This is what a mystery/detective novel should be. The story is riveting, the detecting is superb, there is an affecting love story as a subplot, and all this without gore, sadism, f-bombs, or other objectionable material. The extensive vocabulary for once treats the reader as an intelligent, educated human being. I do wish Holmes wasn’t portrayed as a cocaine user, but that ship has sailed long ago. I wish publishers today would take a lesson from this book, but I fear this kind of quality is long gone. The reader, David Timson, is excellent, doing all the voices in different, easily distinguishable accents.
Every so often I’ve used the predictive power of the Google Ngram Viewer to create a story from a seed phrase. I fed Ngram the italicized words in the story and the website predicts the next word based on the last three or four words. It gives the ten most frequent following words (if there are that many). Occasionally I had to use the second or third word instead of the first to avoid lengthy run-on sentences or loops, but other than the seed phrases, the story is google’s.
Who would have believed that the world was created by God. No one ever said that to me before I left for the United States. Nevertheless I couldn’t help but notice that the second and third centuries are the most common cause of death. Then, surprisingly, he was not a man to be a man of the world. On New Year’s Day in Pasadena and the San Gabriel Valley in the early days of their marriage he had been a member of the family. That region was not a part of the body of the text is not a substitute for the advice of an attorney.
The taint is elsewhere.
It is now a month after I had brachytherapy for my prostate cancer. I still have some unpleasant side effects, but they are much less intrusive than before. I also still have some unpleasant interaction with doctors. Read on.
A couple of weeks after the procedure I received a letter from my health insurance company that if I needed a long-term (90 day) prescription for Tamsulosin (generic Flomax) I needed to switch from the drug store I used for the first prescription to their mail order service or another local pharmacy that participates in their discount service. I could tell I would need a refill, so even though it was cheap at the pharmacy I used first (about $5.00 for a 1-month supply) I wanted to make it cheaper for the health plan as they had requested. I messaged Dr. A that I wanted to switch from the pharmacy he had sent the first Rx to and to send a 90-day one to Pharmacy #2. He replied quickly that he would. Three days later he still had not and I was down to my last five days worth. So I called my health plan’s drug service and explained and they said they would contact the doctor and get it renewed through them and they would send my refill by mail. Two days later I got an email from them saying the doctor had not responded. I was down to my last two pills and had decided I would have to get a refill at the original pharmacy. However, before I got around to that, that pharmacy called me and told me my prescription was ready. Dr. A had sent a 90-day refill there instead of to the one that participated in the discount program. Even though he had read my message, he apparently had not understood anything other than I wanted a refill. He totally disregarded which pharmacy I wanted it sent to, even though I included the name, address and phone number of that pharmacy in my written message. He also disregarded the request from the mail order people. Ironically, the new Rx cost the same amount ($5 a month) as before, and less than the mail order service provided, and it was for twice as much because the doctor had doubled the dosage. I didn’t need the double dosage, so now I have a six-month supply at what is effectively $2.50/mo but will probably only need another two or three weeks worth, based on my progress. What a waste; only drug companies benefit while your premiums and mine go higher. All because the doctor didn’t read my message carefully and didn’t do what he said he would. Doctors are clueless about insurance.
So a few days ago I was sitting at home and got a call from the office of Dr. K. The woman there asked if I could come in for my 1-month follow-up. She wanted to know if I could come right away. What the heck!? If I was supposed to have a 1-month follow-up, why didn’t they schedule that much earlier, at the same time they scheduled the procedure, for example? The patient is supposed to drop everything during the holidays and run right over if the doctor calls? She told me it would only take 15 minutes and if I couldn’t do it, I wouldn’t be able to get an appointment until mid-January (three weeks away). I had another doctor’s appointment (annual vision check) right after lunch, but fortunately I was free for the morning so I decided to get it over with. I took my book (foresight!) and went. I was quickly given a CT scan, which is standard procedure to verify the seed placement after the swelling has gone down, The attendant tried to put me in an examining room, but they were all full (which flummoxed her), so I sat in the waiting room reading waiting for the doctor. They obviously weren’t really prepared for me, which makes we wonder why they called me in. Half an hour later I was getting visibly peeved and the receptionist noticed it. She apologized for the delay. I told her I had another appointment and wasn’t going to skip lunch to make it, so if the doctor didn’t see me in the next five minutes I was going to have to leave. Two minutes later Dr. K emerged and asked “who’s next?” The receptionist pointed to me. I sat down with him in an exam room and he asked about my post-operative side effects, etc. It was pretty standard stuff, no surprises for me and apparently not for him. But when I asked him the results of the CT scan he told me “they’ll be fine – they always are.” He obviously hadn’t looked at them yet. I then asked him to confirm what I’d remembered about the number of seeds and needles used in the procedure. He didn’t remember and left the room to get my file, which he obviously hadn’t even reviewed before seeing me. He came back and confirmed that my recollection was correct as to those numbers. I asked him what my prostate size was, something that is sometimes important in rates of recurrence or future treatment options if the PSA goes up again. He didn’t remember that either and flipped through some pages, but couldn’t find it. That was what I had come in for the first time I saw him, to measure my prostate, but now he can’t find it. He obviously had no recollection of me as a patient and was making almost no attempt to answer my questions.
