When I started daily nocturnal home hemodialysis in May 2006, I dialyzed six times a week and took Sundays off. It was that way for a long, long time. However those were the days of huge fluid weight gains. Sometimes even 5 kgs in one day! So, my Mondays would be pretty uncomfortable. Heavy chest and all. There were two main reasons I was doing this. Most of my mentors in the US (Bill Peckham, Rich Berkowitz and Pierre Lachan) were doing six nights a week. So, I did too. And Jairam, the guy who did the dialysis for me would take Sundays off.

Then somewhere down the line, I learnt the ropes and could do everything on my own - from start to finish. So, I thought why not make my Mondays comfortable? And I switched to seven times a week! Six nights Jairam would do most of it and Sundays I would do everything. I would be alone in my room and I would do everything from start to finish on my own. My parents would be in the house though and I always had my cell phone next to me to call them should I need help.

Earlier this year, however, my parents went on a holiday to the US. I was home alone. Before going, they extracted a promise from me never to dialyze alone. They shuddered at the thought of a blood leak and no one in the house to help me. So, I switched back to six nights a week when Jairam would come and took Sundays off from dialysis.

Recently, involuntarily, my fluid intake has reduced. I put on, on an average, only about 2 to 2.5 kgs of fluid weight between sessions. Also, to be honest with you, I have started to tire of dialysis. Fourteen years are taking their toll. Needles are not pleasant. It is very difficult to get used to them. I was also 'inspired' by Bill Peckham's "two nights on, one night off" regimen! So, I decided to take Thursdays off as well. So, these days, I dialyze Monday, Tuesday, Wednesday, take Thursday off, then dialyze Friday, Saturday and take Sundays off.

Being on dialysis is difficult. Being a caregiver for someone on dialysis can be difficult too. Seeing a loved one being diagnosed with a life-threatening disease can be emotionally very stressful. Every individual reacts differently.

I have seen my family over the years. And now, because of NephroPlus, I have seen and interacted with a whole lot of caregivers. Sons, daughters, wives, husbands, fathers, mothers. Almost every possible relationship.

Everyone starts off with shock and extreme feelings of love and sympathy for the affected person. How that holds differs from person to person. Some maintain the same level of love and affection over the years. In some, it slowly starts to wear off. In some, it turns into total apathy; in some even hate.

The patient also changes mentally. And this causes the family to change as well. I have seen people who were executives at good companies being reduced to simply names who occupy beds at the dialysis units during their allotted shifts. This can be quite humbling for the patients. They, who used to command the  respect of dozens of their subordinates, earned huge salaries, enjoyed the best comforts, always flew business class are now at the mercy of unethical technicians and nurses who sometimes even scold them. Yes, this can be humbling indeed.

I often see caregivers being severely burdened with guilt. Guilt for not doing enough. Guilt for not being there throughout. The whole problem with kidney disease is the continuity, there not being light at the end of the tunnel, it being a week after week thing, in perpetuity. Unlike cardiac disease where a surgery ends the problem (at least for the most part) or cancer where the problem often ends with the person (and the attempt here is not to lessen, in any way, the enormity of the suffering of the patient or the hurt in the family of these two health conditions), the fight with kidney disease is often drawn out over years causing a huge impact on an entire family's finances apart from the mental trauma.

Caregivers often realize that they need to get back to work! And to get on with their life. Sometimes patients make it easy by co-operating and being practical. However, sometimes, due to genuine reasons or otherwise, patients see this as being a crime. "He does not care for me any more!" Or worse, go into bouts of depression.

So, here's my advice to patients: Yes, we have the disease. We suffer the most. No two ways about that. However, let us understand that our family is also affected. In ways that we do not realize. Spare a thought for them. They have their own life. Let us not make our life theirs. Give them space. Let them live their life. If we do that, they will be recharged to help us with our problems.

... to the healthcare world!

I recently switched to a full time role with NephroPlus. These have been very exciting times. Throughout my working life, the only thing I have ever done was software. Development, testing, managing. Years full of deadlines, requirements, design documents and code reviews. It has been a very rewarding experience.

When I started off in late 1999 at Summa Computers, the company belonging to my mother's friend, it was my first job. I was part time. I had just settled down into CAPD after the extremely tumultuous two-odd years with kidney disease and the unsuccessful transplant. I was itching to do something useful and my mother's friend agreed to take me on. I started learning Visual Basic and MS SQL Server.

A few months later, Obul, my uncle Paul's friend was looking to start a software company around web applications using Apple's WebObjects and he was in India and we met up and Effigent was born. Effigent took up the next eight years of my life. I worked on WebObjects apart from doing a lot of management. Effigent was definitely the most significant part of my career till now. I learnt a lot during these years both in terms of software and general stuff as well.

Somewhere in the middle, the tsunami happened and I had to eventually move from PD to home hemo.

I then joined Grene in November 2008 and worked on WebObjects, Cocoa and Cocoa Touch. This were probably my best two years as a pure programmer with no management distraction. I did some great work on home automation.

Software was my first love. It will always hold a special place in my heart.

I have been involved with NephroPlus since Day 1. There is no doubt in my mind that the work I do at NephroPlus is my 'calling'. I have struggled for years to find it. I am glad that I have. Many people don't. So, that way I am fortunate.

Life is very different from that in the software world. When you develop software, you basically enable people to do things. Outside it, you actually do those things! I am now on the other side of the fence where I am looking after the implementation of software prepared by someone else at NephroPlus.

I am very excited about the work at NephroPlus. I hope the years to come are productive, fruitful and intellectually satisfying!

Here are the two videos done for my birthday, the first one by the NephroPlus folks and the second one by my Engineering College friends.