Hello, I'm Kamal from Hyderabad, India. I have been on dialysis for the last 13 years, six of them on PD, the rest on hemo. I have been on daily nocturnal home hemodialysis for the last four and half years. I can do pretty much everything myself. I love to travel and do short weekend trips or longer trips to places which have dialysis centers. Goa in India is a personal favorite. It is a great holiday destination and has two very good dialysis centers.
(This is the third part of a fictional short story - In you we trust. You can find the first part here.)
The month passed by quickly.
Prakash was there on the designated day at the dialysis unit at Charaka Hospital, all excited and ready to take charge. He went over to meet Dr. Jha first. Dr. Jha was getting ready to go on his rounds. Though Prakash would need to report at 7 a.m. every morning, on the first day he was asked to come at 9:30 so that he could be introduced to the rest of the staff. This was going to be a little tricky. Whenever someone from outside comes and joins a team in a superior position, there is always a risk of the existing members of the team feeling insecure, threatened and even being non-cooperative with the new leader.
Dr. Jha was aware of this. He first sat with Prakash and explained this to him. He counseled him on how to deal with each member of the staff, their strengths and weaknesses and how to slowly win each one's confidence. Dr. Jha mentally grinned and patted himself on the back. In a short span of time, he knew more about the dialysis unit staff than he had ever known about any of his direct reports!
The doctor led his hopefully-soon-to-be-trusted lieutenant to the unit and gestured for everyone to come to the nursing station. The staff collected quickly. They all respected the doctor and knew he had concerns regarding the unit. They were all trying to impress him. However, they realized, it hadn't been enough.
In chaste Kannada, the doctor began, "Hello friends, I am happy to introduce Mr. Prakash, the new Chief Dialysis Manager of our dialysis unit." He had picked up the language in his decade or so in the state quite well. It is important for doctors to speak the language of the patients. They can relate better. More than half of his patients were Kannadigas.
Some dialysis patients woke up to see what the fuss was all about. Some slept back. Some strained their ears to catch what Dr. Jha was saying. Any distraction is good enough when you're on dialysis!
"Prakash has many years of experience in running dialysis units. Prior to this, he was working in Sanjivani Hospital as Chief Dialysis Manager. Prakash will now lead the operations of the center. I will be working very closely with him to make sure that the transition will be smooth."
A machine sounded an alarm. One of the junior techs rushed off to press the Mute button. The patient had moved his hand to cause a kink in the tubes. The tech straightened the line and reset the alarm. He rejoined the group. The meeting continued.
"I thank you all for the co-operation you have given me in the last few weeks and am sure you will co-operate with Prakash in the same manner. I wish Prakash and all of you the best of luck in your work at this hospital. Thank you."
There was a light applause.
Dr. Jha asked Prakash to get himself familiar with the unit. He would finish off his rounds and join him. He would start transitioning all the responsibilities one by one to Prakash. Dr. Jha rushed to the IP rooms where his cases were admitted. The IgA Nephropathy case was doing much better. He wasn't fully all right though. The new drug had the desired effect. It took more than two weeks for them to see his values return to normal. Those two weeks were very tense for the patient, his family and the doctor. There was a mild infection which they were treating now. That was also on the wane. Hopefully they would be able to discharge the patient in a few days.
Prakash started interacting with the technicians and nurses. He wanted to get a sense of how things were in the unit. He asked to be introduced to the patients. The junior techs took him around and started telling the patients who were on dialysis about Prakash. Some of them were asleep. Prakash signalled not to bother them. He knew that sleep was the best way someone could spend a session on dialysis. They came over to a bed where there was a pretty, young girl. She was awake reading a book. The techs introduced her to Prakash as Aparna madam. "This is the new Dialysis Manager", said one of the techs, "Prakash sir".
"Oh good", said Aparna, "now your work will become easier", she smiled and said to the junior techs. They all smiled back.
Aparna was on dialysis for the past four and half years. She was diagnosed with chronic kidney failure about five years back at the age of 24. Anyone would have been devastated with this sequence of events but not Aparna. She quickly gathered herself and fought to regain control of her life. She started working part time within a year of being on dialysis and she was now working full time. She had lost both her parents at a young age and only had a brother who stayed in the US with his family. They visited India rarely but kept in touch with her every week on phone. She usually came for her session in the third shift but today she was taking the day off to attend a family function and wanted to be done with it in the morning.
The techs moved to the nursing station and told Prakash that Aparna madam was their most active patient. She knew a lot about dialysis and would correct the mistakes they made not only in her case but also in other cases. Prakash raised an eyebrow. Correct mistakes in other cases as well? Hmmmm...
"Good morning Anu!", Dr. Jha said as he entered his department. Anu had just got in and was surprised to see her boss come in so early. He looked quite excited. He quickly put his things in his room and dashed off towards the IP rooms on his daily rounds of the admitted patients. He had also found something to try for the troubling IgA Nephropathy case.
