. For those who have the gumption to do this, often, financial constraints come in the way.

Sunday, January 20, 2013

The blue pill - 14

(This is the concluding part of the short story The Blue Pill. You can find the entire story here.)

(One year later)

Dr. Roy woke up to the sounds of chirping birds. It was about 6:30. He quickly freshened up and made his way to the cottage next to his house. The patients were still sleeping. The nurses signaled that everything was all right with a thumbs up. Dr. Roy smiled.

Dr. Roy made himself some black tea and sat in the lawn of his house by the River Beas in Jagatsukh, a small town close to Manali in Himachal Pradesh, North India, sipping it slowly. What a year it had been! After their literal escape from the US with Nambiar, Dr. Roy had learnt more and more about the web of deceit that Babylon had woven around him. They never had any intention of bringing his device to market. It was all a ploy to destroy whatever chance there was of it reaching patients. The clinical trial was designed to fail as some of the Babylon staff that were a part of the team sabotaged the entire project.

When the three of them flew back to India after narrowly escaping the attempt on his life, Dr. Roy led a very low-profile life. Nambiar convinced him that any attempt at getting the device to market would be futile as Babylon and its muscle power would never allow that to happen. Legally, they would stop at nothing since they had the rights to the device. What could a small doctor do all by himself?

Nambiar and he then made a plan. They would assemble the devices themselves, one at a time. They would identify a small set of patients who could afford the cost and those who would really benefit from it - young adults diagnosed with CKD, who were dialysis dependent and were not candidates for a kidney transplant. They designed a month-long training program for these patients. The entire operation was shrouded in secrecy. They spread the word among their closest friends in nephrology circles. They got a few names. Candidates were interviewed over video conference and those found suitable would sign waivers and only then be recruited for this project. They had them travel to Jagatsukh and trained them to use the device. Everyone would do daily nocturnal dialysis using the device. 

The results were fantastic. At the end of the training program, the patients had tears in their eyes. They had got their life back. They realized that with this device they could lead lives they were meant to live. They could work, travel, have fun. For the first time since they had been diagnosed with kidney disease did they feel truly free.

Dr. Roy and Nambiar couldn’t have asked for anything better. They decided to make this an annual project. They would be in Delhi the rest of the year. During the two months of summer, they would travel to Jagatsukh and train a new set of patients on the device. 

Dr. Roy continued to make small improvements to the device.

During their summer reveries in Jagatsukh, Dr. Roy and Nambiar, over an evening round of whiskey, would often talk about how the power of money has obscured everything in the world today. “Karl Torrance is not a bad man by himself. He is just a pawn in the entire corporate world that exists today. In the name of being answerable to shareholders and having a moral obligation to them, many people often lose sight of basic human values.”

Dr. Roy concurred. “We don’t realize it but money controls everything in the world today. Very few people recognize this and break free from the shackles of money. Even you and I, Nambiar, to some extent are slaves of money. Why don’t we leave Delhi and settle down in Jagatsukh? Why can’t we treat more patients? It is because of money. The grip that it has over all of us is so dangerous. The worst part is we have no clue about this. We all have our justifications. We all think we are doing what we truly want. But in reality, we are all actually being totally controlled by money.”

Nambiar nodded helplessly. It was true. Dr. Roy had realized something that few of us understand. A small number of people are living a truly independent life - true to basic human values, true to basic ethics, true to their conscience, true to themselves. Few people live lives fully aware of the reality. The rest of us live lives which are considered 'normal'. Surprisingly, this 'normal' life is the one that is so unnatural. We get so convinced about this 'normalcy' that we truly believe that this is really 'normal'.

Dr. Roy and Nambiar thought hard about this. The only noise heard in the background was that of the clear waters of the gushing river Beas.

Saturday, January 19, 2013

The blue pill - 13

(This is the thirteenth part of the short story The Blue Pill. You can find the entire story here.)

The next morning Dr. Roy and his wife were on the way to Los Angeles with Nambiar. They did not want to go back to their homes. It would be too risky. There was no way they were going to underestimate what Babylon would do. They reached the city around noon and checked into a hotel. Nambiar and Dr. Roy discussed their options. 

Dr. Roy wondered why they could not hold a press conference and expose Babylon? Nambiar explained to him that Babylon spent large sums of money to keep the press on their side. They had a whole department that worked on this. That is why, despite many occasions where the press could have had them on the mat, they managed to wriggle out with ease. What could potentially have been damning incidents were reduced to mere raps on the knuckles. Babylon (and many other similar corporations) had the press completely under control.

There seemed to be only one option at the moment. Return to India. They racked their brains to see if there was any way they could continue staying there. It was too risky. It was them against the might of Babylon Corporation. The company wielded so much power in the USA that it was unthinkable for two individuals to put up any semblance of a fight. They controlled government, they controlled the media, there was nothing that could be done.

They agreed that they needed to get on a flight to India as soon as possible. Torrance and his team had surely already heard about the failed attempt and would now be planning their next move. Nambiar looked up the internet and checked flight timings. He found one that left close to midnight for New Delhi. He booked them on the flight. They decided to abandon their home and everything that was in it. It was too risky to go back there.

They ordered food to their rooms as well. They did not want to take any chances. Every knock on the door found them panicking. They would carefully open the door just a little, check who it was and then open it fully. Those next few hours were terribly nerve-wracking.

