Bitter Sugar 4ti3c

Bitter Sugar

Sanchit Sanyal

Copyright © 2019 by Sanchit Sanyal.

Library of Congress Control Number: 2019917165 ISBN: Hardcover 978-1-7960-6715-6 Softcover 978-1-7960-6714-9 eBook 978-1-7960-6713-2

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only. Certain stock imagery © Getty Images.

Rev. date: 10/22/2019

Xlibris 1-888-795-4274 www.Xlibris.com 800134

CONTENTS

Chapter 1 The Comfort of Ice-Cream

Chapter 2 The Price Of It All

Chapter 3 With Love

Chapter 4 A Wake-Up Call

Chapter 5 Take Action

References

CHAPTER 1 The Comfort of Ice-Cream

It was an unbearably hot day… the hot gusts of air around us were ruthlessly oppressive, seemingly trying to suffocate anyone who dared take a breath, and the air manifested itself in those rippling figures as are typically the case when heat emanates from all facades of one’s surroundings. Anything exposed to the sun for any period of time had become scalding to the touch, such that people had become afraid to venture out in their cars. A parked car left out in the unforgiving sun would be transformed into a scorching, red-hot oven that could not be occupied by it’s owners until dusk. I could feel the nauseating heat envelop me, and then reflect off of me into the air. Without a doubt, noons during an Indian summer are sultry and sweltering. “I’m afraid that the hike is going to have to wait. I’m sorry that I picked the wrong day for us to go on this hike. Seems like I’ll have to look at the weather report next time,” my father stated. I could see that his face had begun reddening, all thanks to the scorching heat. “No need to apologize! I would gladly skip the hike on such a warm day,” I replied. Indeed, I did not want to end up hiking to who-knows-where in that unendurable heat. But more importantly, I did not want my father to feel guilty for planning the hike because I knew how stressed he had been at work and how much he had wanted to just take a break and just enjoy the tropical beauty that the Indian wilderness had to offer. “Why don’t we just go back home and turn up the air conditioning?” Just then, my younger brother, Veer, exclaimed, “I’m so thirsty! My throat is parching dry. I need some cold water or I’m going to out right here!” “Enough with the theatrics, Veer! We’ll find you some water but you will need to be patient. After all, patience is the mother of all virtues,” my mother replied. She was quite exhausted by the heat as well, and I could imagine that she would have preferred staying back at our air-conditioned room. “I saw a street vendor when we were ing by. It looked like he might be able to sell us a bottle of

water.” As we retraced our steps back to the street vendor, we saw that other vendors had also come out and were selling various products. Of these, however, the most popular vendors, by far, were those selling ice-cream. All around these ice-cream carts, the vendors had placed posters filled with pictures of the most enticing icecream flavors. The three of us—my mother, Veer, and I, that is—were eyeing the posters hoping to catch a glimpse. None of us wanted to openly look at the icecream posters because my father, who is diabetic, could not have any of the icecream himself. As a child, my father had been a dessert-lover. He enjoyed ice-cream, sandesh, rosogolla, malpua¹, among other desserts. However, when he was diagnosed with Type-II Diabetes, he had to stop eating desserts because his body could no longer process sugar in an efficient manner. It seemed cruel to indulge in a cooling ice-cream bar when we knew that were eating my father’s childhood-favorite dessert in front of him when he could no longer eat it. Yes, he could take a bite of some dessert here and there, but it wasn’t the same as freely feasting on a Choco-Bar whenever he pleased. So the three of us tried to avoid eating desserts altogether, whenever my father was around. However, maybe because of the insufferable heat, I couldn’t resist looking at the posters. Out of the corner of my eyes, I tried to look at the posters without seeming like I was interested in them. I could see pictures of flavor upon flavor of ice-creams. Strawberry shortcake. Choco-Bar. Creme Brulee. Alphonso Mango. Black Currant. Lychee Delight. Death By Chocolate. Personally, I was drawn to the refreshing tropical fruit flavors, especially the Lychee Delight. Despite the roaring heat, I knew I had to resist my temptation to ask either of my parents to buy me the ice-cream. I decided it would be best to not look at the posters if I couldn’t actually buy the ice-cream. “There, I see that vendor selling water-bottles. Could you go buy some from him, my dear?” asked my mother. I could tell that she too was fighting the urge to buy some ice-cream. Unlike my fascination with fruit-flavored ice-creams, she had always liked chocolate ice-cream in its various forms. I knew in its

popular Choco-Bar, which was simply vanilla ice-cream covered in a chocolate coating. “How many do we want? Are two going to be enough?” my father asked. Both Veer and I knew that he was asking my mom, so we looked towards her. “Yes. Two will be plenty. Those are large bottles,” she replied. “If possible, ask him for refrigerated water-bottles. I need something cold to fight this heat. Do you have cash with you? He may not accept a credit card.” “Yeah, I have more than enough cash with me,” remarked my father and left to go get the water. “I kinda want some of that,” whispered Veer. He was pointing towards the Death By Chocolate poster. “I wish we could get some.” “Veer, I’m pretty sure we all want some ice-cream. But you know the drill!” I snapped, curtly. It wasn’t Veer’s fault as much as my frustration. I was upset that the other kids could get ice-cream whenever they wanted, but Veer and I had to wait till my father was not with us. I didn’t blame my father for this, of course, but I just felt cheated that I couldn’t necessarily enjoy the same pleasures of life as those other kids. Lamentful, I would watch the neighborhood kids who could be seen walking down the street with brightly-colored popsicles in their hands while on a walk with their parents. I would be filled with a rage of sorts, questioning why I couldn’t be like those kids. Why did we have to be conscious of my father’s diabetes all the time? Why did a health condition of one familymember govern what and when the entire family ate? And why were we not able to come up with a solution to this omnipresent problem? Just then, my father returned. “Here are the water bottles. Luckily, they are nice and chilled,” stated my father. “Here you go. Be sure to completely hydrate yourselves or you might find yourself suffering from a heat stroke! Hahahaha!” The rest of us were amazed at my father’s capacity to laugh at his own jokes. None of us thought that the possibility of a heat stroke in a remote area was amusing, but my father was seemingly very pleased with the joke he had cracked and could not stop thunderously laughing. In fact, such was the notoriety of his bad humor that his college-friends had made up a special name for these: J J (or

