tag:blogger.com,1999:blog-60177238097304121412024-03-13T03:39:47.177-07:00Things people sayShravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.comBlogger64125tag:blogger.com,1999:blog-6017723809730412141.post-17589095059882427682021-11-13T10:33:00.002-08:002021-11-13T10:33:16.816-08:00Year 12 of Dialysis<p> I think that November 11 was the start of my twelfth year of dialysis. I've been back on hemodialysis during the afternoon shift, since April 2021 or so. I have a new shunt on my left arm, I hope it keeps functioning without problems for the next year. I've become completely paranoid about listening for the distinctive "bruit" of the shunt. <br /></p><p>The doctors keep telling me I am high on the list for a transplant, but no transplant seems to be in sight. I guess this has to do with the ongoing pandemic. So I've hunkered down and started to try to get through another long period of hemodialysis. So far, the side-effects of dialysis have been minimal: some loss of sensation in the chest, the development of breasts like a woman (just the left side!). Things could be a lot worse I guess.</p><p>The critical thing is to stay fit. I have a stationary bike at home and I do a lot of cycling, walking, Qi Gong, Tai Chi, and a bit of Shaolin Kung Fu. This combination seems to be good enough for keeping me reasonably fit. I gave up the gym in 2020, and never looked back. I find that as far as building up muscle strength in my legs goes, Qi Gong is surprisingly helpful, especially Shaolin Qi Gong.<br /></p>Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-52340908033196481232021-02-02T11:40:00.001-08:002021-02-02T11:40:12.539-08:00Year 11 of dialysis<p> Year 11 of dialysis began on 11th Nov 2020. The last time I blogged about my dialysis, I had just switched to peritoneal dialysis. That was June 2020 or so. Things haven't worked out well with peritoneal. For one thing, I've lost sensation on my skin, a result of nerve damage following insufficiently effective dialysis (due to the peritoneal dialysis not working as well as it should or could). I can't feel anything on the skin near my solar phlexus, and along both trapezoid muscles. Also, my left foot's sole has gone numb, and the right foot's sole is starting to go number too. Another thing that happened was this unexplained pain in the upper abdomen. The doctors did a lot of tests but found nothing. The pain is simply there, and the only solution doctors have offered is strong opiods to kill the pain. They seem completely uninterested in finding out why the pain occurs at all; in fact, my doctor told me that he thinks the pain is psychological and that I don't really want to do peritoneal dialysis. Another problem is this feeling of fullness in the stomach, which is either also psychological or has some physiological basis, but the doctors are not really interested in why I have this problem.<br /></p><p>The doctor advised me to switch to hemodialysis, which of course requires a new dialysis shunt, this time on my left arm because the right arm has been used up (too many operations). So last week, I had the shunt operation.I will now have to wait six weeks before the shunt is mature enough to work. Until then, I have to just put up with the pain and the feeling of fullness. A pretty unpleasant thing to be stuck with.</p><p>Initially, the idea was to keep me on peritoneal until I get a transplant. But now I will switch to hemo and wait for a transplant that way. The wait is expected to be another two years at least. Let's hope this second round with hemo is not as horrible as the first.<br /></p><p><br /></p><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-Lz8APzrcOac/YBmofmw7tuI/AAAAAAAAPEU/133FkOJB23QNhveu8dt8Od4lr1Vng06sQCLcBGAsYHQ/s1616/Photo%2Bon%2B02.02.21%2Bat%2B19.55.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1077" data-original-width="1616" src="https://1.bp.blogspot.com/-Lz8APzrcOac/YBmofmw7tuI/AAAAAAAAPEU/133FkOJB23QNhveu8dt8Od4lr1Vng06sQCLcBGAsYHQ/s320/Photo%2Bon%2B02.02.21%2Bat%2B19.55.jpg" width="320" /></a></div><br /><p><br /></p>Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-380909826152791112020-09-07T00:00:00.005-07:002020-09-07T00:00:07.573-07:00Statistical Methods for Linguistics and Psychology: Opening <iframe width="560" height="315" src="https://www.youtube.com/embed/bD4HoqQ76wk" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-50558476592972285602020-07-03T13:04:00.003-07:002023-04-08T08:03:50.676-07:00Year 9 of dialysis: Transition to peritoneal dialysis<div dir="ltr" style="text-align: left;" trbidi="on">
The last few months (March-July 2020) have been pretty life-changing for my dialysis regime. In the beginning of March, the surgeons decided to operate on my shunt in order to fix a narrowing of the artery; the danger was that the shunt would shut down. One problem solved, but a new problem created. A couple of weeks after the operation, I developed a high fever and shivering. Because it's corona time, I am immediately quarantined for a week until the test results show a negative result. They never figured out what the infection was, but they gave me antibiotics anyway, and the fever went down. Two weeks in hospital, and they send me home, continuing to give me antibiotics for three more weeks. Then they stop the antibiotics.<br />
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Three weeks pass, and then again I suddenly develop high fever (40 degrees celsius) and shivering. It's a Sunday evening, no doctor is reachable. I just call the surgeon's number just out of desperation...and the head surgeon is sitting in his office on a Sunday evening, so he picks up the phone. I explain what's happening, and he tells me to call 112. I call them (for the first time in my life), and two firemen arrive home. They do some basic tests and decide I might have coronavirus (again). So an ambulance is arranged (the firemen came in an ambulance, but they are apparently not allowed to take me to hospital, they were more like a medical team) and I am brought to my usual hospital, where I always end up.<br />
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This time, I spent four or so weeks in hospital (it's all a haze, difficult to reconstruct). The first week was just in isolation, just eliminating corona, and then the remaining weeks they spent trying to figure out what was wrong with me. Eventually, after a very laborious PET scan (had to be driven to another hospital for it), they figured out that my shunt was infected. Shunt must be removed immediately---major operation. Because this ended all possibilities of doing hemodialysis, they installed an emergency catheter in my neck for continuing with dialysis. This was only a temporary solution; either they would need to build a new shunt on my left arm (the right arm is "used up") or do something else.<br />
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The doctors decided to switch me to peritoneal dialysis. The reasoning is that my left arm is the last resort for hemodialysis, and they want to wait till I am much older before they use my left arm. For the next years, I have to manage some other way. <br />
<br />
Peritoneal is a very weird kind of dialysis: a tube is installed permanently in your abdomen (peritoneal cavity), and you put in 1.5 liters to 2 liters of fluid into the cavity four times a day, including overnight. The tube installation was done in another major operation (general anesthesia), and since late June I have switched completely to peritoneal dialysis. I have been doing it for a week now. The results are kind of mixed. The plus side is I never have to go anywhere to do dialysis; I can do it all at home or in office, just using gravity. I also feel much better overall; no fatigue from hemodialysis, a much more stable day. The negative side is I lose some 2-3 hours daily doing the procedure, which involves removing the fluid from the abdomen and putting in new fluid. Also, I am having trouble removing fluid from the body, but this is probably because it is early days and it's not clear yet which combination of solution concentrations to use. I'm hoping this will work out.<br />
<br />
Overall, this period from March to June has been truly hellish. The hospital was in corona-chaos both times, and I was kept in the suspected-corona-ward for a full two weeks. The patients I had to share the room with...the less said about them the better. No visitors were allowed, so I couldn't see my wife (she did visit me a couple of times, we took a short walk outside in a park). Even one whole month out from hospital I am struggling to pull myself together.<br />
<br />
I really hope this is over now and I can stay out of hospital.<br />
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Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-1108284831697979942020-04-08T02:03:00.003-07:002020-07-03T13:53:43.709-07:00The most depressing thing about living in GermanyWhat bothers me most about living in Germany is the Rücksichtslosigkeit, the lack of concern that one is inconveniencing others, that is deeply embedded in the culture. For example, these days I have to do dialysis in a big center, with five other patients in the room. Some of these people are sleeping (it's exhausting to do dialysis). And yet, one person is happily chatting, loudly, on their phone; this has been going on for at least 40 minutes now. They just don't care how it affects the others.
This behavior is not unique to Germany; but it is in stark contrast to the normal behavior in Japan. I have dialyzed many times in Kyoto and Tokyo, and not once has it happened that anyone would behave in such a manner. It's just unthinkable. I think it's this day-to-day consideration for the other that I miss most about Japan. There's much to like about Germany compared to Japan, and really on balance, I can't imagine living in Japan any more, not permanently. The quality of life in Germany is simply much better. But this aspect of German life really bothers me, and it's a mystery why nobody cares how others are affected.
This kind of attitude spreads to everything, car drivers, cyclists, people in the subway, even pedestrians. It just makes life just a bit more miserable than it already is, and unnecessarily so.Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-43959114898663557192020-03-28T05:57:00.001-07:002020-03-28T05:57:50.171-07:00Why I quit twitter<div dir="ltr" style="text-align: left;" trbidi="on">
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Yesterday I deactivated my twitter account. I think that in 30 days from now, the account will be deleted (or so it says on the twitter settings page, I hope they are not lying).<br>
I have been toying with deleting twitter for a long time. For a while twitter was very interesting. I also met a lot of interesting people, whom I then met in real life. I was also able to reach a wide audience for stats related papers, and for my students' research papers. If there were a twitter replacement for posting scientific papers, I would sign up. I guess google scholar notifications do that job, and blogs. I will post more on my blogs from now on. <br>
So there is a lot of positive stuff to say about twitter, but there always was so much noise, even if one only follows stats-twitter. One also encountered a lot of truly crazy people. But what tipped me over was the recent crisis. This crisis resulted in everyone becoming an infectious diseases expert, posting advice and "useful" graphical summaries. Another weird thing that happened was that people started to whine. Their perfect lives had been ever so slightly disrupted. They couldn't do their Caribbean vacation, they couldn't go have a beer with their friends, they couldn't meet their relatives. Meanwhile there are people out there with serious life-threatening problems. This whole lot of people were just so...revolting. I decided to socially isolate myself from them. I even knew some of them well and liked them, but I realized I don't need to know how weak these people are mentally, and how spoilt they are by the luxury of good health and a basically normal life. <br>
Discovering how much people are going to start whining if they experience even the slightest inconvenience is a bit like when you have known a friend for a long time, and you then suddenly discover something really unpleasant about them. Twitter delivers that kind of information about people, especially during this time. <br>
Perhaps deleting twitter will give me a chance to re-set my life and develop a more inward-looking life, without any outside noise. I will continue to post cat pictures in my google photos album. I I will link to it from my home page. Because my cats deserve a wider audience; they are so wonderful.
