Sunday, April 13, 2014

Another Death

“He’s over there! I think it’s an emergency!”

Emerging from the elevator, I do not want to hear this announcement. Despite the impression left by television, cardiac arrests are usually fatal. Outside a hospital, seven percent survive.

The survival rate of the few I encounter is zero, and this did not look like an exception. An overweight security officer was kneeling clumsily on the bed, bouncing up and down as he pounded an old man’s chest. The guest’s false teeth had jarred loose and protruded from his mouth; I plucked them out.

Security officers learn CPR but rarely use it, so they forget the details. Cardiac massage on a soft bed doesn’t work. The officer should have dragged the guest onto the floor. At the time of this visit, another officer should have given mouth-to-mouth respiration, but it was almost impossible to persuade laymen to do something they considered disgusting. Mouth to mouth respiration was essential until 2010 when experts decided that chest compression alone was OK.

I asked how much time has passed since the arrest.

“I don’t know. He was out when I got here.” gasped the officer.

There was no pulse or heartbeat, and it was obvious the man had been dead for some time, so I told the officer to stop. Hearing this, an elderly lady in a nightgown hovering nearby burst into tears. At that moment, two paramedics and two firemen clumped noisily into the room accompanied by a man in a suit and a young woman, apparently the manager and the concierge. Cardiac arrests attract too many people.

Observing the corpse and the weeping woman, the senior paramedic flipped through his clipboard. “Is that your husband, ma’am? Could you give me his name?”

She couldn’t. Disobeying my rule about staying out of the way in the presence of paramedics, I comforted her. Lowering his clipboard, he waited patiently. This is the single activity paramedics are happy to leave in the hands of a physician. After a few minutes, she became calmer.

Disposing of the dead guest took a while. Two police arrived and transcribed the wife’s story a second time. One by one, the staff left, followed by the police and paramedics. The medical examiner’s ambulance drove off with the body. The lady couldn’t find her sleeping pills, so I provided some. I left my phone number and promised to call in the morning.

Wednesday, April 9, 2014

A Terrible Year for Conjunctivitis

Where are all the eye infections? I’ve seen so few over the past year that I’ll discard half a dozen bottles of antibiotic eye drops when they reach their expiration date.

I carry thirty-two drugs. I don’t like to send guests searching for a pharmacy in a strange city, so I hand out whatever they need whether it’s a week of antibiotics or a tube of antifungal cream. I’m also generous with cough medicines, decongestants, expectorants, laxatives, and other over-the-counter remedies. I know that many patients including you don’t expect medicine whenever you see a doctor, but we in the profession get that impression.

When I restock, my order must be large to avoid a big handling fee. This becomes awkward when I run low on a critical drug such as prescription eye drops. I can’t allow myself to run out, and I can’t order other essentials such as antibiotics or antivomiting drugs until I need them because of the expiration date. I also can’t shrink my inventory by prescribing them when they’re not necessary.

This is where useless drugs come in handy (I’m stretching a point; it’s not certain that cough remedies, decongestants, expectorants et al don’t work, but researchers who conduct studies have trouble showing that they’re superior to placebos).

As I run low on important drugs, I become more generous with the others. This is easy because minor respiratory infections are every doctor’s most common ailment. For weeks, I’ve been loading up guests with sniffles, colds, “sinus,” “bronchitis,” flu, and similar bugs with every elixir, gargle, capsule, or lozenge in my possession. Soon I’ll run low on enough medication to eliminate the handling fee when I restock.    

Saturday, April 5, 2014

A Better Shot

 “Is he a VIP?”

“All our citizens are VIPs” said the consul for Qatar, referring to a countryman at the Airport Hilton.

Guests from small nations often call the local consul. Asked to find a doctor, he usually phones the hotel.

Once a consul has my number, he tends to remember it, so these calls are good news. On the other hand, guests who phone them are sicker than usual.

A woman in a headscarf answered door, and indicated a young man, curled up in bed. It was their honeymoon. Back pain is usually an easy visit from my point of view. Most acute backs are not so bad after the first day, and they steadily improve.

Unfortunately, this was not the first day. Pain had come on five days earlier in Las Vegas. A hotel doctor had dispensed the usual remedies, and pain had diminished only to return that morning.

I delivered the largest injection and strongest pills in my possession, adding that he might need more evaluation if this didn’t work.

At midnight, he phoned to say that he had improved, but now pain made it difficult to sleep. He agreed to go to an ER but wanted to wait until morning. There was no answer when I called that morning or that afternoon.

The ER doctor had given a shot, the guest said that evening, but it was not as good as mine. Desperate to return home, he had booked a flight. Would I give another shot before he checked out?

So I did. Handing me his card, he urged me to visit if I came to Qatar. Then, supported by the wife and a cane, he hobbled off.