Dr. Jha hated for a transplant to fail. A transplant, he believed was the ultimate challenge in nephrology. It was the only real treatment, he felt. Dialysis - even daily - was at best a compromise. Yes, good, frequent, long duration dialysis did offer a good quality of life but it wasn't even close to the quality of life offered by a transplant. And then you had the whole act of donating an organ. This, he felt, was the ultimate donation anyone could ever make, the ultimate act of altruism. Dr. Jha would always have a one-on-one session with the donor before the transplant allaying any fears, giving strength and strongly praising the decision to donate. One of the main reasons he was very keen that every transplant succeeded, apart from the well-being of his patients, was that he did not want the donation to go in vain.
Dr. Jha made his way to the Transplant ICU where the IgA Nephropathy case was being kept. It was a young boy of about 28 years. Everything went well during the transplant. His mother had donated. The mother was fine, as expected. For about a month, everything was fine and then suddenly the creatinine started rising. Dr. Jha, the boy and his family, everyone was on tenterhooks. This wasn't a new occurrence for the doctor. He had handled rejections and worse in the past. Yet, with every case, there was this nervousness. The stakes, after all, were so high! For Dr. Jha, it was one of many transplants. For the patient however, this was his only shot at a normal life. His one chance. Dr. Jha realized this.
As he greeted the patient after donning the mandatory gown, mask, gloves and slippers, he said he was changing one of the drugs in his prescription and hopefully that should improve the kidney function. The patient understood. Transplants are a tricky business. You are never quite sure of what to do. The boy was aware of this and was happy to be in good hands. He trusted Dr. Jha completely.
By the time he completed his rounds of the other IP patients and returned to his room, it was around 11:30. He asked Anu for a cup of black tea and settled down at his table rummaging through the journals to read up a little more on one of the IP cases he had just seen.
"Sir, Prakash, dialysis technician, is here for an interview", Anu's voice announced on the phone.
"Send him in!"
In his preoccupation with the transplant case, Dr. Jha forgot to visit the dialysis unit and all about his problems with the understaffing. He looked up in anticipation as a short, lean and unassuming young guy, twenty five perhaps, asked to come in. Dr. Jha gestured him to come and sit just as his cell phone rang. Quickly muttering an apology to the caller, Dr. Jha focussed on the resume which the candidate gave him respectfully. It was the same resume that he had seen earlier. The same mistakes, the bad formatting, the wrong spellings. These things did not matter of course, as long as the guy knew his job well!
The interview lasted about 45 minutes. The doctor and technician took an instant liking for one another. Prakash knew dialysis. He was passionate about it. It was easy to see. Unlike many other technicians Dr. Jha had encountered in his career who had at best, a superficial understanding of dialysis, Prakash knew the concepts. About twenty minutes into the interview Dr. Jha had made up his mind to hire him. But he continued because it had been a long time since he had had an interesting discussion on the subject with someone of Prakash's background. More than anything, Prakash's enthusiasm intrigued the doctor. They discussed Kt/V, its merits and demerits, Peritoneal Dialysis, using high flux dialyzers, cross infections and much more. Towards the end, Prakash also felt the interview was going well and was quite confident of being hired.
Dr. Jha then broached the topic of the salary. Prakash's expectations were reasonable. He asked for about 25% more than what they were paying Ramesh and about 30% more than what he was being paid at his previous job. Prakash would serve his notice period of a month and then join Charaka.
"Welcome to Charaka!", Dr. Suketu Jha said as he offered a handshake to Prakash. Prakash beamed as he took the doctor's hand and excitedly said, "Thank you sir!"
"Welcome to Charaka!", Dr. Suketu Jha said as he offered a handshake to Prakash. Prakash beamed as he took the doctor's hand and excitedly said, "Thank you sir!"
Dr. Jha's search had ended. Ever since the senior most technician of the dialysis unit of Bangalore's swanky and famous Charaka Hospital, Ramesh, had resigned to join one of the new standalone dialysis chains coming up in the city, the operations of the dialysis unit had suffered. What could two junior technicians do, after all? The number of patients also kept growing as Dr. Jha was a skilled and empathetic doctor, a rarity these days. Months of newspaper ads, checking with contacts, even unabashedly calling techs himself, yielded little success.
Then finally, almost out of nowhere, Dr. Jha saw an email in his inbox one evening after his usual rounds. The subject read, "Applicn. for Sr. Dialysis Tech. - 8 yrs exp". Dr. Jha chuckled as he took in the abbreviations. But 8 years experience looked tempting. He went over the resume. It was a typical technician's resume. Bad formatting, spelling mistakes, a pompous objective. One thing struck him however. 8 years in only 2 jobs. That was rare in this industry! Dr. Jha called Anu, his secretary, and asked her to schedule an interview.