Thankfully nothing untoward happened. They left for the airport in a cab. Dr. Roy had tears in his eyes. He had landed in this city with a dream. He was leaving it with the dream still unfulfilled. They reached the airport and checked-in their baggage. They kept looking around to see if there was any sign of suspicious activity. Once they were inside the airport, ordinarily, they should have been safe. However, they were in such a precarious position, they couldn’t be sure of anything at all.

The flight finally took off. Dr. Roy and Nambiar finally felt safe. Now, no one could touch them!

Friday, January 18, 2013

The blue pill - 12

(This is the twelfth part of the short story The Blue Pill. You can find the entire story here.)

Nambiar got the two quickly along with their things into their car and sped away. They left Yosemite and checked into an inn on the way from Yosemite to Los Angeles. They freshened up and sat down.

Nambiar began.

“I sent that anonymous email to you, Dr. Roy. Everything I wrote there was true. I was going to send you proof as well soon but you took the email and showed it to Torrance. From then on, I knew your life was in danger. Your device is a huge threat to Babylon.”

“Why? They would make so much money!”

“Look at the size of the company, the centers they have. They would never want to jeopardize their entire business model just for the sake of patients! Do you even realize what would happen if your device hit the market and became successful. Hundreds and thousands of patients would not need to visit their centers. They would all be able to dialyze at their homes by buying the device off the market. The cost of dialysis would come down. Great for the patients but not so for companies like Babylon.”

“But Karl, he is not like that for sure. He is so committed to patient care!”

Nambiar laughed out loud.

“Do you really believe all the crap he talks? I have heard him laugh at you in meetings!”

“Ok. One second now. Nambiar, how do I know whether what you’re saying is true or not? I have no reason to believe you. Karl has been nice to me. Why should I disbelieve him and believe you? Give me one good reason I should do that.”

“I understand your problem Dr. Roy. You have no reason to believe me over Torrance but think logically. What would your device do to Babylon’s business? Do you think their centers would continue to exist?”

“Surely, their centers would not stop immediately. This kind of device would take a long time to become popular.”

“Yes, but eventually? Babylon is a service provider. Large companies like this don’t change their primary way of doing business easily. It is a huge change for them. They would never be comfortable. From providing dialysis services, they would need to change to a company that simply sells the device and trains people. What would happen to all the centers? What would happen to all the staff?”

“Surely that cannot be the reason to deny patients a better quality of life?”

“Even a smaller reason is enough. Remember, for companies like Babylon, it is not about the patient, really. They exist for the investors. Torrance is not answerable to patients. Torrance is answerable only to the investors.”

“Isn’t he answerable to his conscience?”

Another loud laugh.

“Having a conscience is quite a challenge these days, Dr. Roy!”

“One second, are you saying that Karl Torrance sent that guy to kill me? Are you out of your mind? For a while, let us assume that Babylon is not serious about getting the device out to the market. Do you really think Karl would kill me to avoid that? All he had to do was pull the plug on the project. That’s it. The device would be dead. Nambiar, you are sounding ridiculous!”

“In the past four years, Babylon has acquired two other such devices. Both were tested on individual patients with excellent results. Both failed the Phase 1 trial due to circumstances very similar to yours. Torrance decided to stop work on the first one. The scientist behind the device created a huge problem. He went to the press. Babylon made sure nothing ever got out though. But by then they had learned a lesson. They felt it was not worth taking the risk. The second guy is still missing.”

Dr. Roy felt his heart turn into lead. “Still missing? What do you mean?”

“He supposedly went for a walk one morning while on a holiday and went missing. Neither he nor his body was found. His family has still not given up hope. But its been more than two years now.”

Nambiar opened his laptop and showed him internet clips about the two cases he had just mentioned. 

Dr. Roy began to feel helpless. “What do you have in mind now?”

“Get some rest now. We will head out at 5 in the morning.”

Thursday, January 17, 2013

The blue pill - 11

(This is the eleventh part of the short story The Blue Pill. You can find the entire story here.)

Yosemite National Park was a beautiful place. Dr. Roy was fond of driving. His wife and he took the almost six hour drive and reached the Yosemite hotel Torrance had booked for them by late afternoon. They checked in, freshened up and then went for a walk.

After dinner, Dr. Roy called Torrance and thanked him for sending him to this beautiful place and apologized again for doubting him. Torrance asked him not to think about work for a week and get all the rest and rejuvenation he needed.

Dr. Roy told his wife that was he feeling very guilty about what he did. Why did he doubt Karl? Karl was the reason he would finally be able to achieve his dream of bringing the device to the world. Without Karl, he would still be struggling for day to day funding of his project. With one stroke, all his financial worries were taken care of. All he needed to do now was to focus on the work.

The week passed by quickly. The next morning, Dr. Roy and his wife were to head back to Los Angeles. 

The Roys had a relaxed dinner at the hotel’s restaurant and returned to their room early. They were packing up their stuff when they heard a knock on the door. 

“I’ll get it”, said Dr. Roy and went to open the door.

There was a stranger at the door, dressed in a T-shirt and jeans with a coat.

“Dr. Achinta Roy?” he asked, mispronouncing the first name badly.

“Yes. How can I help you?”

The stranger put his right hand inside his coat and pulled out a pistol. Dr. Roy froze. 

Just then, there was a loud shout.


Someone sprang from out and grabbed the stranger’s hand. The stranger fired as his hand was thrust upward. The shot hit the ceiling. Dr. Roy’s wife ran towards the door and screamed on hearing the shot. 


