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.
Prakash found Aparna very depressed these days on dialysis. He secretly seemed happy at her plight. Serves you right! Next time think twice before attempting to insult me. He recollected how he cooked up the whole story about the mistake in the reprocessing unit. He just wanted to scare her for a bit. After a few months, when the reports would consistently come out negative, she would be ok. So no harm was being done. At the same time, he felt he was only dispensing justice. She did it only to insult him. So, she needed to be taught a lesson. And anyways, it was not as if he had really infected her with the virus. So it was all ok.
Unfortunately, Prakash had horribly underestimated the mental trauma he was putting Aparna through.
Month after month, Aparna would dread the first week when the blood would be drawn. The next 24 hours would be absolute hell until the reports came back. There would be temporary relief for a couple of weeks and the countdown to the beginning of the month would start all over again. Many times, Aparna considered ending it all. She could bear it no more. However, every time, she fought those depressing thoughts and said to herself, "I have not turned positive yet, right? If I ever do, then we'll see." and got herself back on track.
It was about seven months since Prakash had first broken the news about the possible infection to her. It was the beginning of the month again. Prakash drew the sample and sent it to the lab. By now Aparna was also less anxious about the results. This had been going on for so many months now. And the result was always negative. The rest of the session was uneventful. She requested Prakash to call her as usual and let her know when the results came back and left for home.
The next morning, three results came from the lab and Prakash opened the envelopes one by one to check the values. One Hemoglobin was only 6.8. He made a mental note to let Dr. Jha know. His Erythropoietin probably needed to be increased.Another patient's Potassium was 6.5. Too much fruit! The next report was Aparna's. HCV Negative,he muttered as he opened the report. The report said Positive! Prakash was shocked. How could that be? How could she turn positive? That was all a prank! Her dialyzer was not mistakenly reprocessed in the positive machine!
He was convinced it was wrong. He called the lab and blasted them. He said they had probably mixed the samples with someone else's. The lab was defiant. "No way!", they said. He said he would be sending a repeat. "Sure!", they responded.
How would he tell Aparna this? He felt the ground slipping from beneath his feet. He started sweating profusely. He sat down on a chair and started thinking about what he should do. My career is finished. Aparna will definitely complain to Dr. Jha and the hospital. They will suspend me. No hospital will take me. What have I done?!He then regained composure and told himself, I haven't really done anything. Relax. I have not made any mistake. I did not reprocess Aparna's dialyzer in the positive machine.
The whole sequence of events caused him to believe, at the back of his mind, that he had actually done something wrong, that he had actually infected Aparna's dialyzer with the virus.
He decided that he would send a repeat sample. The problem however was how he would tell Aparna about this? He would not be able to take a sample without her knowing. Prakash decided that he would say that the earlier sample got spoilt due to faulty storage and they couldn't do the test.
Aparna came the next day and Prakash seemed unusually tense and in a hurry. Prakash told her that the sample they had drawn last time got spoilt and they would need to send it again. Aparna was too tired that day to react. "Sure", she said and the sample was sent. This time, Prakash called the lab and asked them to be very careful with the sample and give him an accurate result.
The result came back the next day. Positive. Prakash was devastated.
Hepatitis C is a scourge in dialysis units today. Many patients become Hepatitis C positive a few years into dialysis. The indolent nature of the disease has caused not enough attention to be given to it. Medical proessionals are more focussed on immediate problems that dialysis patients face. A disease that takes about a decade to start showing clinical symptoms is not very high on the priority list of nephrologists.
Left untreated, the disease can cause Liver Cirrhosis, Liver Cancer and Liver Failure in about twenty years in non-dialysis patients. In dialysis patients this period is about ten years. Still, ten years is a long time for a dialysis patient.
Many dialysis patients do not even know about the danger of getting cross-infected with Hepatitis C in their dialysis units. It hits them only when they turn positive. Like other chronic conditions, this is also something that 'cannot happen to me'!
Despite all her knowledge about kidney disease Aparna was ignorant about Hepatitis C. All she knew was 'positive patients' had to dialyze in a separate area. She hadn't bothered to find out more about the disease. 'It cannot happen to me', was what she thought too.
One morning, as Prakash started Aparna's session, Aparna noticed him drawing a blood sample for an investigation. She had not asked for any test. Why was he drawing a sample, then? He asked Prakash. Prakash said he was dawing a sample for Hepatitis C testing. Aparna asked him why he was doing that when they had sent the sample in the first week of the month as usual and it was already negative.
Prakash was fumbling as he answered. He said something about some mistake being committed in the Reprocessing Unit, about some mix up happening, about her dialzyer being mistakenly reprocessed in the positive reprocessing machine.
Aparna was apalled. Though she did not know exactly what had happened, it sounded horrible. She had a very disturbed session that day. She started imagining all kinds of horrible things happening to her. The word 'positive' has a very negative connotation. Though people on dialysis who are Hepatitis C positive will very likely not be affected by the disease, a whole lot of other issues crop in.