For what it’s worth, my eye exam was done quickly and professionally and everything was fine there. I have a great ophthalmologist. She and the optometrist in her office are female and had to stand near me, but I’m safe for a pregnant woman or anyone else to be near now. I’m able to run again, although I need to stay near a bathroom. My Achilles tendon is manageable, although there’s still some tendinitis. I’m way out of shape from the long layoff from running, but I feel like my life is returning to normal now.
Here’s one to start some arguments around the dinner table. I have statistical proof that women are better drivers than men. I downloaded from the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) all cases nationwide in 2016 in which there were multiple cars and multiple drivers and at least one male and one female driver and where one driver had a factor listed of “careless driving” and the other did not. Of the tens of thousands of fatal accidents recorded there were exactly 432 that met these criteria. Of these the male was listed as careless 241 times, the female 191 times. When I select for factor “reckless” it’s even worse for men, 222 to 79 and for “aggressive driving/road rage” it’s male 69, female 13. I rest my case.
Bear in mind this only shows what a law enforcement officer reported to NHTSA in fatality cases. It doesn’t include fender benders or single car fatality cases or cases where both drivers were found to be careless. Nor does it include skills like parallel parking or navigating or traffic violations. These numbers compare only cases where careless driving, reckless driving, or aggressive driving was a factor (coded by the officer) but not other listed factors. I ran the data again where I included all cases where there was any driver factor that could be considered bad driving. There, the difference is much less, 5025 for men to 4916 for women. These raw numbers, however, aren’t very significant because they include such minor factors as “overloading” or “inexperience” along with some serious ones like alcohol-related and speeding. If one driver is reckless and the other inexperienced (apples to oranges) they would score the same for this test. That’s why I tested apples to apples limiting it to the three clearest fault indicators.
In California there is a meme (racist?) that Asian drivers are the worst drivers. There is even a fictitious offense of DWA (driving while Asian) bandied about frequently. So I did the same thing for the race of the driver comparing only listings of white vs. Asian. The data produced only three cases. In all three the Asian driver was listed as careless, not the white driver. None were in California. This is too small a data set to be convincing. I suspect that many accident reports do not list the race of the drivers, especially if one is non-white. I would not be surprised if politically correct California has a policy of not putting race on their form, at least in many departments. The vast majority of California reports had no listing or unknown in the race field. The NHTSA coding form specifies several specific Asian “races” (e.g. Chinese, Japanese, Filipino, which are really nationalities) but also a general category of “Other Asian.” I suspect that of those departments that do report the race, they choose that rather than ask or guess at a driver’s Asian “race.” It was the single most frequent Asian race category that was reported in California. I can tell you that I spent a year as a volunteer judge pro tem doing traffic court in Palo Alto, California and there were probably as many ticketed Asian drivers as white drivers in that courtroom. I don’t think native born Americans of Asian descent are any worse than other Americans but so many of the recent immigrants, especially adult women, have had so little experience driving in their native country that I think there is truth to the meme.
Consider the following chart showing the relative ownership of domestic makes of cars to foreign makes by state.
The data is taken from the NHTSA fatal accident data base for 2016. It is not surprising that Michigan and other states with or near U.S. make factories have higher ratios of domestic makes than the coasts. I was surprised the difference was as great as it is, however. North Dakota (the highest ratio) had more than five times as many domestic cars as foreign cars. Hawaii (the lowest) had only about 44% as many domestic makes as foreign. The medium blue of Washington and Oregon indicates about equal numbers of domestic and foreign makes; anything to the right on the color line indicates more U.S. makes.
I used fatal crash data mainly because it was readily available, but I also think it is a reliable indicator of ownership in general. The chart does not represent new car sales but what is on the road now. Since newer cars are safer in general than older cars, the data is probably skewed somewhat toward older cars. I don’t think there is a significant difference in safety between the two groups as a whole, certainly not enough to make the map look much different. The data is based on the state where the accident took place, not the state of registration.
This is as good as it gets. Connelly has produced another masterful police procedural, his best in a long time, although they’re all good. His phenomenal accuracy in describing every detail of how a good LAPD detective thinks and acts still amazes me. Not that I was in the LAPD, but I was in law enforcement. This is a mystery that you can put together yourself if you pick up on all the clues and are as smart as Renee Ballard, Connelly’s new detective.
Ballard is a surfer from Hawaii and one tough cookie, attractive enough to get hit on or harassed, but hard-nosed enough to give as good as she gets. As usual the author has more than one investigation going and Ballard is working them all – a transsexual who got beaten with brass knuckles, a multiple homicide that took place in a bar, and later, the murder of a cop, her former partner. Of course, like Bosch, she has the reputation of being a pain in the ass to the brass. To avoid spoilers, I’ll leave it at that plot-wise.