It was almost 8 in the evening when he could finally leave his room. On the way out, he stopped by at the dialysis unit as usual. Four cases were going on. The two junior technicians were managing the unit. There were two nurses helping out. But Dr. Jha was never sure. He dreaded every call from the unit fearing the worst. He checked with the staff if everything was ok. One patient's BP had dropped a bit. Dr. Jha advised that they reduce the ultrafiltration volume. One of the techs proudly said that they had already done that. Dr. Jha smiled and said, "Good!" Under his breath he muttered, "Wasn't it obvious?!" But he realized that he needed to handle these rookies with kid gloves.
As he made his way to the car park, Dr. Jha thought about how easily he had set up the unit about a year back. He had found a team of technicians who were available as a dialysis unit about six kilometers from where Charaka was located had closed down. Ramesh had been very good, very efficient and took complete responsibility leaving only the medical management to Dr. Jha. But when he was given an offer by the standalone chain that was being started at almost double the salary he was currently getting, Dr. Jha could do little to convince him to stay. He did not even make an effort to talk to the management of Charaka because he knew what they would say. Ever since Ramesh had left, his problems started. The junior fellows did not know even basic inventory management, patient scheduling and other book keeping. Dr. Jha had to spend a lot of time in the unit fixing things and guiding them.
"Let's hope this new guy is some good," he thought to himself as he got into his Honda City and headed home.
That evening as he opened his MacBook Pro to look for some information on uptodate.com about a particularly difficult post-transplant case where an IgA Nephropathy case had shown an increase in renal parameters, he saw an alert in his Google Reader page that was headlined, "The Lufkin Davita Bleach Murder Case: Opening Salvos". He opened the link and read with horror the accusations against a dialysis nurse in Texas state in the US of injecting bleach into some dialysis patients at a Davita dialysis center. Dr. Jha was appalled on reading the sequence of events. How could anyone do this? How could anyone betray the trust of a patient?There was some mention of a Davita conspiracy to implicate the nurse to cover up bad processes. Dr. Jha felt a shiver down his spine. What precautions do I have in place to prevent this kind of a thing from ever happening?
Was the nurse at fault? Was it the unit? Either scenario was scary. I should institute processes immediately to make sure the chlorine content of the RO water is checked every month. Why every month? Why not every week? This was a critical aspect of dialysis. In fact, I should have it done every day! What about the staff? How can I make sure that they do their job? One disgruntled staff member is enough to bring about disaster in our unit. Just one disgruntled staff member!
Dr. Jha then took a Restyl 0.25 mg. He needed some sleep. Everything would be ok, he reassured himself. Indians never feel so strongly about any thing. An Indian would never kill a patient.The Restyl began to act. An Indian would never kill a patient. An Indian would never kill a patient. The Restyl took over completely.
"Dr. Suketu Jha is the Chief Nephrologist at Bangalore's Charaka Hospital. Dr. Jha hated for a transplant to fail. A transplant, he believed was the ultimate challenge in nephrology. It was the only real treatment, he felt. Dialysis - even daily - was at best a compromise. Yes, good, frequent, long duration dialysis did offer a good quality of life but it wasn't even close to the quality of life offered by a transplant."
"Prakash took pride in his work. He was extremely confident about his abilities. Education-wise Prakash was like many other dialysis technicians - no graduation degree, only a diploma in Dialysis Technology. Yet, he was very skilled. Patients wanted only him to cannulate. They hardly felt any pain. He could cannulate in one attempt."
These are the main characters from s short story, "In you we trust" that I wrote recently. I will be posting one part of this story every day, starting tomorrow.
I have been thinking of writing a short story for a long time. I have not come across any fiction that has a dialysis unit as the primary setting. I thought it would be very interesting to try my hand at this. If it turns out well, great! If not, well, it will still be ok!
Please let me know how you find it. As always, bouquets and brickbats will both be welcome!
Cut to last year. I decided to go on a cruise with my friends. I applied for my US visa again, this time a tourist visa. The interview went well. But drat! Again Administrative Processing. This time it took a full four months before I was granted the visa!
Next, the Canadian visa. The cruise starts from Vancouver, Canada. So, I needed a Canadian visa. Now for someone who has a US visa, a Canadian visa is usually a breeze. But no, my visa was refused. I applied again. Refused again!
By this time, I remembered a good friend, Srinivas Palepu's words, "Don't fight nature too hard!" Was the universe telling me not to go to the US/Canada?
I had almost decided but my friends convinced me to re-apply which I eventually did. Finally I got the Canadian visa. I am scheduled to leave for the trip on 12th of July.
So, what is the truth? Should you take heed of such 'signs' from nature or the Universe and take the hint? Or is this all baloney? I fought and got the visa in the end, you see?
I don't know, really!