Your point of view is a valid one Steve but, I'm not so proud.
If I thought apologizing for something I didn't do might save
my life, I think I'd do it.  After all, Glowing's goal here is to
finish his treatment successfully and get out of there.

The problem is a tough one because the best solution
requires Glowing to read the minds of people he doesn't
know.  His options are: placate, fight, or do nothing.  Any one
of the three might be best.  He'll have to make a judgment
call based on his reading of the people involved and on
what he is personally most confidant he can bring off.

If I were him I would make that judgment call solely on
the basis of what I thought might get the best outcome,
without regard for who is right or wrong.

Fighting might be the right call.  Or apologizing might
be it.

   Alan

Flowers, or formal protest?
While flowers MIGHT solve Glowing's problem, they will not help the next
pt, or the next, or the next, etc.

Having considered both ideas, I'd vote for solving the big picture: File
a formal protest against the petulant tech and demand she be watched
like a sex offender. If she can't handle legitimate pt concerns, she's
in the wrong career.

I.P.

I agree that certainly no one wants to think that another person is capable
of this... unfortunately there are precedents.  Not many, I know, but the
odds of it happening are probably better than, say, being struck by lightning

probabilities.  Also we are talking about a low level tech, not a "medical
professional" who has spent years in preparation and taken the Hippocratic
Oath.  Her job is simply to position me under the beam at the proper
coordinates and turn on the machine.  A computer handles everything else.

I am puzzled that the supervisor said anything to her as the supervisor's
position was that they weren't doing anything wrong and I was satisfied with
the explanation.  She specifically asked me if I had any problem with the
techs and I told her no.  I was just trying to understand the process.

It's clear that the supervisor said something to her and that whatever it was
changed her behavior.  I'd hate to think, for example, that this occurred at
annual review time and affected or was perceived to affect her raise.  I
_really_ didn't need this :-(

[snip]

Precisely my concern.

Here is the explanation I was given and it makes sense to me:

The center I go to has a system that is "on rails".  They have a CAT Scan
machine and a Radiation Machine (don't know the technical name) in the same
room.  The treatment table can be shifted between the two using a set of
rails in the floor... hence the name.

Before they begin the treatment series, they fully image the prostate and
place the tattoos.  As far as that, they placed them in the middle of a big
"X" they made with broad magic markers, so they weren't so precisely placed
to begin with.  I remember being surprised at that, but said nothing at the
time.

The protocol for each treatment is as follows:

1. Using laser beams for alignment they position you on the treatment table
under the Radiation Machine.  The tattoos are used in this initial set up.  
In this stage there is a lot of pushing and pulling which seems quite
imprecise.

2. Radiation opaque crosshair targets are then placed over the tattoos and
the table is transported to the CAT Scan machine.  My concern was that the
crosshairs were not being placed over the the tattooed dots but were off by a
radius of about 5-7 mm, at least on the two I was able to check.

3. The CAT Scan machine locates the prostate _with_respect_to_the_targets.  
That compensates for any day-to-day movement and is the big advantage of this
protocol. They claim treatment accuracy to 1 mm resulting in better targeting
of the cancer and less side effects.  This obviates the need for them, for
example, to do a "simulation run" as in other protocols.

4. The table is transported back under the Radiation Machine and the lasers
are used to align it on the crosshairs.  We now have theoretical coincidence
between the CAT Scan machine and the Radiation Machine.

5. A "physicist" in another location reads the CAT Scan and relays the
coordinates for any fine adjustment of the table to the to the tech who then
makes them via a key pad.

6. The irradiation commences.

As can be seen, the critical adjustment occurs in steps 4 and 5 which are
independent of the tattoos.  I imagine the tattoos are much more critical in
other protocols.

The weak point in the protocol, as I see it, is the lack of any "fail safe"
in this adjustment due to either error, inattention, or malice.

Sometimes there is a second person in the room during the adjustment and
sometimes not.  I can't detect a pattern.  It is often a different second
person and from the comments it often seems to be a trainee.

I normally close my eyes at the beginning so as to remain as still as
possible.  If nothing else, I will certainly be keeping them open in the
future :-(

Thank you all for your thoughtful comments.  After "sleeping on this", I find
the only thing which has changed has been that I couldn't sleep :-(

[snip]

That would be reassuring, but I can see no evidence that it's so.  I'd ask if
I didn't think doing so would further exacerbate the situation.  In any
event, the mechanical positioning is only relative to the visual positioning
which is eyeballed to the laser beams.  I don't see any way of tracking or
verifying that... unless I bring a mirror and verify it myself.  I'll bet
_that_ would go over big :-)

I think this is the thinking.  About daily dosing.  But then, ideally,
one would think that you would do it 7 days a week, not 5.  Steve is
taking two days off at 4th of July, making a 4 day break.  They are
working Monday but we asked the doctor if it mattered; he said it was
okay.  (Treatment is 2 hours from our home.)

Anyway, Alan, I believe you are right, and I am wrong, about taking a
couple of weeks off.  However,
_the_alternative_is_a_risk_not_to_be_borne_.

The tech already has put the targets on so sloppily that they are 1 cm
off.  Is that about an inch?  Over a half inch, I am sure.  When you
are talking about radiation to the prostate area, a half inch can make
all the difference in the world.  Both for treatment effectiveness, and
for side effects.  Instead of centering on the prostate (or prostate
bed), it could very well be centering on the colon.  And this was
*before* she got upset with him.

Bert (or was it Bill?) had IMRT, then seeds, then an IMRT boost.  He
did the boost 2 months after the seeds.  I think it is not set in
stone.  Regardless, if it is a choice between no RT or RT that is not
going to cure the cancer, then choose no RT.  You only have one shot to
get it right.  At least if you don't use up all your options, you can
find a way back to it.

GitD needs some answers, now.  Before that tech gets at him again.  Its
not just the tech.  The doctor's soothing oh-well-it-doesn't-matter
pitch is raising my hackles. I don't believe it.  Why the hell tattoo
targets on people if they don't need them?  They'd just put one below
the navel, one on the hip bone, or whatever.  I don't buy it.  Maybe
I'm wrong.  But if I'm right, then not only is the tech unprofessional,
the whole place is questionable.  I don't think that radiation therapy
is something you pick up at the dollar store.  You either get
qualified, capable radiation therapy, or you pull back, reassess, and
make some other decision.  Take the time to get some changes.  Even if
it means going to the medical board to get other treatment.  Or file
claims with the insurance company to force them to pay for a qualified
center.  Whatever.

He still has X-number of Gys available for treatment.  He can get
assessed and a new plan done.  Whether that includes brachy or
whatever.  The cost of continuing in this obviously unacceptable
situation far higher than the cost of "not making waves."  I am sure he
would be glad to bring her roses AND kiss her a.s (literally) before
every treatment but I am afraid that would not address the issues of
ability and competence.  The cost of incompetence could well be
lifelong pain and disability and a shortened life.

I just don't see this as a personality conflict.  I see it as a medical
care issue with potentially devastating consequences if ignored.

laurel

I was treated by a technician who told me she had previously
worked at a big, public, general hospital in Washington DC.  They
were treating 50 patients a day on each of two radiation machines.
Assuming 8 hour work days, I make that 9 minutes and 36 seconds
per patient.  [ Who said we don't have the best health care in the
world :) ]

So, although your situation seems rushed, you are getting a bit
over double the amount of attention being given to patients in some
facilities.

Sacrificing a piece to win the game is a time-honored strategy.

Good luck.

   Alan

I respect this, and your points are very well made.  laurel