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com2tag:blogger.com,1999:blog-6017723809730412141.post-35965535221123490632019-03-07T20:48:00.003-08:002019-03-07T21:22:11.657-08:00A new kind of dialysis hell<div dir="ltr" style="text-align: left;" trbidi="on">
I think it's fair to say that modern hemodialysis in Germany generally allows for a fairly normal life. I go for night dialysis, I sleep comfortably in a hospital three nights a week with two needles stuck in my dialysis shunt all night, and then I am woken up at 5:15AM and disconnected from the machine. I'm usually home by 7AM. Occasional drama occurs when my shunt starts to bleed after the needles are removed, but even this is fairly controllable, if a bit messy.<br />
<br />
But no more. Now I've entered such an endless, dialysis-induced hell that I sometimes feel that I am getting payback for some old crimes from a previous life, like in Hindu karmic theory.<br />
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It all began in January 2019, with me coming home on a Saturday morning from a dialysis session. I lay down to rest at 8AM or so (I tend to sleep a few hours to recover from the night dialysis; dialysis is exhausting even if you sleep through it). Then I woke up at 10:30AM, I reflexively touch my dialysis shunt to feel for a pulse and the characteristic <i>bruit</i> or <i>thrill</i>, the whoosh-whoosh of the shunt under the skin. Normally, I can just feel the thrill by putting my finger over the shunt. Now, there's nothing. I pick up the stethoscope to check, maybe the pulse is weaker today and so the bruit can be heard but not felt with the fingers. Nothing. Shunt has shut down again. So I pack my bags and rush to emergency. When you rush to emergency for a shunt shutdown they take their time to process you, in my case some six hours. Finally, in the evening of that Saturday, they operated on me. It was a painful operation, with local anesthesia, but it was over in an hour. The surgeon says to me, this time you'll last out at least a year. Great, I think, I hope you're right.<br />
<br />
Two or three days later I develop a high fever (40 degrees C), shivering. This fever develops suddenly during the night dialysis, so I'm directly sent to emergency at 5:45AM. They again take their time to process me, and then eventually admit me to one of the nephrology wards. Twelve days pass in hospital, the long duration is just so they can give me an antibiotic intravenously. Proteus milabilis bacteria in the blood---a sepsis has developed. The cause is unknown; how can bacteria, that normally benignly live in the intestine, end up in the bloodstream? After a lot of tests (heart ultrasound, full body CT scan), the doctors take a guess: it's my father's kidney and it's infected. This guess is based on elimination; they couldn't find a focus for the infection so they came up with the only plausible thing they could think of. My father's transplanted kidney is lying a bit to the right of my belly button and has been non-functional since 2011. So the head doctor instructs me to get the kidney removed as soon as possible. I get out of hospital and organize the kidney removal operation at Charite-Virchow hospital, where I am scheduled to, some day, get a transplant. I contact the transplant team there, and they set me up with the head of transplant surgery. The head surgeon gives me 1st/2nd April as the date for the operation, which has various names like explantation and nephrectomy of the Transplantatniere (learnt a new word, the German for transplanted kidney). So I thought, OK, at least we know what happened and things are back to normal. But no.<br />
<br />
A few days later, I notice a "boil" on my shunt. It's like a soft skin bubble with a reddishness on it. Doesn't look good. I go for my regular night dialysis where I see the doctor once a week. He takes a look, and says, oh they forgot to remove a stitch. He removes it. Just keep an eye on that boil he says; cover it up with tape and let me know next week if it isn't gone. So a week goes by with this boil implacably sitting on my shunt, not changing. The next week I show it to the doctor (a different doctor, they keep rotating), he says the same thing, keep an eye on it. Now, I've had this boil on my shunt for 10 days. By chance, I have a follow up appointment in the shunt surgeon's appointment the next day. The surgeon looks at the boil for all of one second and says, "The shunt's infected, I have to operate right away. Get ready, because this is a big operation; I will cut out that part of the shunt entirely and we have to do it under full anesthesia this time". Then he says: "this time, after the operation, your shunt could suddenly start bleeding. Do you know how to stop a shunt from bleeding?" I say no. He says, "just press down real hard on the artery, it'll stop the blood flow completely." Great. Learning a new skill in real time.<br />
<br />
So what I thought was a casual follow-up visit to the surgeon lands me immediately in emergency again. This time things go fast, the anesthetist comes in to tell me all the different things that can go wrong in the next hours. I'm like whatever, it's not like I have a choice here. The operation itself lasts some two hours and I find myself lying, groggy, in a recovery room. The surgeon quickly walks in and tells me what he did, but I am so dazed I am not sure if I dreamt it or if he really was there, and I don't even know which surgeon talked to me. I know now that they cut out 5 cm of my shunt, which was in fact infected with proteus mirabilis, and replaced it with a "transplant" tubing made of some kind of implantable material. There are huge swaths of tape coated in blood all over my upper arm, lots of cutting has taken place. So I lie in the room throwing up periodically (side effect of the anesthesia). There's a slow bleed in the shunt but it looks like the normal postoperative seepage, there's even a drainage pipe coming out of the shunt to draw out the blood, like they have in bigger operations. It's being collected in a bottle. <br />
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Some hours later, the nurse comes in and says, "hey, we are moving you to a room with two other people. I should warn you though that it's going to be unpleasant." Then she smiles and winks at me. I say, unpleasant how? "Wir lassen uns ueberraschen", says she, again with a smile. Let it be a surprise. At this moment I realize why the Germans just <i>had</i> to invent the word <i>Schadenfreude</i>. It's an integral part of the culture. They simply enjoy watching others suffer, it's part of the fun of being alive. <br />
<br />
And a surprise it is. I am wheeled into a room with two nearly dead old men. Both are in nappies and both are unconscious. As I learn in the next days, one of them has some kind of fecal bag coming out of his stomach, which periodically leaks after it gets overfull, and has to be changed. Thus I enter into a hellish new period of my dialysis-induced problems, spending time in this room. It smells so horrible here amid the shit and the piss and the shadow of impending death that I step out and get myself a couple of face masks and keep one on all the time. Up until this time I am still holding up, trying my best to keep calm and get through this. I get one single-needle dialysis on Friday and I spend the weekend sleeping and in recovery, with a hugely swollen right arm.<br />
<br />
But then, the next Monday, they take me for dialysis within the hospital. This is a different dialysis center than my usual night dialysis place, but in the same hospital. The male nurse who is assigned to stick the needles into my arm decides unilaterally that if he sticks the needle deep enough into my arm, he'll get to the shunt magically, ignoring me completely when I say that no, the shunt is right under the skin. So he pierces my shunt through and through and goes deep into my muscle in the arm, and I am crying out loudly in pain and asking him---actually, begging him---to stop. I tell him, you've punctured right through the shunt, stop pushing the needle in. His response: "Herr Vasishth, bitte." He thinks I'm engaged in theatrics and drama. One other nurse watching us is actually <i>laughing</i> at the sight of me crying (I mean, I am weeping at this point, with tears streaming down my face); she thinks I'm just over-dramatizing the whole thing. Eventually, I tell the male nurse, just pull out the needle, I will put it in myself. That is enough motivation for him (he doesn't have to do any more work any more), and he finally pulls out this needle that is causing such excruciating pain. I get a new needle from him and stick it into the shunt within about two seconds, without incident. If he had listened to me when I told him where to insert the needle, he would have managed it too. All the nurses around me are now silent and nobody is laughing any more. They don't see many patients puncture their own shunts in this dialysis center because most patients are very old and very sick here. I guess they are embarrassed that I could do something the male nurse struggled and failed to do a few minutes ago, professional nurse that he is. Anyway, now I am bawling like a baby because the pain is still very intense from the failed needle insertion. They bring me some pain medication to shut me up with my theatrics. And that's the end of that episode.<br />
<br />
But this disastrous dialysis episode really left me shaken. First having to share a room with such sick people, then this. It was all too much sensory overload for me. I am anyway oversensitive to smells, sounds, light, pain. I just couldn't take this any more and needed some reduction in stress. So I ask my ward head nurse (the one who wanted to surprise me) to please find me another room to move to that is not so horrific as the current one. She says, absolutely not. It is what it is. I go into the visitors room and sit there and cry for a full hour; I just can't take this any more. I considered jumping out of the window, but I'm just on the third floor and if I fall and don't actually die, I'll just make my situation worse. Besides, my wife is about to come over and she would have a hard time finding me if I've jumped out of the window. At one point someone from the kitchen staff walked in and asked me what was wrong. I should have said, Everything is wrong. But I just waved her away. I think news got to the head nurse that I was sitting there just crying silently, because within an hour she has mercy on me and moves me to a more reasonable room. Here's the thing: the head nurse could have said, I'll do my best and get back to you, when I asked her to move me. Because patient throughput is such that statistically, she should be able to find me a more tolerable place to move to. But she did the second thing (other than this Schadenfreude thing) that is typical of Germans: just say no. Never say, I'll see what I can do.<br />
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One week has gone by by this time. Then the head doctor comes over and I ask her, when can I go home. She says, you have to stay another week so we can deliver the antibiotic into your bloodstream. I look so shocked that she says, you know what, we'll send you home tomorrow. You seem like you understand the situation and we can trust you to take the antibiotics yourself at home for the full course. And that's how I escaped from hospital.<br />
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I'm still getting nightmares about the male nurse pushing the needle right through my shunt deep into my arm (that's why I am up so early writing this all down to get it out of my system). I have two ugly, angry hematomas in the shunt from all ther internal bleeding he induced with his incompetent needle insertion. I just hope the shunt is not permanently damaged.<br />
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I hope this current cycle of problems is now over and that this newly reconstructed shunt now works without problems. I am currently celebrating every 60 minutes that I spend out of hospital. It feels like a miracle just to be able to walk down the street, to make one's own coffee, to eat my wife's delicious food, to kiss my son good morning or good night, to lie in one's own bed, in complete silence with no fecal matter smell in the air. No sounds of people shouting out loudly "Schwester, Schwester" all through the night. It's paradise.<br />
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Next hospitalization is on April 1, for the explantation of my father's kidney. It feels strange that a piece of living tissue from my body that belongs to my dead father is now going to be just cut out and thrown away into the garbage like a piece of trash. Somehow I feel I should try to arrange for a cremation of my father's kidney. It accompanied me through the most crucial 25 years of adult life, and this kidney made it possible for me to have a life. But I don't know how to arrange this with the hospital. They will probably think I am insane.<br />
<br />
</div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com1tag:blogger.com,1999:blog-6017723809730412141.post-24294069827679841952018-11-11T03:33:00.002-08:002018-11-11T03:33:33.455-08:00Year 8 of dialysis, 0 to 6 more to go<div dir="ltr" style="text-align: left;" trbidi="on">
Today is the start of the 8th year of dialysis. 2018 has also been an eventful year. First, I broke my left wrist in a bicycle accident and ended up getting an operating to put a T-plate on the broken bone. That was a big drama that took away five days of my life, stuck in hospital, and just before the start of AMLaP right here in Berlin. The broken wrist meant I could not do night dialysis any more (because I have to press the holes in my shunt with my fingers once the needles are pulled out, and in the night clinic the patient has to do this him/herself, as the nurses are on a tight schedule and can't assist), and had to do day-time dialysis (Mon-Wed-Fri) in the regular clinic rather than in the night clinic. This was a horrible experience in itself, because I had to put up with other patients, who are usually total assholes. For example, one guy (Turkish, Arab, not sure) would play music on his phone without headphones, so everyone else has to hear his crap. I told him to stop it, and he turns to me and says in broken German, "What the fuck is your problem? Why don't you go and dialyze somewhere else if this bothers you?" That's the typical dialysis patient for you here in Berlin. The city attracts total jerks.<br />
