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.