Jyoti-Jokes). “The ice-cream here looks good! Does anybody want some?” asked my father, once he finally stopped laughing. “Let’s just drive home, Jyoti. I can’t stand this heat anymore,” my mother replied, promptly. “I think I might be coming down with a migraine.” “Hold on! I’ll go get you all some ice-cream. It will help with your head-ache and cool your body down,” responded my father. “No, Jyoti. I think some rest at home will do me wonders. Why don’t we skip the ice-cream today?” suggested my mother. But my father just wouldn’t budge. He insisted, “The kids must be tired from the heat. That ice-cream will re-energize them. Why don’t you all stand under that tree by that fence? I’ll go get some ice-cream for all of you. Which flavors do you want?” “But—” “Come on, Vidhi! Live a little!” smirked my father. He persevered, and turned to Veer: “What do you want? Did you have a chance to look at the options on our way here?” “Yes! I’ll have a Death By Chocolate, single scoop in a cone. Also, can I get some chocolate sprinkles on top?” replied Veer eagerly. He spoke as quick as he could before my mother could object. “I’ll take a Lychee Delight please. Just one scoop in a waffle cone,” I said, following Veer. Although I tried to pretend to think about my order, my excitement to try the delicious ice-cream got the better of me, and my answer seemed wholly premeditated. “Okay! What will you have Vidhi?” asked my father. “I guess I’ll take a Choco-Bar then,” she said, finally succumbing to my father’s persistence. “Okay, so I’m getting a Choco-Bar for mom, Lychee Deluxe for Sanchit, and

Deathly Chocolate for Veer. Does that sound about right?” asked my father. “No papa! It’s Lychee Delight and Death By Chocolate,” retorted Veer. Oh boy, Veer always took his ice-cream very seriously! Ridiculously seriously! “Yeah, same thing. Okay, I’ll go get those. Stand tight,” replied my father. He left, walking toward one of the ice-cream vendors’ carts. The queue had grown phenomenally long by this point, and it seemed like we would be waiting for quite a long while. To the time, my mother resorted to browse through a lifestyle magazine while Veer and I played cowboy. I had not played for quite some time, and Veer was able to beat me quite easily. Luckily, the line moved fast and my father had returned to our spot in under twenty minutes. He had three ice-creams with him in a bag. “Here you go! Eat it now or it will surely melt away in this sun. And here are some tissues if anyone wants them for later,” he said, handing each of us a small wad of yellow paper-napkins. Naturally, none of us needed to be told twice to eat delicious, cold ice-cream! We all instinctively dug into our respective flavors. Occasionally, we would pause to take a bite from each other’s flavors, and then resume gobbling down our own ice-cream. For a moment, nothing in the world seemed to matter but that next bite of creamy, satiating goodness! Ice-cream had never tasted better than right there, on that scorching day. But out of the corner of my eye, I saw my father’s face, which contained a subtle expression of bittersweet longing. I could tell that he was ing his childhood days of enjoying a bar of ice-cream in the sun. Yet, he realized that he could never relive those precious moments from his childhood. He was a diabetic now, and had to watch what he ate for every meal of his life. According to the doctors, his condition was incurable and my father realized the permanence of his restrictions. How could God be so cruel?, he must think… How could God punish me so harshly for my actions that I did when I was younger and didn’t know that they would have such catastrophic consequences? I suddenly snapped away from my thoughts when I felt something cold around my hands. The intense heat had quickly melted some of my Lychee Delight

which had subsequently trickled down the waffle cone and onto my hands beneath. I proceeded to continue with my ice-cream, not wanting to make a mess all over my hands. Veer was done with his Death By Chocolate within minutes of getting a hold of it, and started “borrowing” some of mine. My mother was also almost done with her Choco-Bar. Time seemed to go by exceptionally slow as I tried to finish my own ice-cream. The image of my father’s expression stuck with me. I contemplated: How could my father’s diet, which was entirely controllable, cause such a serious and permanent condition? Why did my father have to continually suffer for the choices he made during his childhood? Do any remedies or treatments exist that could potentially counteract his condition, essentially curing him? And why was he not fully aware of the disastrous consequences of a high-sugar, carbohydrate-rich diet? As these questions floated through my mind, my mother asked me, “Sanchit, are you done? We should get going now or it’s going to be dark by the time we return.” “Yes, I’m done. I’ll just go trash this,” I responded, referring to the paper-napkin I held in my hand. Hurriedly, I ate my last bite of ice-cream and quickly discarded the paper-napkin in the nearest wastebasket. The rest of the car-ride back, and the night afterwards went by in a blur. But I could not get rid of that image of my father’s expression when he saw us eating our ice-cream. Sometimes, even today after so many years, I can my father’s bittersweet expression when I enter an icecream parlor.

CHAPTER 2 The Price Of It All

I have always been amazed by my maternal grandfather’s aptitude and various talents in even the most unexpected of areas. He has this innate ability to masterfully pick up skills in a short amount of time, and then use those skills as if he was trained in it professionally. Although he had visited us several times when I was younger, I only one of his visits with great clarity. It was winter, and school was closed for the holiday-season. Since it was a weekday, both my parents were at work, and I was at home with Veer. Of course, we weren’t home alone! There was also a nanny (that I didn’t particularly like) there with us. After all, how well could a seven year-old take care of a three year-old. It was a colder day, and we had shut the windows and all the patio doors. Veer and I were wrapped up in a blanket and were watching a cartoon show on our irritating TV set. I say that because a few days earlier, when I was terribly bored and everyone was taking their afternoon siesta, I was trying to figure out a way to entertain myself. I decided that the best way to have some fun by myself would be to climb on top of the shelf which incidentally also housed our TV set, which was one of those older, box TVs and weighed more than an adult human! I mean, nothing could go wrong if a seven year-old decided to climb on top of furniture on a whim, right? Wrong! I was certainly able to climb on top of the shelf, but getting back down proved to be a challenge. Everyone was asleep and I didn’t want to get in trouble for my actions so I couldn’t even call out for help. So I thought that my next best option would be to hold on to the TV so that I could hang off of it and nimbly land on the floor underneath. It seemed like the perfect plan: nobody would know about what had happened, nothing would break, and I would return perfectly safe. But boy was I wrong! As soon as I released my weight in the hopes that TV would keep me from falling to the floor, the entire shelf, along with that monstrous TV, toppled over.

