Easy because we are lazy

Being able is not the reason,
Neither is it our wisdom,

Not that we care,
Not that we are scared,

The uncertainty of our ability,
The certainty of the infeasibility,

The mind takes a guided course,
Of which, it itself is the source,

Which it does frequently,
Carrying it out eloquenty,

Doing things because it’s easy,
Promoting the ignorant and the lazy.

#Easyway #BeingIgnorant #BeResponsible #poem

The Paradox of Vocab

Cat one: Aren’t you too drunk already?
Cat Two: Bro, do you know what happens when I drink more?
Cat One: What?
Cat Two: My hands shake more; and what happens when my hands shake more?
Cat One: I don’t know
Cat Two: I spill more!
Cat One: Okay?
Cat Two: And the more I spill the less I drink
Cat One: Yes?
Cat Two: And so you see Dear Watson, the more I drink the less I drink, and in order to drink less I need to drink more.
Cat One: uh! I need another drink.

Kitty Party

Cat One: That’s balderdash.
Cat Two: What the hell’s a balderdash??
Cat One: It means nonsense, I meant you don’t make sense.
Cat Two: Oh, why didn’t you say so?
Cat One: I did, and I used less words in doing that, it’s called using your vocabulary.
Cat Two: And how do you earn this vocabulary?
Cat One: By reading – by learning more words
Cat Two: So you mean to say, I have to learn more words so that I can speak in less words?
Cat One: Yes!
Cat Two: Isn’t that just like my drinking paradox, my Watson?
Cat One: Balderdash!


Inhuman or Insensitive

I feel all of us go through some tough times and we have no option but to be strong. There can be a clear mismatch as to what our mind and what our heart wants us to do. I wrote the below lines, keeping this in mind.

Let me know if you can relate to it and answer the below questions:

When the moments are frozen in the heart,

When the tears are frozen in the eyes,

When the mind dodges the emotions,

When the gestures betray the feelings,

Are we living the moment?
Are we becoming more mature?


Are we becoming more inhuman?
Are we becoming more insensitive?


Turning Evangelist

I was trying hard to stay awake on the night of the Europa League finals game between Chelsea and Arsenal. It was supposed to air at 00:30 India time on 30th May, 2019. I had gotten used to sleeping early and hence it was being a challenge.

The challenge became easier when one of my friends working at Isha Foundation sent a message on my WhatsApp. It was a link to a blog post on a right wing portal. I have no prejudice, they’re a self proclaimed right wing portal. I gave it a click.

The blog was about an insidious event. A man – presumably a Christian evangelist or an evangelist messenger made a walk towards the bust of Aadi Yogi Shiva at the Isha Foundation in Coimbatore and starts shouting at the top of his voice about Jesus being the sole savior and aadi yogi a distraction.

Here’s the link to the video on a tweet that went viral.

The blog post went on to talk about how Indians have been talking about religious intolerance by the hindus while the act of religious evangelism by other religions especially Christianity has always existed and has encroached the fabric of Indian spirituality and religious heritage.

This topic of evangelism and conversions is always a sensitive and a difficult topic to talk or think about. Not because we have not been subject to or exposed to it but because the rationale behind it is a little confusing. Confusing as in unknown. The lack of empathy could be one reason.

Why is a person trying to convert someone else? Why do I want to stray someone from their path and convert and mould them into wanting to walk on my path? That’s the basic question.

Now that we’ve formed the question, we’re half way there. Most of our answers reside in Maslow’s work. After one has reached the pinnacle of the need hierarchy of self actualization, one looks to change other’s lives. It’s called the level of Self Transcendence. Hence evangelism.

That was easy – and a little academic. Let me try again. If I believe in something really hard, like to take a simple example if I’m a diehard fan of Chelsea football club, I would first myself be immersed completely in it, and the joy of being a fan is so elevating that I wouldn’t stop talking about it. I will talk about Chelsea with everyone and try to bring people to games who are not Chelsea fans, not even football fans. Without caring if they need or want to be Chelsea fans. Because I am so convinced that Chelsea is the path to absolute bills and liberation that I will try as hard as possible to make others see what I see.

