Five: Dr. Goetz at Kaiser, April 24th, 2009

Monterey Coast December, 2008

Where Dixon was brief, his colleague Dr. Laura Goetz was expansive in her explanations. While he described one route, she opened up the map, allowing us the feeling that we were deciding. She was a woman, and whether or not that alone translated into breaking the paternal model, I do not know. Unlike Dixon, she came from a liberal arts background. She and her sister, we read on her Kaiser bio, had spent time helping others in Africa. Her long brown hair was wound on the top of her head. Her dark brown eyes focused on you, the patient. She spoke, and then listened. Actually listened.

“It’s your choice,” she said.

Beyond paternalism, Goetz broke the model for me on what a good doctor should be—her patience, her focus, her combination of professionalism and down-to-earth ease. I would want her to operate on me, not Dixon, I told Dan after the appointment. He was in love with her too. She blew our minds. She asked Dan what had brought him in to see his doctor in the first place—in other words, how was the cancer discovered. Dixon had not asked. She dismissed Dan’s General Practitioner’s diagnosis of acid reflux with a guffaw. She wanted Dan to tell his story, like a good listener does, drawing him out.

She examined him, the “digital exam,” which means the doctor sticks a finger up the anus. Dan was used to this by now, the literal prodding and the need for more information.

Our questions stemmed from our considerable research on options other than radical surgery. The anal excision did not remove of as much tissue and was an outpatient treatment. That, in combination with radiation was one option.

“No,” she said. “It isn’t typically used for this diagnosis.”

She reminded us of the behavior of the lymph nodes, which direction they spread.

We asked her,” What if we did nothing?”

She said, “You can look at percentages, she instructed, but beyond that you have to make your own decision because you don’t know where you’re going to fall—in the 30% or the 70%. I’ve had five patients who have gone off to Asia or Europe to do alternative cures, all with early stage, and who have all come back with a more advanced disease.”

I asked Dr. Goetz about another surgery I had read about and seen touted on the chat sites, “T.E.M,” excising, different than the transanal excision. T.E.M. takes no lymph nodes—just the area around where the polyp was found. This was another sphincter-saving operation, like the transanal excision. Those muscles at the anus—so valuable, people risked cancer turning to spare them, as tissue was left behind. 


She said we would need to consult with an oncologist and radiation oncologist. After the T.E.M. procedure, she told us, they would do an ultrasound of the anus to see if the lymph nodes had enlarged. This had a 75 – 80% chance for telling the truth. “Close surveillance” meant ultrasound every few months for 2-3 years. The follow up would also involve 1-2 other excisions in the operating room—not just a minor procedure, in other words. T.E.M., she said, takes the full thickness, a segment of the rectum. The upshot: 10% of the cancer returning with a minor operation, and 100% guarantee for return if one did nothing. She also warned that the Kaiser oncologists would most likely resist doing radiation for stage one cancer, as an adjuvant therapy—it was used with stage 2, stage 3, stage 4.

We still had an appointment with the oncologist later that afternoon, which we would keep, but after talking to Dr. Goetz, the lay of the land was clear. I now saw that radical surgery was the 98% solution. I wanted to make amends with it, imagine it.