The sound that erupted from the crash was thunderous, and it resonated through the entire apartment complex. I was soon surrounded by people, not only my family but also neighbors, who had frantically rushed over to see what had created the cacophonous clamor. Naturally, I was quite afraid and I sat on the floor, paralyzed with fear. Then the pain hit me. Not only had I fallen from a height on a hard marble floor, but my left index finger had also gotten lodged between the floor and the TV for a moment before I instinctively pulled it out from underneath. Yet, the pain that seethed through my fingers was comparable to that of a dozen bee stings, and I could not help but bawl like a baby. Looking back at the event, I’m glad I did because that saved me from a whole lot of trouble. I only got a slap on the wrist because I was injured. I’d hate to imagine what would have happened had I emerged perfectly unharmed. Anyways, after that event, the TV would randomly go static on us and we always had to strike the right side of it either three or four times (at least) to get it to work again. On a good day, we had to do this every twenty minutes or so. On a bad day, maybe once every thirty seconds, which made it impossible to watch TV. Anyways, on that winter day, Veer and I were watching TV and fortunately, we didn’t have to strike it as many times. The nanny had made us some snacks, and was taking a nap. Besides the noise of the TV, I could hear the faint, monotonous hum of the ceiling fan. That was the same continuous sound that helped me go to sleep at night. Everything was calm, everything was normal, everything was boring! Suddenly, we heard the doorbell ring. The nanny didn’t wake up. We did not know what to do. I was scared because I had heard how young children could get kidnapped by older, creepy men. Some were never found again. My heart was beating. Being the older brother, I instructed Veer to hide himself underneath the blanket and wait for my signal to come out. I tried to look through the peephole before I opened the door, but I wasn’t tall enough to reach it. I decided to pull a chair over so I could look through the peephole. Meanwhile, the doorbell rang once again. The ringer seemed to grow impatient, ringing with greater frequency now. To me, the entire scenario seemed like the beginning of a crime movie. An insane psychopath, eager to find his next victim, has been trying to prey on houses that he knew were going to have defenseless kids in them. I began

picturing myself tied up with a blindfold and gag on, in the trunk of someone’s car, being driven into a remote location. My mind tended to assume the worst case scenario, and I hurried to get the chair. I dragged the chair over to right underneath the peephole. “Anyone inside?” someone called. “It’s me!” the person replied. That was a very informative reply indeed! But the person’s voice sounded distinctly familiar. I was trying to who it was, but wasn’t able to pinpoint exactly who the voice belonged to. “Let me in!” I looked through the peephole, but couldn’t see anybody. Apprehensively, I opened the door. As I did, I expected a scary, masked man who was ready to grab me. But to my relief, it was only Nana-ji. He stood there, immaculate in his signature attire: a brown checked sports jacket, a plain white shirt, a wristwatch, and matching brown tros. Immediately, I gave him a hug and started helping him with his bags. He lifted the heavy suitcase, while I carried his briefcase. I showed him to the guest bedroom and set his briefcase down. ing that the front door was still ajar, I went back to it and was about to shut it, when Nana-ji interrupted me. “Wait! There is one more bag outside. It’s black and not too heavy. Can you get it for me, Sanchit?” he asked. Although he had framed it as a request, I knew I had no other option but to comply. The bag was unlike any luggage I had seen before. It was a black hard-shelled box of sorts, with a handle on the top of it. It was almost like an oversized toolkit. Being a curious child, I felt inclined to investigate. I tried opening the box but it seemed to be locked. Upon further investigation, I discovered that there was a small lock attached. What could possibly be so important that it had to be kept under lock and key, away from prying eyes? I thought. I picked it up and took it inside, locking the door behind me. “What’s in this? I’ve never seen a suitcase like this before?” I asked nana-ji inquisitively. “Well, it just stores some of my materials for making furniture—” “Furniture! Since when did you start making furniture?” I asked, puzzled. I had

always considered my grandfather as a white-collar man. “Here, it’d be easier for me to just show you,” he said, pulling out a silver key from his sports jacket. Putting it in the keyhole, he turned to me and said: “It still isn’t completed. It’s going to take a few more days to finish.” He pulled out a foldable structure made of what seemed to be some kind of metal painted black, along with a wide roll of thin, brightly colored fabric. “Well, this structure is the basic structure of a patio chair. And I’m going to weave this special synthetic fabric onto this structure to build a fully functioning chair. It’s great for outdoors since it can easily dry off if wet, and doesn’t get discolored in the sun!” he explained. “But why do you need to make chairs? Can’t we just go buy one if needed?” I asked. “Well, the idea of being able to create my own furniture seemed so novel and exciting! Imagine, you get to make all the decisions when it comes to your furniture. Take this fabric for example: I get to pick it’s width, it’s color, it’s texture, it’s thickness, it’s composition. All these factors makes it possible for me to come up with a product that is most relevant and suited to my needs and tastes. I’ve also had so much extra time on my hands that this became a project of sorts for me to occupy my mind.” I was amazed at how he could go from not knowing anything about furniturebuilding to being able to create beautiful, fully-functional furniture in a matter of weeks. Within three or four days, he had already completed two patio chairs, one blue and one yellow. This creative spirit of his was always very inspiring to me, and esteemed his many endeavours with awe. Such was his determination that he decided to pursue a Ph.D. even though he was in his seventies. Yet, his creative spirit and resoluteness succumbed to diabetes. Having grown up on a carbohydrate-rich diet, nana-ji was never able to develop a diabetes-friendly diet. Moreover, he had a sweet tooth and I personally witnessed him eat things he should have rather avoided. One day, after running around with my friends, I came upstairs to get some cold water from the fridge. At the time, both my parents were at work so only nana-ji and I were inside the house. As I walked into the kitchen, I saw the fridge was