Religious evangelism is similar to that, a little complex ofcourse as all games of grownups are. Not all conversions or evangelist activities are nobel. Because these are huge organisations with unreal goals – most politically and financially motivated too. So not always do the people trying to convert you want you to see the light or improve your life.

However, a Chelsea fan does want to improve your life so if you see a Blue trying to get you to a Chelsea game, just go!


Kanyamagufa is Real

In the October of 2017, for no reason at all I took a 12 year oath.

I will witness and experience the next 12 Pushkarams in the next 12 years.

Ok, first there’s a technical term in the vow. Pushkaram – let’s define that.

Pushkaram in it’s bare sense is a river festival. Rivers in India, and in most other ancient civilizations of the world are worshipped as the embodiment of a life giving and cradling spirit. Ofcourse we always go overboard with our conceptions. No one knows when the attitude of gratitude and befriended living turned into an overzealous superstition. Naturally the river festivals became more and more superstitious.

Or maybe not? I won’t take a scientific approach to rationalize it, but let me use some common sense. India has many rivers and we cant say we’ll just worship one or two, hence they created a formula. A 12 year cycle to worship 12 prominent rivers. And what’s the measure the time? The heavens!

Jupiter is said to take 12 years to make one full circle. So if Jupiter is in Libra now, it will come back to libra next in 12 years. And each year, one river gets a chance, 12 signs of the zodiac, 12 rivers and 12 years. Makes perfect sense. Now I am not going to comment on the spiritual side of the story or the scientific side, because I’m neither a priest nor a scientist. I’m just an experiencer. So I experience. And hence the lofty vow.

Let’s take a few examples to drive this home.

In 2017 when Jupiter moved into Libra, the river Kaveri gets the Pushkaram – It’s river festival.

Next year, the next sign, the next Pushkaram. That is, in 2018 when Jupiter moves into Scorpio, the river Bhima gets the Pushkaram.

Like this, the cycle goes on for years. The hype is not about maintaining this complicated calculation or about anything over religious, but it’s about river cleaning and celebration. Ofcourse some of the Pushkarams like Ganga – also called the Kumbh – river Yamuna and river Godavari attract huge crowds – running into tens of millions – these invariably end up dirtying the river more than purifying it. But hey, it’s a celebration and an opportunity to cleanse ourselves.


Phew! Now let’s get into Kanyamagufa. Oops, sorry it’s another technical term, its actually a mythical place in Micheal Crichton’s 1980 book called Congo. It’s the place of the bones.

In 2018, it was the turn of the river Bhima, which originates in the state of Maharashtra, flows into Karnataka and merges with the river Krishna in Telangana. I decided to go-to a small place – almost a suburb or Pune called Tulapur.

Tulapur is famous because it’s has the tomb of Sambhaji maharaj. He was the eldest son of the great Shivaji Maharaj, the founder of the Maratha Empire. The river Bhima flows through Tulapur and hence I decided to go there to witness the Pushkaram – this was a mistake.

I first paid my respects to Sambhaji Maharaj and cooled down for a while under the shade of a tamarind tree. It was high noon and it was hot. The group of foreigners were turning pink to red to orange. Apart from them there were also students, basically couples who wanted some time quite place to be with each other’s words. And – my favourite, a bunch of old grannys, they must’ve been easily over 70. They all had earthen pots of spiced butter milk that they sold for 10 rupees. They had no teeth, and spoke with me warmly in Marathi, either they were complaining of the heat or of something else, but they just laughed and smiled at me because I was nodding and they figured I wasn’t understanding a word. I said my goodbyes and asked for a photo, the granny declined and so I just paid and left for the river.

There was no Pushkaram, no fairs, no tents, no music, no carnival, no people, nor any water. The place is a meeting point of three Rivers: Bhima, Bhamma and Indrayani. I’m not sure if it was the season or the rivers are going dry everywhere, but Tulapur was dry. I could see shallow streams of water and soft shiny pebbles exposed on the river floor.

I decided to take a walk upstream in search of water, I was actually walking on the river when it happened. I noticed a few pieces of bones. I ignored and walked further upstream. More bones. Some dried flowers and bangles too. Now I was getting suspicious. Is this an old battle ground? Do we have the tomb here because it’s where Sambhaji died? In a battle?