It was Kanwal Nambiar, the reticent executive who had accompanied Satish Raju on the initial meetings in Kolkata!

“ON THE FLOOR, BOTH OF YOU!” he shouted again!

Dr. Roy and his wife both crouched.

Nambiar and the stranger were struggling with each other. Nambiar had not yet let go of his hand with the pistol. The stranger was pulling with all his might. He shot again. The bullet hit the floor. Nambiar was trying desperately to move the pistol away from the inside of the room. The stranger managed to get it in line with Dr. Roy and shot. Just then Nambiar jerked his hand and the bullet narrowly missed Dr. Roy.

Dr. Roy and his wife were trying to make sense of what was happening.

Nambiar gave the stranger a punch in his eye with his left hand. The stranger cried out in pain. Nambiar squeezed his hand. At the same time he kicked him in the groin with his knee. The stranger yelled out loud and at the same time let the gun go. Nambiar grabbed the gun and aimed at the stranger. The stranger put his hands up. Nambiar looked to see if Dr. Roy and his wife were all right. The stranger jumped and reached for Nambiar’s legs in an attempt to make him fall. Nambiar shot. A bullet hit the stranger’s leg. He screamed in pain while falling on the ground. Nambiar aimed at his head. The stranger lay motionless.

Nambiar ran towards the room’s telephone and called the reception. “SOS. Emergency at room 2574. Gunman inside.”

Within seconds sirens were heard. By the time Nambiar was done with the call, the stranger had disappeared. Nambiar ran outside. The stranger was nowhere to be seen. 

“Dr. Roy, ma’am, let’s get out of here. You’re not safe yet.”

“Nambiar, can you first explain to me what is happening?” demanded Dr. Roy.

“There is no time for that really, Dr. Roy. You must trust in me. Let’s get you to a safe place. I promise I will explain everything.”

Dr. Roy was totally confused. He was completely shaken with the incident. He looked to his wife. His wife nodded. They had no option but to trust Nambiar.

Wednesday, January 16, 2013

The blue pill - 10

(This is the tenth part of the short story The Blue Pill. You can find the entire story here.)

The next morning, when Dr. Roy checked his email, he noticed an email that had the subject, “Important and Urgent”. The sender’s name had “Anonymous”. Dr. Roy was about to delete it thinking it was some spam but then his eyes fell on the word “device” and realized it wasn’t spam.

He read through the email.

“Dear Dr. Roy,
I am sorry the trial for your device did not go through. You must be wondering what went wrong despite everything being in place and tested earlier. 

Your work is really great and deserves to reach patients. Unfortunately, Karl Torrance and Babylon don’t want this. They will go to any extent to wrap this project up. Take my advice, go back to India and work on your device independently. That is the only way you will be able to make this device reach patients.

-A well wisher”

Dr. Roy was stunned. He read the email again and again. What could this mean? Who could this person be? Why would Babylon and Karl not want this device to be successful? They would potentially earn a lot of money if it succeeded.

He did not know what to do. Could this be a prank by someone he knew? Who would joke at a time like this? Maybe I should confront Karl with this email? This cannot be true. There is no reason for Babylon to not want this device. Yes, they are commercial. But this device will bring them millions. Why would they spend so much money to buy the rights of the device if they did not want to see it through? I think I should show the email to Karl. He will be able to make sense of it.

Dr. Roy printed out the email and went to work. He straightaway called Karl and asked to see him. “Something urgent has come up. I need to talk to to you.”

“In fifteen minutes?”

“Sure, I’ll be there.”

Dr. Roy took the print of the email and gave it to Karl, “I got this email this morning.”

Torrance took the paper and went through it. He went through it a couple of times before keeping it on the table and then looking at Dr. Roy. 

“What do you think?”

“I don’t know what to think.”

“Oh Dr. Roy, I am disappointed! How can you even, for a second, believe this? You know how much we have spent on this? You know how much is riding on this project for Babylon and me personally? Dr. Roy, you know me so well. Do you think I would ever....” 

“I did not believe this Karl. I just wanted to show you what I got in this email. I did not say I believed it, did I?”

“I would have expected you to delete the email immediately, Dr. Roy! Any of our competitors could be doing this. They are all following this very closely. None of them want us to succeed.”

“Oh yes! That is it! I have been so foolish! They could be doing this. I am so sorry Karl!”

“No, no, don’t be! I understand the stress you’re going through. I really don’t blame you.”

“Yes, I am stressed out Karl. I was really hoping this would go through.”

“Do one thing, Dr. Roy, take a few days off. Go somewhere. It will really do you a world of good!”

“No, I couldn’t! We need to get started on this again. We need to do a lot of work. We need to investigate on why this happened.”

“Yes of course, we will do that but after one week. One week won’t make any difference. It will actually do the project a lot of good because you will come back fully refreshed. You can do much better work once you’re back.”

“But Karl-”

“I insist, Dr. Roy. In fact, let me do this. Why don’t you drive down to Yosemite? We have an arrangement with a beautiful hotel there. I could set you up for a week there.”


“Listen to me, Dr. Roy. This will be great for you - and the device!”

“Ok. I will.”

Tuesday, January 15, 2013

The blue pill - 9

(This is the ninth part of the short story The Blue Pill. You can find the entire story here.)