wide open and nana was crouched down with a pink, strawberry-flavored candy bar in his hands. I was very surprised because I knew that he was diabetic and wasn’t allowed to consume sugary products. “It’s okay if I only do it once in a while,” he said, quickly. But I soon learned that “once in a while” actually meant “whenever possible”. Whenever he got the chance, he would indulge in all kinds of sugary drinks and desserts. Outwardly, he was trying to justify the candy bar to me, but I think internally, he was justifying it for himself. However, rationalizing poor decisions does not grant us any protection from the negative consequences of that decision and soon after, nana’s condition worsened and some of his organs, such as his kidneys, started failing. He had to be taken to a hospital in a different city, because the town he lived in did not have the resources to provide treatment for his deteriorated condition. There, he underwent multiple, high-risk surgeries…. Nana was very fond of visiting his ancestral home and agricultural lands in a distant village. He would make a trip almost every month, driving up in his car from the town where he lived all the way to the village in a car along the narrow, winding roads while absorbing the beautiful rural landscape, dotted with rice paddies and green fields. The route was long, and even if the weather and road conditions were on his side, the journey could last up to an entire day. Yet, this was a small price to pay because nana was his happiest self in that village, where he spent his most of his childhood; in fact, some of his happiest memories were attached to that village. When I visited, I was attracted to the relaxed way of life. People were never stressed about the trivial things, such as how many more cars one owned than their neighbor, which was prevalent in many urban areas. The community was very connected, which might have been because concerns and problems were either directly or indirectly shared by all residents of the village and very rarely confined to a single person. If, for example, the river which was the village’s main water supply started drying up, it concerned the entire village and spurred a genuine and mutual sense of solidarity between the villagers. What stuck most with me though, was the natural beauty of the landscape. The calm, rolling rivers wandered lazily through the thick foliage of bamboo groves and lush forests. Storks and cranes traversed the shallows searching for the many colorful fish to eat, and cattle waded through the calm waters, a respite from the glaring sun. Fishermen sat by the riverbanks, soaking their feet in the water while waiting for a catch. The visual beauty of that serene sight was accentuated

by the relaxing music of the flowing water, which developed a tranquil rhythm of inextricable perfection. Retrospectively, I think that a lot of nana’s creative spirit originated from his beginnings in that pristine haven, which fortunately had not compromised its natural, soothing qualities in order to accommodate urbanization. Among my nana’s many talents is his aptitude for art, and I can see his profound appreciation for the natural beauty of the village in which he grew up in the various landscape paintings he has created. Gazing at these paintings, I almost feel as if I have been transported back to the village and I am standing there, basking in the sun, beholding that majestic sight with my eyes. Each stroke of his paintbrush serves to encapture his emotion onto the canvas. Special effort goes towards the river to showcase the flowing and calming nature of the water and he mixes various shades of green to recreate the lush forests surrounding the village. Every time he returned from a trip, he would bring back all sorts of fresh-grown fruits and produce—mangoes, guavas, lychees, bittermelons, and the like. The lands around the village were exceptionally fertile and crops grew with minimal effort. Without a doubt, these visits were a central portion of nana’s life. Yet, with the worsening of his diabetic condition, even these visits had to stop and his dietary habits heavily contributed to this. As his condition deteriorated, nana had to start taking even more medication (on top of the pills he was already taking). But more so, he had to be put on dialysis to compensate for his kidney failure. By not adjusting his diet, nana was putting more sugar in his body every day than he could process in a week. Undoubtedly, the implications were grave. You see, the excess sugar was not being able to be properly processed by the pancreas, which meant that all the sugar in his bloodstream was being led to the kidneys. High blood sugar content can damage the blood vessels in and around the kidney, and after sufficient exposure, the organ can be damaged irreparably. One of the many functions of the kidney, purifying blood and expelling waste as urine, is dependent on a fully- and well-functioning kidney. However, once the kidneys are damaged as a result of the mismanagement of diet by diabetics, the resulting diabetic kidney disease (or DKD) is a permanent condition in most affected persons. As a result, in end-stage kidney failure patients, the body is not able to purify its blood and expel waste from the bloodstream in the form of urine, and relies on devices to externally purify the blood.

To this end, nana had to undergo dialysis sessions thrice every week, which is roughly almost every other day. I am told that these sessions aren’t necessarily painful or high-risk. Rather, they are incredibly boring and time-consuming. Essentially, the patient has to visit an equipped hospital or dialysis center for every session since the dialysis machines themselves are quite expensive to procure for single-patient use only. At the dialysis center, a healthcare professional inserts a needle into the patient’s graft which establishes a connection for the dialysis machine to retrieve the blood from the body and process it externally to purify the bloodstream in the same manner as a healthy kidney would. While the duration of the process may depend on several factors such as the severity of kidney damage, the amount of blood in the patient’s body, and the amount of waste to be processed, among other variables, the average time spent on a single session by dialysis patients is about four to five hours. Those four to five hours are unremarkable in the best sense and insipid to most, if not all, patients receiving the treatment. After all, how can one enjoy watching television for five hours straight while strapped to a bed? Barring the financial burdens of dialysis treatments, as sessions are extremely expensive and may not be affordable for some, the time-consuming nature of dialysis denies the patient any semblance of a normal life. For example, let’s take a look at my nana’s dialysis sessions. He wakes up a bit earlier, around 5:30 a.m., on dialysis days to get ready to go out. He has breakfast at 8 a.m. and normally has something light because he has to have his lunch soon after at 11:00 a.m. After a hurried lunch, he leaves for the dialysis center at around 11:30 a.m. to reach for his 12 o’clock appointment. From then till 4:00 p.m., nana is confined to a bed where his dialysis treatment takes place. There, he takes a nap or watches television, but there really isn’t more he can do. At four o’clock, the healthcare professionals start detaching the dialysis equipment from nana and begin dismantling the set-up. At 4:30 p.m., he is all ready to leave the dialysis center and he reaches home at around 5:00 p.m. Shortly after a dialysis treatment, nana experiences discomfort and certain symptoms. Among these are dizziness, excessive sweating, restlessness, and fatigue even without physical exertion. Such symptoms are, however, normal and experienced by the majority of dialysis patients. Even by the time nana reaches home, he doesn’t recover from these symptoms and sits down in his favorite chair by the television set for hours at an end. Again, he is confined to that area and is not able to move around as much, even though he may want to.