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Then, because I could not press my shunt after the needles were removed, they used a kind of tight bandage to stop the bleeding. This in turn led to a shunt failure. I noticed one night at midnight that my shunt did not exhibit any "thrill" any more---this is a characteristic whoosh-whoosh sound that you can even feel by putting a finger lightly on the shunt. I had to pack my bags immediately and go to emergency. I spent the whole night there awake and freezing, waiting to be assigned a bed, and then they operated on me around 11AM the next day. So that was dramar number two. I can't remember how many days I spent in hospital this time, but it was a long time. It wasn't fun enduring a patient in the same room as me who watched TV all night.<br />
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Then I finally got out of hospital, and am back to nearly normal life, with (thankfully) night dialysis back on the table. The transplant looks like it's still far away. The doctors say I am still somewhere between 0 and 6 years away from getting a kidney. Waiting times are getting longer and longer in Germany because almost nobody is willing to be an organ donor, and the government is unwilling or unable to change the law to a default opt-in for organ donation. So, situation normal, all messed up. </div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-69765047337684144482017-12-20T22:52:00.000-08:002017-12-20T22:52:28.606-08:00Year 7 of dialysis, four more to go<div dir="ltr" style="text-align: left;" trbidi="on">
On November 11 2017 I started the seventh year of dialysis. This last year has been a complete mess. Four shunt operations in the last 12 months have left my shunt pretty much at the end of its life.<br />
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The shunt still works, but I have a very narrow band of skin left that is still puncturable, and I have to keep inserting the needle from further and further away, which means piercing fresh skin (very painful, especially when I hit a bundle of nerves). This will go on for another two years now. To make matters worse, the current shunt is showing signs of weakness, which means I have to go see the surgeon again, which means I might again end up on the operating table.<br />
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Maybe I should bite the bullet and get a new shunt; the only downside is that at least currently I plan to get transplanted when my time comes on the waiting list. It seems like a waste to get a shunt now. So my best hope is that my shunt just keeps working another four years. If it fails, I will have to get an emergency catheter and then a new shunt. Let the chips fall where they may.<br />
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Dialysis itself seems tolerable; I could go on like this till the end of my life. There are nights with serious pain (when I hit a nerve) but in general, life could be a lot worse. And despite all my complaints about Germany, health care here is the best, one couldn't ask for more. I really dodged a bullet moving out of India when I did.<br />
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Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-81113563035485271232017-11-16T08:51:00.001-08:002017-11-16T08:51:48.718-08:00Shunt operation number 4<div dir="ltr" style="text-align: left;" trbidi="on">
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So, the last time (August 2017) the surgeons decided to operate on my shunt because it was becoming too narrow. This operation was successful, but it also had the effect that my shunt volume increased dramatically, a blood flow of 2-3 liters per minute. In the long run this would lead to heart damage, so I requested a shunt narrowing. And that's what this fourth operation was about.<br />
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The operation itself ran for two hours, nearly, and was the most painful one I have experienced in the last 6 years. It was again under local anaesthesia (on my request), but this time I could feel all the pricks and cuts and kept crying out in pain, and in response they kept pumping my arm full of anaesthetic (what's the English for lokale Betäubung?), to the point that I lost all sensation in the entire hand for maybe one day.<br />
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So the operation was particularly hard this time round. They installed some kind of plastic tubing in the shunt to by-pass the main blood flow (something like that), thereby reducing blood flow. I hope that I can now catch a break in 2018, and can be operation-free for some time at least. The surgeon warned me that my shunt was in its last stages, and in about two years they will have to build a new one. Let's hope the surgeon is wrong and that this shunt will keep going for another four years, the period of time I need to wait before I get a transplant.<br />
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I ended up in hospital for a whole week this time, usually it is only two days. This was the most horrible part of the whole experience. My neighbor was a guy who had diabetes, and had lost his eyesight, kidney function, and part of his foot to gangrene---all known consequences of uncontrolled blood sugar in diabetics. What was weird was that he didn't seem to understand that his foot no longer functions, and he kept walking all over the room with his amputated foot, leaving a gruesome trail of blood wherever he went. He still had gangrene in his foot, and I assume more amputations are coming, but he was oblivious to the crisis he was facing. He had lots of sugar with his tea, and all deserts and meals that the hospital offers (disgusting, unhealthy German crud, more on that one day).<br />
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The worst part of this experience was not even being in the same room as a guy with gangrene and a bleeding, amputated foot. The worst part came when the doctor sauntered into our room, my fifth day with this guy, and told him: "Congratulations! I have good news! You don't have tuberculosis!"<br />
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What would have happened to me if this guy had had tuberculosis? How did I end up in a room with a suspected case of TB?<br />
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Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-2710928922471220792017-08-04T03:52:00.002-07:002017-08-04T03:52:27.343-07:00New shunt operation in the land of the half-assed way of doing things<div dir="ltr" style="text-align: left;" trbidi="on">
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I just came back home from my third shunt operation of the year (if memory serves). This time they fixed a narrowing of the shunt in my underarm by installing some kind of stent that widens it. One more operation is due, because now too much blood is flowing through the shunt. This time the operation wasn't as painful as the last time round and it seems everything to do with the operation went smoothly. It was over in one hour, with two surgeons operating. As usual I did this with local anaesthesia, but one of the surgeons warned me that they might have to switch to full anaesthesia if they had to go deeper into my body. Thankfully that didn't happen, otherwise I would have been throwing up all over the place after the op.<br />
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One thing that continues to annoy me is the sloppy attitude of German medical personnel. A previous time that I was admitted there, the person taking my blood let the bare needle fall on my bed and was about to put it into my arm before I stopped her and asked her to use a new needle.<br />
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This time (I think it is the same person, a doctor), the doctor just grabbed some hand disinfectant liquid that's available at the entrance of a room, and dabbed it on a cotton swab, and then dumped the cotton swab face down onto a non-sterile surface, the side table which had just had my lunch on it. Then she cleaned the spot she wanted to draw blood from by using this swab, using the swab's face that had come into contact with the table. In the meantime, she dumped two cotton swabs onto the table, and after drawing the blood bundled them up and put them on the spot on my arm that she had drawn blood from. She's a doctor, she should know better than to take such a risk by not following protocol. I think it was the same person the previous time as well, I had thought she must be some rookie nurse, but now I think it was this same doctor. What she did was an improvement on another doctor at Charite who, back in 2011 or 2012, didn't even bother to disinfect my arm before sticking a needle in. I had complained about that to my nephrologist back then but my doctor just shrugged and said he knew that doctor at Charite, he had briefly worked for the nephrologist and been fired quickly afterwards from the dialysis center.<br />
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I notice this general tendency towards sloppiness in all of German culture; in this respect, Germany shares a lot with India. The way they run their trains (compared to Japan), the way they run their hospitals, telephone companies, universities, everything. Germany is the land of the half-assed approach. Germany does day to day bureaucracy well, but that's about it. They are good at being bureaucrats, they are not good at doing things right.<br />
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It is ironic to think that I survived years of dangerous medical care in Delhi, only to end up in an advanced western country where the same careless practices happen as back home in uneducated, underfunded India. It will be very funny if I end up being done in by German medical care, having escaped intact from India, although my wife and child will probably not see the humor in the situation.<br />
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Maybe all medical care is like this everywhere. It's hard for me to judge because whenever I go for dialysis to a European country or Japan, or the US, or southern Germany, I find superior adherence to protocol than I see in Berlin. Maybe it's a Berlin thing, perhaps we need a name for it. How about the "geht schon" attitude? I hear that phrase a lot when someone is about to break from protocol.<br />
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There is something I can do about this, however. I found out how to register a complaint to the hospital, and I will, and the next time I am going to be an asshole and tell the doctor to stop doing what she is doing and draw blood using the correct disinfection protocol. I was just not ready to confront the doctor this time, but next time I will be mentally prepared. I have to rehearse the language in advance so I don't insult them, but I still get the formal rigour that I want from them.<br />
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<tr><td class="tr-caption" style="text-align: center;">Shunt operation site.</td></tr>
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Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-65620173515179170492017-04-13T12:32:00.000-07:002017-04-13T12:32:25.264-07:00I have a philosophical objection to falling sick or dying due to a stupid, avoidable errorBack in hospital for a routine shunt angiography, a nurse comes in to draw blood. She takes out the needle from its sheath, and accidentally drops it onto the bed. The exposed needle has now made contact with the surface of the bed, where I have been sitting for 15-20 minutes. What is the correct procedure here? It doesn't take 10 years of medical school to work it out: you replace the needle with a new one. But no.<br />
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The nurse proceeds to pick up the needle to put it into my vein. I stop her and ask her if she can use a new needle, and she immediately says, "sure", and replaces it.<br />
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What could possibly happen if she had put the needle into my vein? It's possible nothing would happen. As a nurse once casually informed me when I complained about lack of hygiene in a Berlin dialysis center I used to be at, whether one would get an infection in such situations really depends on how many bacteria are entering your body. This may well be true. But, if there is an avoidable source of infection, is it not reasonable to avoid it?<br />
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If, instead of nothing happening, I now get an infection that knocks me out for some weeks, or I get an infection that kills me, if all that it takes to avoid that rare event is that the needle be replaced, is it not worth doing it? Clearly, the answer for the nurse was, fuck that, I'm too damn lazy to now go get a new needle that's one meter away from me. For the nurse, it's just another day in the workplace, *she* will go home to her family, *she* will not have to pay any price for her mistake. The risk is all mine to take.<br />
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My impression is that German nurses and doctors are especially casual about hygiene in a medical setting. In Japan, the UK, France, Sweden, the US, the standards are much, much higher. There are stringent rules about disinfecting the hands even before one puts on gloves; this is unheard of in Germany. A doctor at a dialysis clinic in Berlin once yelled at me when I mentioned that there was an infection risk if nurses didn't disinfect their hands. Her argument: the clinic has a zero infection rate so the current procedures are adequate, and besides it's not reasonable to require that medical personnel disinfect their hands every time they move from one patient to the next, it's just too much work.