I listened to it on disc and the reader, Katherine Moennig, was both good and bad. She had the right tough cookie voice and was a good actress but her frequent mispronunciations detracted from her reading: joolery-jewelry, supposably-supposedly, My-Ako – Miyako. She just didn’t sound smart enough to be Ballard.
Interesting article here. For the record, I am not on Mueller’s investigation team and I did not contribute to the Clinton campaign or the Trump campaign. I do not know, nor have I ever previously heard of, the Russ Atkinson in the story.
“Deputy AG Rod Rosenstein is answering questions in Congress this morning. In the light of the clearly partisan views of Peter Strzok, which Ed wrote about this morning, Republicans are looking to question the partisanship of the team assembled by Special Counsel Mueller to investigate Russian interference in the election. … Next, again in alphabetical order, Russ Atkinson. He donated to the Clinton campaign last year. Again, zero to the Trump campaign.”
Full article here: Hot Air
The author is one of the scientists who helped invent the CRISPR tool that makes possible easy gene editing. The first half of the book gives the history of how the tool was discovered and improved. That part is quite technical. I found it interesting, but many will find it too difficult. It is also quite repetitive. How many times do we need to be told that scientists have used gene editing to create micropigs or that the tool can be used to find treatments for muscular dystrophy? For those not into the hard science, though, you can skip directly to Part II where the complex ethical and moral issues are discussed. The tool can be used to cure disease and to feed starving populations. Crops are already being made more resistant to pests or diseases, thus allowing for crops that have more nutritional value and which do not require pesticides, fungicides or other harmful chemicals, or at least not in the same volume as before. The author makes a compelling case for the value of gene editing and indeed for GMO foods, which are actually healthier both for the consumer and the environment than traditionally farmed foods, not to mention cheaper, yet 60% of Americans think they are somehow harmful or at least less desirable than traditional farming methods.
However, the CRISPR tool can also be used to modify the human genome. For now that is only being done therapeutically in somatic cells, i.e. ones that are not involved in reproduction. The genetic changes are only for an affected individual who is suffering from a genetic disease. But the technology can be used to modify egg and sperm cells’ DNA, either for good, such as repairing a defective gene that would have led to a horrible heritable disease in the child, or, in theory at least, to “designer babies” or some Nazi-inspired eugenics movement. Human embryos have been modified in the lab, although only non-viable triploid embryos were used. The author does an outstanding job of showing the different viewpoints and the goods and bads of gene editing. Personally I side squarely with those who are plunging forward with the research. I don’t fear an onslaught of designer babies. I doubt the technology will ever be used for cosmetic reasons except perhaps in a few dozen cases a year, if that, and that’s not likely to be harmful. Much more likely, it will be able to eliminate defective genes that nature provided by its random mutations, diseases like Duchennes muscular dystrophy, sickle cell disease, and early onset Alzheimer’s. Why some people consider that a bad thing is beyond me. Even the so-called “designer babies,” i.e. modifications not done to cure a disease, aren’t likely to be Aryan master race experiments or super athletes, but severely myopic parents who “design” a child with 20-20 vision, or musician parents who “design” a child with perfect pitch. I see these as helpful for everyone and not harmful. I am more concerned with the use of the technology in a way the author does NOT discuss – as a weapon. I can foresee some dictator (e.g. Assad) dropping genetically-modified unkillable bacteria or viruses on their enemies and a worldwide pandemic beginning. We must continue responsible genetic engineering to be able to prevent or protect against those who do not have the ethical or moral compass we do.
The Silence Breakers, Person of the year = They kneel not as before; careers perish
This unfinished memoir by a neurosurgeon who died of cancer documents his decline and suffering along with his aspirations and accomplishments during the period of his diagnosis and treatment. It contains a plethora of medical information that will be fascinating to those into brain science. Despite this, I cannot give it a high rating for two reasons: it is unnecessarily depressing and pretentious. The author almost wallows in self-pity at the unfairness and the suffering of his disease, and indeed it is a great loss not only to him, his friends, family, and colleagues but also to future patients who are denied his skill. He was no doubt a highly skilled and dedicated doctor, a fact I know only because he repeatedly tells us so. He tells us so in flowery, overwritten prose stuffed full of literary quotes, esoteric vocabulary, and accounts of his sacrifice and the admiration of colleagues. In addition he takes it upon himself to tell the reader what is important in life and how to live it as though he were an oracle or philosopher. Reading this I am reminded of the Smothers Brothers skit where the psychiatrist wears a badge that says M.D. and points to it while identifying himself as “me, deity.” The long epilogue by his wife places him on an even higher pedestal than he has placed himself.
Also, Russian hackers and fake news.
It is Sunday, five days after my brachytherapy procedure. I am now going to focus on what the patient should expect rather than on the doctors and medical establishment. The short version is that my body received a major intrusion and it’s not all sweetness and light afterward. But it is bearable. However, doctors continue to screw up. See Part 11 for more of that.
