I recently switched to an arrangement at Grene, the company I have been working for, for the last two years, where I would be like a contractor. I would have flexible timings. I could work from home when I wanted to but would come to the office as required. I would make sure all the work I needed to do would get it dome in a timely manner.

Around the same time, I took on an official role at NephroPlus, the chain of dialysis centers I have been informally involved with right from its inception.

My life has changed dramatically.

When you are not an employee, there is a remarkable change in attitude towards work. Even though I am making significantly less money than I was until a couple of months back, life is much better professionally and personally. I find myself enjoying my work much more. I do not perceive my work to be a chore, to be done day after day. Suddenly, I find it very stimulating.

And then there is NephroPlus. I am enjoying my role there thoroughly. For the first time in my life I am working for a non-software company. The whole dynamic is very different from a software company. The goals are different. The working style is different. Well, obviously, you might say! But you only realize the extent of difference when you actually experience it. In a software company, despite all the complaints about the chaotic nature of the work and the schedules, there is a semblance of a plan, a structured team, defined deadlines, goals, deliverables.

In a startup chain of dialysis centers, there is no 'deliverable' as such. It is a continuous process of improvement, of catering to patient needs. There is no 'end point' as such. You have a few problems. You deal with them. Then the next set of problems comes up. There is not much scope for gratification at the end of a project like you have in software. After the successful execution of a project, there is celebration, a sense of catharsis, a time for relaxing. No such thing here.

What then is good about this?

Whenever I visit the center, I go over to chat with the patients that are getting dialysis there. I talk to them about how they are doing, how they are feeling and if they are having any problems. We usually have a heart to heart chat. I talk to them about the problems I might have had recently similar to theirs and how it got resolved. They give me tips about how they are dealing with the disease. I share my experiences. There is an immediate connect, an immediate feeling of empathy from both sides. I really like the time I spend with them.

There is one thing for sure. Only a dialysis patient can understand what another dialysis patient goes through. Not a nephrologist, not a technician, not a nurse, not a family member, not a best friend. Irrespective of any claims made by these people.

... http://www.kamaldshah.com/2010/12/what-i-am-up-to-these-days.html

I strongly believe that you should never do business with family. I try to avoid doing any transaction that involves money with a family member or a close friend. I try to avoid getting into any business or hiring a family member or a close friend for a business. I also try to avoid working for someone who is family or is a very close friend.

Money is a strange beast. However professional we are or try to be, money can corrupt. Us and others. I don't claim to be unaffected by it, either. It is the very character of money. Due to this, our minds play havoc with the relationship and many times, a good relationship is soured due to this.

Some would argue that is is actually good to involve family or close friends in business because it is very good to have someone you can trust. That is really a call you have to make. Are you ready to risk spoiling the relationship?

The converse is also true. Never make someone you have a professional relationship with as close as family. Never get too close with someone you transact financially with. It can mess things up.

When you are paying for some services or products and the expectation is not met, you need to have the comfort to be able to talk about it. This comfort is compromised when you have a close relationship. It works the opposite way too. When you provide services or products in return for money and you have a grievance, it is difficult to air it with someone close.

I am writing this from experience and have seen both these aspects play out badly in the past.

... http://www.kamaldshah.com/2010/12/mixing-business-with-family.html

As you know, I have been trying to figure out my dry weight. I really should have figured this out sooner. Yesterday shouldn't have happened.

I was about 4.2 kgs above my dry weight. I had not got enough dialysis the previous night. So, there was some fluid from the previous day that I had to remove. So, I told Jayaram to set the UF to 4.5 kgs to account for the half liter of water I usually have at night and keeping in mind that I had just had dinner, so about 300 grams was probably food.

As usual, for the first few hours, everything went well. Around 4:20 in the morning however, I started cramping. The familiar sensation of the calf muscles contracting involuntarily causing my feet to get pulled was mildly disturbing at first. These days, in the rare occasion of cramps, I don't wake Jayaram. I simply press my feet downward and it usually takes care of the cramps. That is what happened yesterday as well.

