Four: Dr. Dixon Second Consultation, April 17th, 2009, Salsa and the Aftermath

While our first consultation with Dr. Dixon did not inspire much confidence in me— his certainty, little discussion, and his sudden disappearance— our second meeting with him proved more auspicious.


Rather than scrubs, he cut style in slacks and a shirt with a tie under his long white coat. We were his last visit for the day, and he was on the verge of his week-long vacation, we knew. But the tie? Bold green and blue, shiny wide stripes, it stood out against the subtle green shirt, the deep blue of the tie reflecting his eyes. Not suitable for a business meeting nor daily business, this tie screamed "social activity." He looked a little swank for the likes of Kaiser. I theorized later that he had a dinner engagement. File the tie under the Lives of Doctors, the encyclopedia.

We asked Dixon if we would be able to take our trip to England as planned at the end of May.

“I don’t see any reason why you can’t do it,” he said, as confident about that as anything else.

We asked about second opinions. Dixon recommended we talk with his colleague, Dr. Goetz, also at Kaiser, formerly of UCSF, almost like an outside opinion. We said we were going to get an opinion from UCSF itself, but would be glad to talk to Dr. Goetz. Additionally, Dixon said he would confer with someone else outside Kaiser, a man named Dr. Garcia-Aguilar.

When we got home, we discussed the meeting. Dan seized on the validity of the colostomy, what Dixon seemed to prescribe over the resection. The colostomy would entail taking the colon and creating an opening, or “stoma” where a bag would attach outside the body, near the belly button. The entire section of the colon, and lowest part called the rectum, would be removed, as well as a "margin" of surrounding tissue, which held the possibly cancerous lymph nodes. The rectum opening, then, would be sewed up, no longer useful since the waste would be re-routed to the “stoma.”

We take the rectum for granted in our daily function was the rectum, with its storage area, and the anus too, which its sphincter muscles. Dan suddenly valued all this now that he was going to lose it. What an amazing system, we thought, and it was funny how we suddenly loved it. The brain controls the sphincter muscles in the anus, one on either side. This keeps the waste produced over time in storage. Without a sphincter the brain doesn’t know where to send its signals, and leakage becomes dangerously imminent. The lowness, then, of the cancer site, was more crucial to our decision than the “stage,” ironically. If the polyp had been found in the sigmoid colon, the curved section next up from the rectum section, or in the colon itself, above the sigmoid, then a resection would have been a certainty and we wouldn't be talking about a colostomy bag.

Dan’s disbelief made sense. When someone tells you need radical surgery, but you have such an early stage cancer it may not even have spread, let alone be causing real symptoms other than what you thought was gastrointestinal burning, how can you not look at them and think they’re crazy? Earlier he had gone in to see his G.P. in February complaining of stomach problems and she prescribed ant-acids. At least she also ordered a sigmoidoscopy, where the two polyps were found—one a tiny pebble-size, the other large enough the for the room full of staff to hush suddenly, and then step in to another room to talk, Dan lying on the table, ears open, heart pounding.

The rest of that week, as our hope of normalcy disappeared, we chose research and second opinions over the trip, and with this decision something to look forward to was lost. I canceled the accommodations I had booked in the Cotswolds, York, and London. In spite of this reality, I still fantasized about even extending the trip for a few days so we could add in the Lake District, a great place to go hiking. I thought, we could go to Amsterdam, then Belgium, then Paris, Normandy, and then fly out of Paris. I wanted to be poetic, dream and write, but I couldn’t really during this time of pragmatism, questions, and research. 


Too many people reassured me it would be okay in the end. This was not useful to hear. I wanted answers, real help. I said to Dan that making the right decision was more important than rushing. We needed time to do this right. Pressure at Dan’s work to be productive was met by the response from me that he needed to make the Kaiser appointments and work from home on those days. They would have to understand. Sometimes he had one test, and sometimes he had two or three appointments in one day. It varied, with blood test, CAT Scans, ultrasounds of the rectum and liver, which I didn’t join him in, and consultations, which I did. The upside— it was a bonus to spend time during the weekdays together, discuss options, make decisions, do this work. And we worked well together.

Dan said he was going to have the radical surgery for his kids and me. Otherwise he would do nothing, he said. I later heard in my partners support group that this is a common statement. But at the time, it disturbed me that he wouldn’t want to do it for his own life. It was hard to hear.

One day, at a lunch break during a busy day full of appointments at Kaiser, we sat at the taco shop nearby.

“We should get married,” he said.

I spilled salsa on his pants leg, the red chunky sauce dripping down the tan material.

We talked about legal rights of partners, of wills, of social security. What if he were to die? This was the implied question lurking underneath. Me, who never intended on marriage, and he, who had been married for twelve years but irreverently, eloping with her because their landlord thought they already were.

The result of this discussion: he put me on his checking account and added my Social Security number to his work’s life insurance policy. Dan said he felt like he was preparing to die, writing a medical directive— getting his “affairs in order,” as he put it. I said it should have been done before anyhow, but it was hard for me to respond to his morbid frame of mind. When we talked about getting married, I wasn’t thinking about doing it because he was going to die. I was responding to him, and that arose out of the legal issues. My mother collected my father’s social security after he died because it was larger than her own. The idea of marriage arising out of something negative bothered me, though, so I had to reassure him.

“You would marry someone with a bag?” he said.

“Not someone—you.” And I responded with a kiss.