The first day or two were actually pretty easy. My perineum was tender, bruised, and swollen, but I could still sit comfortably with care. It had had sixteen large puncture wounds, so that’s not surprising. I had taken the generic Flomax on days 1 and 2 so I could manage to urinate reasonably well, although you should expect to have a small stream. The prostate is swollen. The penis also hurts, right at the tip. I don’t know if this is from the trauma of the catheter or perhaps even another instrument used in the urethra during the procedure. It still hurts now, five days later, although much less. I sat around in my recliner a lot and didn’t do much. I was able to sit on my office chair at the computer, too, but didn’t have a lot of energy. I think I only had to get up once each night.
Day three, Friday, things got worse. The penile pain was greater after having lessened over the preceding two days. I had felt some odd lightheadedness a couple of times in the preceding days which I suspected was due to the Flomax, so I decided to see if I could go without it. I did not have the lightheadedness, but my stream became much smaller, leading to more frequent urination and long bouts in the bathroom. That night I had to get up twice, and 1:00 AM and 4:00 AM and I was not able to get back to sleep after the second time. So when I finally dragged myself out of bed Saturday around 5:30 I was wiped out and I really wanted to be able to pee better, so I immediately took a Flomax. After another 10 minutes in the bathroom I got up to get dressed and have breakfast. Immediately I felt a wave of nausea and dizziness. I won’t go into detail, but the next miserable half hour was spent in the bathroom. I managed to keep the Flomax down, but it was nip and tuck. It was my fault for disregarding the instructions for the Flomax. You are supposed to take it on a full stomach – 30 – 120 minutes after a full meal. It’s powerful stuff and known side effects include nausea and dizziness. It’s important to take it with food so that it enters the bloodstream slowly. I never fully recovered yesterday. Thank heaven for college football. I could veg out in my recliner and watch something, even though I’m not much of a fan. I managed to eat and kept it down, but there was no way I could drive a car, for example. I was able to pee a lot better, though. The Flomax does work in that way.
Today I’m better. I ate a big breakfast and waited an hour before taking the Flomax. My urination is nearly painless and near normal. I took a short walk today. There is some discomfort in the perineal area from walking. I’m not as tender as I was, but I still have to sit carefully. I have yet to drive my car since the procedure. It’s boring sitting around so much and not being able to exercise, either at the gym or running. I am not feeling well enough to do anything creative like working on my latest novel. I left off writing that a week ago. I pulled out a big jigsaw puzzle so I would have something to keep my mind off my body. I am in recovery mode, there is no doubt.
Edit: It is now 17 days after the procedure. The radiation is less than a third of what it was at the beginning, but the cumulative effects on my innards have taken their toll. My ability to urinate has begun to approach normalcy finally, but only as of yesterday. It is still somewhat painful, but in a different way than before; if feels like excessive pressure inside – in the prostate area – until I’m finished. I still use Flomax. More troubling have been my bowel habits. If I don’t want to visit the bathroom every hour I have to take Imodium. There was one night the first week, around day five, that I slept through the night. Since that time I have had to get up to pee two or three times every night. Last night there was a stretch of almost five hours of continuous sleep. That’s the longest since that one night I slept through. I have been able to go out for walks and to the gym over the last week. I’ve taken it easy and stayed near a bathroom, but it is possible to exercise moderately without much discomfort. In fact, it has invigorated me and let me feel almost normal. I’ve had no trouble doing ordinary household chores like washing dishes, mowing the lawn (with an electric push mower), and taking the garbage cans out to the curb, but I have avoided any heavy lifting or jarring activity. I’ve been able to concentrate more and I actually worked on my novel over the last two days. About a week after the surgery my private parts turned a spectacular purple, which later turned to black. I also had a similar bruise on my arm where the IV was. Those places are now faded and should soon be back to normal. My cat has not tried to sit on my lap, despite the cold weather. My wife has gotten that privilege – the cat on her lap, I mean, not my wife on mine.
Edit: 27 days after the brachytherapy – I went running for the first time since the surgery. I had several problems, but the prostate was not among them, nor was the Achilles. The weather was really cold this morning, which is not surprising since it’s mid-December. I’m way out of shape. Not only have I been quite sedentary for the last month, I was pretty sedentary for the two months before that due to my Achilles tear. I was cold and sucking wind after only a slow one-mile jog. Then I realized I had to get to a bathroom. I barely made it back to the parking lot rest room in time. My frequent BMs continue to be a problem of sorts although other than frequency, they are normal. I am not taking any other drugs than the Flomax. I slept through the night last night for the first time since the first week after the brachy. My urination is close to normal most of the time, at least it was as of yesterday. Now that the weather is colder, the cat is sitting on my lap. The radiation is about 13% of the original strength now. With the Cesium-131 seeds I am supposed to be safe around pregnant women and everyone else after one month. With other isotopes, it’s longer due to their longer half-life.
Continued on Part 11.
