Monday, 25 June 2012 19:00

In you we trust - 4

Written by  Kamal Shah
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(This is the third part of a fictional short story - In you we trust. You can find the first part here.)

Within a few weeks, everyone got to know that Prakash was very skilled. He could cannulate difficult cases with ease. He knew the machines inside out. He could handle complications also fairly well. He gained everyone's confidence.

Prakash took pride in his work. He was extremely confident about his abilities. Education-wise Prakash was like many other dialysis technicians - no graduation degree, only a diploma in Dialysis Technology. Yet, he was very skilled. Patients wanted only him to cannulate. They hardly felt any pain. He could cannulate in one attempt.

Cannulation is a tricky beast. Some people say it is a natural gift. Some people say it can be mastered by practice. Some people accuse it of being over-rated. Whatever it is, one thing is for sure - cannulation is the thing most dialysis patients fear like hell. Severe pain is one of the less damaging effects of a badly done cannulation. Worse things can also happen.

Prakash slowly took over the administration of the unit as well from Dr. Jha. He adroitly handled staff scheduling, patient scheduling, inventory, housekeeping - everything that needed to be done in the unit. The junior staff did not mind this at all. They recognized their limitations and were also happy that the burden of all these things was no longer on them.

Dr. Jha was a happy man! He could now focus on things he really needed to focus on, things he was meant to focus on.

One Friday evening, Aparna came in for her session. Of late, Aparna had also been impressed by Prakash's handling of the unit. She found that she got onto the session much sooner than before, could leave once her session was completed much sooner and overall the unit looked much cleaner and more organized than before. 

It wasn't like this always though. She was coming to Charaka only because she stayed close by. She would not generally tolerate inefficiencies easily. But she had little choice given the distance other units were from her house. But now, things looked better. She was hoping Charaka would offer good quality dialysis now that they had a good technician in place.

Aparna got on to her bed and waited as the junior tech primed the dialyzer and the bloodlines. She had checked her weight herself and was calculating the weight gain. 3.5 kgs! Hmmmm, however much I restrict my fluid, I do not put on less than 3 kgs! What is the point in restricting?

Prakash came and wished her. 

"How are you Aparna madam?" 

"Fine, thank you, Prakash"

"How much weight gain today?"

"3.5 kgs"

"Hmmm, too much water?"

"No Prakash. I hardly drink any water."

"That's what all patients say madam! I wonder how the weight goes up so much then!"

Prakash laughed as he said that.

Aparna hated to be compared with 'all patients'. She was not one among 'all patients'. She knew her body and no one else did. She did not drink that much. She knew it. Who is this technician telling me all this bullshit?

She refrained from reacting however.

Prakash got ready to start the session. The junior tech who primed the line was assisting. Cannulation went on smoothly. Prakash connected the bloodlines and started dialysis. Within a minute or so, the Air Bubble Detector Alarm rang. Beep, beep, beep! Prakash reset the alarm. Very often these alarms are only transient alarms. A mere reset a few times does the trick. 

Not this time. Beep, beep, beep!It went on.

Prakash noticed the venous chamber had become frothy. There was excess air in the system. 

Beep, beep, beep,the noise continued.

Aparna was worried by now. Most alarms were always taken care of by resetting. What was this,Aparna wondered. She asked Prakash which alarm this was. Prakash ignored her. She persisted. 

"One minute, madam."

Aparna waited.

Beep, beep, beep,the alarm nauseatingly continued.

Aparna asked the junior which alarm it was. 

"Air detector, madam", the junior offered. He knew there was no point in hiding anything from this patient.

Aparna also got really worried now. This was the most dangerous alarm among all the alarms that could go off in a dialysis machine. Dialysis machines were designed to ensure that even a little amount of air did not enter the blood of a patient.There is an air bubble detector that is placed in the circuit just before the blood is returned to the patient. Any tiny droplet of air sets of an alarm and the blood is stopped. Only when the air is removed can the blood be returned.

Aparna kept a close watch on what Prakash was doing. She saw Prakash remove the line from the air detector. This would bypass the alarm without actually correcting the problem.

"No!", she yelled, "don't remove that!" Prakash instinctively put it back on hearing her. "It might be a false alarm", Prakash retorted.

"Its not. The venous chamber is full of bubbles! Check the connections to the dialyzer and the dialyzer caps. They might be lose." Aparna said.

In an instant Prakash knew that she was right. That could be the only reason. He immediately reached for the dialyzer. One of the connections to the bloodlines was loose. Air was entering into the system through that. Prakash immediately tightened the connection, inverted the dialyzer and hit the dialyser with his palm nudging the air to the top so that it could all accumulate inside the venous chamber. Within about five minutes, the air bubble detector alarm stopped and dialysis began.

Prakash was livid. The junior had not tightened the connections. This was a part of the priming process! How could he have not done it? He quickly completed the other formalities and asked the junior who had primed the kit to come into the ante-room that was behind the nursing station. The junior's face paled. Within a few seconds of him entering the ante-room, a loud slap was heard. The junior came running out of the room, hand on cheek, tears rolling down his cheeks and left the unit. The patients were all shocked. Aparna couldn't believe her eyes. She did not know what to do or say. 

Silence enveloped the entire unit the rest of the evening. Prakash was still angry. The staff were all visibly shaken. The patients hoped they would have no complications that evening. Aparna couldn't think of anything else. She replayed the sequence of events in her mind again and again. She wondered if she could have handled the situation in a different way. She was convincing herself that she did what was right for her. If she had allowed Prakash to remove the line from the air detector, her life could be at risk. 

Prakash came to close her session at the end of four hours. They did not say a word to each other. Another junior lead Aparna out after checking her weight. As she settled into the seat of her car, she thought to herself, "What just happened?" She had no clue. It was all like a blur. Like it never happened. It was too weird to have really happened.


Kamal Shah

Kamal Shah

Hello, I'm Kamal from Hyderabad, India. I have been on dialysis for the last 13 years, six of them on PD, the rest on hemo. I have been on daily nocturnal home hemodialysis for the last four and half years. I can do pretty much everything myself. I love to travel and do short weekend trips or longer trips to places which have dialysis centers. Goa in India is a personal favorite. It is a great holiday destination and has two very good dialysis centers.

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