Since there was no carnival there was nothing to experience, and thanks to the discovery of bones, I wasn’t going to take a “holy” dip in the Bhima either. I started walking back downstream towards the steps. The view of the tomb, temple and the tall chimneys made a beautiful frame, I clicked a couple of pictures and continued walking. I sat down at the foot of the stairs on the bank disappointed when I saw the priest, he turned around and asked something in Marathi. But I understood he was asking me if I wanted to perform someone’s last rites. Was I looking that disappointed?

That’s when I understood why there was no carnival or festival at this place. It was a cremation ground. The chimneys were of an incinerator. And the bones were actually mortal remains of dead people cremated in this place. Ouch. Mistake.

I laughed at myself, gave the priest a headache, stood up and walked back to road feeling foolish. Ofcourse I did find a place where the Pushkaram was going on later – but that’s for another day.

Two years later, the pieces of bones on the dried river bed still haunt me. Not because of the dead, but because of what we are doing to our rivers. I wonder what would turn up if all the rivers dried? Bones? Kanyamagufa?


Part 6 – The Naga Conversations

Two thoughts come to mind when we think Nagaland.

  1. Dog meat
  2. Head hunters

It’s very sad that these are the only things we can think of. Nagas are said to be the one of the bravest of the Indian army. The current chief minister of Nagaland, Neiphiu Rio had been the CM 3 times before. A 13 year old girl started an armed resistance against the British rule in 1929; Rani
Gaidinliu was arrested in 1932 at the age of 16 and was only released in 1947 after the independence of India. There are many Naga football stars including Talimeren Ao in who’s honour the government has released a postal stamp. But do we know any of this? Noooo.. we can only think of dog meat and “violent” head hunting.

Sadly both of these topics are highly misunderstood, misinterpreted and misconstrued. Stereotype dog meat jokes on the Nagas are one thing, but alleging that they feed dog meat to tourists or to anyone without consent is rubbish.

Finding Dogmeat in the famous Shah house of Hyderabad or some hyped restaurant on Indiranagar of Bangalore might be bad. Bad because they sell Dogmeat in the name of mutton. But this doesn’t happen in Nagaland.

In our visit to Kohima, one of our expectation was to see dog meat and other exotic animals for sale in the markets – we missed it. In Kisama, we did see black boards outside Morungs with menus selling dog meat.

The board clearly read:

Local Dog Meat – ₹150

Local Pork – ₹180

Local Beaf – ₹200

So it’s just like ordering salad or juice, just another item of the menu. You order it, you get it – simple.

For dinner we tried a variety of food from a line of eateries – who were all hoteliers from across the state and had set up stalls to serve food at the Hornbill Festival. They were also part of a contest for the best food stall. Choices were abundant, both for veg and non veg. They served grasshoppers; crispy, roasted grasshoppers. I didn’t eat but they asked everyone explicitly for prawn allergies before serving. Of course we also had rice beer in bamboo shoots. I asked our friend from the TV channel if they used the bamboo shoots as a drinking glass at their homes also or was it just for the tourists in restaurants. He wasn’t surprised, he said in the towns we use normal steel, or plastic or coffee mugs – just like everyone, but in villages some traditional people do use the bamboo shoots.

This was followed by some karaoke, the head chef came out and sang too, it seemed like he was very popular. A group if pretty girls – they could be older – got excited and had animated conversations with him. The ladies of Nagaland were by far the prettiest in the north east.


Back at the house, it was biting cold. Avin had started a fire outside and there was a group having dinner around it. We said our goodbyes to our friends and went up to the room – which is where Nikie came to enquire about our stay.

Upon seeing us, she realised we had run into her a couple of times in the carnival. After pleasantries, we started talking of the different stalls and activities at the fest. I said I was surprised to see the Indian army put up stalls too. To which she said Nagaland provides a sixth if all soldiers to the Assam rifles. The hornbill festival was a major showcasing platform for the army. Infact there was also a stall from the BSF and another war memorial stall that showed us about the war of Kohima – A world war 2 battle that lasted for nearly 4 months.

Speaking to her was easy, she had done her graduation and post grad at St. Aloysius in Mangalore. She was now doing her PhD in history at Guwahati University. She enlightened us about the myth of head hunting.