Today’s the day. It’s 5:30 AM and I’ve had my shower and put on clean underwear as instructed by the emmi video.. Yesterday I got calls from the hospital, a very competent-sounding nurse who answered almost all my questions and one from the anesthesiologist. Both asked me a nearly identical set of questions such as what previous surgeries have I had, do I have any drug allergies, and so forth. The nurse’s list was somewhat longer. One question she asked that surprised me was whether I had been taking my Flomax. I told her no and asked if I was supposed to. She seemed surprised I hadn’t had any instructions on that and said “It’s too late now, but you can still have the surgery.” So I guess I was supposed to start using that back when the pharmacy filled it. I just double checked the instructions I received from the scheduler and there is no mention of that prescription.
I’m not allowed to have anything to eat or drink, so I’ll just sit around and watch the morning news until my son arrives. To be continued …. I hope.
Okay, I survived. Except for the waiting and answering a zillion questions (mostly the same ones repeated), it wasn’t any worse than the biopsy. It ended up being 57 seeds, not 33. I never got an explanation as to why that number. The recovery room nurse said it was pretty standard. She gave the normal range as 30 – 60, but the product website said average was around 80. One nurse told me 17 were in the interior region, the rest on the the perimeter. Maybe when they decided not to do the EBRT they increased the number of seeds. Dr. K said he would insert the protective gel to prevent rectal damage from the radiation and I had to initial another release in the operating room. This gel shield, called a SpaceOAR, is really just a spacer. It doesn’t block the X-rays; it simply makes use of the Inverse-square Law to reduce radiation to the rectum by increasing the distance. Dr. A used the same line as after the biopsy, telling me right before the surgery that he would call my son in a half hour or so and “give him the good news.” That seems to be his shtick whether or not he is expecting good news. I won’t go into all the grisly details but the bottom line, no pun intended, is that they won’t release you until you can pass at least 100cc of urine. It took me a while, but I made it there and was sent home with my son. The nurse freaked out a bit when she used ultrasound to measure how full my bladder was, and it was almost at 500cc. She threatened to call Dr. A come and catheterize me, which seemed to be all the motivation I needed.
I can walk around without significant discomfort, although I have to plop down carefully. The biggest surprise in my post-op instructions was that I am not to have my cat or other pet on my lap for 30 days. I don’t glow in the dark, but I am somewhat radioactive. Also no pregnant women or young children within six feet for that duration. I am not to ride a bicycle or do other activities that cause vibration for that same period, so running is out. I am supposed to avoid orange juice, tomato juice, and spicy foods because they can cause bleeding. So I guess that’s it for now. I do not have that “severe pain” the scheduler mentioned, nor was any pain medication prescribed. The post-op instructions just say to avoid Ibuprofen, which I would do anyway since I’m allergic. They didn’t even say no aspirin, but I’ll stick with acetaminophen for now. I’ll update the blog when something happens worth reporting, but that may be a few weeks away.
This very short, very accessible book on astrophysics, or, more accurately, astronomy with a bit of physics thrown in, is written in Tyson’s easy-going style. It is dumbed down to the point where even I can understand it. There’s relatively little scientific jargon, although one cannot escape basic terminology. The author seems to be trying to accomplish a few specific things: give readers confidence in the scientific method (and scientific establishment), an appreciation for how insignificant we humans are in the universe, and an understanding of the value of basic scientific research. Most readers will be accepting of these viewpoints and those who are unaccepting, such as some fundamentalists, probably won’t read this book. As one might expect in such a short book covering such a vast topic, it skims over a lot of complicated things and skips from topic to topic without any obvious pattern. I learned a few new factoids that I will never put to use outside a crossword puzzle, perhaps, but it’s a quick, pleasant enough read.
As I get close to the day of the procedure, I encounter more surprises. I received a call from my local pharmacy that my prescription was ready. I didn’t know what that was. No one had told me that I would be getting a prescription prior to the surgery. It turned out to be generic Flomax. I suppose this is good to have on hand for after the surgery, but as I mentioned earlier, I wasn’t having any urinary symptoms and hadn’t been given any instructions on this.
Then I got an email from the hospital with a link to a website. It requested me to go to this site to view their “emmi” program. This turned out to be a series of four audio/video clips. They provide a long numeric password for my privacy. I’m not sure what they were trying to protect since the videos provided nothing but the most basic information. There was nothing in them identifying me or specific to my procedure. One of them was about “my hospital stay”. It took ten minutes to say that my medical team cared about me, washed their hands, and that I should ask if I have any questions. Another one was on how to prepare my skin for the surgery. It made two important points: 1) wash your skin thoroughly before the procedure, especially the area of the body where the surgery will take place; 2) but do NOT do this for the genital area. Hello – the area of my surgery is the genital area. Do I wash it or not? The narrator for all of them is a woman who sounds exactly like she’s reading a story book to four-year-olds. It’s very demeaning. They even assure the viewer that it is very easy to use a computer to watch the videos, which the viewer can only hear if they have already begun watching the videos on the computer. The unit on anesthesia begins by telling me what surgery is. Do I really need that? Again the emphasis is all about how much everyone cares about me, yada yada. Then it lists 11 risks of anesthesia alone and point out this does not include all the risks of anesthesia, and none of the risks of the surgery part itself. It’s pretty scary, actually. I don’t know why they want the patient to view this unless the lawyers want them to force it onto the patients for liability reasons. The last one was about Advance Directives. My wife and I just had our estate plan updated and have new Advance Directives, and the hospital and our family doctor have copies, so this video is totally unnecessary for me. If they’d bothered to check or personalize it they would have known this, but obviously they didn’t. Altogether these pointless videos take almost an hour. I found them patronizing almost to the point of being insulting, although for some very young or very poorly educated patients I can see how they might be appropriate. Watching them all was harmless enough, I suppose, but irritating and I came away feeling that I was just a checkbox item they had to check according to their lawyers. They seemed worried about their skin, not mine.
