An Accidental Friendship

"Why did they leave me? What did I do wrong?" Duke seemed to be thinking, as he wandered aimlessly through the park. His eyes were keenly watching every passerby for a glimpse of his master.  His little black nose sniffed religiously at every inkling of a smell even slightly close to his little master, Timothy. "Woof!Woof!" He barked weakly with the hope of being found by his family again.
It had been 2 months since Dukes family moved to South Florida. " Duke!" Timothy had cried as his father had dragged him to the car.
"He'll be fine honey! He has his other Dog friends over here. Why would he want to come with us? " Timothy's mother had said with a stern smile on her face. " Now get into the car or we'll be late for our flight."
Duke had watched with his nose stuck on the window , his sad eyes following the car until it finally disappeared out of sight. He had known something was wrong. He had known they were not coming back for him. Quickly getting out of  the house through the 'doggy door' , he had chased the car down the lane till his little legs could carry him.
Since then, Duke had wandered this huge park with the hope that little timothy would one day come looking for him. A new family had moved into his house in just two days. Two dog catchers and one big stone later, Duke understood he was never wanted near the house again. Ever since Duke was a puppy, he came to this park everyday with timothy for their adventurous quests. He knew every nook and corner of this old abandoned park. The beautifully maintained planted grass in this park was replaced by bushes, shrubs and wild trees and had taken the form of a scary forest.
Duke's ears straightened up as he keenly tried to hear something moving admidst the wild grass. His nose sniffed vigorously to find out who the tiny ball of fur was . An excited Duke followed the squirrel as quickly as he could. he kept trying to trap the squirrel in between his paws but it proved too fast for him.
 WHACK!
 That was the last noice duke heard before he landed on a pile of leaves. He noticed timothy running towards him just before he completely blacked out.


Greg lay on his bed staring at the ceiling for which seemed a very long time. As he did ever morning, he was searching for a reason to wake up. He remembered how happy he used to be. How his 10 year old son used to run around the house trying to play tricks on him and his wife . And how he would laugh when they found that it was his doing. He remembered that fateful day two years ago. How he wished he hadn't taken John to the zoo that day. How he wished the car crash had killed him instead of his innocent little son. He thought about his wife who was never the same again, and how they rarely spoke now. If they did speak, it was usually because his wife had something to say about how useless he was, or how he could not even do one job properly. Eventually, They had forgotten how to smile.
He had turned to his brother for comfort and his brother saw this as an opportunity to squander him of his money. Greg had an appointment with his lawyer today, which made it a lot more difficult to get out of bed.

The only solace Greg found was during his evening walks in the old abandoned park. Not many people visited the park anymore and so he had a chance to hide away from the world, away from his wife. the straight path he took everyday had a beautiful view of the thick foliage on either side and somehow it calmed him, atleast for a while. As days went by , even the serenity of the green leaves didn't give him much peace.
This evening as Greg walked the path, his heart seemed to be racing faster than usual. He felt something bad was about to happen. He had heard rumors of frequent muggings in this part of the park but never was worried much about it until today. He sensed something or somebody move admidst the bushes. His legs froze. How he wished he had bought that gun. He looked around and found a log big enough to bring a man down.
'Hello!' he called out slowly. No answer. "HELLO!" he called out louder. no answer again.
He hurled the log with all his might. Immediately a whine was heard and then complete silence.
" Oh Man!! its a Dog!" He screeched out. He looked all around for his owners but there was no one in sight. "please dont die! please dont die!" He cried repeatedly and softly ran his hands over the Golden retriever . Before Greg could understand what happened next, the heap of fur just sprung to his feet and rushed away as fast as he could. Greg tried to follow the Dog to see if he was alright but he could no longer see any sign of life around him. A terrified Greg quickly ran back to his car and drove off home before some angry dog owners could come looking for him.

" Why could I see timothy when this man hit me?" Duke wondered as he raced deep into the park.

The next evening , Greg saw the Dog again. This time, the Dog was standing at the same spot he was hit the day before. It was as if he was waiting for Gregs return. His legs shivered as the Dog Watched him with his eyes fixated on Greg anywhere he moved. He decided it would be intelligent to just calmly walk by without threatening the Dog in anyway. As he could get to a safe distance , he turned around and saw that the dog was still sitting there and watching him. Glad he was not going to end up in the emergency room for a dogbite, he wandered of into the park for his peaceful retreat.