Aparna got on to the internet and read up all she could about Hepatitis C in dialysis patients. The fact that there wouldn't be any symptoms for years offered no consolation. She had plans of living for long on dialysis and this could mess things up a lot. She started doubting Prakash's role in this. The guy probably hates me. He might have done this just to get back at me. But then she thought that may not be true. No one can fall to that level. Not even Prakash. He has an ego but he will not stoop to a level where he would play with someone's health.
The report came back negative. Aparna was relieved. However it was not all over yet. The Hepatitis C virus can be in a so-called incubation period for months. Every month, Aparna would have to undergo the test to make sure she has not turned positive. At least for another 4-6 months.
Aparna was quite disturbed with the recent turn of events. At the back of her mind she had this nagging doubt that this was done on purpose by Prakash. She wasn't convinced however. She thought no one could do such a thing. She was wondering if she should talk to Dr. Jha about this. She debated this for a while. Maybe Dr. Jha could do something about the virus in the incubation period if it was already there? Maybe some additional tests might help check on this? She decided to talk to him eventually.
Dr. Jha appeared quite unfazed when she talked to him. He offered rather blandly, "Aparna, let us not assume anything until we get a positive result."
Aparna got a little worked up.
"But Doctor, what if I have really been infected? What if the virus is in the incubation period?"
"I would strongly advise you not to stress yourself too much with this. Let us repeat the test every month and see."
Aparna was disappointed. Dr. Jha hadn't been very helpful.
That evening, while watching TV at home, her brother called her. For the first time in many months, she broke down. Her brother felt helpless. He wanted to help her but could do nothing. He was stuck in a job in the US and couldn't return to India for another year. After the call as well, she put her head in her pillow and cried bitterly for about an hour. She felt very lonely and desperately wanted some support. She felt it was totally unfair for her to deal with all this all by herself. All her friends had got married and had loving and caring husbands. Some even had kids. And here she was, all alone in this world having to deal with this disease. She had come to terms with the dialysis bit. But this whole new Hepatitis C angle to it left her very scared.
(This is the sixth part of a fictional short story - In you we trust. You can find the first part here.)
Aparna used to read up a lot about her condition. She also read up a lot about dialysis. She was a member of an online forum of dialysis patients too where she would get a lot of information about the dialysis process and the various factors involved in it. Over the months she had developed a very good understanding of the concepts involved. She was completely on top of her dialysis settings and would insist that she dictate the parameters rather than the technicians.
Prakash, on the other hand, got all his dialysis knowledge from practice. For the past so many years, he had encountered many situations which helped him to handle most complications fairly well. However, his theoretical background was weak. The diploma he had done was like most other diplomas in the city. Theory was rarely taught. The students were simply expected to come to the unit and then learn the practical aspects of dialysis from the seniors. They did what the seniors did. If some senior learnt something the wrong way many generations back, chances are that several generations of dialysis technicians down the line were repeating the same mistake.
For the past few weeks, Aparna noticed something peculiar about an elderly male patient who used to generally be taken in the bed opposite to her on the same days as her, in the same shift as her. He would come in with barely a liter of extra fluid but about halfway into the session, he would get severe cramps. The technicians were simply not able to pull off even that minimal amount of fluid. This baffled even Prakash. Aparna had an idea. But she was wondering how she could tell Prakash.
Aparna knew exactly how Prakash would react. He was the kind of guy who would feel so belittled if someone else gave him an idea in his field of expertise that actually worked. It would be much worse if that someone was a patient. And even worse if Aparna gave that idea. Aparna realized this. But she couldn't let the patient suffer any more!
"Increase the conductivity!" she shouted out as Prakash was discussing the problem with the junior technicians while starting the man's session.
Everyone turned to look at her. Prakash's face turned red. The juniors turned to look at Prakash. The patient looked at Aparna and then at Prakash. Aparna regretted it instantly. What have I done?
Prakash burst out laughing. He shook his head in disbelief. There was silence all around. He did increase the conductivity however. He increased the Prescribed Sodium setting. The conductivity came up to about 14.5 in a few minutes. Prakash kept returning to the patient to check if he was cramping. He was doing quite well. The fluid was all successfully removed. For the first time. Aparna was also keeping an eye on the patient. She was happy to see that the fluid was removed as well. She knew what keeping extra fluid on meant. Prakash did not talk to Aparna that day. He closed her session. But did not say a word.
Prakash went home that night very dejected. Why didn't I think of that? There was nothing great in what she suggested. It was not a new medical discovery. It was the obvious solution. But still, why didn't I think of that? She is not even qualified in dialysis. She has no experience. She is only a patient. How did she think of that and why didn't I?
He recollected all the nice things patients said about him. They treated him like God. They brought gifts for him. He thought about all the times he thought of innovative solutions to the issues patients were having on dialysis and how he had relieved them of their problems. He kept picturing himself cannulating different patients. He remembered patients allowing only him to cannulate. It felt good. It felt good to have so many people look up to you. It felt good to have so many people revere you.
And then there was this patient. What did she think of herself? Who did she think she was? Telling me what to do! Look at her guts. The way she shouted out in front of everyone. She wanted to insult me. That was her only intention. She had no interest in the patient. All she wanted to do was to insult me. The bitch! She must be taught a lesson. A lesson she would never forget.