Tuesday, April 1, 2014

A Bad Check

A guest at the Hyatt had fallen ill and cancelled a flight. He had recovered, but the airline insisted on a doctor’s note before allowing him on board.

Determining if someone is healthy enough to fly requires only a few questions, but I do a thorough exam. He delivered a steady patter as I worked, describing himself as a venture capitalist with an exciting but stressful life as he prepared for an important meeting in Japan.

As I composed the note, I saw him writing a check and immediately announced that I accept credit cards.

Apologizing, he told me that it would be a hassle unless payment came out of the company account. Seeing my hesitation, he added that he had credit cards and would give me a number. He pulled one out and scribbled on my invoice, getting one number wrong. 

I’ve received a few dozen bad checks, the last in 2000 just before I began accepting credit cards.

You can imagine my feeling later as I stood watching a teller fiddle at his computer…. and fiddle…. and fiddle… and finally explain that it wasn’t accepting the check.

Naturally, I felt stupid. Young single males write most bad checks, and this guest fit the pattern.

Now came the tedious process of trying to recover the money which occasionally happens. Most likely, the address and phone number on the check were wrong. Asking the hotel for contact information sometimes helped, but I might hear that it must respect the guest’s privacy. The credit card was certainly worthless.

But it wasn’t! When I phoned the computer and entered the numbers, it approved. Some things are hard to explain.

Friday, March 28, 2014

The Occasional Surprise

A travel insurer asked me to see a lady in Mission Hills complaining of high blood pressure.

I drove off confident that this wasn’t her problem because high blood pressure causes no symptoms. Mostly patients are suffering a headache or anxiety or dizziness.

Now and then I’m surprised. In hotel doctoring, surprises are generally unpleasant but not in this case.

She didn’t have high blood pressure, admitted the lady apologetically. She’d lost her thyroid pills and only needed a prescription.

When I learn that guests need a legitimate medicine, I phone a pharmacy. I don’t make a house call. Guests with travel insurance don’t call me but their agency’s 800 number. Embarrassed to use insurance for a trivial problem, they lie. Sometimes hotel doctoring is easy.

Monday, March 24, 2014

The Most Difficult Calls

I stopped chopping an onion yesterday when the phone rang. A young man at the Airport Hilton had been vomiting all day.This was a difficult call.

For a hotel doctor, a difficult call refers not to an illness but to traffic conditions. It was four o’clock, so I would drive eight miles both ways during the freeway rush hour, returning hungry and with no dinner prepared. I delay some visits but not for acutely miserable symptoms, vomiting most often.

Before I left, the phone rang again. I yearned to hear that it was another airport hotel, but the guest was downtown, fifteen miles in the opposite direction. Worse, she had a migraine, so I couldn’t delay.

Delivering medical care is sometimes challenging. Always challenging and the mark of a seasoned hotel doctor is the ability to remain serene in gridlock.

Certain rules apply. Unless lanes are blocked, leaving the freeway for city streets is a bad idea.

Another rule is that blocking a lane at any hour stops traffic cold. Steady movement, however slow, is simply a sign of congestion.

“I wonder if there’s an accident,” I thought a dozen times after several minutes of immobility, but I never saw one. So much for rules.

Two housecalls which normally take two hours took four and a half, but I maintained my serenity, sucking on the hard candy I keep handy to dull my hunger and listening to a novel on my CD.

Returning home, I made a meal of dried fruit and nuts which I also keep handy for evenings with no supper.

Thursday, March 20, 2014

"Wow!... Hotel Doctors Charge That Much?!"

Guests don’t say that. Mostly I hear: “Do you mind if I call you back…..?”

Unlike the competition, I don’t confine myself to upscale hotels. Plenty of Holiday Inns, Ramadas, and motels call, and I quote fees less than the going rate. Colleagues point this out but admit that it’s not a competitive advantage because hotels don’t care what the doctor charges. Still, counting driving time, a hotel visit takes at least an hour, so it’s not cheap.

Helpless in a strange country and forewarned that medical care in America requires vast sums, foreign guests are easier to deal with.

American medical insurance takes a dim view of housecalls. No hotel doctor accepts it, so Americans, already disoriented at finding a doctor willing to make a housecall, learn that they must pay out of their pocket. It’s a shock.

I like to present myself as a humanitarian in this blog, and I often reduce my fee if the guest feels too miserable to leave the room, but mostly, when Americans object, I send them to an urgent care clinic.

Walking through the clinic door costs around $100. While this is much less than a housecall, clinics charge extra for tests, procedures, shots, and supplies, and the patient must find a pharmacy to fill a prescription. Telling all this to guests sounds too much like a sales pitch, so I prefer to send them to a clinic. Insurance might pay part of the bill.