thand rakh harjas

i used to be a hopeless romantic but now i am just hopeless

[thand rakh harjas @harjask21]

Sometimes humour is just masked sadness.

[shahitukdaaa @shahitukdaaaa]

Main kisi aadmi se umeed lagaun aur wo meri humble na kare aisa ho sakta hai bhala

[dasia @PhelpsDasia]

only way to save money is to not care about your appearance and have no friends and not eat

[sammm ☆ @onlysammms]

no data center is worth destroying this

[gal౨ৎ @prtygal777]

What if my purpose in life is just to admire the sun through the trees?

[The sunny side of Franz Kafka @AmschelKavka]

I shall drink hot lemonade, wrap a hot towel around me, withdraw from the world, and dream about you.

Franz Kafka, 1913.

[thand rakh harjas @harjask21]

@isawsukul 3333

[Rajjath @Rajjath24]

reading is the only grind no one applauds, until you meet a reader and see how amazing their thought process is.

[owen cyclops @owenbroadcast]

moved 1000 miles away. in a thrift store, i pick up a random children’s book. read it that night with my kid. its really good - oddly good. may be the best random book ive found. i check the inside: the author is from the exact town i grew up in. the spirit of a place colors you

[TheLiverDoc™ @theliverdoc]

STAY WITH ME.

A few years ago, a patient was referred to me because he was diagnosed with complicated cirrhosis. He had an infection which led to a condition called hepatic encephalopathy (brain failure due to high ammonia levels). The treatment largely involved ammonia reducing therapies. One drug was central to this - Rifaximin - a non-absorbable antibiotic that reduced ammonia in the body. I prescribed him Rifaximin for 6 weeks and advised him follow-up.

He came back to me, not after six weeks, but in 4 weeks, this time, in liver coma (worst stage of brain failure - due to very high ammonia). He spent two days in the ICU and six days in total in the hospital. His hospital bill was close to INR 80,000. He had no insurance and his wife borrowed the money from neighbors and friends to clear hospital dues.

Upon questioning, I found that he was not taking the Rifaximin drug I had prescribed. He was only on the other two drugs (one, a syrup called lactulose for improving ammonia clearance in gut). I was furious, because the patient spent a whole week unecessarily in the ICU and wasted so much money that he never had - just because he was "not compliant" to my orders. I decided it was time for me to school him a bit.

But I was wrong. He was compliant. He had purchased Rifaximin and was on it. For 15 days. Thereafter, he could not afford it. He was an autorickshaw driver who shuttled school children every morning and evening. He could hardly make ends meet. He had two children of his own. The Rifaximin brand I prescribed him was 42 rupees per tablet. He had to consume two a day - which would mean 2520 rupees a month. He just did not have that money - so he skipped it - to not compromise on other important matters - childrens education and food.

He was confused and scared about opting for a cheaper version of Rifaximin because one, he was unsure about the quality of Rifaximin that was not prescribed by me and two, he was "scared" that I would scold him for buying a cheaper Rifaximin and if that got him into trouble.

I was confused and scared about prescribing a cheaper version of Rifaximin because one, I was unsure about the quality of Rifaximin that was not "a good promoted brand" and two, I was "scared" that his family would scold me for prescribing a cheaper Rifaximin and if that got him into trouble.

It is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like my patient.

This narrative, that generic drugs 'are never good' and that only big pharmaceutical marketed drugs are what works has been deeply ingrained into doctors and patients alike - I do not know by whom and since when. Looking back, these strong emotions were based on either opinions, testimonials or second- and third-hand information. Not evidence.

Like I said. Stay with me. This is life changing and will disrupt the drug market in India. Here are the results of The Citizens Generic vs. Brand Drugs Quality Project.
1/11

[shato @meishato]

the secret to being a private person is to overshare dumb shit so people think you are an open book but then not tell them any of the important details of your life

[Jaskaran @harichutneylvr]

Mera child like wonder nahi tootna chahiye Khatana bhai

[abby @abby4thepeople]

Yesterday this girl told me that she's never felt alone in the world because she knows her mom will always be there for her and I don't know if I've ever been more jealous of anything in my entire life

[poppa @popitforpoppa]

ain’t no way god thinks i’m this strong bro

[Maddy Ravi @missmaddenstein]

☕️ All the coffee tweets you've seen today are not a coincidence ☕️

A well-known cafe’s secret playbook for expansion has been revealed:
- Direct and persistent marketing to customers, often cold messaging and not taking no for an answer
- Based in Mumbai but actively looks for franchise partners in other cities
- Woos customers with the promise of heavenly, over-the-moon concoctions, as seen in Disney movies
- Flowery, poetic descriptions of various brews, none of which taste good
- Sending various photos of menu items without consideration, even when explicitly told not to by customers
- Coffee innuendo including wanting to be inside the customer and imagining the cup in their hands
- Suggesting food items which are basic and non-befitting a cafe
- Constant reminders of hydration to customers, which are off-putting when consuming a beverage
- Forcing travelling customers to visit the cafe even if they have other plans

This is a warning to all potential customers to avoid the cafe at all costs — it is overpriced, with consistently bad reviews from everyone who has ever had the misfortune of visiting and tasting any item on the menu.

And whatever you do, stay away from the tiramisu.

[Taijitu Observer @taijitu_sees]

My wife has so many skills and puts in so much effort. I'm going to start a thread to track these wins so I can show her from time to time.

[thand rakh harjas @harjask21]

@richardsiken yeah, considering the wrath they have I feel like I would have to do a greater penance to win their trust this time around

[thand rakh harjas @harjask21]

mr @richardsiken how do i make amends with my parents for doing things they are too conservative to allow

[thand rakh harjas @harjask21]

@richardsiken okay then how do i make amends for lying about doing things i want instead of being strong enough to stand up to them about it