(This is the fifth part of a fictional short story - In you we trust. You can find the first part here.)
"I can't believe no one told you yet!", said Aparna. Dr. Jha's face was very serious. Aparna came to meet him before her session. It was a week since the incident had happened. Nothing was done about it. She came to Dr. Jha to check what he was going to do about the incident. No, not the alarm. Alarms happen all the time. Even air detector alarms. But a senior technician slapping a junior technician. That couldn't be allowed!
Dr. Jha asked when this had happened. "Exactly a week back. Last Friday. In the evening shift.", Aparna replied. Dr. Jha immediately understood. Of course no one would complain. Who would? The junior techs? The patients? Who would take on the mighty technician and risk his wrath?
"Aparna", Dr. Jha continued, "are you facing any problems in your dialysis?"
"Ok, then you forget about this. I will deal with it."
"Don't worry. I will deal with it. I am telling you na!"
"Ok Doctor." Aparna got up to go to the unit and get started. As she was leaving the OP room, Prakash was entering. They avoided eye contact. The last two sessions had been similar. No eye contact. Prakash would avoid all conversation. Aparna also did not say a word. Nothing much changed inside the unit. The junior was back the very next day. Everything seemed normal.
Aparna wondered why no one had complained to the Doctor. Well, patients would definitely not complain. For one, they had nothing to do with it. And then, who wanted to upset the lead technician? But what about the staff? The staff were probably too scared to complain against their senior. He had all the power in the unit. Dr. Jha fully trusted him. The patients loved him. So, was nothing going to be done about this? Perhaps. Unless Dr. Jha puts his foot down.
Prakash entered the unit after about five minutes. He went and sat at the nursing station. Aparna was waiting for him to come and start the session. He got busy on the inventory register. After a couple of minutes, he called out to the junior tech who had assisted him last Friday. He whispered something in his ear. The junior looked surprised. He came over to Aparna's bed and said he was going to start the session as Prakash sir was busy. Aparna's heart became leaden. So this was what happened if you complained!
Luckily the session started without any problems and the cannulation wasn't bad either. But Aparna felt her eyes become heavy once the session was on and the tech had also moved away. She fought off her tears.
After a while Dr. Jha came on his rounds of the unit. Prakash accompanied him as he moved from bed to bed. When he came to Aparna's bed, there was no discussion about the incident or the complaint. After the session, Aparna went to his OP room but he had left. She was about to dial his cell phone on her way to the car. But she disconnected when she realized it was 9 in the night. What had the Doctor told Prakash?
She couldn't sleep until late that night. She kept thinking about the last one week. She was wondering if she had done anything wrong. Now that she had complained against Prakash, would he never cannulate her? Would she always be cannulated by the junior techs? What if she ran into complications during the session that couldn't be handled by the juniors? What if Prakash refused to help? Should she change her unit? The others were too far away.
Aparna called Dr. Jha next morning and asked him what he had told Prakash. Dr. Jha said he had sorted the matter. Prakash would control his temper and not slap anyone in the unit. "That's it? No punishment?", she asked.
"Aparna, this is not a school where we can punish students. I counseled him on how to behave with junior staff. After all he is very good at his work. A few rough edges for sure. But nothing that can't be corrected. How are you feeling?"
"Fine doctor. Thank you. Ok bye doctor." Aparna said as she hung up.
On the next session on Monday, Aparna dreaded what was going to happen as she walked towards the dialysis unit. When she went in Prakash was cannulating another patient. She checked her weight as usual and went over to her regular bed. After a few minutes Prakash came over to her and started the process of beginning dialysis. Aparna felt a little relieved. They did not speak anything. But at least he was starting her session.
The next session when she entered the unit Prakash greeted her and asked her how she felt. She smiled back and responded. Within a few more more sessions, both were normal. The past was forgotten, Aparna felt. In her own interest, she must be on good terms with Prakash. Let's face it, I need him more than he needs me.
(This is the third part of a fictional short story - In you we trust. You can find the first part here.)
Within a few weeks, everyone got to know that Prakash was very skilled. He could cannulate difficult cases with ease. He knew the machines inside out. He could handle complications also fairly well. He gained everyone's confidence.
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.
Cannulation is a tricky beast. Some people say it is a natural gift. Some people say it can be mastered by practice. Some people accuse it of being over-rated. Whatever it is, one thing is for sure - cannulation is the thing most dialysis patients fear like hell. Severe pain is one of the less damaging effects of a badly done cannulation. Worse things can also happen.
Prakash slowly took over the administration of the unit as well from Dr. Jha. He adroitly handled staff scheduling, patient scheduling, inventory, housekeeping - everything that needed to be done in the unit. The junior staff did not mind this at all. They recognized their limitations and were also happy that the burden of all these things was no longer on them.
Dr. Jha was a happy man! He could now focus on things he really needed to focus on, things he was meant to focus on.
Aparna kept a close watch on what Prakash was doing. She saw Prakash remove the line from the air detector. This would bypass the alarm without actually correcting the problem.