Two days later, Greg found himself stopping at a Pet food shop. He didnt understand why he picked up the biscuits. He didnt like Dogs and never understood why people even did. They are smelly,messy and loud creatures with the potential of staying immature brats for the whole 12 years of their lives. He shuddered at the thought of their teeth and what would happen if he made one wrong move to upset them.
 As he had expected the Dog was there again. He reached a safe spot and placed the biscuit as close to the Dog as possible. He saw that he had a collar with a name.
"Marmaduke" Greg read it out loudly. The Dog barked and quickly gobbled down the biscuits.
Greg began making regular visits to the Pet food shop before he went for his daily walk. As days went by Greg found that Duke began following him around the park . When he would reach his car, Duke would sit by the side of the road until he leaves. Greg understood that Duke began trusting him more and more each day. Duke would allow him to pet him and at times would role over on his back for a tummy tickle. Greg smiled when he did that for the first time. " You need a tummy rub do ya! " He laughed and ran his hands through his soft fur. Greg began looking forward to meeting his little friend everyday. He liked the fact that everytime Duke heard his car, he would rush over to the parking lot and run around like he was a crazy kid. He liked that when he got out of the car, Duke would just jump on him and tackle him to ground and would not release him until his face was dripping with his wet licks of  love.
Some days Greg would be telling him stories about his son and how much fun they used to have together and Duke would just faithfully follow him with a face as if to be listening so intently. Some days he would bring a ball for Duke  to play catch with or watch him explore little squirrels.
Other days, a naughty duke would be tearing apart Bags or books left around by passerbys. "Duke ! what are you doing!! HA! HA!" Greg would laugh.
"Hey leave my bag alone! get your dog of my bag!" they would hear someone screaming. "Come Duke! lets run!"  he would say and they both would run as fast as the free wind that blew through their happy lungs. Greg would remember how it felt like to be a small boy again.
The days When Greg would bring a book to read, Duke would just sit by his side faithfully until it was time to go home again. Greg began noticing that everytime he got into his car to go home, Duke eyes would become sad. But somehow Greg understood that Duke would never leave the park to come home with him nor could he take Duke home . He knew that Victoria would never understand and hence he would drive home with a heavy heart.
Greg was at the park that day after a meeting with his lawyer. He remembered how he had screamed at his brother for betraying him and how his brother had sat there quietly, like he was looking at a crazy person. Greg sat quietly at the park bench with Duke beside him. Duke slowly came close to Greg, licked his face softly and placed his head on Gregs lap. Greg burst into tears and hugged Duke like he never wanted to let go. Duke let out a small whine like he was asking him to stop crying.
That night before Greg went home, he bought his wife a bunch of roses. " what is this for? she asked him. What can a bunch of flowers do? bring our old life back? she asked with tears in her eyes. She left the roses on the table and went to bed.

"I can see that you are a wanderer" Greg told Duke the next day. However the rainy season is coming up , and so I am going to build you a kennel." He said cheerfully.
After his wife threw away the roses he bought her this day as well, he quietly walked  into his workshop for the first time in two years and began his work. Victoria watched him through the window, her eyes tearing up. She remembered the last thing he built was a tree house for little John.

Greg began regularly getting flowers and gifts for his wife and didn't mind how rude or hurtful she tried to be. He would follow her around the house , in and out of the kitchen until one day she couldn't help but smile at the desperate attempts of her husband to reconcile. The next day , Greg saw some roses placed in the flower vase near her bed.

"You can keep the money my brother. You have lost the most important thing in life. your family's trust. I couldn't punish you any other way." he said and walked out of the lawyers office. He felt a lot of relief that day as he walked towards his car.

Duke stood at the parking lot waiting for Greg, but there was no sign of him. Hours later, Duke walked back to his kennel distraught. the next three days , Duke would run over to the parking lot in the morning itself with the hope that Greg might want to catch up on his walking. But he never came. Duke would leave for his kennel only after it would become dark.

"Hey Duke! Catch! " Duke heard timothys voice calling after him. He was so excited to see the red ball and ran behind it to catch it for his master.
" Duke! sleeping near the parking lot today? Did you miss me? " Greg asked with surprise. He understood that Duke was waiting for him. " Where were you running to in your dream my friend? Which little squirrel were you chasing now?" Greg had noticed with a smile that Duke was moving his legs in his sleep.
Duke whined and began licking Gregs face vigorously. He then let out a growl as if to ask him angrily why he didn't come the last few days. " I am sorry little chap. Her name is influenza and i don't expect you to understand." He said giggling. " Now get up! we have a lot of catching up to do!"

Duke was sniffing around a pile of leaves nearby. Greg had gone hunting for some wild flowers to take back home and was no where in sight.
Dukes ears were suddenly alert. He turned around and raced as fast as he could.