The next set of tests were critical. Most people on dialysis undergo sessions thrice a week, for four hours each time. Short duration dialysis proved only that the device was as good as regular dialysis. This was what was achieved in the first set of tests. That was obviously not what this was all about. Well, by adding flexibility to the patients’ lives, you were making a difference. However, this was not as important as adding years to their lives. This was what the device was capable of achieving. That was the whole point of the device.

Dr. Roy was fairly assured of the results however. This had been tried in his lab in the past. For single patients only. However, the concept remained the same.

The next morning, the team spread out to the various centers and began preparations for the nocturnal tests. They would all stay awake during the entire night monitoring the lines and making sure nothing went wrong. Dr. Roy took an afternoon nap. He wanted to make sure he was alert to take care of anything unexpected that may arise.

All the patients were connected to the device by around 8:45 p.m. The blood samples collected before beginning were all sent off to the lab. Dr. Roy was in touch with all the centers over phone. Everything seemed to be ok.

About three hours into the sessions, Dr. Roy got a call from one of the centers. One patient’s blood started clotting in the device. They tried controlling it with some saline. However, it did not help. Within minutes, he got a call from another center. The same problem. Blood started clotting in the device. Within the next half-hour or so, every single center reported the blood clotting issue from most patients. 

The control team was dumbstruck. Dr. Roy was shocked. He couldn’t believe what was happening. They had an emergency meeting where they reviewed all the treatment parameters. They carefully reviewed the anti-coagulation protocol being followed. Everything seemed to be in place. They were using heparin which was a widely used anti-coagulant. People had been using heparin for regular nocturnal dialysis for years now. What could be wrong?

No one had any ideas. They had to take a decision soon. Time was running out. They decided to pull the plug. Instructions were passed to all centers to stop the dialysis sessions for all patients. Everyone was disappointed. Dr. Roy was devastated. He was sweating profusely. The team urged him to relax saying they would soon figure out the problem. Someone offered him a glass of cold water. What could have gone wrong? They all wondered.

The entire team returned to the Babylon lab from where the control team monitored the trial. They were all discussing what had just happened. Dr. Roy than asked all of them to come to the meeting room. He had calmed down by then. No need to panic. They had obviously missed something. Let us look at this systematically. One piece at a time. We will soon figure it out.

One by one, he collected the exact sequence of events at each center. It all seemed to follow a pattern. The first couple of hours went smoothly. After about two and half hours, one by one, the clotting started. Nothing they tried would help. There was something really wrong. They had used the standard anti-coagulant. What could have caused the clotting?

Dr. Roy called it a night and asked the entire team to go home and return the next day when the future course of action would be decided.

The next morning, Dr. Roy first met with Karl Torrance. Dr. Roy suggested they scrap the trial and start from scratch. Torrance wanted to investigate and try and fix the problem before the next scheduled session. They would have two full days and a night before starting the sessions. Dr. Roy felt they couldn’t put the patients at risk. Already many of them had lost a lot of blood because of the clotting. Torrance relented in the end.

Dr. Roy met his team at the control room. He announced that the trial was being scrapped.

Monday, January 14, 2013

The blue pill - 8

(This is the eighth part of the short story The Blue Pill. You can find the entire story here.)

Work began in full swing on the devices. The parts were ordered. Carefully the team assembled 50 devices. They formed multiple teams who would work in serial putting together the individual parts of the device. It was a painstaking process. Every part had to be tested for quality. A single mistake could jeopardize the whole project.

The teams were lead by a mix of people from Dr. Roy’s original team and some of the new people who had joined since the project moved to Babylon. Everyday the leads would meet in the morning at 8 in the Conference Room and plan the day, discuss roadblocks and figure out solutions. 

Simultaneously, the recruitment drive started. The team identified seven centers (all belonging to Babylon) where patients would be recruited to try the device. They would first use the device for 2 hours every day for 5 days, then use the device for seven hours thrice a week and then finally use the device for eight hours every night for 5 nights. Every day, blood samples would be drawn before, during and after the sessions. All the patients would be dialyzing in the centers.

There was a huge clamor for getting onto the trial. This was a testament to the dire need of such a device. Patients did not mind any risks that might come with an untested device. They wanted to try something that would give them freedom. They received a total of 463 applications for the trial.

The team shortlisted about 75 people out of which they would eventually choose 50.

In about four months, everything was in place for the trials to begin. 

A team from Babylon was sent along with devices to each center. Dr. Roy would work out of Babylon monitoring the trials closely and visiting each center in rotation.

The trials began.

Dr. Roy and his entire team were all on tenterhooks throughout the entire two hours. Dr. Roy could feel his heart pounding like crazy. All his efforts, all his hard work and all his dedication to this device were now on the line. He expected everything to go as per plan. It was after all the same device he had used on single patients in his lab and they had only got it to be better. At worst, the device should give them the same results as he had got in his previous experiments. These were good enough to get approval to proceed. At best they would be better than his earlier results which would be great!

The first day’s sessions all came to an end. Bloods were drawn and sent to the labs. No one could sleep until the results were back. It was all on expected lines! 

The next few days proceeded on predictable lines. The patients got decent clearances. Middle molecules were not removed but this was expected since they did only two hour sessions.

That weekend, the team put together all the results and ran the numbers through some statistical programs that computed the results as one comprehensive set of data rather than patient-wise figures. The numbers looked great!

The next set of tests would be longer duration ones. These were the tests that would really prove that the device would actually make a difference to people’s lives. The team was ready.