But, the most shocking aspect of the dialysis treatment is the strictly restrictive qualities of his diet, especially in regards to fluids. At first, like most others, I expected that nana would face more restrictions on foods rich in simple carbohydrates and sugars. Or maybe he would be banned from eating highsodium deep-fried foods. But the most unexpected, and wholly shocking aspect, was the heavy restriction on drinking water! Something as essential as water, which we often take for granted. After any physical activity, like a long run or a workout, or even just a tiring day at school, the thing I long most for is a glass of chilled water, preferably with a few ice cubes floating on the surface. I couldn’t imagine living in a world where I have to count and track and sadly, limit, the amount of water I can drink. I this incident vividly, which had repeated itself on multiple occasions while I was visiting my grandparents. It was different than anything I had experienced before, and certainly not something I would want to experience again. I would be lying if I said that my nana didn’t enjoy crime television series. He is a vivid aficionado of the genre and is notorious in my family for watching it on television while waiting for the next meal. Being interested in crime shows myself, I decided to him whenever he was watching a crime show, instead of a news channel (another personal favorite of his). He would sit on his favorite chair, which is almost as big as a loveseat, and I would sit next to him. “Can you bring me a glass of water? I can feel the dryness on the back of my throat,” he said, as soon as there was a break in the show and the ments were being broadcasted. Looking at him, I could see his face seemed unusually drooped, almost wilted. Immediately, I stood up and replied: “Yeah, sure! I’ll be right back!” Walking into the kitchen, I filled a large glass full of room-temperature water and was headed back, when I felt somebody’s hand on my shoulder. Turning around, I saw that it was my mother. “What is it?” I asked, bewildered. “Is that for nana? Or someone else?” she asked. She knew that I preferred

refrigerated water, and could tell that I wouldn’t be pouring room-temperature water for myself. “Yeah, it’s for nana,” I replied. “Is he not allowed to drink water too?” I added, jokingly. I was confident that water could not possibly banned for anybody. In fact, doctors often encourage patients to hydrate themselves more. Imagine my surprise when my mother replied: “As a matter of fact, yes, your nana isn’t allowed to drink too much water since he is on dialysis.” At first I was completely bewildered. Then, I thought that my mother was just pranking me. After all, she did get far less serious, and even playful, whenever she returned to the town she had spent her childhood in. “Yeah, sure! I bet told him to minimize his breathing too!” I responded, full to the brim with sarcasm. I expected my mother to give up and start laughing along with me anytime. But her face was as steely as before, and she repeated what she had just told me. “You see, nana’s dialysis treatment doesn’t allow for him to drink too many fluids. He can’t drink too much tea, coffee, or even water as much as he might want to.” I later realized that my mother was right and I found that dialysis patients had to restrict their fluid intake. Just like I was, I’m sure you must be confused. After all, a regular glass of water is as harmless as things get. Well, not necessarily. The basic principle of hemodialysis is to perform the vital functions of a healthy kidney through an external device. However, a major difference is that while a healthy kidney performs its functions continuously, a dialysis machine can only do so while a treatment is in session. As a result, a dialysis patient is not able to process fluids in their kidneys, and the fluids and any waste gets accumulated in the body. This is then externally processed by a dialysis machine which purifies the blood of all waste products, and removes any excess fluid from the body. However, dialysis patients must restrict fluid consumption because excess fluid can cause high blood pressure, swollen areas, sudden drops in blood pressure or various cardiovascular conditions.

Given that he needs to receive dialysis treatments every alternate day, nana is not free to travel to the places that he misses or has not yet seen. He can’t go back to the seat of his childhood and revisit the fond memories of his carefree and innocent life by the whispering trees and roaming rivers. Neither can he travel to all those places that he might have wanted to visit… those destinations that working professionals reserve for after their retirement were now forever out of his reach. And that was it. That was the all-consuming nature of diabetes. That was ultimately the price that nana had to pay. It cost him his creative spirit: he was no longer in a position to return to the village that inspired his art and neither could he partake in his skill-based activities (such as chairmaking) because his dialysis treatments rendered him fatigued and sedentary. It cost him his ability to enjoy his favorite foods and drinks, and even a basic commodity like water had become an indulgence. It cost him his mobility, and in turn, his ability to reconnect with old friends and family. Neither could he visit the destinations he might have wanted to go with his wife in his retirement days. All his ambitions and aspirations, of which he had quite a few even in his retired years, were reduced to mere fantasies with the deterioration of his condition. This came as a particularly rude shock to me for obvious reasons… diabetes is an entirely preventable disease! Most, if not all, of the symptoms revolve around lifestyle choices: how much you eat, what you eat, how much you sit, how much you exercise, how much stress you endure, to name a few. Although there is some genetic predisposition that can increase a person’s risk of being diagnosed with diabetes, it is still preventable. This is because the inherited genes that can contribute to diabetes are only expressed (or “turned on”) when the patient has a history of: an inactive, sedentary lifestyle; stressful conditions; or poor diet. Therefore, a person may have the specific genes that increase susceptibility to the disease, but these genes may not be in action (as if they never existed!) if the person maintains an active and stress-free lifestyle combined with a nutritious and balanced diet. Many people have a skewed sense of the importance of genetics in being diagnosed with diabetes. Often, people accept that diabetes must be an inevitability for them if their family have a history of the disease, because they believe that their healthy choices won’t make as much of a difference.