"Give me all you money!" the man with the gun said.
" I dont have anything on me! you have to believe me!" Greg begged.
"you 'd better cooperate or else...." He began clicking his gun.
"GROWL!" Before the man could turn to see what it was, Duke pounced on him.
A couple nearby heard a shot being fired and quickly called 911.

Two hours later , Greg walked into the animal hospital with tears rolling down his face. " I am sorry Mr Montgomery, but i don't think your dog is going to survive the gun shot. We tried the best we could but he has lost a lot of blood. I really am sorry." the doctor said sadly." If you need to spend some time with him, he is in the room over there."

Gregs face was drenched in tears as he saw Duke on the table with tubes running to and from him.
" You were willing to give up you life for me! ", he cried out. " You're just an animal! you're not supposed to have such complex emotions!" He hurried over to the table as Duke wagged his tail feebly and licked him.
Greg slowly began whispering into his long brown ears "All my life I was looking for atleast one person I could purely love, without an ounce of doubt or any negative feeling. I just wanted a friend who i would want to stand by at all times and who would do the same for me. Duke, it is you. I will never forget you my friend. You taught me to love without expectations. You taught me to never give up. I know you never left the park because you were waiting for the wretched family that abandoned you. You taught me to be free. you taught me that I can find happiness in the most unlikely of places, in something as small and furry as you!"

"Is this the Dog that saved your life? asked Victoria as she walked in slowly.
"More than once. " Said Greg as Victoria placed her hand on Dukes head. As Duke slowly closed his eyes, Greg noticed his legs began moving like he was running towards someone.



"We shall name him Duke junior! " Greg announced two weeks later. Greg and Victoria looked on affectionately at the tiny new addition to their family. "Yelp ! Yelp!" voiced the golden retriever pup as he stumbled into the room. They burst into laughter as they watched the cute awkward little puppy with his little black nose twitching away. Victoria placed her head on Gregs shoulder, as he rested his chin on her head. " I am sorry I was never there for you when you needed me the most Vicky." He said sincerely.
" I understand Greg." she said as she laid a kiss on his heart.

                                                                      THE END


"Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. Love never fails" ~ 1 Corinthians 13:4–8a

Old Ms Amala

“You see those beautiful fluorescent lights up on the ceiling? Well,  maama put them up there . He used to find it easy going to sleep looking up at these pretty green stars and  moon… Here,  let me switch the lights off for you…”

   Old Ms Amala., aged 65 years old. Being a retired school teacher , she had the perfect combination of the confidence of a woman who had handled many brats of boys at school  and the strict discipline of a god fearing Brahmin.

          She wakes up at 6 in the morning, takes a walk all the way from sector 3 to sector 4 breathing the cool november delhi air.

          As she walks home, she buys milk and other necessities required to make a tastey breakfast , an Indian delicacy which she would later astonish me with.

I try to hop out of bed by 7.15  and rush to the bathroom before she gets home. Young and carefree as I am, having no prior chance to spend time with someone in such an age group,,  being a guest at her home (even  just for a day or two) was becoming quite a tricky issue. What to do.. what not to…? How clean should the room be… can I use her utensils? Should I not?

           “Good morning dear!”  She calls after me… “Have your tea first and then take a bath…I have just switched the water heater on”

“Oh I have already taken my bath, maami… the water was not that cold.” I said, .. remembering how I had to keep myself from groaning out loudly from the freezing water. “ Do you need any help making breakfast?” I make my way into the kitchen. The tiny size of the pots and vessels  were a tell tale sign of a lonely widower whose children have settled in other parts of the globe.

         “A nice collection of vessels maami! So compact and easy to store.”

         “ ah! Yes… these belonged to maama” she said . I was to  learn later that maama ( her husband) had been suffering from a cancer due to which he  passed away two years ago  “He left this house so comfortable for me to live in” She said in such a jolly note that you would think he was still alive. “he had written the numbers of the plumber , carpenter and every possible person  whose help I might need. My neighbours here are also such helpful people. Mr and Mrs Ram are also a retired couple staying in B12. They don’t have any children. Lucy is all they have” I had met Lucy the day before. A smart little dog…I wondered how old she was

         , Mr Varma, another neighbour drops me of at the Medical Council on  Maamis request.

          I come home with Jeena Davis. My college-mate who had to apply for registration along with me. She had a small complication with  the passing of her certificates and had to postpone her ticket to chennai for the next day… “Welcome home my children! Is this the Jeena you talked about over the phone? Nice to meet you dear! make yourself comfortable” she says and leads us into the apartment.

         “Today was my sister in laws birthday  I was out with her family” she says after she has inquired about our experience at the council. “I saw her birthdate on the diary your maama left. He had a whole list of birthdays written down you see. I was not as good at trying to remember them like he did, but now, its easier.” Her eyes showed the same smile it did hours ago.