The patient must pay the price for this casual attitude.<br />
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I have a strong objection to all this: I don't mind dying as a result of an unavoidable situation. The heart can and will eventually fail. A deadly infection that you get by chance that ends your life. An accident on the street ends your life. I can live with all these ways of dying, so to speak.
But, on principle, I have a strong objection to having to incur risks just because of situations like a nurse being too sloppy to replace a needle she has dropped on the bed. I understand fully that nobody gives a rat's ass what my position on this important issue is, but here it is, for the record.
Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-21565826783696202712017-02-23T00:06:00.002-08:002017-02-23T02:02:57.036-08:00Dialysis shunt shut-down<div dir="ltr" style="text-align: left;" trbidi="on">
When I first got my dialysis shunt in mid-2011, I received clear instructions on paper to check every day, several times a day, with a stethoscope, that the shunt is still working. When a shunt is working, it has this unmistakable whoosh-whoosh-whoosh sound. The instruction was to go to emergency if I don't hear that sound.<br />
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In the beginning, I was rigorous about checking shunt function. After a few years of largely uneventful dialysis, I became complacent. I eventually paid the price for this complacency. Last week on Wednesday night, I went for my regular overnight dialysis, and the nurse came around and got ready to puncture the shunt. Lately I haven't been doing the puncturing myself because I just got operated on for an aneursym and it's now much more difficult to insert the needle myself: due to the operation the shunt has been embedded deeper inside the arm and it takes a lot of force to pierce the needle into the artery and I don't feel confident doing that (yet).<br />
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So the nurse simply stuck the needle in... and nothing happened. Normally, when a needle enters the shunt, a gush of fresh red blood appears in the tubing attached to the needle. It pulsates strongly because of the pressure in the shunt. That's how you know you are in. But nothing. Thinking that she had missed the shunt, the nurse moves the needle around under the skin (this is very painful because she has to change the direction of piercing under the skin--the sharp needle must be ripping through the muscle and tissue) and a bit of blood appears, but it's nearly black and not pusating at all. That's when the nurse realized that the shunt was not working.<br />
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It seems that my shunt had shut down sometime between Tuesday morning, when I finished my last dialysis and Wednesday evening, and I had no idea when. I had felt some pain and distension in the shunt, but it was consistent with the usual pains associated with the shunt, so I didn't bother to look more closely. I had gone about my usual work on Tuesday and Wednesday, when I should have been in emergency getting the shunt reopened.<br />
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So this is now 10PM and my shunt is down. I have three liters of fluid that have to be removed from my body so dialysis is urgently needed. The nurses then sent me to emergency one floor below (the night dialysis is in a hospital). The nurses there were quick to do an EKG, and blood tests to establish potassium levels. They decided the potassium was too high and gave me a battery of medicines to reduce potassium levels, and stuck me in a hospital room for the night. I've never had a shunt shutdown so this was a terrifying experience for me; I had kind of expected that they'd operate on the shunt immediately that very night, but no. It was some 12 hours later that I was scheduled for an operation. All this time the shunt is just not working. What's happening to the blood that's stuck in the shunt? It must be festering, because stagnant blood is just like flesh. I have no idea how bad the situation is, so I'm just lying there in the hospital bed the whole night, anxious.<br />
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The operation happened around 10:25AM and lasted an hour. I opted for local anaesthetic as always; these operations are really painful but getting general anaesthesia means you pay a price later. I generally throw up a lot and recovery takes longer. It's just too expensive time-wise to get general anaesthesia and I always opt for the more painful but faster option. However, this operation was way more painful than any shunt OP I have had in a while, and I think this was my sixth shunt operation. The thing with pain is that it flows through you and takes over all your ability to feel anything else; you only feel the pain and nothing else impinges on consciousness. In that sense, it's possible to tolerate even high levels of pain, if you treat yourself as an observer. But it was harder this time and eventually I was crying, silently. Not sobbing or anything, I just had tears streaming down my face. This seemed to upset a nurse passing by much more than it upset me---if crying gives my body an outlet and gives relief, why not? It's a natural reaction. But the nurse felt horrified that I was crying, and came and stood by me and hold my free hand. Strangely, that led to an increased stream of tears. I suppose that any human contact magnifies one's emotional response. Is crying such a rare response on the operating table, I wonder? What do other patients do? Maybe they are all opting for general anaesthesia. The surgeon asked me if I feeling any pain and I said yes, but I told him to keep going because I could tolerate it. But the other nurse standing by him found that outrageous and said it would be inhuman to make me endure pain and they injected more local anaesthetic into the arm. I don't really understand that. If I can tolerate the pain, in the sense that it doesn't make me cry out loud, it should be OK, no? There's no need for more anaesthetic. But apparently the doctrine in medicine is, no pain whatsoever.<br />
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The surgeon was the same one as for the aneurysm; a very competent guy. Within an hour, after much painful cutting and pulling and shearing, he had the shunt working again. I learnt later that my shunt had shut down due to calcium deposits blocking it. They literally used a sucking device to pull out the calcium from the shunt (I could hear it, it sounded like a vacuum cleaner).<br />
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So, the shunt is working at 11:30AM on Thursday, and, amazingly, I was dialysed through the shunt at 2PM, right there in the hospital. I thought this was nothing short of miraculous.<br />
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The hospital stay lasted four days while I recovered from the operation. I was put in a room with two other patients. Unfortunately for me, one of the patients had a cough and running nose that eventually proved to be the influenza. This came back to bite me later.<br />
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Saturday they sent me home, and told me to get re-admitted to hospital on Tuesday morning to get a follow-up shunt angiography. This involves sticking a large catheter into the shunt and injecting iodine and then watching the flow of the iodine through some kind of x-ray type of machine. They wanted to establish whether the shunt had some dangerous narrow spots. When it does, they can use a balloon catheter to widen it. The angio is not a big operation, but one has to stay overnight in hospital. So I ended up spending Tuesday night in the hospital. By this time, I have a cough and the sniffles as well. The doctor takes one look at me and quickly decides I must have the flu as well because I had been in the same room with the guy with the flu, and puts me into strict isolation <i>in the same room with the</i><i> guy who has the proven case of the flu</i>! I had a strong feeling that she was wrong about the flu, so I took matters into my own hands. I was stuck in a room with a guy who has the flu, I probably just have a common cold. If I breathe the same air as him (he was coughing non-stop) I would probably get the flu as well. I was inoculated against the flu but it seems the injection failed this year. So my solution was to ask the nurse to give me one of their heavy duty masks that they wear when dealing with infectious patients. She gave me one, it was a massive mask that covers the whole mouth and it's not so easy to breathe through it, but it's not impossible. I spent the whole night lying there with the mask on while my neighbor alternated between snorting, snoring, and coughing right through the night. I could block out the astonishingly loud sound mostly, through my trusted Bose noise cancelling headphones, but I didn't get much sleep because it was so hard to suck in air. But I wasn't willing to risk getting the flu on top of my cold so I was disciplined enough to hold on. At one point I must have dozed off and in my sleep removed the mask; so I was exposed for I don't know how long. <br />
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Anyway, I'm home now and recovering from this harrowing experience. Could I learn something from this? I think that I could have reduced the shock of having to go to emergency in the middle of the night, and a lot of the attendant unpleasantness if I had continued to be rigorous about checking my shunt's operation two or three times a day as instructed. At least I would have gotten to emergency earlier and would be in control of the situation rather than being buffeted about by the surprise of a shunt shutdown. It seems to help me a lot psychologically if I am being proactive about the problem rather than being pushed ahead by factors out of your control.<br />
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The second lesson I learnt is to always have a supply of heavy duty sterile face masks at hand. I am going to order them from the pharmacy later today. The next time I'm in hospital I am going to keep the mask on all the time. I may even use it when traveling on the train to work when the infection season is on (like right now). <br />
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PS The ironic end (?) of this story is that I <i>do</i> have the flu. The initial diagnosis was right. I only learnt this when I called my doctors to tell them that the hospital had given me the wrong dose of Tamiflu to take home. They said: "you have the flu, the hospital just informed us; the hospital should have never let you leave for home". The strange thing here is nobody thought to call me and tell me this. I have now exposed my son and wife as well to possible infection. I just don't understand how the medical world functions. My doctors also told me to get a face mask to protect others from getting my infection. So I send my wife to the pharmacy to get the same mask they gave me in hospital, the 3M Aura 1862+. It seems this mask is not for sale to ordinary citizens. Even if one were to order it from the wholesaler, bypassing the usual routes, it would take 10 days! On amazon.de it is available right now however, it costs a whopping 90 Euros for 20 masks. We have asked the pharmacy to get whatever is appropriate for the current situation.</div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-48785373547553569592016-12-29T14:39:00.001-08:002016-12-29T14:39:12.281-08:00Kidney transplant: yes or no?For a long time I have been thinking about what I am going to do when the time comes for me to decide whether to get a kidney transplant. I have another 5-6 years to wait so there is no real hurry, but I still need to have put thought into it. If I talk to a transplant surgeon or a nephrologist, they have no hesitation in arguing for a transplant. However, none of these people have any personal experience of living with a transplant. I have 25 years' experience. It's a nightmare. You have to constantly be under stress about your blood values, you are in a doctor's office every few weeks getting a blood test (and then the excruciating wait till the results are known), the occasional, random increases in creatinine stressing the hell out of you (is this the end?). You have to take immunosuppressives, and they make you catch infections all the time. Transplantation just replaces one problem with another set of problems.<br />
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But yesterday I talked to a nephrologist who gave me a much more sensible criterion for making the call. He told me that <i>for my specific case</i>, i.e., for my individual and particular situation, it makes sense to hold out for a good quality kidney. Then he defined good quality for me: from a young, healthy person, non-smoker, does not take too long to get to me, has a good match. When I get the phone call, I will be allowed to ask the surgeons whether these criteria are met before deciding whether to say yes or no.<br />
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This doctor's advice was to just say no if the kidney didn't meet the criteria, and wait for the next one. And if the kidney met these criteria, I should take the chance and get a transplant. I think this makes a lot of sense: I can maximize whatever gain I can get by a transplant by getting the best possible kidney I can get. Until then I am just doing fine on dialysis. I feel much less stressed about this now.<br />