A few days before the scheduled surgery I got a call from Dr. K. He began by introducing himself and saying he worked with Dr. N whom I had met. Dr. K didn’t even remember that he had examined me and measured my prostate, much less his promise that he would coordinate with Dr. A (which I already knew he had not done). The good news is that he and Dr. A had been talking and had decided that the EBRT was unnecessary. He described it as overkill. So he would be ordering seeds for the brachytherapy at a stronger level. If the brachytherapy is to be followed by EBRT, they have to reduce the initial dose from the brachytherapy to avoid an overdose of radiation. I was glad to hear this, of course, since the whole thing is over much sooner, and because there are a few side effects from the EBRT that are not present, or not as often present or in the same strength, as with brachytherapy alone. I don’t want to expose my body to any more radiation than is necessary. The reduction was also reassuring in that it signified that my biopsy results were not as serious as previously thought and that there was no evidence cancer cells had escaped the prostate to the surrounding tissue. It was very disturbing, however, to find that my treating doctor had no memory of me. What else didn’t he know? Did he see the note about the bad Cipro reaction that I had called in to his office?
See the next post in this series here: http://blog.ackgame.com/onwords/prostate-cancer-doctors-wrong-part-9/
This non-fiction account of the white author’s search for the African roots of his family name is partly a piece of journalistic research and partly a personal memoir. It never fully succeeds at being either, but it does contain a number of interesting historical and personal insights. He traces his genealogical roots to the area around colonial Jamestown, Virginia. There all the Mozingos appear to have originated from Edward Mozingo, an African slave brought there in 1644 and who won his freedom in a court case in 1672. Edward married a white woman and his children and their issue eventually spawned both black and white family trees.
Now, over three hundred years later, most white Mozingos think their name derived from Italian or Basque forbears. Some joined the KKK while others learned of their African roots and embraced them. The author interviewed dozens of Mozingos or relatives of the original white owner of Edward as well as academics and historians. The Mozingos he interviewed ranged from middle class whites and blacks to what some uncharitable folks might term white trash – poor, relatively uneducated, and bigoted, although also often welcoming and open, at least until the topic of their name possibly being African arose. After traveling the U.S. researching his name, the author flew to Africa to try to trace Edward’s origins further. He found Mozingo to be a common name in Cameroon and Angola. He was welcomed in both countries.
The book was fascinating for me because I recently learned that despite being very white (blond, blue eyes) I, too, have an African ancestor. Reliable family and census records establish that my paternal great great grandfather married a woman who was the granddaughter of an Alexander Fuller in North Carolina who was described in a store account of 1763-1765 as a mulatto carpenter. Like Edward, my ancestor was free, practicing a trade, running store credit and owning land. He, too, married a white woman and all his grandchildren were listed in later census records as white. Unlike Mozingo, I was never able to identify the likely black African man who first reached American soil. I know it was a man, though, because various DNA relatives of mine named Fuller carry an African haplotype (a genetic marker than can come from only one parent) on their Y chromosome. In researching my own history I learned that intermarriage was quite common back then and not frowned on or made illegal as later when racism set in hard. Many African slaves were freed after a period of indentured servitude, just as the poor Irish and English were. The author gives an eye-opening account of life in those times.
One area where he falls short, though, is that he never really establishes his direct connection to Edward. He had his DNA tested and he did not have the African haplotype on his Y chromosome that would mark him as a direct descendant along the male line. He speculates that he descended from one of Edward’s unmarried daughters who kept the Mozingo name. In fact, he speculates about a lot of things. The book is filled with his many accounts of things based on little more than his imagination “I could envision so-and-so sitting here…” “Perhaps this is where such and such might have happened” “I felt like ….” The author’s travels in Africa bear the same problems. He goes to various villages and talks to many experts, but never really establishes where Edward came from. He does paint an extraordinary picture of slavery in Africa that preceded the European and American slave trade and continued long afterward. I certainly cannot defend the horrific slavery era in the U.S., but compared to what those same slaves might have experienced in Africa, they might actually have been better off. Slave trade in Africa continued into the 1950s and might even still be occurring there today.