           She swiftly runs into the  kitchen to prepare dinner for us and will not hear of any offer to help. She shooes us into our room to rest our tired legs until dinner will be ready.

          Perfectly round tiny chappatis, with palak panner and boondhi raita on the side; A delhi special I secretly love (it has to be kept a secret because I am slightly overweight and all my wellwishers have banned me from touching any kind of  cheese). Our conversation includs all topics from her children in America and Canada , to the ekta kapoor serials on television. We even brush through all her favourite recipes which she has learnt all over the years. I tell her my dream of carrying on a carrier in clinical research.. A few proud words of encouragement from  her when  we hear Lucy barking across the hall.

        “Lucy, a loving Dog.” She says.  Maama used to always buy biscuits for him. When he calls out her name from inside the apartment, she still hears him and rushes over here to collect her treat…”she said smiling. “ when maama passed away,  she did not eat or move around for days!” my lips were paralysed in a dilemma , either to utter words of consolation or to let her know how loved he was.

“well, your maama was a loved man”,  she said at last. "But that’s all a story long over", she said leaving a big sigh. . so tomorrow you need to go to the airport you said? Let me arrange a taxi for you……”

         that night I found it difficult to sleep. As I lay on the bed staring at the ‘pretty green stars' above.. I saw a love that has endured years of hardship, disagreements, the growth of three children and then finally,  distance..

 Some day in the future. I will have my share of marriage troubles, disagreements, and sometimes I may feel the desperation to let go…. 

           But on this night , all I could think of was the day I will be 65, the day I will remember my love . with a smile on my lips.

                                                                                     By,

                                                                                           An inexperienced author

  

           

Confessions of a 20 something drama queen...

i woke up one fateful morning...my eyelids still stuck together; trying hard to remember the vague dream i had last night . something about flowers and petals .... and a dress... the most beautiful dress i had ever seen. "some day i will buy that dress" i thought to myself . some day... when i am able to fit into it of course.

         i stumbled into the bathroom and forced my eyes open in front of the mirror. i looked at my ever growing waistline. " did it grow a little from the pizza i had last night?" i wondered. i remembered the dress again , yah right, someday....

my eyes slowly made its way up to my face... "aaaaaahhhhh!!! is that a wrinkle?????" i felt nauseous . the bathroom walls seemed to be spinning over my head and a little fairy was playing weird tunes next to my ear...

"thats a worry line u knuckle head. happy birthday..." that was my sister walking in to grab my spot in front of the mirror.

a worry line? yah thats for sure.
 " what do you have to worry about at your age?? " my mom always asks. "whats not to worry about???" i would think.

i am a full grown adult  but i still feel like the insecure little teenage girl i was years ago. i still believe in fairy tales with fairy god mothers and princes , but act like i dont.
" the perfect man ?? he doesnt exist!!!" i would say..but secretly believe that he will find me some day.
lets not forget the fact that at such moments ,i almost always assume that  I am the perfect girl....

i add background music in my head to any situation i m in. and laugh like a loony toon at the most unfortunate of times...
of course not everyone around me shared the same enthusiasm. i wonder why...

i look shocked when a school child calls me 'aunty' ,while i compensate by addressing her mom the same way...
i really have to join the gym!!!... someday....

i spend hours singing my favourite songs around the house over and over again, while my sister begs me to shut up...
even though i know i sound exactly like the original singers i wonder why i never get selected into those reality shows.??? hmmm.....must be an inside job.....


and finally as i was standing in front of my birthday cake , with just 5 candles ( too many candles spoil the beauty of the cake) and looking at my loving family smiling at me and showering me with gifts, my worry lines deepened as i wondered if the the cake underneath the icing was chocolate or vanilla.......










         

IF Only....

The charachters portrayed in this short story are purely fictional.  Resemblance to any person living or dead is only co-incidental...

"You will disgrace us completely if you keep doing this Ananya!! why on earth do you keep regecting every proposal we bring for your marriage. do you not want to get married at all?!!"
          Ananya slowly stood up and with out uttering a word she walked out of her parents room. she took her mobile and began dialling ...
"hey nancy... when are you comin over to pick me up. sudhirs party is tonight right?"

 "yes dear... i'll be over by 6"

In the evening as ananya rushed out of the house... she caught a glimpse of her mother weeping... she quickly closed the door behind her and galloped down the stairwell.