But a few minutes later, the cramping worsened. The pain was severe and my left calf muscles contracted really badly. No amount of pressure on the feet would release my calf muscles. The pain become unbearable quickly.

I started screaming. I woke Jayaram up and shouted out that I had bad cramps. I asked him to push my feet to release the muscle that had contracted so stubbornly. He tried and it worked. But only just. Within a few seconds, the muscle contracted again, this time worse than before. With every passing second, the pain was becoming worse. I was shouting out with pain.

Jayaram immediately opened the saline clamp and let some saline into my blood. It did not help. By now I was sitting up on my bed. No help. I asked Jayaram to give me more saline. He reopened the saline clamp and pumped in about half a liter of saline. I also stood up simultaneously, something I have never done on dialysis. There was immediate relief. The saline was giving my blood some volume which was loosening up the muscles.

In a few minutes, the saline helped relieve the cramps entirely. I settled down in my bed and slowly went back to sleep.

Dialysis ended about an hour after. I was feeling quite exhausted and drained. My fingers were feeling weird. The left calf was also very sore. I went back to sleep after Jayaram closed and left.

This was probably the worst incident in terms of pain that I have had while on dialysis. The blood loss incident was probably more dangerous but I did not have any pain or trauma. This incident was like going through hell for that short period of a few minutes.

Jayaram remarked that he had never seen anyone have such severe cramps ever. I thought how lucky I was that this happened when Jayaram was there. I have no idea what I would have done if I was alone that night.

... http://www.kamaldshah.com/2010/12/worst-ever-cramps.html

First Annual Ex Effigent Reunion

Date: 25th December 2010
Time: 9 a.m.
Venue: A farmhouse on the outskirts of Hyderabad

Click here and register asap so that arrangements can be made accordingly.

A voluntary contribution towards the expenses would be appreciated! Link available in the site above.

(Acknowledgements: M V Krishna for taking this excellent initiative!)

... http://www.kamaldshah.com/2010/12/first-annual-ex-effigent-reunion.html

Yesterday, as I was on my way from Grene to NephroPlus, I felt a familiar sensation. My head suddenly felt cold and I could feel tiny droplets of sweat on my head. I felt slightly giddy and weak. It wasn't very bad. But I knew it could get worse if I didn't do anything about it.

I asked my driver to go to a snack center nearby. I rushed in and ordered an Idli. It came pretty fast. I quickly ate the Idli and could immediately feel better. Not totally normal, but definitely better.

I then got dropped at NephroPlus and sent my driver to bring me a soft drink. I then sat down in a chair, set the air-conditioner to a comfortable temperature and took a few deep breaths.

Slowly, I regained composure and felt normal.

What was this? It could have been one of two things - hypoglycemia or hypotension. I cannot say for sure which.

Hypoglycemia is a condition where the sugars in the blood go down suddenly and you have exactly these symptoms. Diabetics experience this sometimes if they have taken too much of the sugar-lowering drugs.

Hypotension, on the other hand, is something which people lucky enough to be on dialysis sometimes have. Let's say you have been eating well and eating healthy food like sweets and fried food. Your weight increases. Now, when you go for your next dialysis session, this can be misconstrued as fluid weight and the good folks (aren't they all?) at the dialysis unit try to pull it off. Now, this results in the amount of water in the blood actually going below what it should be. This causes thickening of the blood and reduces its pressure.

This can result in the symptoms I had, as well.

So, knowing your 'dry weight' is key. I knew my dry weight had gone up a little but I was in a little bit of denial. I somehow wanted to convince myself that my daily swim is helping me reduce weight. What I did not realize is that my regular cola binges are not helping matters. Hence, the hypotension.

But then, if it was truly hypotension, maybe, I shouldn't have felt better with the Idli. But then, I did have cramps in the last hour of my dialysis and I also had a little bit of a cramp in my hand that afternoon.

So, I am really not sure what it was. All I can say is I really enjoyed the full bottle of Thums Up that morning!

... http://www.kamaldshah.com/2010/12/figuring-out-my-dry-weight.html