Sunday, January 13, 2013

The blue pill - 7

(This is the seventh part of the short story The Blue Pill. You can find the entire story here.)

Dr. Achinta Roy and Karl Torrance got very comfortable with each other over the next few months. They got along very well. Their relationship was professional but had a touch of warmth. Torrance would make sure Dr. Roy got most of what he wanted keeping in mind the boundaries of a corporate structure. Dr. Roy was completely convinced that he had done the right thing by joining Babylon and bringing his work into the company.

Dr. Roy was happy with the fact that Torrance held similar values as he did. They both believed that dialysis patients suffered a lot and anything that could reduce their suffering was welcome. They agreed that the device would allow patients to break free from the shackles of conventional treatment modalities.

Work on the device was progressing as expected. There were small glitches which Dr. Roy and his team would mostly overcome. They got support from Torrance whenever needed to push something through, to get funding for an experiment and make sure any delays from other departments did not impede the work. The boundaries of the company's structure would never be crossed but things were made as smooth as possible.

As Dr. Roy saw it, in about a year, they would be able to start full scale clinical trials. They needed approval from a government organization that would allow them to recruit patients for the trials. Dr. Roy asked for a team of people who hand done similar trials on Babylon's behalf before. Torrance arranged a team for this immediately. In an email, Torrance told Dr. Roy, "I am putting my most trusted man, Sam Mulcahy on this. Let's get this out there quickly!"

Dr. Roy was elated. He began preparations for the trials immediately. He and Mulcahy chalked out a detailed plan for getting this trial going. They discussed what kinds of patients would be needed, what would actually be done in the trial, what they had to prove and other such details. They referred to previous such studies and firmed up their plans.

This was the first significant step that would put the device out there. So far, it was used under careful supervision for a very small number of patients, a strictly private thing. Now, during this trial, the device would actually be tested on a much larger group. The patients would be from very different backgrounds and would have varied medical conditions. The team would also have to produce many more copies of the device. It was critical that they did this very accurately because any small defect in even one of the copies could push the whole process back by many months in addition to the frustration that would inevitably accompany repetition of the exercise.

By this time, Dr. Roy's team had also grown significantly. He had brought on board many experts from Babylon's existing team and also hired new people with different backgrounds. All this was possible only with the financial power of a company like Babylon. Without people with expertise in different fields, it would be impossible to take this project to completion. Getting this kind of a team would have truly been impossible with the resources he had been able to gather back in his little lab at Kolkata.

In about six months, they had their first plan ready. They showed it to Torrance who did not get into the nitty-gritties but understood at a high level. He was ok with it. They submitted their plan to the authorities and waited patiently for the approvals.

After about a month, they got approval for the first clinical trial!

Saturday, January 12, 2013

The blue pill - 6

(This is the sixth part of the short story The Blue Pill. You can find the entire story here.)

Dr. Roy's entire team was at work in a week. Though the primary application of the device was in nephrology, developing such a device needed the expertise of many disciplines. Among the team were a Chemist, a Fluid Mechanics Engineer, a Materials Scientist and a Mass Transport Scientist. Together, they contributed to different aspects of the device, working on the design under Dr. Roy.

Karl Torrance seemed very interested in the development of the device. He would review the plan with Dr. Roy every week on Monday morning. Dr. Roy would update him about what was done the previous week, what the plans were for this week and about any roadblocks or issues the team was having.

One thing Dr. Roy realized was the way large corporations in the US work was very different from his small, little team in Kolkata. It did not surprise him. He understood that in companies such as this, there would be a number of processes to make sure things move smoothly. However, he would get frustrated at times with the delays these processes would cause.

For conducting one particular test on the device, the team needed a small quantity of a particular chemical. It was to simulate a certain solute in the blood. Dr. Roy sent an email to the procurement department. For about a week, he did not hear anything. On sending a reminder, he got a response saying that they have just got quotes from multiple vendors and were in the process of finalizing the order. Dr. Roy was appalled. Quotes? For this quantity? He immediately dashed off an email to Torrance.

Torrance responded after a couple of hours saying that even he could not overrule processes that have worked for years now and requested him to be patient. Dr. Roy had no choice but to wait.

By and large, however, development on the device was going smoothly except for such minor delays that were mainly due to the nature of the environment. Dr. Roy told his team that in a company like this, there would be such issues and they would have to learn to live with it. The team understood. They had been a part of the struggle that Dr. Roy had undergone. The resource crunch, the lack of funds, the frustrating wait for grants, they had been a part of all this.

They remembered the day Dr. Roy had called them all to his room. He was looking so sad. It was like he had lost everything. He had called them to announce that the team was being disbanded as he had no funds to continue development on the device. They were all so shocked. They had breathed this device for the past so many months. And now it was all going to end. Everyone continued to come to the lab however. About a week after the meeting, Dr. Roy managed to get a grant of Rs. 1 crore from a foundation in Chennai that provided subsidized dialysis to the needy. They had been following Dr. Roy's work and got in touch with him and arranged the grant.

This breathed a lease of life into the project. However, the money would soon be exhausted. They would need a much stronger power to be able to take this device to fruition. That was when the whole Babylon thing happened. They realized that this was the only option they had to bring the device to the patients. They realized that innovation cannot breathe without the power of money. They would need more money, much more money to have any hope of their hard work reaching the intended beneficiaries.