Ananya had been waiting for sudhirs party for a long time. it was the day she was going to meet all her friends from medical school after 2 years... a day for going back to the time when everything was so beautiful.when everyone were so innocent and happy; so clean, so indestructible, unscarred by the realities of life.
     she had also been waiting for this day because she was going to see Ashwin again. She had remembered how he tried to convey his love for her time and again and how she would always turn him down... because her family would never accept. but he never stopped, nor did she ever tell him how much she truly loved him.
 she had been counting the days until when she would just get to see him once more;  until a week ago. after when nothing seemed so important or exciting anymore.

"Great party sudhir!!!" screamed nancy from across the hall and then walked over to the rest of their gang.
" so whens your next appointment, ananya? " sheela asked .
" Tomorrow. " answered nancy " at 2"
" so when is the big day sheela? " ananya asked
" we havent decided yet. but jagdish is leaving for US in two months so i hope its before that!!"
" did i hear music around here somewhere? " jagdish walked into the little circle and swiped sheela into his arms. "what are we talking about? "he asked cheekily...
ananya walked over to a chair and sat down... she slowly let her eyes wander over to all her friends around who were trying so hard to keep her occupied. they hadnt let her alone for one moment that whole night. tried to keep her spirits high, but all she could manage to do was to keep herself from going insane. all night she had noticed ashwin smiling at her from a distance. but all she could feel was pain. not the pain of love, or of separation. This pain was different,  which even ashwins kind smile could not heal. the feeling of a sharp knife boring down her central being, not just once but repeated stabs with the blade twisting down her core each time....

"i have to go home" she said and quickly disappeared down the hall.

..........

"hello Mr Harsh.i am Dr Ananya, i will be taking your blood today for sampling. can you hold your hand like this for me please.. good.. this will just take a minute. she took the syringe into her hand and pressed the needle into his vein. dark blood gushed into the syringe.. pleased with herself for doing such a good job she slowly pulled the needle out ...
" hey Ananya!!!!"
 Startled by the voice calling out to her as she tried to turn the needle accidently piecered deep into ananyas skin...
 Ananya woke up suddenly with sweat all over her body. she took slow deep breaths trying to get some air. she rested her head on her pillow again hoping  that the dream would not return.

"Hey how long have you been waiting? have they called you yet? " sheela asked as she walked into the waiting room. Nancy and jagdish followed her in.
"nope. but i am next i guess"
"ok" they said in unison and sat beside her...ananya silently placed her head on jagdishs shoulder. a tear trickled down her eyes.

after an hour in Dr Randy's room, nancy, sheela and jagdish walked out of the hospital silently with anaya...nancys hands tightly around anaya.

the next day ananya went to the lake, hoping to find the peace that so many claim to feel when they r out there. all she could feel was the urge to run fast . to run and run and run and to not stop until she jumped into the lake. she felt herself drowning deeper and deeper. she wanted to come up again but something just kept pushing her further down. ananya was gasping for breath when she opened her eyes . she looked around and realised she was on dry land and yet she did not feel releaved.

for the past whole week she had kept replaying that fateful day a year ago over and over in her head.. if only that intern had frantically called her name a lot earlier to warn her that the patient was HIV positive. if only she had worn some gloves. if only she had been more careful. if only she had listened to her friends when they told her to take post exposure prophylaxis immediately.  but it was all an ' if only'  now. she had been infected. she had been in a state of shock and denial. it had taken three days for her to walk over to the STD couselling centre to ask for her options. by that time it had become too late. 72 hours too late.
 " The chances of transmission this way is minimal dear. dont worry about it." her friends said trying to counsel her. she had believed them and had let go.

her past had come back to bite her when she went for a general serology check in order to apply for post grad schools . and ever since her future had taken a complete turn in the opposite direction. she had not even figured out a way to tell her parents. they thought she was rebelling against the idea of marriage. the thought of getting married was the last thing on her mind.  she felt so lost. it was not so long ago she had felt indestructible. even a cold or a cough was a rare event in ananyas life. but now she had to get used to the idea of disease.... and death just a few years away.

as the days went by ananya began to understand herself. she still had time. she had her health and her strong will. and so she slowly began making her plans. one little step at a time.she began concentrating on her medications, her diet, her purpose for the little time she had before the viral load would spike up and the CD4 count would spiral down.
but she never had the courage to tell her family. what would i say? how would i say it? what about their hopes and dreams....?will they be able to survive through this with me? her throat would always clog in when she thought about it...and she would stop.

two months later....

"I am finally married!!!" sheela screeched as she ran down from the marriage pandal. the gang was together again after a long time. the girls all hugged each other and did a silly dance when ananya noticed ashwin walk towards sheela and jagdish. she quickly pulled herself away and sat down on a chair nearby. she noticed that he congratulated them and began pacing towards her. she quickly got up to go when she heard him call her name. she felt paralyzed.