Another failing is in the DNA arena. He does not have the African haplotype, but there are plenty of other African genes. He never reveals whether his DNA test showed him to have any African ancestry at all. Mine did, which helped me to trace where it came from despite it being less than 1% of my DNA. Because there was one female in my line, I do not have that haplotype either, but do have a third or fourth cousin who is 70% sub-Saharan African and at least two DNA white relatives who carry that haplotype. I get the feeling the author was padding his book with speculation in part as filler and in part as wishful thinking of himself as a sort of white Roots story. He spends a lot of verbiage describing local countryside, his hotel accommodations, and the booze he is obviously quite fond of. It would be a better book without this. Even so, you can gain a very good insight into the colonial era African-American experience on both sides of the Atlantic from this book.
Dr. A’s scheduler, a nurse, called me the next day. She began by telling me the date I was scheduled for the procedure. So much for asking me what dates I might not be able to do it. This is the third time I was forced into what was convenient for doctors or their assistants. Fortunately the date was fine with me. I asked her about the timetable afterward, when would I have the external beam radiation therapy (EBRT)? How soon would I be able to resume normal activity after the implant procedure? Would I need care, such as someone to bring me medicines or a bedpan or whatever? She seemed totally unprepared for these questions but said she would find out these things from Dr. K’s office. She read me a set of instructions. I was to report at 6:30 AM for an 8:30 surgery. Really – two full hours? Since I would not be able to drive, that meant my son would have to get up before 6:00 to pick me up and take me, then come back many hours later. I knew better than to ask how long the surgery would take. I’ve had a few minor procedures and learned that they never know and will never tell you. The surprise for me was that it wouldn’t take place at my local hospital, Instead it would be at an affiliated hospital 10 miles south – that’s right, the one closer to where Dr. N usually practices. Go figure. She said she’d send me a message with all the instructions. She did send this the same day.
She warned me against taking aspirin or other blood thinners before the surgery, then mentioned I would be given a drug (I didn’t recognize the name) for “severe pain.” Wait! I’m going to have severe pain? Then she asked me what allergies I had. All of this I had provided to PAMF multiple times, but I repeated them and told her to add Cipro to the list. She did. Then she said she noticed I was allergic to Codeine and Vicodin. I confirmed that. Then she said oh, well then they’ll have to give you Ibuprofen. I told her I was allergic to that, too. She said that wasn’t in my allergy list they had on record. This ticked me off since it is always the first thing I list when doctors ask me. She then corrected herself and said yes, it was in there after all. She just hadn’t noticed it. This did not give me confidence she was competent since she had neither looked at my allergy list before deciding what drug I’d be taking, nor when she did look at it, noticed the most important drug I can’t have. It’s the only one that gives me life threatening reactions. She quizzed me quite some time on what my reactions were when I took those drugs as though she didn’t believe me. After I described my symptoms she became convinced I couldn’t have them. Then she asked me what doctors gave me for severe pain. I told her I didn’t normally have severe pain. I had severe pain when I had inflammatory arthritis and took heavy doses of ibuprofen at that time, but I can’t take that since I developed an allergy to it. When I had plantar fasciitis the doctor gave me a cortisone shot, which worked well, but that’s not something for general surgical pain. I had a very painful wrenched back and the doctor prescribed Naproxen, which I could tolerate, but it didn’t really help with the pain so I stopped taking it. After she heard this she acted frustrated and said she didn’t know what they could give me, then. Great – so I’m going to have severe pain and there’s no drug they can give me to relieve it. Comforting.
She called me back a few days later but said she couldn’t get the answers to those questions about the post surgery timetable. She said I needed to talk to my doctor about that. Great. I’d tried to get a timetable from Dr. N, Dr. K, and Dr. A. and got referred to this nurse for all scheduling questions and now she couldn’t answer them, although Dr. N had gone over this in very general terms. I needed to know specifically what days or weeks I would need to be in town for the EBRT. Dr. A had given me a fancy pamphlet printed up by Intuitive Surgical, the maker of the Da Vinci robotic surgery system used for the prostatectomy, giving all this kind of stuff in detail, along with a DVD worthy of Cecil B. De Mille. Brachytherapy is a rather common procedure that Dr. A performs. Why can’t they have a simple pamphlet or one-page flyer at least that provides this basic information? I’d gotten one for the biopsy. How about a standard email they can forward? You can find sites that give you a general idea about your physical condition and limitations for the first month or so, but they won’t tell you when the EBRT is likely to be. Besides, a patient should be able to get this kind of thing from his doctor, not the Internet. Once again, another promise broken.
The instructions said I needed to have some tests, including a blood test and an EKG and they had to be done at that medical group, PAMF. They gave me a phone number to call and schedule these. I called and got a woman who was friendly and competent! Finally! She asked me when I would like to come in. I told her. She said that was fine. I about fell over dead from shock. Someone actually asked me what I wanted and agreed to it. I went there that day and they saw me promptly. The tests were done quickly and the phlebotomist was totally painless. They always like me. I have good protruding veins for them. I’m glad I finally have something good to say about PAMF.
See part 8.