Friday, January 11, 2013

The blue pill - 5

(This is the fifth part of the short story The Blue Pill. You can find the entire story here.)

Dr. Roy had been to Los Angeles before but had never actually stayed there as a resident. Things were very, very different from his Kolkata home. In a few weeks the Roys settled into their home. Dr. Roy took a month off before he would join Babylon officially. Of course, he continued his work from home, working on the models, working on papers and thinking a lot about how he would like to take things forward on the device within Babylon.

Dr. Roy had ensured that most of his old team was also absorbed by Babylon. This was in the company's interest as well because having the same team would make sure that work on the device did not slow down. In all, eight people other than Dr. Roy joined Babylon. They would all join about a week after Dr. Roy.

The day of joining finally came. Dr. Roy drove down to the Babylon's R&D center right next to the building that housed the headquarters. He was welcomed warmly by Kanwal Nambiar who had also moved to Babylon's headquarters. Nambiar took Dr. Roy to his office and asked him to settle down. He said the CEO wanted to meet with him in about an hour.

Dr. Roy had heard a lot about Babylon's CEO. He had never met him though. Karl Torrance was a flamboyant person who changed the culture of the company from being very serious and matter-of-fact to one where having fun at work was encouraged. Torrance believed that if employees had fun at work, they would be more productive and especially in a heath-care company, the joy would actually rub off on patients as well who would associate the company with a place where they could forget their problems and be with people who are smiling.

When Dr. Roy was led into the CEO's room, he was quite surprised. Despite all he'd heard, he did not expect the CEO to be so young and clad in a T-Shirt and jeans. The men shook hands and Torrance asked Dr. Roy to sit.

"Pleasure to meet you, Dr. Roy!"

"Good morning Mr. Torrance!"

"Karl, just Karl, Dr. Roy."

"Sure, Karl!"

"Have you settled down into your new place?"

"Mostly. Was a little difficult. I was so used to my Indian ways! It will take a little more time to feel completely at home."

"I can totally imagine!"

They chatted about the difference in the way Indian and American medical industries operate, about how politicians are the same irrespective of where you are and about the differences in taxation laws.

Torrance then said, "I will be spending a lot of time with you Dr. Roy. As you can imagine, the work that you are doing is extremely important for us. It is a high priority item for me and let us work together to make sure we take it to its logical conclusion."

"Yes, definitely!"

The meeting ended. Dr. Roy was very happy with the meeting. He walked back to his office mulling about how his life had changed so much recently. He went back to the time he had come across the information about the new material that was engineered which he finally used in his device that actually made most of this possible. He thought about the challenges he faced in doing anything, the amount of money required to do anything meaningful. He shook his head in disbelief reminiscing all the pain he had been through trying to develop the device. He was very clear. He would not have been able to bring this device to market had it not been for a third party like Babylon.

One thing that he could not figure out was - why had Planet Renal not reached out to him at all? Was it because they had already bought something else recently?

Anyway, he was happy the way things had begun and was all excited about getting to work on the project again. In a week his team would join and he could get kicking right away!

Thursday, January 10, 2013

The blue pill - 4

(This is the fourth part of the short story The Blue Pill. You can find the entire story here.)

During the next few days, Dr. Achinta Roy met with Gopal Dass multiple times and also met with his boss to discuss the advantages and disadvantages of both the options. Dr. Roy was more and more convinced that he should not let go of the technology he had designed. Giving it all away to someone and getting big money was quite attractive but he somehow couldn't convince himself to do this.

The two executives from Babylon returned soon. Satish Raju pulled out his laptop and opened a presentation. Gopal Dass was also present. Dr. Roy wanted him to be there so that any terms he did not understand could be translated into layman's language by him. Raju started the presentation. Some slides about Babylon's strong commitment to innovation in dialysis to ultimately benefit patients, some with sketchy details about Dr. Roy's new device, then finally some slides about the financials.

Raju talked about the first option. They would give Dr. Roy a large sum of money and he would hand over all the patents, the designs, the experiments he had done and all the Intellectual Property that he held pertaining to the device to Babylon. He would hold no rights whatsoever on the device. Wow, Dr. Roy thought to himself. With that money, he wouldn't need to do anything else for the rest of his life. He could spend his time on whatever he chose to, work only for the pleasure of it and not have to worry about money ever again.

Raju then came to the second option. Babylon would hire Dr. Roy. He would get some stock options of which a portion would vest immediately for the technology he is bringing in. He would need to move to the US and be based out of Los Angeles, work in the Babylon headquarters and bring the device to market under the Babylon flag.

Hmmmm, thought Dr. Roy, not so lucrative as the first option!

Raju ended his presentation saying both had a common goal - bringing this device which would change lives of millions to the market as soon as possible. Raju said they would like a decision quickly in order to get started on this.

Dr. Roy thanked him for the proposals and said he needed some time to think about both and then get back to them.

"Of course, totally understand!"

Dr. Roy had endless discussions with Dass and Dass' boss. Everyone advised him to take the cash and go home! Dr. Roy did not feel it would be the right thing to do. "This is my baby. I cannot let someone else take it away!" Once they were all clear that they would go with the second option, they started talking about how to negotiate. Dass told Dr. Roy that these kinds of companies would give an offer assuming there would be some negotiation. It was, by no means, their final offer.

About a month had passed. There were numerous calls and emails from Raju in the meantime. They offered to have meetings to discuss various things. Dr. Roy asked for more time. He wanted to understand the offer completely and what it meant for him.