The world outside the Naga society thinks it’s a way of living that the Naga tribes go on beheading and collecting heads of their rivals. While it’s true that tribes get into conflicts and the Nagas have beheaded each other, they don’t collect heads and it’s definitely not a tradition to behead one another. The Nagas too are victims of the British misconstrue. When the British and other exploiters came to Nagaland through Myanmar, like any natives the Nagas resisted, and to de-legitimise their claims the Nagas were made to look evil, violent and dangerous.

The girl had seemed like a carefree “girl from the north east” who ran to the beaches. She looked so different now. We were left with a sudden realisation of our ignorance as she made her way back to her room.

The fire was still burning and the other group – who were a bunch of consultants looking to get students to their colleges from the North east – had gone, so we went down to sit by the fire. Avin, who we thought was the caretaker was there sat with us. We were to find that he was an artist, a sculpture, he worked different jobs and had come to Delhi in 2017 to work with the media for a sporting event. He was now taking care of this property for the winter and had plans of going up to Guwahati or Delhi in the summer.

We had heard him stum on his guitar, so we asked if he could play for us, he wasn’t shy, he played the guitar and RJ – my other travel companion sang. It was a nice soothing end to the night. Realisation of our ignorance on one side, and understanding of the Naga way by these casual conversations on the other. Both had left us yearning for Nagaland.


We left the next morning, took a rather bad and lengthy drive to Mao Gate in Manipur, switched cabs and passed through some towns that ended with -oan, except for Senapati. We ATM-ed at Senapati, bought some water and headed to Imphal. That’s where we saw hoardings about something called Sangai Fest in Manipur. Its an annual festival in of Manipur – just like the Hornbill of Nagaland. It happens in the last week of November – so you could go-to Manipur in the last week of November, experience the Sangai feat and then come to Nagaland in December for the Hornbill. Make it happen!


Also read: Part 5 – Nagaland

Part 5 – Nagaland

Nagaland is one of the few states in India where the biggest city is not the capital by default. Kohima is the capital city of Nagaland, it is located in the south-south central region of the state. Kohima also serves as the seat of the Legislative and Executive arms of the state government of Nagaland. The state doesn’t have a High court – but has a Kohima Bench in the Gauhati High Court.

The largest city of Nagaland is Dimapur, located about 75 Km from Kohima in the south west corner of the state bordering the neighboring state of Assam. Dimapur is the last accessible place by Air and Train in Nagaland. It is not unnatural as Nagaland is mostly covered in hills – about 90% of the landscape is covered in hills and hilly terrain.  

There are numerous trains on the route and 10 of them are daily trains. So we pushed our departure and decided to take a late night train that would a. Give us time to meet the players of Bengaluru FC in the day, and b. save us the hotel cost for the night. We’d booked a non-AC – sleeper coach – which cost us a little more than 200 rupees. The train was on time at Guwahati – but was filthy. Since mine was an upper berth and it was a late-night train I didn’t bother if the floor was clean or not – I hopped in and slept. I was told that the train was duly cleaned before it left the station.

The train pulled into Dimapur a little after 6 AM. I was exhausted and visibly dehydrated. Luckily the train station has enough food joints and to our pleasant surprise, there was a south Indian stand that served Dosas – which we had with much gratitude.

We had run into the tourist police – female – with whom we spoke about the ILP. The ILP – Inner Line Permit is what tourists and other non-native expats need to visit Nagaland. It is made essential because of the Armed Forces Special Powers Act that is in force in the area. The Act itself might be enforced in different regions up to different extents, but the ILP is required in only a few regions of India – and we didn’t have it. Our friend and host – who worked at a Kohima based TV station had said don’t worry about it, you’re only in Nagaland for 2 days. So we didn’t worry about it and fat mouthed the cops who detained us at the railway station for our troubles. Eventually we were let off on our own cognizance and on assurance that we would obtain the ILP from the commissioner’s office in Dimapur town. I would suggest – you get the ILP before hand and not try to pull stunts like these – its available online or in bigger cities like New Delhi, Kolkata, Guwahati and Shillong.

