I had written about dialysing our elderly here a few days back. I reflected on that deeply a few days back while discussing the treatment options of a patient with her son along with a nephrologist. The lady was 70+ years old. Her son was as committed as ever. I could tell that the option for withdrawing treatment had not once crossed his mind.

The nephrologist made a very important point. The question she asked was, "Is the treatment doing anything to improve her quality of life or is it merely prolonging her suffering?"

It was easy to see that the dialysis session was nothing short of torture for the patient. Within a few minutes of starting, she would ask for it be closed. She was also not totally aware of what was happening around her. For her, it was a strange surrounding even though she had been there a few times. In her mind she was probably wondering why she had been brought there.

The family was considering PD as one of the options to make it easy on her. The nephrologist did not feel it would benefit her.

The nephrologist asked the family to consider this question and answer honestly if they really thought the treatment was benefitting her.

Once the conversation wound up, the son went over to her mother and gently stroked her head asking her if she wanted to eat anything. He could hardly hold back his emotions. Neither could any of us.

Many people on dialysis keep changing their nephrologist. Every now and then. This is not a good thing. There is a lot of undocumented history that resides in a nephrologist's mind. This can never be substituted by anything.

Why do people change their nephrologist?

Mostly, it is because they hear something good about some other nephrologist. "He is very good, why don't you try him?" kind of a thing. Remember one thing. Once you're on dialysis, things happen. It is often not due to the nephrologist's fault. Chronic Kidney Disease lends itself to a host of co-morbidities (conditions that occur alongside the primary disease itself). This is part of the game. The nephrologist can often not do anything to prevent it. So, do not blame your nephrologist for everything that happens to you.

Some people do not find the time given by the nephrologist to them adequate. This is a valid concern. Some nephrologists do not spend enough time with their patients. It is not their fault. They have to see so many patients in a limited span of time. But what does the patient do in the circumstances? This is something that I have no solution for. But think hard before changing the nephrologist.

The time the nephrologist spends with you is very important in your overall treatment. A lot of thought goes on in his or her mind that gets stored in his or her brain. This cannot be replaced by any amount of documentation.

Think about how the human brain works. There is a lot of processing that goes on before arriving at a decision. Things that can never be substituted by books, journals and documents. The decision is arrived at based on a lot of experiences of the past, the dozens of cases the nephrologist has dealt with in the past and the results of so many different treatments and their outcomes that are stored only in his brain.

I am not saying NEVER change the nephrologist. But you must have a strong reason to do so. Don't do it just because the patient in the next bed at the dialysis unit asked you to.

Rolling stones, they say, gather no moss.

I was recently chatting with an elderly gentleman of my 'sangh' (the community of people who belong to the same temple). He asked me what I was doing these days. I said I was working at NephroPlus, a chain of dialysis centers.

"Oh! so you have dedicated your entire life to this cause?"

I immediately clarified that I was getting a salary and this was a for-profit organization.

Yesterday's Business Line also attributed a lot of things to me that are not entirely true. They said that I started NephroPlus after years of fighting kidney disease. It was actually Vikram Vuppala who started NephroPlus. I was with him in spirit from Day 1. But it was totally his baby. I supported him. I officially joined part time last year and full time a few weeks back. To Vikram's (and the other co-founder Sandeep's) credit, they involved me right from the beginning so that they could get the patient's perspective while setting this up.

I loved the time spent there as this was very close to my heart. I finally answered my calling and joined the company. But this is a for-profit organization and I get a salary and sweat equity. So, its not like I have sacrificed anything for this or am giving up anything for this. So, please don't accuse me of these honorable things!

This year, NephroPlus put up a stall at the Annual Conference for the Indian Society of Nephrology. I attended all the days of the four day event. It was a great experience.

First of all, I saw everything 'nephrology' around me. Erythropoietin stalls, Iron stalls, Dialysis machine stalls, Dialysis center stalls. Kidney was probably the most used word around the conference!

There were a lot of very good sessions by stalwarts from round the world. And there were a lot of people attending the sessions - something contrary to what I was given to believe.

More than anything, however, I got the feeling that it was a great opportunity to network. For nephrologists, for corporates, for vendors, for everyone in the Nephrology industry.

I met with a lot of nephrologists, some of them pioneers, from around the country.

I ran into my own nephrologist, the man who has been treating me for the last fourteen years, Dr. Girish Narayen. He introduced me to his friend. While introducing me, he said he was not sure whether he should refer to me as his patient or his colleague (because of my current job at NephroPlus)!!

The most interesting meeting was with a doctor formerly associated with AIIMS, New Delhi. He came to our stall along with another doctor and started writing his name in our Visitor's Register. I was dumbstruck for a second as I saw the letters form. It was Dr. S. C. Dash. Dr. Dash is a very senior and respected nephrologist. When I was initially diagnosed with atypical Hemolytic Uremic Syndrome, a kidney biopsy was done to confirm the diagnosis. Due to the extremely rare nature of this disease, the biopsy slides were sent to Dr. Dash to confirm the diagnosis. This was a major step in my treatment.

I introduced myself to the doctor and told him that he had seen my biopsy slides years back! He of course did not remember that (he has probably seen thousands of biopsy slides!). But he gave me a playful box on my stomach and said he was very happy to see me like this, meaning, in good shape.

It was an excellent experience overall. When I moved to healthcare, specifically nephrology, from something as different as software, I never thought these things would happen. It has brought me close to many people I never imagined I could even be in touch with.