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This is the first time a nephrologist or surgeon has given me anything other than an unconditional "yes" answer. I think that doctors need to think harder about their patients and their particular situation and give more informed advice than they generally do. Just giving a patient an oversimplified answer is more harmful than helpful.<br />
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<br />Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-51868110331815291152016-12-26T00:01:00.000-08:002016-12-26T00:01:00.873-08:00Shunt Revision [Warning: blood-drenched photos of shunt]<div dir="ltr" style="text-align: left;" trbidi="on">
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So I just got home yesterday from a four day stay in hospital, following what the Germans call a Shunt Revision, which I guess translates to shunt repair. I had developed an aneurysm in the shunt, and it had to be urgently repaired because there was a danger of the shunt just breaking open. It is an interesting academic exercise to think about what would happen if it did: I have five liters of blood and the rate of flow in my shunt is one liter per minute. This time round we didn't get a chance to test the outcome empirically because the surgeons quickly operated on the shunt and (hopefully) fixed it.<br />
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The OP was done under local anaesthesia under my request. This is my ninth operation. I don't like general anaesthesia and avoid it when I can. It's dangerous and I suffer much longer if I get general.<br />
I guess I will save the next general anaesthesia operation for my next kidney transplant, imminent in 5-6 years. The price I had to pay for local was hearing them cutting into the shunt and a certain amount of pain when they pierced the shunt with various sharp implements. However, I have read somewhere reliable that pain is largely in the mind. This seems to be true. When you feel pain, you can stop to observe it objectively like an outsider. If you just let it wash over you and treat it like an exercise in observation, it doesn't have as much of an effect on you as when you react to it, as we reflexively do. I would say the pain during the OP was bearable, much less than a toe-stub, and certainly less than certain nights when I accidentally hit a nerve when I insert the needle into the shunt; on those occasions, I have to suffer 7-8 hours straight and no psychological tricks can get rid of it (falsifying my earlier statement that it's all in the mind---maybe I just haven't figured out the right trick yet).<br />
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The operation itself went smoothly, the surgeons were super-duper relaxed guys who talked non-stop during the one hour procedure and it felt like they were sitting around at at a coffee table and just chatting about inconsequential stuff. I was really impressed at how these guys can do such complicated procedures so effortlessly. I cannot even understand how one can do such an operation: they opened up half my shunt and then stitched it up again, without my losing much blood. How?? My shunt gushes out blood like a fountain when I insert or remove needles. How can one just cut open the shunt and control bleeding? Sure, they used a clamp to prevent the artery from delivering blood. No big deal. But they had to stitch together about 6 cm of opened up shunt, and stitch it so well that no blood would come out. Or almost none, as you can see below. At one point I did feel a gush of blood just flowing out of the shunt and pouring out like a shower onto my arm, but the surgeons continued to sound completely cool and relaxed, and it stopped pretty quickly.<br />
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<tr><td class="tr-caption" style="text-align: center;">Right after the operation</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">An hour or so later</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Several hours later</td></tr>
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It was really remarkable how little blood came out over the next 12 hours. And the next day I was dialyzed in the hospital with a single-needle procedure, using the shunt!!! It feels like an amazing feat of surgical skill to open up a shunt, fix it, close it up, and then use it the next day like nothing happened! <br />
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It's awe-inspiring to see such skill in action. It's so great that in surgery there is a binary outcome: success or failure. You don't need to do any BS statistics to work out if you found an effect. You either got it or you didn't get it. Few things in life have such clarity.<br />
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Anyway, I am now finally out of hospital and hope to be able to get back to my normal life.<br />
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I must say I am very thankful to be living in such a civilized country like Germany. Thanks to the amazing medical facilities here, I can live a nearly completely normal, some would <i>even</i> say productive, life, despite being half blind and in total kidney failure. That privilege is not available in many other countries.<br />
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Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com1tag:blogger.com,1999:blog-6017723809730412141.post-50305157393202308342016-11-15T04:29:00.000-08:002016-11-15T06:06:48.160-08:00Year six of dialysis<div dir="ltr" style="text-align: left;" trbidi="on">
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In the flurry of the US presidential election, I didn't even realize that I have crossed the five-year mark of my dialysis. I've now entered the sixth year. So, how are things going?<br />
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<b>The good</b><br />
I'm still in very good shape for a 52 year old guy with kidney failure. On a good day I can do 200 pushups, on a bad day 100. I regularly skip rope, ride the stationary bike in the gym, lift weights, do body weight training and <a href="https://plus.google.com/103799779261382759362/posts/aHGNXZ88yyR">Iaido</a>. I go for longish walks, either with my wife or alone. Overall, I end up spending quite a bit of time on exercise, maybe an average of 50 minutes to one hour a day. This seems like the bare minimum. If I do anything less than this, I start to lose muscle mass very fast, probably to do with the dialysis sucking out so much protein from my body. I have to accept that there is no way I can build up more muscle mass than I currently have (which is not much), and have to settle for just maintaining strength and endurance at a steady state. It's not that I want to bulk up like those poor bozos in the gym whose brains have settled into their biceps; they have so little brain power left they have to randomly walk around the gym trying to find out where their locker is. But I wouldn't mind having a <i>bit</i> more muscle. My doctors are pretty amazed that I exercise; it seems I am the only one under their care who does. They keep telling me vaguely to "take it easy", without really defining what that means, so I just ignore them.<br />
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Another good thing is dialysis in Germany. Despite the recent cut-backs in dialysis funding, the system hasn't yet become a totally dysfunctional one. There is now such a scarcity of narrow tape for taping up the needles during dialysis that nurses have to rip up a wide tape lengthwise to get the right width. Even the tubing has become much shorter, so that I have to have the dialysis machine extremely close to me when I sleep. I believe the nurses are also getting paid less. Nevertheless, I am lucky not to be living in any of the following countries: USA, France, Netherlands, Austria, Sweden. Did I mention the US? After the recent amazing discussion about <a href="http://www.japantimes.co.jp/news/2016/10/22/business/shocking-blog-post-forces-debate-financial-drain-dialysis-japan/">how dialysis patients should be just allowed to die because they cost so much</a>, I want to add Japan, but maybe not just yet. Germany is still better than most of these countries. I feel very lucky to get night dialysis so that I can lead a near-normal life.<br />
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<b>The bad</b><br />
I can't think of anything <i>bad</i> at the moment. Oh yes, my shunt is narrowing and will need regular treatment at the hospital (every three months). They will have to regularly stick in a <a href="https://en.wikipedia.org/wiki/Balloon_catheter">balloon catheter</a> into the shunt to widen a narrowing in my armpit. It isn't much fun, but I guess things could be worse. Here too, the only really annoying thing about the procedure is having to spend a night in the hospital with other patients, who loudly talk their way through their hospital stay (see below, The Ugly).<br />
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<b>The ugly</b><br />
That's a no-brainer. It's the typical (dialysis) patient in Berlin. The typical patient in Berlin is basically an animal with no ability to think about what effect their behavior has on other people. TV: on at full volume. Music: the same. Walk around the dialysis center touching the water bottles and glasses while holding on to one's urine container. Playing the guitar loudly, singing a weirdly demented version of Stairway to Heaven at the top of their lungs. Talking loudly to fellow dialysis patients while dialyzing despite the fact that many other patients are sleeping. Jesus, who the <i>fuck</i> are these people? I'm trying to recall where I have seen this kind of behavior in Berlin. Oh yeah, everywhere! The definition of Berlin is <i>Rücksichtslosigkeit</i>. If there were a polar opposite to the consideration people show in Japan to each other, it is Berlin. <br />
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So now I have some five more years of dialysis to do before I get a transplant. I must say I am now totally willing to risk another transplant to squeeze out another 10 or so years of near-normal life.<br />
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Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-35011052551076056022016-11-14T22:56:00.001-08:002016-11-14T22:56:30.832-08:00The worst thing about dialysis in Berlin is other dialysis patients<div dir="ltr" style="text-align: left;" trbidi="on">
In the last five years, I have now dialyzed all over western Europe, Japan, and the US (just two weeks or so there). One striking difference between dialyzing in Berlin vs any other city I have been to is the sheer obnoxiousness of dialysis patients. They will either turn their TV headphones to full blast and put them on the table so they don't have to put them over their heads, or talk loudly to each other even when other patients are sleeping, talk loudly on the phone, or all of the above at the same time. I have seen doctors sometimes try to get patients to be more considerate, but in one particular case I saw, the patient told the doctor that there is nothing the doctor could do to stop the patient from talking loudly. In my dialysis center, one guy actually brings his guitar and walks around all over the dialysis center loudly singing and strumming his guitar. What's so special about Berliners? Why are they such assholes?<br />
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Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-30942946859723422622016-03-20T00:40:00.001-07:002016-03-20T00:40:17.022-07:00Fifth year of dialysisSo, I'm now in my fifth year of dialysis, my third year on overnight dialysis. What has changed in these years?<br />
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1. I finally got used to night dialysis. The main challenge was getting to sleep with the noise of the dialysis machine (the machine can be very loud, these are really very old machines, not the fancy Japanese ones I saw in Tokyo and Kyoto). The other major challenge was keeping my shunt arm immobile for eight hours. I solved the sleeping problem by exhausting myself with work on the day of dialysis---I get up early and work non-stop to the point that I can't go on any more after 6PM, so that falling asleep by 9:30PM really is no problem any more. This works on most days. The shunt arm problem I solved by placing my arm on a cushion; the contact with the cushion provides enough of a cue to my brain to keep it stationary even if I am asleep. The brain is an amazing machine that can be trained to do virtually anything.<br />
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2. I have become really good at inserting my own needles. Gone are the days of failed punctures and fountains of blood. I can always get the needles in with no or almost no blood. I still occasionally mess up, but this seems to be within the bounds of normal error. My last serious error was about a year ago, when I went right through the shunt, but I have learnt to change the angle of the needle when I'm going in.<br />
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3. The skin on the shunt is getting weak from repeated puncturing. There are parts of the shunt where I cannot puncture any more or else I will bleed all night. The skin can't take any more assaults of the needle. So I have to creatively enter the shunt from the side, a bit of a challenge that I sometimes leave to the nurse.<br />