Upon our “release” from the Railway station, we were hounded by cabbies – normal of any city in India. We found a cab that had 1 passenger ready to leave and with the 3 of us joining, we were ready to go – except – now we had to find a driver. The cabs may not always be privately owned – hence there are 3 moving parts – the passengers, the vehicle, and the driver. It was only on the road to Kohima did we find out that every part in the car is a moving part and it’s a miracle the chassis still holds, and engine still runs. The road is terrible, most of it is attributed to the new highway project, but the construction has been going on for years and likely to go on for years more. The distance of 75 Km took us nearly 6 hours. Bikers and landslides were a common site. Armored vehicles too. I couldn’t enjoy the mountainous scenery much – but the mountains and valleys can make an enjoyable sight.

The terrain gradient of the city of Kohima was constantly varying. The city itself wasn’t any cleaner than majority of India, but there was a lot of construction going on, houses, shopping complexes, bigger housing buildings – which suggested a sort of progress. There were also numerous schools and coaching centers – coaching centers that taught computers, and other professional certifications. Good signs! Since it was Christmas season, the whole city had Christmas decorations – not a lot of lights – as electricity is a commodity, but decorations, sky lights, and a lot of red and green everywhere. The homogeneity of the decorations made me as our friendly -stranger co passenger if it was handed by the government – which was the case. We took another cab from downtown Kohima towards our homestay in Kigwema.

We were welcomed warmly by the owner/keeper of the house. As a welcome drink, we were offered rice tea. Rice is a big part in Naga society, rice with meat, rice tea, and rice beer are every Naga’s daily routine. The homestay was a minimalist stay with minimal furniture – just beds and bedding, a small table with a bible and a calendar. There were candles and matches reminding us we were in rural India – albeit a tourist destination. The facility had community bath and toilet – toilet being the squat toilet.  We freshened ourselves up and waited for our friend to pick us up to go to the Hornbill festival.

 Kisama is an artificial village created just for the sake of the festival. It gets the name from the two nearby places of Ki-gwema and phe-Sama. The village is basically a big carnival area with parking, outdoor stage area, restaurants, a chapel, ATMs, medics, outdoor flea markets and everything else you find in a carnival. The main attraction however are the Morungs. A Morung literally means a habitat – a place of residence for a family or a group of families of a Naga Tribe.

Nagaland is home to 17 indigenous tribes, some are as big as 200 thousand people while some endangered ones at less than 20 thousand inhabitants. All these tribes are incredibly interesting with their own unique culture, language, scripts and art forms. The Hornbill Festival is an event that showcases and celebrates all the different cultures of these tribes. Each of the 17 tribes are depicted in their Morung, which they get to design and decorate themselves, cook food, set up stalls, brew beer and hold all of these for sales. Photos are encouraged and everyone is friendly.

The festival not only runs in Kisama but after nightfall, concerts from famous and upcoming native bands are held in the city concert ground in Kohima – which is just 15 Km from Kisama,

The people we met, our friends who we had seen in a different light and the new friends we made opened our minds to a whole new world. The conversations with the Nagas will be last of the 6 part travelogue of the incredible North East of India.

Also Read : Part 4 – Dawki and Jaintia


AV Fistula – The Surgery

Procedure we called it. Because it’s small, done under local anaesthesia and can be discharged from the hospital on the same day. Or the real reason – too scared to call it a surgery. Let’s not be scared and call it what it is – a minor surgery.

In the previous post, we learnt what is an AV Fistula and why we need it. Some of the readers of the blog have asked me to write about the surgery with special emphasis on my experience through the surgery. Sorry I don’t have comments on the blog to prove it, but you don’t have a choice – read on.

The buildup

Once the doc saw the numbers on my blood work, he declared let’s get the Fistula done soon. Get admitted on Monday. We’ll hydrate you for a day and see what to do next. We sensed the seriousness in the tone and didn’t ask many questions – or should
I say any questions.

The weekend was spent reading, and the few phone calls and mails to office to let them know I would be off work for the week. I had already read up on what and why Fistula, but there wasn’t much info on how the surgery would go and other patient experience about the whole process. As due, we reached the hospital in time thanks to Raaghu who picked us up late from home but dropped us in time at the hospital for the admission.