" how much longer are you going to run from me ananya? " he said
"you already know what my answer is ashwin. please, just leave me alone."
"ananya. i know....."
"what are you talking about?"
"i know how you feel about me ananya."
"i have better offers now ashwin. why would i even consider you now. you were just a college crush for me."
"dont lie to me. nancy told me everything...about everything. so stop acting like a stubborn child and let me in atleast now. please dont push me away . let me show you how much i love you."

" its going to be very hard ashwin.."
"i know. i am a doctor too silly. and thats why i know it will be difficult to face it alone."
"i will grow ugly, and skinny"
"i will be by your side holding your hand until the end....." he slowly took her  hand into his... " so you want to go tell your parents now?"
the clog in ananyas throat began to build up...but somehow it was easier to bear this time...she looked up into his eyes... "yes" she said. she slowly followed as he led her out of the wedding hall into her future......
                                                          
                                                      THE END

this short story was not meant to scare anyone...... but docs... remember PREVENTION IS BETTER THAN CURE.....

• use universal precautions
• treat every patient with unknown serology to be a positive patient.
• the risk of HIV transmission through percutaneous exposure is 0.3 %... very little but possible.

The following scenarios warrant Post exposure prophylaxis.

• Two Drug PEP Recommended
• Three Drug PEP Recommended
• exposure to asymptomatic HIV+ person via deep puncture from a large bore hollow needle
• a puncture from a needle with visible blood on the needle
• a puncture from a needle used in a patient's vein or artery.
• exposure to asymptomatic HIV+ person by solid needle stick or superficial injury that break the skin
• a mucous membrane exposure to a large volume of HIV infected blood that's source is asymptomatic (consider for a lesser volume, a few drops)
• a mucous membrane exposure to a small volume of HIV infected blood that's source is symptomatic.

Three or More Drug PEP Recommended

• any needle stick exposure from any type needle used on a symptomatic HIV+ person
• a mucous membrane exposure to a large volume of HIV infected blood whose source is symptomatic.

Preferred Two-Drug Regimen

• Option 1 - Retrovir (zidovudine, AZT)+ Epivir (lamivudine) twice daily. Combivir (Retrovir + Epivir)twice daily is typically substituted for ease of administration. This twice a day regimen is a bit harder to take but is recommended in pregnancy.
• Option 2 - Truvada (tenofovir + emtricitabine) taken once daily. This one drug regimen is easier to take but does have the risk of liver toxicity.

Preferred Three-Drug Expanded Regimen

• Basic two drug regimen option 1 or 2 above with the addition of Kaletra (lopinavir + ritonavir) twice daily.

any mistakes in the above information please let me know so that i can correct it......

                                                                                         


     

Sway with me...

' A jack of all trades ...'  thats what they used to call me... but as the saying goes..i also happened to be the Master of none.
     Be it singing, dancing, writing poems, short stories, sketching, painting, photography, one month of playing the guitar, another month the piano, collecting stuff... i ve tried it all... not to mention the fact that my interest in these activities would grow most often as the examinations grew near...
        ' you can do them after the exams are over!!! my mom would scream ' of to your books now!!
     ' its not important to try everything and then leave them!!' she would say.. 'but to try your best in one field and excel!'
  so what if i was not a master... i had the confidence that i could do anything, if i wanted to... not coz i was good at it.. but because it was an adventure each time i tried... '

but that was a long time ago...

now,  i'm just a lost wanderer with a medical degree with apparently no time for anything else but to obssess over my future...something u or i have no freakin control over. what post grad am i going to do ?.. where am i going to do it..? how soon am i going to buy a home or atleast a car? when will my parents take a sigh of relief..? i left all my adventures behind to answer these questions .or else i would feel so guilty. coz thats whats more important isnt it... or is it...?

when my mom urged me to join singing classes or dancing classes during my medical internship, i laughed saying ' i have no time for that'!!

sigh....!!dancing... !!
when i remember the days on  stage, clad in heavy make up , bright lights adorning the face , with smile so huge u can see all  32 teeth,   hands and feet navigating around in rythmic fashion.. i remember what it feels like to be free...
          whether it is the strict posture maintenance required in bharathnatyam, the graceful swaying in kutchipudi or strong footwork required in kathak, the feeling of ecstasy that surrounds your soul transends the aching that every small muscle in your body would be suffering...no inhibitions , no fear of looking foolish, because u r there just to dance. to lose yourself in the story and  glory of it all.....

         the perfect part comes ,when the freshness you would feel after an hour of dancing is like a pathway that opens in your mind, allowing every book that u study flow in like a beautiful river of fresh water. (not to ignore the fact that i scored better in exams during my dancing years!!!)
     