Dr. Roy and his advisors came up with a counter-offer finally. He called Satish Raju and asked for a meeting. The next day, the four men met in Dr. Roy's lab.

Dr. Roy began, "Satish, I am not very tech savvy. I don't have a fancy presentation but I have my thoughts in my mind and I will put them before you."

Raju smiled.

"I would not like to part with the technology and not have anything to do with it. I am very passionate about this and would like to see it through to the end. There is no way I can go with the first option. The second option seems too little for me to transfer ownership to you people. So, this discussion, I guess, ends here!"

Raju was a little taken aback. "So, maybe you found our offer low. What numbers are you looking at?"

"If there is a 5-10% difference, there may be some point talking, right? If the difference is so huge, there really isn't any point pursuing this! I think you underestimate the huge potential of this device!"

"Dr. Roy, rest assured that we fully appreciate the impact this device is likely to have. However, you must realize that the offer that we have given is a very generous one! In the history of Bablyon acquisitions, no one has ever been given so much stock! Not only do you make money on every unit of the device sold, you also make money on everything the company does. You are becoming one of the owners of the entire company!"

"I understand that. However, the device is going to become the company's. For that I think I deserve much more!"

Over the next few weeks, Dr. Roy met multiple times with Satish Raju and Kanwal Nambiar, the persistent executives from Babylon. They went back on forth on the numbers - the stock, the vesting schedule, the milestones, the salary and so on.

After a painstaking two months, they finally reached a settlement over all the terms of the agreement. Dr. Roy was fairly satisfied with the deal. He would be moving to the US in a month's time along with his wife. He could finally get back to what he loved doing the most - working on the device!

Wednesday, January 9, 2013

The blue pill - 3

(This is the third part of the short story The Blue Pill. You can find the entire story here.)

Satish Raju and Kanwal Nambiar were back in about a week. As usual, Raju did most of the talking.

"As we see it, Dr. Roy, there are two options we are considering at a very high level."


"One is Babylon buys the entire technology and the IP for this device from you and gives you a certain sum of money for it and you lose all rights. We then complete all the remaining work on it and take it to market."

"The second option is you join Babylon. We give you some stock in the company in return for the technology you are bringing in. You lead the team that works on the device and we take it to market together."

"Of course, a lot of finer aspects of the two options would need to be worked out. But at a very high level, this is what we're thinking. Do you have any other options in mind?"

"No, actually."

"Well, so among these two, is there something you would like to rule out entirely?"

"No, not really. It all depends on the specific numbers."

"How right you are, Dr. Roy! So, then please give us some time and we will get back to you with the numbers. In the meantime, can you share with us the current status of the device?"

"Yes, of course. You must have seen pictures of the device in the media. We have further reduced the weight by about 10%. We have also demonstrated the clearance of middle molecules. The device also is now capable of removing up to 10 ml of water per minute. We have tried the machine on patients for up to 9 hours as well without any significant problems."

"Impressive, Dr. Roy!"

"Yes, the device has surpassed all our expectations!"

"Can I have a look at it?"

"Sure! Come right in."

Dr. Roy led the two executives into his lab and took them straight to the device.

"Here it is!"

"Hmmmm.... interesting....."

"Quite a remarkable piece of work, Dr. Roy", said Nambiar. It was the first sentence he had said that day.

"Great then, let us get back to you with the detailed proposals."

"Sure. Good day, gentlemen!"

Dr. Roy called his wife as soon as they left and let her know what had transpired. She immediately called their friend, Gopal Dass who was an accountant at a software development firm. They agreed to wait until the numbers came back. In the meantime, Gopal Dass did some reading up on the internet on how such contracts worked. Dass also talked to his boss who was an MBA and got some more information.

There was one piece of advice his boss gave him, "The contract is very critical. It all boils down to the terms in the contract. Make sure you read every word, understand it and then read it again. It all depends on the words in the contract. This doctor friend of yours, he would understand the legal terms, wouldn't he?"

"Yes, of course he would", Dass lied.

Tuesday, January 8, 2013

The blue pill - 2

(This is the second part of the short story The Blue Pill. You can find the entire story here.)

It was about a week after the middle molecule experiment. Dr. Achinta Roy woke up at around 5. He washed up and then opened his laptop to check his email. There was an email from an Indian guy in  Babylon Corporation requesting an appointment. This could be interesting, thought Dr. Roy. He responded immediately asking them if 10 a.m. the next day would be ok.

Babylon Corporation was a manufacturer of dialysis equipment. They also had dialysis clinics in some parts of the US and were soon expanding to other countries as well. They were neck deep in competition with Planet Renal Incorporated who were one of the US' big dialysis center chains. Both were headquartered in the US but were eager to build their presence outside the US as well.

By mid-day, Dr. Roy got a confirmation for the 10 a.m. meeting the next day. Dr. Roy spent the rest of the day giving finishing touches to his paper presenting the latest results from his device and sent it off to the American Society of Nephrology journal for review.

The next day at 10, as Dr. Roy was sipping his cup of coffee, his secretary ushered two suit-clad men into his cabin.

"Good morning Dr. Roy!"

"Good morning!"

"Satish Raju", said one of them as he handed out his card. Dr. Roy couldn't help smiling at the rather flashy business card he was given. It looked more like an entertainment company's rather than a dialysis provider's!