The first day

I was put in a room, robes on, hospital tag and IV line attached, and then there was nothing left to do but wait. The doctor came in, no small talk, took a look at my wrists and elbows and said let’s do it at the elbows. He was the nephrologist, he ordered the nurse to put me on fluids for the next 24 hours and monitor the vitals along with my urine output. I had an uneventful night – apart from the 92 year old grandpa who constantly craved for coffee deep into the night. He was in because he was just old and had taken a tumble that had send the sugar racing.

The Prep

An afternoon surgery was planned and since it was a local anaesthetic process, there was no requirement to have an empty abdomen. Hence I had my lunch at around 12:30 and waited for an hour for my ferry to the OT. (called OR is some parts of the world) As I was wheeled into the OT complex I could see a white board that had a list of all the surgeries for the day.  I was a little taken aback on how they could just list them so publicly. It had details of the patients, doctors on duty and even the procedure. Perhaps the OT complex is an small community in itself and everyone’s a professional. But they have guests – the patients, who may not always be so trustable to keep the contents of the board to themselves. 

The surgeon walked in as I was being prepped and wasn’t happy that the staff wasn’t ready for him. Sir, 2 minutes  pleaded who seemed to be the senior most nurse in the OT. They quickly adjusted my position on the operating table, held out my arm and dabbed it in betadine and other disinfectants. As one nurse held my arm up to drain out excess betadine, I could see a tattoo on her arm that red “Irresponsible” for a second I felt like the moment the cop saw Mr. Bean in the hospital – luckily Dr. Timepass was in town, and I could see the funny side soon. 

The surgeon stormed into OT 3 a few minute later and the nurses stiffened up again. He tore the scrub that was draped over my face to reveal the right side view – Don’t cover the face, the patient can get claustrophobic – actually I felt comfortable and warmer while fully covered. 

Just a small prick, after which you wont feel anything. The surgeon said to me

Prick, Sting and a Shock

I wasn’t sure if it was the surgeon or a nurse, but I felt the prick, a sharp sting and a sudden shock run down my arm – maybe that’s why they had padded my palm. Then everything went numb. I could hear the surgeon voice commands like we see in movies – scalpel, forceps, clamps, suction and a few others that I can’t recall. I couldn’t hear cutting or what was happening inside as my left arm was totally numb. 

About 10 or 20 minutes into the operation, the “Irresponsible” nurse came over to my right side and asked sir are you awake? Not so irresponsible I was thinking when we asked again, sir can you open your eyes? I opened my eyes and gave a thumbs up on my right hand. But as I kept my eyes open and turned my gaze upward, I could see my reflection in the clear glass and shiny rim of the huge operating lights. The incistion itself was hardly 2 inches long – so nothing much could be made out – but it felt funny that all their efforts to shield the patient from seeing the blood and gore was undone. 

Soon after I felt my arm tightening. Like when you feel the arm under pressure while they check your BP.  I hadn’t realised what had happened. The surgeon continued voice commands for more tools, and he said get the Heparin ready – the anti clot. The nurses were fiddling or getting it rather slowly and the surgeon made sure he didn’t waste time and gave them some constructive negative feedback – on which I laughed a little. He must’ve notices my shaking belly as he acknowledged the laugh and addressed me to say the main operation is done, we’ll just close it up.

Surgeon's tools

I could hear some hard pulling and yanking in between shouts of wet your hands, wet my hands, don’t touch him without wetting your hands. Is this how all operations go? maybe just mine because it was a minor surgery. He was the only doctor in the OT, the 4 others were either nurses or far too junior than the main Surgeon

Its done, it went well. He said more like a declaration and went out to meet my parents. The nurses got me out to a room just outside called the Recovery where I spent the next 2 hours before being moved to my room. 

My arm felt tight. The pressure at the elbow was still there and I couldn’t flex and stretch – I felt I wasn’t supposed to move my arm because of the stitches and tried to keep still. It wasn’t until late that evening – around 7:30 that my Nephrologist walked in and told me to feel the Fistula. I put a finger on it and could feel it – like a jet of water running in pipe. Just that it was my blood and was flowing in full force just a few millimeters below the skin. I little freaky, but I managed to stay sane. I had an uneasy night – the stiffness, the pressure and the uncertainty of whether I should move my arm or not kept me up most of the night. 