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4. Perhaps because I'm getting older, it takes much more work to retain muscular mass and fitness levels. If I don't exercise for a week, it feels as if I lost the last six months' gains instantly. This is an area that needs significantly more effort from me. I spent maybe four or five sessions a weeks, 1-1.5 hours each, exercising; once or twice a week, these sessions involve weights. Each session has about 40 minutes of core exercises (I spend most of my energy on maintaining core strength because I had a hernia operation in 2010 and never, ever want a repeat of that experience). The positive outcome of all this effort is that at least I don't have the typical potato-with-matchsticks-for-legs-and-arms look of a German professor. But I am definitely nowhere near the fitness levels when I was at my peak in my transplant days. I am currently working with the Sports medical center at the University of Potsdam to build up an exercise program that will help me build up stamina. My goal is to get to 1.5 hours six days a week. Another measurable yardstick I set for myself is being able to do 250 pushups in multiple sets but in one exercise session. Currently I am at 150. I will need to be very fit if I decide to get a transplant, the operation is huge stressor for the heart, and I anyway need to be very fit in order to have a decent chance of surviving till retirement. So I'm very motivated to fix the fitness problem. One thing I don't know is: how fit can a dialysis patient get? Is there an upper limiting bound? It would be cool if I could talk to a doctor about that, but unfortunately such a doctor would have to know both about exercise science and dialysis, and such people apparently do not exist in my immediate circle.<br />
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So, now I just need to hunker down and keep going like this for another five years till I get high up enough on the transplant list. I'll be 57 years old by then, and will have to decide then whether to get a transplant. If I get a transplant at 57 and it survives another 10 years, I could even spend the last 10 years of my working life as a nearly normal person.<br />
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In closing, I must say that I am extremely lucky to be living in Germany, and in Berlin in particular. I've seen dialysis establishments all over western Europe, US, and Japan. Almost none of them provide night dialysis; it's a huge luxury and allows me to live an almost normal life. Germany is really the only country I know (maybe apart from Japan) that really found the right balance between patient needs, sustainable medical cost, and quality of care. A fantastic achievement.<br />Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-24193204928983900872016-02-15T23:26:00.001-08:002016-02-15T23:26:41.004-08:00When breath becomes air by Paul Kalanithi<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X">This book</a> was a very difficult one for me to read, but I could not put it down once I started. Kalanithi was a neurosurgeon who died in his late 30s from lung cancer. This book is a record of his illness. This book is not for the faint of heart, and if you have a chronic illness yourself, you should be ready to face your own fears if you read this book.<br />
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Instead of talking about the book, I will just quote some of the passages from the book that gave me pause.<br />
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<i>I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnosis, I knew that someday I would die, but I didn't know when. But now I knew it acutely. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live.</i><br />
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<i>"Leave some room for a statistically improbable but still plausible outcome---a survival just above the measured 95 percent confidence interval". Is that what hope was? ... It occurred to me that my relationship with statistics changed as soon as I became one.... Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability. </i><br />
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<i>That morning, I made a decision: I would push myself to return to the OR. Why? Because I could. Because that's who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I'm dying, until I actually die, I am still living. </i><br />
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<i>The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I having to learn how to budget. </i><br />
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<i>The most obvious might be an impulse to frantic activity: to "live life to the fullest," to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist.</i><br />
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His wife reports that Kalanithi made a huge effort to write this book as he slowly deteriorated. This is the most important work I have read in many years. Everyone should read it. Healthy people who take their lives for granted, and sick people who are trying to find direction in their truncated lives.<br />
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Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-22894272153756204162015-12-05T17:30:00.000-08:002015-12-13T02:44:51.756-08:00Last photograph with my parents<div dir="ltr" style="text-align: left;" trbidi="on">
Here is the last photograph of my parents and me together, 2004. My father, who was a physicist at the National Physical Laboratory, died last year. He just turned over in bed, and then he was gone. And my mother died today. Her apartment, where she lived alone after Dad died, caught fire while she was sleeping and she died of smoke inhalation. Her body was found in the bathroom, with one hand on a bucket. She was 83, and part way through <a href="http://www.hindustantimes.com/punjab/an-open-book-herself-saroj-opened-her-heart-to-many/story-PVzRK5MNPBa4yml3MR5U5I.html">a book</a> she was writing.<br />
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<a href="http://www.tribuneindia.com/news/himachal/community/social-worker-dies-in-shimla-fire-incident/167566.html">Here</a> is a news announcement about Mom. There was also a <a href="http://www.htsyndication.com/htsportal/article/SAROJ-VASISHTH-TO-BE-CREMATED-TODAY/10313964">notice</a> about her cremation. And finally, <a href="http://timesofindia.indiatimes.com/Saroj-Vasishth-Cmdr-Satish-Vasishth/tributeshow/50141520.cms">prayers were held</a> at the Arya Samaj temple in Delhi on 13 Dec 2015.<br />
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And here is the last photo of all the five sisters (Mom was the oldest) together. This was taken at a family reunion this year:<br />
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This poem by Larkin comes back to me.<br />
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<strong style="background-color: white; color: #181818; font-family: Georgia, 'Times New Roman', serif; font-size: 14px; line-height: 18px;">Aubade (Philip Larkin)</strong><br />
<br style="background-color: white; color: #181818; font-family: Georgia, 'Times New Roman', serif; font-size: 14px; line-height: 18px;" />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">I work all day, and get half-drunk at night. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Waking at four to soundless dark, I stare. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">In time the curtain-edges will grow light. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Till then I see what’s really always there: </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Unresting death, a whole day nearer now, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Making all thought impossible but how </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">And where and when I shall myself die. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Arid interrogation: yet the dread </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Of dying, and being dead, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Flashes afresh to hold and horrify. </span><br />
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<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">The mind blanks at the glare. Not in remorse </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">—The good not done, the love not given, time </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Torn off unused—nor wretchedly because </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">An only life can take so long to climb </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Clear of its wrong beginnings, and may never; </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">But at the total emptiness for ever, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">The sure extinction that we travel to </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">And shall be lost in always. Not to be here, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Not to be anywhere, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">And soon; nothing more terrible, nothing more true. </span><br />
<br style="background-color: white; color: #181818; font-family: Georgia, 'Times New Roman', serif; font-size: 14px; line-height: 18px;" />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">This is a special way of being afraid </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">No trick dispels. Religion used to try, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">That vast moth-eaten musical brocade </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Created to pretend we never die, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">And specious stuff that says No rational being </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Can fear a thing it will not feel, not seeing </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">That this is what we fear—no sight, no sound, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">No touch or taste or smell, nothing to think with, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Nothing to love or link with, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">The anaesthetic from which none come round. </span><br />
<br style="background-color: white; color: #181818; font-family: Georgia, 'Times New Roman', serif; font-size: 14px; line-height: 18px;" />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">And so it stays just on the edge of vision, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">A small unfocused blur, a standing chill </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">That slows each impulse down to indecision. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Most things may never happen: this one will, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">And realisation of it rages out </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">In furnace-fear when we are caught without </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">People or drink. Courage is no good: </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">It means not scaring others. Being brave </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Lets no one off the grave. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Death is no different whined at than withstood. </span><br />
<br style="background-color: white; color: #181818; font-family: Georgia, 'Times New Roman', serif; font-size: 14px; line-height: 18px;" />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Slowly light strengthens, and the room takes shape. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">It stands plain as a wardrobe, what we know, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Have always known, know that we can’t escape, </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Yet can’t accept. One side will have to go. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Meanwhile telephones crouch, getting ready to ring </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">In locked-up offices, and all the uncaring </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Intricate rented world begins to rouse. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">The sky is white as clay, with no sun. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Work has to be done. </span><br />
<span style="background-color: white; color: #181818; font-family: "georgia" , "times new roman" , serif; font-size: 14px; line-height: 18px;">Postmen like doctors go from house to house</span></div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-80762772207794848442015-07-10T23:43:00.000-07:002015-07-10T23:43:03.327-07:00Review of Midnight's Furies by Nisid Hajari<div dir="ltr" style="text-align: left;" trbidi="on">
Anyone growing up in India during the 1960s and 1970s has probably heard the horrifying stories of the events surrounding the 1947 India-Pakistan partition. The most scary ones I remember are about trains packed with dead bodies coming into Lahore (dead Muslims) and into India (dead Hindus). My own parents lived in Lahore, or in the part of Punjab that is now in Pakistan; they were lucky to avoid the massacre---they used to spend their summer in Shimla, and had moved en masse in June, so that when August 1947 came around, they escaped the killings. They left their Lahore home in June, for the summer holidays in Shimla, and never went back---the Pakistanis who took over the home kept their clothes and possessions in a trunk for them to retrieve decades later. My mother's father, Shyamlal Meini, an industrialist, made many dangerous car trips between Shimla and the to-be-formed Pakistan during the summer of 1947 to move his money out of there to India.<br />
<br />