Immediately after my visit to Dr. N I called back to Dr. A’s office to arrange another appointment. I wanted to talk it over with him face to face and ask about the brachytherapy option. I had as much skepticism about the natural bias of Dr. N as I did about the natural bias of Dr. A. I wanted to give him a chance to convince me that prostatectomy was the better choice. When I called for an appointment I was told the earliest one was a month away. I told the appointment woman that I just wanted to ask a couple of questions and then inform Dr. A of my decision. I pointed out that I had originally had an appointment scheduled for that same day. She would not budge, so I went ahead and scheduled the appointment. I didn’t want to wait for a month to get the decision made so I chose to contact Dr. A using the online messaging function. PAMF has such a function, although it’s very clunky to use. I wish they just had email, but be that as it may I sent him a message telling him that I had seen Dr. N and I was leaning toward brachytherapy but wanted his opinion on whether that was really a mistake.
That evening I got a reply saying he thought brachytherapy would be an excellent choice in my case. He said he did not know Dr. N, usually worked with Dr. K, and “wished me well.” Wished me well? What did that mean? Was he firing me as his patient? Dr. N had said he worked “with” urologists, but what did that mean? Was a urologist in the operating theater or just consulting and doing follow-up? I messaged Dr. A back and thanked him for his prompt reply and said I was canceling the appointment for a month away. I spent the next two or three days researching brachytherapy online and decided to go ahead with that option. Following Dr. N’s direction I called to his office to inform them that I wanted to go ahead. The woman there was puzzled and asked why I was calling there instead of the urologist. She told me (which Dr. N hadn’t) that the urologist schedules the surgery, not the oncologist. I explained about my messages to and from Dr. A. She said she’d talk to Dr. N about it and someone would get back to me.
I messaged Dr. A again after that and said I had decided to get the brachytherapy and should I go through his office or Dr. N’s to get the process started. His only response was “Again, I don’t know Dr. N.” So I guess I was fired as his patient. I needed a urologist and didn’t have one. Later that day Dr. N called me and said he was glad I had decided to go forward with the procedure. I told him about the puzzling exchange with Dr. A and he seemed surprised. He knew Dr. M had referred me to him , not Dr. A, but apparently he had never contacted Dr. A and had never realized that Dr. A did not know of my consultation with him. He said he understood now why that was, because Dr. A usually works with his partner, Dr. K. He told me that Dr. K would actually be doing the procedure because he works with Dr. A who is my urologist. He assured me he would coordinate everything with Dr. K and Dr. A and that I shouldn’t have to worry about that. He scheduled me to have my prostate measured so the seeds could be manufactured to order. So for the second time I had chosen a doctor and been forced to the care of another doctor. The notion of patient choice is a fiction in our medical system.
A few days later I saw Dr. K and had my prostate measured by ultrasound, a simple, painless procedure. The first question I asked him was whether he had coordinated with Dr. A. He assured me he had but he seemed confused as to why and how I came to his office. I explained to him just as I had to Dr. N that I had been referred by Dr. M, had been given both names (K and N) and did not know it made any difference, but had chosen Dr. N because I recognized his name as the treating doctor for my friend. He said that made perfect sense and now that he understood, he would let Dr. A know. I had thought Dr. N would have already done that, but at least now felt it was all straightened out. I pressed Dr. K for a schedule but he said he couldn’t tell me when it would be because the seeds are made to order and he couldn’t be sure when they would be ready. He said someone would be in touch with me once they knew. He asked me if I had any scheduling issues and I told him the main thing was that I wanted it all to be over, including the EBRT, for my daughter’s wedding, which was several months away. He assured me that it would all be over long before that. I left glad that things were finally under way.
Weeks went by without a call. I kept getting invitations for holiday events and couldn’t RSVP. I also wanted it all to be over in 2017 since I had satisfied my insurance deductible. Finally I decided to call to Dr. A’s office to press them on what was happening. The woman at the desk seemed to appreciate my dilemma and said she’d talk to Dr. A about it. I got a call from him that evening. He was totally surprised that I was still his patient and he didn’t know who my oncologist was. I told him about the assurances I had received from both Dr. N and Dr. K that they had coordinated with him. He said he had talked to Dr. K before Dr. K had seen me and neither one of them knew why I was being scheduled with Dr. K. No one had told him I was going forward with the procedure and he thought I was under the care of Dr. N, a stranger to him. He confirmed what the receptionist at Dr. N’s office had said, which is that the urologist is the one who schedules things and that now that he knows he is expected to be treating me, he will schedule it. Apparently not one of these three doctors was concerned enough about the patient to take responsibility for seeing his patient got needed treatment. Promises to me they would coordinate were broken. I don’t know which of the doctors is most to blame, but I blame all three. When they see a patient who has told them he wants to go ahead with a potentially life-saving procedure, he or she should follow up to make sure it happens. If I hadn’t pursued this I would still be waiting by the phone for the call Dr. K promised. Dr. A assured me he would have his scheduler call me the next day and I would finally get a timetable. I told him I had some dates that might conflict, like my daughter’s wedding, but he said to tell it to the scheduler. I did get a call from her the next day, but that didn’t exactly go well, either. Read part 7 to learn why.