  how many times have you heard a foot tapping song while you were in a crowded area and wanted to just stretch your hands , wave your hips and lose yourself in the beats.... how many parties have you stood at the corner clapping your hands pretending to be shy when all u wanted to do was the exact opposite.
dance may seem difficult, tiring, stupid or even a waste of time ...but try it, when u can ...cause it can set you free....

         well... am i going to stop with the indian cultural forms?...  two weeks ago i saw an advertisement in the paper for latin dancing... would i risk ' wasting' my time taking these classes? the salsa, mambo, merengue, ball room dancing ... when i see the pussycat dolls swaying away with their slender long legs (well thats something i reeeeally need to work on ;-)) it makes me wonder... can i pull it off? or should i rather be using my time preparing for a future i have no idea about... we'll just have to live life and see,  dont we...?

my first successful intubation....a lesson well learnt.

"Dont be afraid Doctor Archana ... endotracheal intubation is not difficult. its not the muscle strength but the technique that matters. once you master the technique...you'll be an intubation expert!!"  thats what came from my senior doctor after i had struggled through my 15th unsuccessful intubation. he had to intubate the patient instead of me coz i was 'taking too much time' as described by the frustrated nursing staff .

          intubating a gasping patient just followed by effective CPR is an art i have always wanted to master from the first day i started medical school. How many ever other procedures you may have performed on a patient, i always new that  performing this procedure will leave you completly satisfied that you have actually saved a patients life that day. you have brought him back from the doorway of death. thats what completes a doctor... and thats what would complete my purpose...

          but somehow i never seemed to get a hang of this timely act. an arresting patient when brought inside the icu, almost always can be saved if intubated at the right moment.....and then there are the 'DNR' patients of course..
          the word DNR means 'do not resuscitate', which in certain institutions, is a desicion made either by the patient themself ,if in sane mind , or by the patients relatives. but in certain instituions where there is almost always a shortage of beds due to the heavy influx of patients everyday ,this term is an unspoken code used for those patients who, if put on ' the machine' to be kept pumping would only cause a lot of physical, mental and emotional stress to the relatives and the doctors themselves. such patients can be kept alive only mechanically. the machines breathes in and out for them and and thus the heart is forced to pump blood. this only goes on until the heart tires out. this is what is called brain death, as the patients brain must have stopped working a long time ago.
       and as the saying goes;  ' a doctor should be able to tell the patients relatives that they did everything they could to save him or her' and so thats what they do ; ..everything. but sometimes trying to save someone who can definitely not be saved is a waste of hands when some one in some other part of the hospital who can be saved needs to be resucitated right away.
      it is these DNR patients that we young doctors are allowed to intubate at first, as this art needs to be mastered when required at the right moment.
      i am one of those young doctors , who has tried intubating many gasping patients desperate to get it right each time but has never been able to take it till the end as i lacked the stamina as i thought it to be. my senior doctor would always have to finish it for me.
 ' Not again!!!'  i thought, as i was walking away from my 15th attempt.
" You have one more intubation you can try ' said my senior with a ray of hope. "Its the patient on bed number 2. She has been pulling on for a long time but she looks a bit bad today. Unfortunately there is no point in bringing her back as she will not be able to survive the night anyway." she said apologetically. "so there is no urgency. but it is important that you learn soon as you have many more lives to save."
           i moved towards bed number 2. a woman in her late 60s, her hands and legs tied up to the sides of the bed so that she doesnt disturb the infinite array of tubes attached to her body.
not a pleasant site to see. i flinched as i looked onto her face. she probably would have been a pretty face during her healthy days but now all i could see were the remains of a worn out face battered by disease and misfortune. i gazed into her charts ; chronic kidney disease stage 5 , ischemic heart disease, hypertension, diabetes.
      her heart rate  was decreasing by the minute.i was instructed to try intubating after her loved ones had a chance to say good bye. i quietly walked outside the ICU rehearsing in my mind what i would say to her relatives. ' i believe you have already been explained about the seriousness of her illness. i am sorry to say her condition is getting worse .........' i have done this a number of times , passing of bad news to loved ones. i have seen different reactions; sudden outbursts of grief, some fall at your feet begging you to save their life somehow, some silently listen and take in the information you have just given them.
            this time , her son listened to what i had to say, his eyes gettingg wet and quietly walked of. he came back with his family. a young lady similar to the son probably her daughter, an old man himself in his 60s and an old lady around the same age as well. i noticed that each one silently walked to her, one at a time. after whispering a soft prayer into her ears they stroked her hair slowly,and then her feet. as each walked out i saw the glistening of tears down their cheeks.
           it was my turn. i had requested the nurse to place the intubation tray next to the bed so i could start my little lesson. i saw her heart rate drop down to a minimum. i saw her taking slow, shallow but peaceful breaths. i put on my gloves and touched her forehead. she moved a little. but this time i saw her face for the beauty she really was. i saw the hearts she had touched. the love she would be leaving behind. 'please be at ease' i whispered into her ear. i didnt want to cause her anymore discomfort than she already was in.
         i slid the scope into her mouth and into her throat when she slowly flinched. her eyebrows drew closer to show her discomfort. as i held the scope a little higher i visualized the epiglottis and vocal cords.i pushed the tube in with comfort and checked the entry of air after connecting it to the ambu bag. i was in. i had done it at last... i had intubated a patient. i kept pushing the ambu bag to keep her chest moving in and out as i saw the reading on the ecg monitor reduce into a straight line.
         as i walked out of the ICU that day i felt myself fighting back tears. as she left this world ,she made me feel like a complete doctor. she helped me learn so that i could help save many more lives. as i walked past soft weeping sounds at a distance, i heard the shreaks of a relieved mother falling at her doctors feet because his timely action saved her sons life...
             