And then there were the wars with Pakistan. I remember when we were instructed to paste brown paper on all glass windows to block the lights out during nighttime, in case Pakistani bombers attacked Delhi. I think I was seven or so, and although it was fun to stick rectangles of brown paper on all the windows, it didn't really sink in what a bombing would do. My father (he died in September last year), was a physicist at the National Physical Laboratory in Delhi, and was also involved in R&D related to the war, although I don't know what exactly it was about.<br />
<br />
The Khalistan movement and the terror the Sikhs unleashed in India is another salient memory from my time in India. A turning point came when Indira Gandhi was assassinated by her Sikh bodyguard, and the population of Delhi started to systematically kill Sikhs and their families in retaliation; Sikhs were strung up to hang on a bridge right on the street outside our apartment. It seems like the only response we have in India, despite our supposed 5000 or whatever years of culture, to injustice and brutality is more brutality. That's how the partition played out, and that's how 1984 played out. And there have been more such killings since then. The hatred seems to be passed on from one generation to the next; I recently met a childhood friend who invoked the partition and what the Muslims did to his family to justify his feelings about the fate all Muslims should experience.<br />
<br />
The partition seems to control our attitudes and beliefs even today. A lot of Punjabis moved into Delhi, replacing the refined and restrained Muslim culture with a new, brash, and VERY LOUD, aggressive Punjabi style of doing things. At least until I was in India in the early and mid 1990s, it was fashionable to make fun of Punjabis for their brashness and aggressiveness. I had Jain and Muslim friends who openly mocked Punjabis in front of me, and mocked me for being Punjabi (and yes, I am as brash and aggressive as they come---and believe me, I am holding back). Using words in Hindi that are derived from Punjabi is a sure way to elicit derision from one of these groups. Punjabis were and maybe still are considered fair game in Delhi, by non-Punjabis of course. The Hindi language changed after the Punjabis arrived in Delhi; and purists from central India routinely make fun of the way Punjabis like me pronounce certain words like "read" (paRa, not the correct paRha), occasionally introduce tones and odd accenting patterns into Hindi, and use the ergative case marking incorrectly, almost certainly a borrowing from Punjabi. Sneering at groups other than one's own is an Indian speciality, and the arrival of the Punjabis in Delhi provided a lot of free mocking-value for the other groups who thought themselves superior to these barbarians. It didn't help that the Punjabis ended up dominating many aspects of the economy in Delhi. Of course, the Punjabis sneer at others too, for being Merchant caste money-grubbers and weak-minded ditherers, among other things. So nobody really is blameless in this culture of defining one's cultural "team".<br />
<br />
This book, Midnight's Furies, by Nisid Hajari, is an astonishing chronicle of the events that led to the partition:<br />
<br />
http://www.amazon.com/Midnights-Furies-Deadly-Legacy-Partition/dp/0547669216<br />
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Fantastically fast paced and well written, I had a very hard time putting this book down to work during the day. The main thing I learnt, which I didn't know much about until now, was the sheer incompetence and short-sightedness of all parties involved in the partition: Nehru, Gandhi, Jinnah, the entire British imperial machinery, Churchill (Hindus: "a beastly people with a beastly religion"). Jinnah and Nehru are both blamed in this book for making the situation worse and for precipitating the partition. I can see how that might happen; even if they had been more accommodating with each other, and just mildly rational human beings, they had no experience in nation-building. I can imagine that anyone who has to deal with a situation like this is going to make mistakes. What surprised me was how badly the British---who have some experience in nation-building from scratch, especially <i>other</i> people's nations---handled the hand-over of India to the Indians. I guess the British didn't even see the Indians as particularly human ("a beastly people with a beastly religion"), so it didn't really matter to them either way whether they lived or died. The big lesson I learnt from this book was that leadership matters. If you are leading the way, whether it's something big or small, you have to be bigger than yourself. You have to put aside your sense of self-importance, and be willing to recognize that you are sometimes wrong, and then you have to correct course. A lot of what happened---except for the criminal British incompetence---was because of people not being willing to back down and conceding a point in the face of overwhelming evidence. Rather reminiscent of the way we do science in most fields.<br />
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The story that Hajari tells was carefully omitted from my history textbooks in school, or at least the details were whitewashed. Of course everyone knew about the partition; the machinations that led to it were kept pretty obscure in the textbooks I had to read. If instead of making us memorize the names, special characteristics, and dates of creation of various temples, had the school history books just told this story, my history lessons in school would have been much more useful. In many ways, this book reminded me of the classic Lies my Teacher Told me: Everything your American History Textbook Got Wrong:<br />
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http://www.amazon.com/Lies-My-Teacher-Told-Everything/dp/0743296281<br />
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The only thing that disappointed me about Nisid Hajari is his enthusiastic support for <a href="http://theweek.com/articles/442125/three-major-publications-have-acknowledged-plagiarism-by-fareed-zakaria-does-cnn-have-no-shame">that plagiarist, Fareed Zakaria</a>. South Asians <i>love</i> to plagiarize, and so Zakaria's plagiarism in itself is not surprising or remarkable. But I am very uncomfortable with Hajari's association with Zakaria.<br />
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<br />
<br /></div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com1tag:blogger.com,1999:blog-6017723809730412141.post-14701722659243156292015-07-04T00:03:00.002-07:002015-07-04T00:03:38.053-07:00Dialysis: The attitude of nurses<div dir="ltr" style="text-align: left;" trbidi="on">
I'm convinced that at least this one nurse in my dialysis center has only contempt for me. I used to encounter the attitude in India that anyone with an illness was considered to be to blame for having that illness---probably the result of some vaguely formulated karmic theory that Indians find so attractive. I sometimes (very rarely) get the same impression in Germany too. There is one nurse in my dialysis center who is assigned to the night shift quite rarely, but when she is there and is assigned to connecting me up, my night is sure to be hell.<br />
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First, she gets all the parameter settings wrong; when I correct her, she says I don't trust her. Damn right! You are getting all the numbers wrong. If the heparin stop time is not set correctly, I can be sitting there for one hour waiting for the bleeding to stop, after the needles are removed. It matters whether the parameters are exactly right. The biggest problem I have with this nurse is that she consistently leaves air bubbles in the heparin feed line, which leads to non-stop alarms all night. After this happened three times with her, I have become firm with her about removing those air bubbles. Every time she mutters about my not having any faith in her.<br />
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So I've managed to piss this lady off; I can understand that. After all, I am essentially questioning her competence by checking everything she does. It doesn't matter that she *is* incompetent.<br />
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But the thing I don't understand is that she takes out her frustration with me by taking revenge: she slams the door shut loudly every time she comes in to check during the night whether everything is in order, waking me up each time. Why would she do that? I can understand that she's pissed off with me because I keep correcting her mistakes, but what's the logic of waking me up throughout the night and ruining my next day? I guess it must be satisfying for her to "get back" at me. But it speaks to an attitude of contempt for the patient.<br />
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There was an interesting case recently in the US of a patient accidentally recording what their doctors said while he was getting a procedure under anaesthesia. You can read all about it here:<br />
<br />
<a href="http://www.washingtonpost.com/local/anesthesiologist-trashes-sedated-patient-jury-orders-her-to-pay-500000/2015/06/23/cae05c00-18f3-11e5-ab92-c75ae6ab94b5_story.html">http://www.washingtonpost.com/local/anesthesiologist-trashes-sedated-patient-jury-orders-her-to-pay-500000/2015/06/23/cae05c00-18f3-11e5-ab92-c75ae6ab94b5_story.html</a><br />
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It's very hard for me to understand why medical personnel ever think it's OK look down on their patients and to treat them like they are worth nothing.</div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-15762948172775469082015-04-10T08:00:00.003-07:002015-04-10T08:00:57.420-07:00The high drama of self-cannulation<div dir="ltr" style="text-align: left;" trbidi="on">
I've been inserting my own dialysis needles into my shunt for more than two years now. One would think I'm an expert by now. But each time it's a challenge. You have to push the needle past the skin into the shunt, but not too far in, or else you will go right through the lower wall of the shunt and into the muscle below it. At a certain point after insertion, you have to change angle so you can move along the inside of the shunt, and not hit the wall at the other end. All this is one smooth movement. In and turn.<br />
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I have had a nearly 100% success rate so far over the last two years. The first six months were hell, bloodbath after bloodbath, but I got good at it and could get it in nearly pain-free (unless I hit a nerve, but I gradually learned to avoid the bad spots).<br />
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But on Monday this week I made a huge blunder. I pushed the needle in just a little too hard, and it ended up <i>deeply</i> embedded into the muscle underneath. It doesn't hurt, but you hear a distinctive pop, which is the sound of the needle exiting the shunt from the other side deep inside.<br />
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At this point I lost my nerve; do I pull out the needle, and if so, how will I know that I'm out? Could I end up pulling it out entirely if I pulled too hard, and have a bloodbath on my hands? The nurse was standing by luckily, and he took over. It turns out you hear a distinctive pop when the needle exits the muscle on retraction. So the nurse expertly pulled it out just enough to get the needle correctly positioned and all was well...till the next morning. Now that a hole had opened up in the shunt, blood leaked out slowly all night into the tissue underneath, with the result that I developed a huge swelling around the shunt, so much so that I could not even see my shunt any more (at least not the part where I had done my mis-insertion). The visual impression of my shunt half disappearing really freaked me out. It's the one thing that's keeping me alive and seeing it "gone" amid the swelling somehow really shocked me.<br />
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So much so that I didn't really have the nerve to insert my needles again on Wednesday, I had the nurse insert it. There wasn't much space left on my shunt to insert the needles, so the nurse stuck it into a fresh spot that had never been needled before, high up on my shunt. Very very painful! The skin on the upper part of the shunt was fresh and never punctured, so it had no hardened skin. To make matters worse, I think the nurse inadvertently hit a nerve and so I was in pain all night. Amazingly, I managed to go to sleep, but I dreamt of being tortured by someone or the other.<br />
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Today's Friday, my last dialysis for the week happens tonight. Am I going to go back to inserting my own needles? We will see how much nerve I can muster. I must say, I feel like a total failure---so much for being a third degree black belt in Iaido! A needle insertion is very much like classical Japanese sword technique: you go in straight, with the sharp end of the needle, and you have to make a quick change of angle to make a sharp clean cut with the edge of the needle to enter the shunt. If you do this just right, there is not a trace of blood. I should be really, really good at this, I've been practising this movement for decades! I guess the problem is that there is so little room for error, it's happening at millimeter precision.<br />
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Dialysis is usually OK for me, I can live with it and it doesn't intrude into my life much any more, now that I do it overnight. But these incidents really mess up my life.</div>
