Day 1: Confusion worse confounded

I took off for Chennai on Monday morning for the home hemo training. The hospital apparently had organised an inauguration and a small ceremony which I did not know about and so had to miss. I got some rest and reached Madras Medical Mission (MMM) hospital around 4:30.

There was a small room that was setup for the home hemo training. I should be able to post a picture of the room soon. It was a very nice little room, very different from your general hospital rooms. It had a small cot at one side, next to which was the Fresenius 4008S. There was a wash basin and a table to keep things.

I met the team, Dr. Georgi Abraham, the chief nephrologist, Thiagarajan Thandavan, the head of clinical coordinators for Fresenius in India and the driving force behind this entire program, Geetha from Fresenius' home therapy program and Sugan Raj, clinical coordinator from Fresenius. They were all very affable people with a passion for their work and a genuine desire to make this program a success.

We got started with a very touchy topic - to use xylocaine or not. Xylocaine is a local anesthetic. Many people on dialysis like to inject a little at the point of cannulation to avoid the pain of the thick needles going in for dialysis. Most medical professionals discourage the use of xylocaine saying that it is harmful in the long term. I have used it for the most part. It makes the pain less. Thiagarajan suggested we try not to use it. I hesitatingly agreed. Next was the technique to wash hands effectively. I was given a presentation about the importance of washing hands well and the six step washing method. I was given a demo of how to wash hands before a dialysis session and then made to do a dry run.

We then broke for dinner and I got back to the hospital at 9:30.

We decided to start dialysis. There was general confusion because this was the first time this was being done. We put the machine to test and in the meantime I started connecting the dialyser and the blood lines. When I started connecting the bloodlines, we realised that they were 'pre-pump' type. I have always used the 'post-pump' type. I got a little flustered. This entailed a slightly different priming method. The team guided me as I primed the dialyser and the bloodlines.

The machine self test however failed. The temperature and the diasafe tests kept failing. The service engineer from Fresenius was immediately called. It was close to 11 in the night when he came. Sugan Raj, the clinical coordinator assured me that they had tested everything that morning and it was all in order. The service engineer came and fixed the problem by opening the machine up and doing some calibration.

We then proceeded with the treatment. The team watched as I injected xylocaine (we agreed that I would use it as we hadn't had a good start and we wanted to reduce any further pain and discomfort). I then cannulated myself. The tape that was used (micropore) was also different from the one I was used to (transpore). This made things a little unwieldy. But in a few minutes I was on dialysis!

We did a five and half hour run. I took a mild sedative to get some sleep.

The treatment completed at around 5:45 in the morning. I did most of the closing on my own with tips from Thiagarajan on how to remove the needles and hold the gauze with one hand. He taught me a nice little technique where we tape the other end of the needle to a trolley or a firm place and then move your arm away from it so that the needle is removed and you can press the gauze on the site with the free hand. I will try and post a video of this some time.

All in all, it wasn't the start that I had hoped for. But the team, of course, did all they could and sometimes, things take a little time to settle down. The plan today is to have a discussion on trouble shooting at around six in the evening, break for an early dinner and then begin by around nine.

I got a chance to swim at the place I am staying. That felt really good! We also went over to the Murugan Idly shop at T nagar. The food there was truly heavenly. I took a quick nap to make up for the lost sleep. Let's hope tonight is better!