However, we fail to realize that, more often than not, families share similar dietary choices and lifestyles, due to their cultural and socioeconomic backgrounds. For example, picture this: a large family of six—a father, mother, and their four children—live in an urban area where simple commodities and groceries are sold at a price. The family maintains a sedentary lifestyle: the father works as a truck driver, the mother stays at home, and the children ride the bus to school and watch cartoon shows at home. There is no park nearby for the children to play, and recess at school just doesn’t give them enough time to be active enough. Because the family has so many in it, there is a heightened cost of groceries which is barely provided for by the truck driver’s salary. The mother, in order to ensure that none of her children have to go hungry at night, compromises on the quality and nutritional value of the groceries and instead focuses acquiring more food without spending too much on it. Unfortunately, most times this means that the mother is buying processed carbohydrates, packed with preservatives and artificial sweeteners. Statistical observations have been made to show that establish a direct relationship between growing obesity rates—a key contributor of diabetes—and poverty. An obvious reason for this is that fresh food, namely produce such as fruits and vegetables, are much more expensive than their processed grain counterparts. Government subsidization of grains like wheat and corn has led food industries to market these grains more readily to the public, even though they are reduced to simple carbohydrates after being processed. Complex carbohydrates found in nutrientrich sources such as quinoa or produce are less accessible to the poor, making it harder for them to make healthier dietary choices and reduce their risk for diabetes. But it would be simplistic to regard this correlation between poverty and obesity to just the availability of healthier groceries. There is also the concern of a highly sedentary lifestyle, another contributor to diabetes as well as obesity. Gang-violence, a sadly prevalent reality in many poverty-stricken areas, can inhibit childrens’ ability to be active outdoors, encouraging a sedentary and unhealthy lifestyle. Additionally, people in poverty-stricken areas are also less likely to be able to afford a gym hip or fitness equipment that could allow them to maintain an active lifestyle.

Obviously, there are even more factors at play which may not be as easy to recognize, such as the pressures that come with having to worry about whether one’s children will have enough to eat the next day, and how one is going to save enough money to pay the electricity bill on time. Such pressures undoubtedly increase the amount of stress one faces on a daily basis, which also contributes to developing diabetes. Let’s go back to the family of six. Let’s assume that they face the challenges described above. The unhealthy dietary habits of the family, as well as the sedentary lifestyle that they practice is going to become normalized within the minds of the four young children after being conditioned to it for their entire childhood. In turn, they will unknowingly these habits on to their own nuclear families. With the heightened risk of the disease that comes with such a lifestyle, it is indeed possible that numerous of that family develop diabetes. To an outsider, it would appear as though there is some genetic culpability at play. But, if they knew the factors we just discussed, they would understand that this highly unusual occurrence of diabetes within the same family is most likely due to their shared lifestyle choices.

CHAPTER 3 With Love

My paternal grandfather was one of the most cherished individuals I have ever known. Some of my most prized memories revolve around his gentle and tender characteristics and his incredible, lovable personality. Profound innocence… that’s my dada in a nutshell! Every day, after I came home from school, I looked forward to lunch. Not because I was hungry or the food was outstandingly good… it was for what came next. After every lunch, dada and I would go to a large park to talk a walk. Well, he would go there to walk. I would go to explore! The park was, well, large. I think it also contained a national reserve of some sort because often times, you could see cute porcupines and peacocks cooing about. There were also supposedly a few herds of deer that lived in the reserve, but I couldn’t corroborate because I never saw them. On really good days, I might find a porcupine quill or two. Or better still, an entire peacock tail feather! But more importantly, I got to spend some quality time with dada. We didn’t necessarily talk all the time. We just revelled in each others’ company. At least, I hope that the feeling was mutual! But rest assured, it most probably was, because our evening strolls had become a ritual which we participated in religiously. One day, the park had suddenly shut down for some maintenance work. No notice was given, and much to our dismay, when we arrived, we were turned away. Although we didn’t have to drive extraordinarily far to come to the house, as it was only a mile away from our house, it was a huge blow to us because we would have to forego our evening stroll for that day. Even missing a single day felt like a week for us! So that day, we left and found a different park. It was much farther, and we had to wait in the car for a lot longer. I was immensely disappointed and didn’t shy away from making it known. The five year old me was not yet educated about

the nuances of how to interact with your elders, even close ones. How to show the utmost respect without being formal. In other words, I was being annoying! Yet dada was very patient. He didn’t reply to me if I was out of line, but didn’t yell or retort back. He maintained his dignity and avoided stooping to a fiveyear-old’s level in of maturity. Indeed, I still my dada as a man with an imaginable amount of patience and calmness. He was like a symbol of zen for me, a buddhist ideal that revolves around the powers of meditation and intuition. Yet, I don’t want to censor his innocent, childlike nature and make dada sound all solemn and reticent. In fact, he was the very opposite of reticent, and was very expressive, especially when appreciating beauty. It was unbelievable how he managed to find beauty in everything. Here was a man who didn’t need to visit the snow-capped precipices of the Himalayas, or gaze at the evertransforming lights of the mighty Auroras. He would acknowledge the beauty that was present in the simplicity of the many flowering plants he tended to. He would find the beauty of natural bestowment upon the world in even an unopened bud, which was a cyclical mesocosm of creation. He would even find it in the fallen leaves of a money plant, which had fallen after unreservedly serving their purpose, in order to make way for a new generation. He was able to see the progression of the universe in the confined space of our humble balcony garden. Unlike the garden in our balcony, however, his appreciation for beauty was not confined to that found in the natural world. He would generously compliment women whenever he saw fit, genuinely iring the beauty he found in them. It wasn’t unwanted or creepy, it was a true and innocent iration of their beauty. One incident in particular comes to mind. Dada made a special visit to the florist and bought bright red roses. I was confused, because my grandmother usually preferred wildflowers for her prayers. When we returned to the apartment complex where we lived, he pressed the wrong button on the elevator. “That’s the top floor. I think you need to press three, Dada,” I said, expecting a prompt corrective measure by him. “That’s fine. I did it intentionally,” he said plainly. I was surprised, but not entirely because my dada was curiously unpredictable at