Shravan Vasishthhttp://www.blogger.com/profile/05926656325558456592noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-51318898405591727032015-01-18T02:41:00.001-08:002015-01-18T02:41:19.732-08:00Astonishing song with a beautiful, simple melodic lineWhat a song:<br />
<br />
<a href="https://www.youtube.com/watch?v=n_ZmHOSr8Us">https://www.youtube.com/watch?v=n_ZmHOSr8Us</a>Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0tag:blogger.com,1999:blog-6017723809730412141.post-14487659955848399662015-01-03T03:05:00.000-08:002015-01-03T09:57:13.361-08:00Review of Assholes: A Theory, by Aaron JamesAccording to <a href="http://www.faculty.uci.edu/profile.cfm?faculty_id=4884">the author</a>, the definition of an asshole, who is almost always male, is (emphasis mine):<br />
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A person is an asshole when, and only when, he systematically <b>allows himself to enjoy special advantages </b>in interpersonal relations out of an <b>entrenched sense of entitlement</b> that <b>immunizes him against complaints of other people</b>. <br />
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An Asshole (capitalization mine) is to be distinguished from a Jerk; the latter only systematically <b>allows himself to enjoy special advantages</b> in interpersonal relations.<br />
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The Asshole refuses to recognize you as a moral equal. This is a key reason that Assholitude arises in the first place. The recipient ends up fighting for moral recognition, and this is where the frustration on part of the recipient comes from. There's the humilation of knowing that you are considered inferior; and that there's nothing you can do to change that.<br />
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The opposite of an Asshole---presumably something to aspire to---is the Fully Cooperative Person (capitalization mine). These are people who "see themselves as equals, as having grounds for special treatment only in special circumstances that others will equally enjoy at the appropriate times.''<br />
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An example is a person's birthday; we expect (well, most people expect) special celebrations of their existence on that day, but they will equally well celebrate their friends' existence some other day. For the Asshole, every day is his birthday.<br />
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The author offers classification of different types of asshole. There is a delicate balance between deciding that someone is an asshole and deciding that he doesn't really rise to the level of assholitude (one really does need to enrich the English vocabulary to discuss this subject; the author doesn't use this ugly word, however). <br />
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The classification: I won't spell out the details. After all, you should read the book. I do provide some example asshole sub-types from the book, so you can compare your knowledge of these people with the label to get some idea.<br />
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1. Boorish asshole: Rush Limbaugh and Michael Moore<br />
2. Smug asshole: Richard Dawkins, Gustave Flaubert, Bernhard-Henri Levy<br />
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Flaubert: "Woman is a vulgar animal from whom man has created an excessively beautiful ideal".<br />
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This subtype also has a French translation due to the French public intellectual being overrepresented in the list: le smug asshole.<br />
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3. The asshole boss: Naomi Campbell and General Patton<br />
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4. The royal royal asshole: Henry VIII<br />
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5. The presidential asshole: Hugo Chavez, Mahmoud Ahmedinajad, Dick Cheney, Silvio Berlusconi<br />
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6. The corporate asshole: some guy I've never heard of<br />
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7. The reckless asshole: Cheney and his Iraq-war cohort<br />
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8. The self-aggrandizing asshole: Cheney<br />
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One odd thing about the above list is that it's not using attributes consistently. I would have expected better from a professional philosopher :). The corporate/presdential/royal royal asshole has in common the fact that their position changes them into assholes. The smug and other categories of asshole seem to point to internal causes. I was left a bit dissatisfied by this. Perhaps it would have been better to have a typology with several layers: external causes vs internal, and then drill down, perhaps cross-classifying across sub-categories (Cheney ends up everywhere; perhaps the generalized universal one-size-fits-all asshole type applies). We need a type-theoretic treatment of assholes, with a full feature specification. Maybe HPSG practitioners can help. The author does provide further classifications in a subsequent chapter, but I think the classification criteria can be improved. <br />
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The author continues by discussing why it is that it is mostly men that are assholes. He basically argues that it is largely culturally determined; there are female assholes (Ann Coulter is mentioned). This of course raises the question: to what extent is the asshole to blame for their behavior, if most of it is the result of a conditioning process? I didn't quite get his conclusion, but I think he's saying that the asshole bears some moral responsibility and can therefore be blamed for his behavior. <br />
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The author then moves on to asshole management; on his home page, he has a 13-step list (not mentioned in the book as such), but basically it's an amalgam of Stoic principles and small steps one can take to minimize one's own unhappiness. The bottom line is you are not going to change the asshole's behavior, so focus on other issues you can control (e.g., vigilant avoidance, only working with the asshole on your own terms, etc.). Ideal asshole management needs years of training, it seems, a bit like doing aikido. <br />
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The author also talks about things like asshole capitalism, the erosion of social structure as a consequence of the way the political system is set out. He believes that Italy is a prime example of asshole capitalism, and that the US is getting there. His basic theory is that asshole capitalism arises if there are incentives to achieving "unbounded personal enrichment", undermanagement in that there is no system in place for damping the tendency to be an asshole (e.g., in Japan there is a shaming culture). He also lists destabilization (gradual degradation), but this seems more like a consequence of the first two to me.<br />
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Some reflections on the implications of this book:<br />
<br />
One possibly upsetting consequence of reading this book is the realization that, at some point or another in our lives (especially if you are male), we have acted like an asshole. The author provides us with this lifeline: someone can <i>act </i>like an asshole---in a particular situation or over a particular day or week---without really, ultimately, <i>being</i> an asshole. Wow, that's a relief! Because I feel much better about myself now. I've acted like an asshole (um, more than once). I'm sure you have; actually, I can't think of many male academics I know that haven't acted like assholes at one time or another (and I can think of a few females academics who did). By the way, if, while reading this, you didn't realize that you've acted like an asshole in the past but you think pretty much everyone around is one, you probably <i>are</i> the asshole we are discussing here. The author notes this point: "if you would be willing to call yourself an asshole, this indicates that you are not in fact one." The corollary of this statement is the one that's more interesting for me (I'm not one to focus on the positive, I always look at the negative side ;). The author also astutely observes that you may either feel (a) shame, or (b) a thrill of joy, at discovering that you are, in your opinion, an asshole (under the above self-test). (a) is OK, (b) not so much. You can also be a half-assed asshole, not a full-fledged one; but even that is bad enough.<br />
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Ultimately, in my opinion, thinking about assholitude is a bit like talking about alcoholism; a significant proportion of the population is already part of the problem, and a major part of the problem is the inability to recognize that one has a problem through the way one is.<br />
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Another thing that the author doesn't mention but which I think is true is that each one of us has an inner asshole waiting to leap out. The same thing happens with racism. The distinguished liberal professor who would never say an unkind word about a particular minority, and steadfastly votes left of center, will happily express contempt for some sub-class or the other if you just open the way for their inner feelings to express themselves. You can always get the most enlightened and open person to eventually say something that counts as racist. In India, I used to study in a left-wing university, where equality for all was what mattered, and my fellow students were super-conscious of projecting egalitarianism. Even the formal courses on western philosophy were all about studying (and memorizing) Marxist-Leninist pronouncements. But even this group would find some regional group to mock. Surprisingly, these Khaki <a href="http://en.wikipedia.org/wiki/Kurta">kurta</a>-clad intellectuals would mock Punjabis the most in front of me; this is surprising because I am Punjabi---why would they mock this group to my face? Biharis were another common target. They saw no irony in the disconnect between their egalitarian concerns and their mocking of regional groups.<br />
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So how can one mitigate the influence of one's inner asshole? Remind yourself periodically that your interlocutors are your moral equals, that courtesy and respect do not need to be abandoned when bringing up your opinions. <br />
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This book is hugely relevant for academics. The most dramatic manifestation of academic assholeness is in the reviewing process. Reviewers can be unnecessarily harsh when they critique a paper. And yet, I actually sympathize with such an asshole reviewer; I too have felt the rage when reading an incompetently done piece of work. My solution to that has been to write my asshole-version of the review, and let it sit for a day or two. I got it out of my system, I feel happy as I am know I am right and the authors are obviously, each one of them, a piece of shit. Then I rewrite the review. I first start with the positive achievements, and rephrase all my criticisms into a milder form. When I do this, I always find that some of my criticisms were the product of rage, and they do fall by the wayside. I do sometimes fail to do this, but the cases are diminishing with increasing age and experience. Another way to mitigate the assholitude that comes naturally to us during the reviewing process is to sign your review. That will definitely motivate you clean up your act. Academics don't just sit back and take the criticism. If the "enemy" knows who you are, and this opens up the possibility of blowback, your tone will automatically improve. My harshest reviewers have almost always been anonymous. <br />
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The book also made me think about my life in Berlin/Germany: how commuters will elbow you out of their way to get into the train first, how people walk right through you as if you were not even there, and how they just walk past you without acknowledging you if you hold the door open for them. Anyone inside a car automatically acquires a sense of special entitlement too. How everyone plays music ever more loudly on their headphones with every passing year. How people will park all their bags on the seat around them in the train and roll their eyes if you want them to move their stuff so you can sit. How people will smoke in no-smoking areas (and folks have been beaten up and hospitalized in Berlin for asking such people not to smoke in these areas). <br />
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Compared to Japan, or even Paris or the midwest in the US, the contrast is dramatic, and I could not help thinking that somehow German society has managed to foster the culture of assholism. But thankfully we have not succumbed to asshole capitalism (at least not to the extent that the US or Italy has). It would be very interesting to study where this culture of self-entitlement came from. Why didn't Germany evolve into a *relatively* polite society like their immediate neighbor France, or the extremely polite Japanese? It's a fascinating question. However, on the positive side, one thing I took away from this book is to follow Epictetus and just accept things as they are and not fume about all the daily injustices one experiences. Let it go, as the song goes.<br />
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<br />Shravan Vasishthhttp://www.blogger.com/profile/13453158922142934436noreply@blogger.com0