The Next morning

My Nephrologist’s assistant came in early morning as I was having my breakfast.  He saw that my arm was half flexed – and seemed really regid. He said no you need to move it constantly. That’s when it became clear.

  1. The pain was not of the stitches.
  2. The stiffness would only get worse if I didn’t move the hand.
  3. The stitches were secure enough and there’s no need to worry about them ripping.
  4. It is essential to exercise – the flex and stretch movements as well as the wrist pumping action. 

As I tried to stretch – my arm would ache – exactly at the point of the surgery and hence I asked the doctor again if it was normal. He then explained beautifully. 

The veins are superficially located, but arteries are located deeper. So in the surgery, they first made an incision of about an inch and a half on the outer skin, then they dug deeper, seperated your muscles a little, found the artery and linked a portion of it with a suitable nearby vein to create the AV Fistula. Since they went beneath the muscles and fiddled with all that’s inside, the muscles would be disturbed and stiff. By exercising – making the flex and stretch exercise you will get the muscle to perform their intended action and hence restore their original shape and condition. The wrist pumping action will increase blood flow into your arm, and there are many reasons why more blood is better than less – faster blood, more nutrients, more flow and fluidity and hence faster healing.

Hospital Tag

Exercising became easier and made more sense after knowing this. The arm slowly gets better, the veins in your arm slowly start popping and the jet of high pressure blood flowing in a pulsating motion just under the skin becomes an everyday thing that you’ll learn to live with. It’s not easy, but where’s the fun in easy?


AV Fistula – The Details

There’s good news and there’s bad news I would say.

Bad news – My kidneys are failing

Most people would be shocked an a little anxious for me. They would ask me questions on the different things in my blood like creatinine, urea and eGFR and things like that. But they would soon recover, and the recovery was partly because I had said there was good news too – which was just really a placebo.

Upon insistence, I would say the good news is that

I find myself in an unenviable position

Those who knew and loved me enough would crack up and the rest would pout a sad face.

My doctor who has been seeing me for more than 16 years now said that it would be safe to get an AV Fistula done as there was no telling when I might need dialysis and the AV Fistula needs anywhere between 8-12 weeks to mature and be usable for dialysis. Meaning you need to get the AV Fistula done well in advance of your first dialysis sitting.

What is Dialysis?

Dialysis is the process of purifying blood. Our kidneys perform this function and remove toxins and other waste products from the body. When the kidneys have nearly completely failed, the body has no way of regulating the chemical composition and water balance of the body. This will eventually lead to malfunction and failing of other organs like the heart, liver and brain any of which can lead to sudden or slow descend to death.

To prevent this, the medical sciences have invented a method to carry out this process of blood purification outside the human body using a machine unimaginatively called the dialysis machine. The patient is hooked up the machine, two needles are connected into a single vein which acts as both artery and a vein. The needles again, quite obviously are called the arterial needle and the venal needle. Blood is pumped out – using the patient’s own internal blood pressure and no external pump – from the body and made to flow through a long series of pipes lined with osmotic membranes, which is nothing but layers of skin or organic film will allow separation of toxins, chemicals and other waste from the blood. The process is repeated for about 3-4 hours until all of the blood in the body is purified. Depending on the damage of the kidneys and the requirement of the patient, dialysis can be prescribed anywhere between 4 times a month to 3 times a week.

All details listed above are for hemodialysis, there is also a method called peritoneal dialysis – which doesnt require a fistula or getting hooked on a huge machine for 4 hours. Look it up.

What is an AV Fistula?

An AV Fistula is basically an abnormal condition where an artery and a vein interlock and become one. That is, blood from the artery flows into the vain thereby making it swell up.

This abnormality is artificially created in case of patients who need dialysis by surgically connecting an artery to a suitable vein. The process is generally done under local anaesthesia at a few known access points like the wrist or elbows or thighs – choice of the access point for creation of the Fistula is made based on the built of the patient and availability of suitable veins.

Why AV Fistula?