times. As we approached the top floor, he instructed: “Sanchit, why don’t you stand there by the stairs while I deliver these flowers?” Reluctantly, I agreed. After all, I wanted to know who the recipient of the roses would be. I tiptoed behind him and by the time he saw me, he had already knocked on the door. An older woman answered. She had pale, wrinkled skin, and beady black eyes. Her hair was unusually white, likely because she was even older than my dada. “These are for you! I’ve wanted to tell you that I think you are very beautiful,” he announced, smiling. The older woman was puzzled, and she maintained an emotionless expression for a few seconds that seemed like an eternity. I was afraid that she might think of accepting roses from dada as indecent and might decline. After all, both dada and, as I later learned, the older woman were married. I was sure that it would dismay dada if she did this assuming ulterior motives. After all, I have always thought of my dear dada as a free creature, who acted on his innocent impulses. Fortunately, the woman’s cold face transformed into a warm smile, full of a charming charisma. Her face, although aged, seemed enhanced by it and I could feel her warmness resound in that corridor. Relieved, I heaved out a sigh. “Thank you! That is surely the most generous compliment I have received in my eighty-three years of existence! You are a handsome man yourself,” she replied, the heartwarming smile still visible on her visage. Dada modestly brushed off the compliment. But he was, indeed, a very handsome man, even in his advanced age. When my parents heard about it from me, they were astounded. In a conservative society, such an action was unheard of. Dada, however, wasn’t bound by societal constructs of propriety. He was a free bird and did as he pleased if he approved of it morally. Complimenting a woman genuinely and acknowledging her beauty seemed like an appropriate thing to do. He wasn’t concerned about either person’s marital status because he didn’t think it mattered. In a simpler world, it wouldn’t have. In his mind, we lived in a simpler world.

Given his openness and expressive nature, he was never short of friends. Within a span of a few months, he had assembled a group of his bengali buddies, which comprised of older ladies and gents, and entertained regularly. If there was ever a stranger at the door, I would run straight to dada because I knew his appetite for companionship and that he could make new friends on a daily basis if needed. irable as he was, he was also a victim of Type II diabetes. As is a common theme in this narrative, he developed the disease as a result of his dietary habits. After every meal, he would ritualistically wash down his numerous pills with water. One day, my grandmother and dada went to Calcutta, their hometown. Dada was quite excited as he hadn’t been to his ancestral home in over eight years. Little did we know that he would never return. During that trip, dada suffered a stroke. He had suffered from strokes earlier as well, but there seemed to be a finality in this one; after receiving this worrisome news, my parents seemed convinced that there was not much scope of a full recovery. The stroke had left him bed-bound and he couldn’t travel any longer. And so, he never left Calcutta until his last days. Shortly after, we made a visit to Calcutta. I saw him, lying on his back on the bed, blankly staring at the ceiling. He seemed strangely silent, and uncharacteristically reserved. When I went up to him to greet him, he looked up at me with a blank stare. He didn’t recognize me as his grandson, and almost looked through me. At first I was confused, then disheartened. I wasn’t told that he had dementia, and the shock was overwhelming. I read him some short stories and comics, and fed him apples while he lay on the bed. It was as if we had switched roles, as I recounted the many times I would sit by his chair and he would tell me all sorts of scary stories. After a few days, we left Calcutta to head back home. We said our good-byes and I took a moment longer with dada. That was my last moment with him. A few months later, we got a phone call and were told that dada had ed that morning.

CHAPTER 4 A Wake-Up Call

Wanting to take action such that I could curb the effects of diabetes in my family, and in other families like mine, I realized that it was important for people to know the causes of the disease as well as some practices that can prevent its onset. But in order to properly consider a deep-rooted problem, I recognized the need to assess the impact diabetes had on my community. I conducted some research to figure out the impact diabetes has on my community by surveying people. Some of the data I found is summarized below.

Figure 1: Personal and Parental Diabetic Status by Age

Age Group (in years) Number of responses Diabetic Status (% of responses) Personal

Parental

Yes

No

Unsure

Yes

Below 20

10

10%

90%

20 - 40

6

0%

100%

40 - 60

91

9%

88%

Over 60

3

0%

67%

Composite

110

9%

87%

I wanted to see how my data would compare to the national average. According to the CDC², the national average for Type 2 diabetes prevalence is 9.4%. Additionally, 26.1% of the population of the United States is pre-diabetic, or “at risk”, for the disease. This correlates well with my data, since the average rate of diabetes in my survey was 9.1%. I can assume that a substantial portion of the respondents who denied having diabetes are, in fact, pre-diabetic and may develop it within the next five years if not treated. This is problematic because, in the words of the CDC Director Brenda Fitzgerald, “more than a third of U.S. adults have prediabetes, and the majority don’t know it. Now, more than ever, we must step up our efforts to reduce the burden of this serious disease.” The CDC conducted their own surveys to find that only 11.6% of pre-diabetics knew their status, and were aware of the risks they were facing.They also found that almost one in every four American adults with the disease were not aware of their condition. This brings us to an important consideration: how can the public be recognize the signs and symptoms of diabetes so that they take action by consulting a qualified healthcare provider and preventing further damage? I believe that it is imperative for us to teach these things to our younger generations at schools. Not only would this equip them to self-diagnose potential conditions, but also allow them to help family who may be unsure about whether they have the disease. Additionally, self-diagnosis for diabetes can be taught to the general public through public health campaigns, as studies have consistently shown that such campaigns have the potential to promote positive health-related behaviour and prevent negative ones. When I first looked at this data, I was surprised that the parental diabetic status was more likely to be positive than the personal diabetic status. At first, I attributed this to probability: since parental status would consider the health conditions of two individuals (the mother and the father of the responder), there would naturally be a higher chance for parental diabetic status to be positive. However, upon research, I discovered that age is a risk factor for diabetes. According to the CDC, about 4% of adults ages 18-44 years, 17% of adults ages 45-64 years, and as many as 25% of adults ages 65 and above have diabetes. Clearly, there is a general upward trend of type-2 diabetes incidence with the

progress of age.