"Kanwal Nambiar", said the other as he presented his card. Another Babylon card.

"Nice to meet you gentlemen. What can I do for you?"

Satish Raju began by indulging in some small talk by enquiring where Dr. Roy had done his MBBS and then mentioned that he had been with Babylon for the past seven years. He had moved to India recently and had assumed charge as the President of Indian Operations. Kanwal Nambiar was the Vice President for Marketing and had only recently joined Babylon.

Raju then got to the point.

"Dr. Roy, we have been closely following your new dialysis device. As you know Babylon is one of the world leaders in dialysis equipment. It is natural that we would be interested in any device that would eventually improve the quality of dialysis being offered and benefit patients."

"Yes, of course", said Dr. Roy, "I have been very excited about the possibilities this new device brings to dialysis treatments. I am sure you know that I alone and my little team here can do only so much. To take this device to the masses, it would definitely need the power and the money that corporations such as yours have. I fully realize that."

"I am glad you see that Dr. Roy! So, you would be open to some kind of partnership on this device, wouldn't you?"

"Yes, of course."

"Do you have any thoughts on the broad parameters of such a partnership?"

"Oh no, none at all! You see I am new to all this. You could talk to me about how the device removes water or you could talk to me about how the device consumes very little power. About other things, I have no clue! However, I have some friends who know more about this than I and I would like to get them involved when we start talking."

"Oh yes, absolutely! That makes sense."

The men exchanged greetings and left.

Dr. Roy was visibly excited. Finally, his device would get to the actual beneficiaries - the patients.

Monday, January 7, 2013

The blue pill

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


The two executives stepped aside from the hustle-bustle of the conference. They got into a room that was booked in the hotel for this meeting. No one noticed them.

"Quite a good turnout!"

"Let's get to the point. Did you do anything yet?"

"Well, no. He's in India, for God's sake!"

"So what? This is more serious than you think. You must get to him before anyone else does. And if you can't, let us know. We will."

"Take it easy baby! I will take care of this myself."

"You better. Prove it to me that only your CEO is a cunt. Not the whole goddamn company!"

"Ha ha ha ha.... I will!"

The two executives made their way back into the exhibition area of the conference to their respective stalls.


It was unusually hot. Dr. Achinta Roy parked his car and hurriedly made his way into the lab. It was much cooler inside. Dr. Roy believed that the air-conditioner was mankind's most comforting innovation! With one master-stroke, man had overcome any problems nature could bring on - with heat or cold that is! Until of course what he was working on would be ready.

Dr. Roy went straightaway to the lab. Today's experiment was particularly important. If he could demonstrate that the clearance of middle molecules was good enough, it would be a huge win. His team was getting ready. They had the volunteer patient ready. The device was kept on a table beside the patient. Dr. Roy carefully connected the device to the patient and as he switched on the final button that started dialysis, he said to the device, "Come on baby, give me what I want!"

For the last four years, Dr. Roy had painstakingly worked on this device which he believed would change the way people thought about dialysis. Currently, patients got treatments mostly in hospitals in machines that were the size of a washing machine. There were a couple of newer machines that were the size of a desktop printer. However, Dr. Roy's goal was to make it much, much smaller. That would be truly portable! Another of Dr. Roy's goals was to make it accessible in countries like India where medical technology reaches often many years after reaching countries like the US.

There were other teams around the world working on similar devices. Dr. Roy believed there was room for everyone. The number of dialysis patients that could benefit from this kind of device was in millions. No one team could possibly reach all of them. He strongly believed that healthy competition among these researchers was great for patients as the different teams would be spurred to make their respective devices even better and cheaper!

It was about seven hours since Dr. Roy connected the patient. He went in and disconnected the patient and sent off his blood samples to testing.

When the sample came back, Dr. Roy was elated. The experiment was successful. The clearance was as expected. Their device did well at clearing middle molecules as well!

Sunday, January 6, 2013

Starting tomorrow - The blue pill - my third short story!

"For the last four years, Dr. Achinta Roy had painstakingly worked on this device which he believed would change the way people thought about dialysis. Currently, patients got treatments mostly in hospitals in machines that were the size of a washing machine. There were a couple of newer machines that were the size of a desktop printer. However, Dr. Roy's goal was to make it much, much smaller. That would be truly portable! Another of Dr. Roy's goals was to make it accessible in countries like India where medical technology reaches often many years after reaching countries like the US."

Follow Dr. Roy's intriguing journey from a lab in Kolkata to a gigantic corporation in the US in a sincere attempt to change the lives of dialysis patients. Over the next couple of weeks, I will be publishing one part each day of my third fictional short story.

This story is very different from the first two which were patient-focussed. This one looks at the dialysis industry from right inside it. The lead character has been inspired by a real-life person!

I would really appreciate feedback - both positive and negative!

Wednesday, January 2, 2013


Yes, I have not posted for really long. I have been very busy with work lately. I am also working on another short story which should be done soon. I have not been well for the last few days. Nothing too bad. We had a get together of technicians at my house on Sunday and that night I had body aches and a slight fever. The next day I was feeling bad so I took the day off.

New Year's eve, we had a family event at home. I was a part of it but did not do a whole lot. I also skipped dialysis that night. The next day I went to work but worked from home in the afternoon since I felt sick towards the afternoon. I got back and took a Zofer which helped.

I got a good 7.5 hour session last night and I am feeling much better now.

Here's wishing you a very Happy New Year!