There are 2 reasons,

As we’ve learnt a little while ago, needles – substantially thick needles – are inserted into the patient’s body. Now the arteries are thick and fat and can take the piercings, but veins are not always thick and repeated piercings can collapse the veins, secondly, blood flows in the veins in relatively low pressure and hence pumping gallons of blood back into the body for 4 hours may not be possible without proper pressure. The Fistula creates a pressure that is generally higher than usual venal pressure and makes the veins capable of handling blood flow possible.

Other options

Apart from an AV Fistula, doctors may also suggest creation of AV grafts, where in an inorganic connection – in form a tube – is created between the artery and the vein thus performing the same function.

Both the AV Fistula and AV graft need some time. Around 2-3 months to mature and get the veins ready for the reoccurring process of dialysis.

There is 3rd option using an intravenous catheter. This catheter doesn’t need a maturity time and is generally used in case of emergencies.

When it comes to other factors like longevity, usability and maintenance , the AV Fistula is called the best option as it is completely organic, is least prone to clotting and infections. Whatever you choose, you can live a long life on dialysis if you are ready to make some lifestyle changes and stay vigilant of your condition.

Ofcourse if you have a long life to live and have the means to afford it, you should read up on kidney transplant and give it a shot.


Also watch

Continue reading “AV Fistula – The Details”

Bow wow eww

Repost from a 2012 post on the Original Dr. Timepass


Three months after my sister was married, her old cupboard was finally mine. It smelt strongly of cosmetics and little did I know that the perfume of oriflame would eventually help me in understanding dogs. Yeah… it makes less sense, but let’s keep going. I had had the almirah for two or three months, and there wasn’t much I actually wanted to keep inside an almirah. My mom made use of this, she needed a place to keep her herbal tea stock; and since I didn’t have the almirah full by then, my mom stocked a full shelf with her herbal tea. Since then I would be greeted by the scent of tea and herbs as I opened the doors. I should say here, I really missed the scent of oriflame.  

Moving on, just a few weeks back my dad needed a place to store his gifts. Gifts as in wooden mementos. So quite easily he took another empty shelf and filled it with his mementoes. I know!! I really need to stuff things into that almirah! So now the cupboard smelt of wood varnish. I would wrinkle my nose and make a bad face whenever I opened the closet. Actually it was this repelling scent that made me think how important the sense of smell is, and how stimulating it can be. I started thinking about how dogs always sniffed around other dogs’ pee, or I had heard that male star tortoises travelled for miles to the scent of a female tortoise in heat. I started to think that maybe the sense of smell is wasted on us, and of course a lot of other crazy weird shit; but that’s when it hit me! I finally realized why I was being chased by dogs, or why Rani, the dog in our street was thought to be a bad dog or why the number of dog bites had increased in the metros. It was smell! 

I knew that dogs are rarely aggressive towards humans, but the number of Dog bite cases has had an increasing trend over the years.  I had been chased by dogs myself on a few occasions, I really didn’t care to think about it, but I did see a pattern, I saw that on the days I wore an Adidas, ‘sport’ deo(marketed by Calvinkare in India) I noticed dogs barking at me and on two occasions aggressively perused . A dog with a limp near my friend Pinky’s house, which is otherwise the most peaceful dog also seemed to want a piece of me. I though, the deo was bad luck and stopped using it. But It was the scent!  

I was chased again by Rani, this was right after I had had a bath; I had used my mom’s VS shampoo… I thought the shampoo smelled really good, and after I came out of the bath, my mom was seriously mad at me for using too much of her VS shampoo. That was probably worse than Rani’s chase, but the point is, it could be possible that Rani was repelled or felt threatened by the weird smell of my mom’s shampoo. Rani, was also known for barking at fast traveling cars; and she would really get mad at the two guys who had wicked looking Bullet bikes in our street. 

There were reports of dogs attacking infants. It really seemed threatening, and many organizations plus the government took to the streets to sterilize, move and even kill dogs. Maybe, a lamenting infant in the hands of a funny smelling woman with shopping bags full of more smelly things scared him. Just a thought.

In our fit to be metro, we are confusing and threatening these poor creatures. The sense of smell, sight and sound are all that these playful creatures base their life on, and all the different smells, sounds, sizes and shapes that we create or have these days are harming the creatures we share our ecosystem with.  If we can talk about being sensitive to nature, we can surely think why animals do what they do.

The next time you are chased or attacked by a dog, just smell yourself