Source: Canadian Community Health Survey, 2011.

In addition, type-2 diabetes is more prevalent in certain racial groups. According to the CDC, “rates of diagnosed diabetes were higher among American Indians/Alaska Natives (15.1 percent), non-Hispanic blacks (12.7 percent), and Hispanics (12.1 percent), compared to Asians (8.0 percent) and non-Hispanic whites (7.4 percent).”

Also, males have a higher risk factor of being diagnosed with diabetes than women. According to the CDC, 36.6% of men are prediabetic, whereas only 29.3% of women had the condition. The CDC also mentions that the occurrence of new cases is most prevalent in the Appalachian and Southern regions of the United States. Since resources are often limited, and it is unrealistic to assume that public health campaigns can span over an entire population, governments should consider targeting a specific audience. An older, less-educated, American Indian male would have a much higher risk of developing the disease than a younger, highly-educated, Caucasian woman. The campaigns could also focus on key geographical areas, such as the Appalachian regions and the Southern regions of the United States, where the incidence rate is highest. By focusing on subgroups, the government has a higher chance of reducing incidence rates of type-2 diabetes while on a conservative budget.

CHAPTER 5 Take Action

In the previous chapter, it was established that the government can begin working around this problem of diabetes by organizing public health campaigns. It is important, however, to establish how these public health campaigns can translate into reduced incidence of type-2 diabetes. It is integral that they not only teach self diagnosis but also prescribe a lifestyle that lends itself to the prevention of the disease. In this chapter, both components will be addressed.

I. Self-Diagnosis:

According to the ADA³, there are some common symptoms that can help us detect the disease at an early stage. These include:

• Fatigue • Hyperphagia (also known as polyphagia) which causes constant, insatiable hunger • Slow-healing cuts and bruises • Blurry vision • Tingling and/or numbness in the limbs • Constant, insatiable thirst

• Constant urination • Sudden weight loss, despite increased appetite

Such peculiar symptoms can make it easy for people to detect the disease. In fact, my father was diagnosed with diabetes because of my mother’s suspicions after witnessing his drastic weight loss, although he had been eating more and not exercising particularly often. It is always advisable to consult a qualified healthcare provider in case of any doubts, as early detection can prevent further damage, such as complications that result from diabetes. The complications arising from diabetes, as defined by the ADA, include but are not limited to:

• Strokes • High blood pressure • Nephropathy (kidney disease) • Foot complications that can require amputations • Neuropathy • Eye complications

II. Prevention

About 9 in 10 cases in the United States can be prevented. Truly, I’m quite unsure of what emotions to feel when I hear this. Should I celebrate the fact that diabetes can be made a much less common disease through simple changes in our everyday life? Or should I be disheartened when a largely preventable disease becomes one of the most prevalent diseases in a developed country with advanced medical infrastructure and knowledge, when

simple lifestyle changes could have reduced the number of cases by 90%? Regardless, here are some simple ways of reducing risk as prescribed by the Harvard School of Public Health:

• Weight control: seven-times more risk of developing type-2 diabetes for overweight people; forty-times more risk of developing type-2 diabetes for obese people. Losing as little as 7-10% of body weight can halve a person’s chances of developing diabetes. • Exercise: Studies show that as little as a thirty-minute brisk walk performed daily can reduce someone’s risk of developing diabetes by 30%. Moreover, some forms of inactivity can be especially harmful. Watching television, especially, can dramatically increase the risk of developing diabetes, as well as heart disease and an early death. • Well-regulated diet: Avoid red meats, simple sugars, processed foods, sugary drinks, etc. and choose healthy fats and whole grains with a low glycemic index instead. • Avoid smoking: Smokers have a 50% higher chance of developing type-2 diabetes. • Limit alcohol consumption: consistently high intake of alcohol can significantly increase the risk of developing diabetes. If you already drink alcohol, ensure that you consume a moderate amount at most.

As the famous author Yuval Noah Harari puts it: “in 2012 about 56 million people died throughout the world; 620,000 of them died due to human violence (war killed 120,000 people, and crime killed another 500,000). In contrast, 800,000 committed suicide, and 1.5 million died of diabetes. Sugar is now more dangerous than gunpowder.” Yet, this does not have to be. We must make better choices and be the change that we want to see.

REFERENCES

“Diabetes, 2011.” Statistics Canada: Canada’s National Statistical Agency / Statistique Canada: Organisme Statistique National Du Canada, 19 June 2012, www150.statcan.gc.ca/n1/pub/82-625-x/2012001/article/11659-eng.htm. “Simple Steps to Preventing Diabetes.” The Nutrition Source, Harvard T.H. Chan School of Public Health, 23 July 2019, www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetesprevention/preventing-diabetes-full-story/. “New CDC Report: More than 100 Million Americans Have Diabetes or Prediabetes | CDC Online Newsroom | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/media/releases/2017/p0718-diabetes-report.html. “Type 2 Diabetes - Symptoms.” ADA, www.diabetes.org/diabetes/type2/symptoms.

ENDNOTES

1 Sandesh, rosogolla, and malpua are Indian desserts that contain high amounts of sugar, but are delectable nevertheless 2 Centers for Disease Control and Prevention 3 American Diabetes Association