                                                                  
                 


        

Romantic comedies ...and Me

"hi there...."
"hello..."
"what do you do to pass your time?"
"singing, writing, reading...but mostly watchin movies....!"
"so, what movies do you watch?"
"hmmmmmmm.. mystery, thrillers................ "  O what the HECK !! its only romantic comedies and romantic comedies alone!!!......


There used to be a time when i used to enjoy laughing my heads out watchin an occasional slapstick comedy, or a sci fi thriller here and an animation movie there.... now my interest in watching these genres have been phased out and is being governed by one main genre and thats 'Romantic comedies'!!

whats there to watch in these movies you would ask? its absolutely the same story round and round.....!!!!
first, it starts of with a workaholic, lonely protagonist which is either the hero or the heroine who is absolutely comfortable with what life has to offer, having no idea what they r missing untill the other one enters the scene. this person is usually the more carefree bubbly one... first, they fight ..then he or she makes the workaholic realize that the real happiness is in wearing shabby clothes to work, dancing on tables at bars, breaking traffic rules and getting arrested.......
             and of course theres the first kiss.....or an accidental one night stand...
           then there comes a moment of truth where the workaholic has done something to screw the relationship, and the bubbly one gets 'hurt'and leaves...
            then comes the perfect monologue.... the one paragraph that makes whatever crap this person did to create havoc would all just disappear away and let the other one come running into his arms
            the end would be the make up kiss ofcourse....

well.... but you should understand the beauty of these movies.... they are just windows that help every persons deepest dreams to have a breath of fresh air.
 well.... in real life you woul nt expect to hear violins or  Switchfoot playing  'dare you to move' faraway in the background when the boy you have been crushing on all summer was just about to kiss you....would you....
           
 right from the start, when the wind blows the hair off her face , the way he would be in a complete trance , awe-stuck by her beauty; the hours they would spend talking to each other like nothing else existed;   the momentary second when the whole world has stopped because their hands touched for the first time.
                when he describes in a long five minute dumbfounding voice,   the way she makes him feel..... and to add more pain to our tortured souls they would add perfect music in the background that would push us past the cliff....
      we experience our very own love story every day...
                

                   i absolutley  disagree when they say that romanic comedies ruin relationships or prevent single people from finding a good partner....       

        oh yes occasionally when a lively bubbly jane thinks  a silent mysterious guy is interested in her because he likes the way she is so carefree , what hes really thinking in his head is that she is childish and dangerous and he has to get away from her!! or when sad and depressed little Emma sits on a park bench everyday waiting there hoping for a prince charming in a suit to talk away her troubles, she is just busy getting even more sad and depressed.
             when nervous Sharon tries to act confident and aloof hoping to catch the attention of her boss, he is busy pulling her down cause he feels intimidated by her...

                i absolutley would never agree if you told me that these movies are the reason that many husbands sleep on the couch every night because either he hadn't  used charming, breathtaking words to describe how beautiful she looked that day or he had just picked lines right out of the movie she had forced him to watch ,two days ago because he couldnt make something up on his own...

               we all know these things would never exist in reality.... and thats why i watch them in this magical world... where everything is perfect... she gets him.. and they live hapiily ever after

                 well if you asked me if building these unrealistic fantasies was the reason i first look at the eyes of every propective match i meet...i will look the other way and still say no.....

                 and the occasional one that claims to show reality... where the loved ones dont get together..... well.... you wont find me watching that movie anytime soon.....

                                                                                                         the Romantic movie buff...

P.S.  Recommended watches: A walk to remember
                                              Before sunrise....