Two: Dr. Dixon First Consultation, April 10th 2009, or Location Is Everything

With the Badger, 2006

We had our first consultation with the surgeon, Dr. Dixon, at Oakland Kaiser. He was recommended by Dr. Moff of Santa Clara Kaiser, where Dan had the sigmoidoscopy his doctor had ordered and the colonoscopy following it. We had researched Dixon on the internet, and found that he had done extra years of residency in his specialization of colorectal cancer. A hotshot in his field.

We sat in the outer waiting room for thirty minutes, staring at the large fish tank. A couple pairs of smaller fishes with fluttery fins swam by. Eventually, a large fish the size of two fists came out from its hiding place behind a rock. I called it “Figgy,” after Dan’s cat because of the slow trajectory it made in reaching the other fishes and swimming around them. I had two magazines on my lap and gazed, one opened, not read. Finally, a nurse called us in.

“I’m Virgie,” she said. “I work with Dr. Dixon.” She apologized for the wait, and said the Dixon was behind. Virgie was a petite woman with the kind of smile that one wears all the time. At least, this is what I seized on during our dealings with her. Her movements were quick, as if her work was easy, no problem.


“He schedules all his own appointments, she said, as if to explain his lateness.


Why would a surgeon do that, we wondered, rather than having someone below him do it? What was her job? Was she his assistant in some medical way, or did she just show patients to the inner waiting room?


The inner waiting room was tiny, with one bed and one chair computer monitor on a high stand, sink, boxes of neon blue gloves and lighter ones. In plastic slots on the wall, were a stack of brochures about the colostomy procedure, which, we found, leafing through one, showed pictures of men playing golf and a couple ballroom dancing. I put the brochure back in its place. We both sat on the bed, rather than my sitting on the adjoining chair, with hands interlocked.

Some time later, he swept in, his compact form and slight stature appearing to just fit into the light blue scrubs. He exuded confidence.

“Mr. Dickinson?” he said, shaking Dan’s hand. He shook my hand as well, wordlessly, not asking my name.

Dixon placed himself on the chair facing us, shaking his left leg the way a boy who has too much energy does under his school desk.

We had prepared questions for this appointment. I had brought a notebook to write everything down in.

Dixon did not meet all our questions. He did not know where the site of the polyp was.

"Isn’t it in the record from Dr. Moff?” Dan asked.

Dixon didn’t have it, and had brought nothing to this consultation. He wanted to do a brief sigmoidoscopy to “tattoe” the spot, so it didn’t get lost. This meant marking it with a kind of ink.

Location is everything. We had been looking at the piece of paper from Santa Clara Kaiser enough to know where the site was located in the rectum, and would have brought this evidence if we had known it was needed.

Dixon drew pictures on a piece of paper, demonstrating the area that would need to be cut out. He spoke the words “colostomy” and “radical surgery,” stunted in the small room. “I’ll remove the rectum and surrounding tissue,” he said.

Meaningless, abstract words, they did not apply to us.

He gave us one of the pamphlets and flipped to one of the pictures of the insides of a body, and he circled the area of concern with his pen.

“Why early stage yet radical surgery?” Dan asked.

“It’s because of the nature of the polyp, ‘poorly differentiated,’ a more aggressive type,” Dixon said. This meant a 10% chance of the cancer coming back into the lymph nodes.

When Dan pointed out that the biopsy had yielded the result of “moderate to poorly differentiated,” Dixon said to focus on the “poorly” part. Surveillance of the disease was a constant—who would want to live with that? Dixon said we should go home and discuss it, and consult with him again.

We said we wanted him to order the CT scan as soon as possible so we could schedule the surgery, whichever procedure Dan would decide on. We were intent on doing the trip to England.

Dixon said, “I’ll be back in a minute—just need to check my calendar.” He left the room.

Twenty minutes later we wondered how much longer we’d be waiting. I ventured out into the hallway, realizing I didn’t know which way we’d come in, as good a sense of direction as I have. The place was like a rabbit warren, with two long parallel hallways and numerous perpendicular shorter hallways. I saw a nurse sitting in an office.

“Excuse me. I’m looking for Dr. Dixon,” I said.

She smiled. “Let me find out. Which room are you in?”

I went back to the little room.

A knock on the door. ”He went to lunch,” she said.

I asked about Virgie the nurse. The woman went out to find Virgie.

“She went to lunch too,” she said softly, breaking the news. She apologized and offered to look for his appointment book and see what she could do.

We waited some more. Finally, she returned, saying we would need to get in touch with the doctor ourselves to schedule our next consultation. This seemed to confirm that he scheduled his own appointments, if this nurse couldn’t find the book or decided she couldn’t make the appointment herself without Dixon’s okay.

This was not the last time we would see Dixon, and not the last time we felt blocked in getting work done as quickly as possible. When I spoke to Virgie on the phone later that day, trying to make sure we couldn’t book the appointment through her, she said Dan should talk to Dr. Dixon about it.

Getting the scan done took weeks. It had to happen before the surgery could take place. Scheduling anything at Kaiser was impossible. Working with a large entity like Kaiser is humbling because unless you push hard you don’t get anywhere; at the same time, you don’t have a lot of control. Asking questions and being really nice helps. Even if one desk person is not in charge of a something you are trying to get done, they may know who to call about it.

Doctors, too, have to deal with scheduling, on their end. They are at the mercy of long, complicated surgeries, appointments which last longer than the allotted time, which bleeds into another patient’s time. Not only did Dixon disappear in the middle of our appointment, but he was late for it as well, late enough for Virgie to apologize.

They don’t tell you anything ahead of time for these meetings, as if you’re supposed to just go willingly along like a child, trusting in the medical staff completely. I had such anxiety before the whole thing. We were hungry for more information, bringing our questions with us. I ended up looking online later to find out some answers. Dan would need to go in for the “minor” sigmoidoscopy, as Virgie called it, the following week. We could do the scan tomorrow after that appointment, if the doctor would only order it.