Monday, January 15, 2018

Stuck in Liberalism

Walking along Pico, a busy street, I passed a man lying face down on the sidewalk. His head lay on the curb; one leg remained on a bus bench, so he had clearly toppled off. Even prosperous Los Angeles neighborhoods possess a few resident homeless, and this was probably one. He looked disheveled.

Naturally, I continued past. After a dozen paces I stopped because my conscience was hectoring me. “You have to help this fellow,” it pointed out.

“Someone else will notice,” I replied.

“Not good enough.”

“I do fine with patients,” I pointed out. “But this is not a professional situation.”

“Doctors have a moral obligation to help anyone in distress!” said my conscience.

“That’s flattering, but many doctors disagree. You should read the physicians on internet forums. Most are very conservative.”

“You have to help.”

“….They hate Obamacare. They think welfare patients are deadbeats. They don’t even like patients with private insurance. Their idea of heaven is a cash-only practice.”

“Not good enough.”

While I paced in a circle, debating this irritating voice, a hundred cars and dozens of pedestrians passed by. Finally, I gave up. The 911 dispatcher listened to my report and then transferred me to the fire department. The fire department dispatcher listened and then transferred me to the paramedics.

“How old is he?” asked a paramedic.


“What do you mean ‘middle-aged’?  he snapped. “Forty… Fifty… Sixty?”

“Fifty,” I guessed.

After several more questions designed to show that I was bothering him, he told me to wait until the ambulance arrived. As I waited, the man stirred.

“That’s all I need!” I thought. “For him to get up and walk away.”

But he didn’t. The ambulance arrived within five minutes, and the paramedics went to work. When they ignored me, I walked off.

Thursday, January 11, 2018

No Good Deed Goes Unpunished

An Austrian lady had left home without her medication. Could I come and write some prescriptions?

These requests arrive regularly. In the past, I offered to phone a pharmacy, but this took a long time as guests scrambled to find the name, dose, and instructions. Nowadays I tell them to go to a pharmacy, explain exactly what they need, and give my number. I would approve over the phone.

Guests are pleased that it is so simple and more pleased to learn that I don’t charge for this.

Later, a caller explained that he was the tour leader for an Austrian group. “You gave a prescription for one of our members. Could you tell me where is the pharmacy?”

The lady’s English was poor, so she had misheard me. I repeated that the guest had to go to the pharmacy and describe precisely what she needed. An hour later, I answered another call from the tour leader. He was at a pharmacy near the hotel; he had given the names of the lady’s medication, but they had refused to accept them. Again, I explained that the lady had to tell the pharmacist precisely what she needed.

An hour later, a pharmacist informed me that a foreign customer was requesting several medications. He wanted to know the dose and instructions. I told him that he would have to get this information from the guest.

Several hours passed before the pharmacy called again because the lady had had to phone her doctor in Austria. One of her drugs was not available in the US. What would I advise?... I had no idea but suggested that he probably knew an equivalent. After some research, he found one and called back. I agreed with his suggestion.

Don’t forget to pack your pills.

Sunday, January 7, 2018

Worry, Part 2

I drove to the Magic hotel in Hollywood where a Danish couple’s 18 month-old was vomiting. He looked fine, and looking is essential:  sick children look sick. Nothing abnormal turned up on an exam, so my diagnosis was a common stomach virus. I told the parents it might last a few days and gave the usual dietary advice.

I check on patients before going to bed, but the Danish parents beat me to it. The child had vomited once again, they reported. He was still in no distress, so I told them it was OK to wait.

My assurance was proper, but patients occasionally deliver unpleasant surprises, so I worried a little as I went to bed.

I phoned the Danes the following day to learn that the child hadn’t vomited but was now feverish. This was to be expected, I explained, and I approved their decision to give Tylenol.

The Danish child was still feverish, his parents reported the next day, and now he had diarrhea. I gave dietary advice.

There was no answer the following morning. From the front desk I learned that they had checked out. I had just returned from seeing a young man with abdominal pain at a youth hostel. He was worried about appendicitis; my exam made that unlikely. Since he had no health insurance, I did not want to make my life easier by sending him to an emergency room where a workup including CT scans would run to about $5,000. His symptoms hadn’t improved when I called, but they still didn’t seem like appendicitis. He promised to phone if there was any change. I worried a little as I went to bed.

Wednesday, January 3, 2018

Worry, Part 1

A guest had stumbled in the shower and thrown out her back. Could I make a visit to decide if she needed hospitalization?

Going to the hospital with back pain is a bad idea; even if you’re in agony, no doctor will admit you without evidence of nerve damage such as paralysis or inability to urinate. He will order x-rays (worthless for acute back pain but an ER tradition), explain that you will recover in a few days, and prescribe pain medication.

My examination showed no nerve damage, so I explained that she would probably improve in a few days. I handed over pain pills, adding that, while it wasn’t essential, I could give an injection that would help for several hours. She agreed, so I gave it. 

 “Not so good,” she replied when I called to ask how she was doing. She had been vomiting since the injection, and each vomit hurt her back. That’s an occasional side-effect. I assured her it would pass, but I worried.

She was marginally better the following morning and the morning after that. She wanted to fly home. Could I provide medical clearance? Visits for “medical clearance” are a lucrative perk of hotel doctoring, but I resisted the temptation, explaining that there’s no medical reason why someone with back pain can’t travel. If she could hobble onto the plane, she should go.

Could I give a “mild” injection so she could move more easily. No such injection exists. I suggested she try the pain medicine.

Later, the lady reported that the medicine made her dizzy. What should she do? I told her it would pass. Rest is not helpful for treating back pain. She should try to make her plane. When I called later she had checked out. I worried that I might hear from her, but I didn’t.

Saturday, December 30, 2017

A Creepy Frat Guy

The Andaz Hyatt had given my number, explained the caller. Could I see a member of their cast who was suffering an earache? Unfortunately, he was on location and wouldn’t return until evening.

She was delighted at my suggestion that I come to the film shoot, and I’m as eager as anyone to mingle with movie people. On the downside, I live six miles from the Hyatt; the film was shooting at the far end of the San Fernando Valley, twenty-five miles away, and I’d quoted my fee before learning this. 

The producers had taken over a run-down motel, painted it pink, and restored the coffee shop to its mid-twentieth century interior. I drove past warning “closed to the public” signs and parked among the cabins and scattered 1950s cars.

Several dozen people stood around, none over forty. You should realize that shooting a movie is boring. Filming takes up perhaps two percent of the day. The remainder involves setting up, technical changes, errands, and waiting around. Everyone looks forward to lunch. I attracted attention, being far older and much better dressed.

Earaches are easy. I followed a young man into the empty 1950s diner, made the diagnosis, handed over medicine, and took my leave.

As usual, one aspect of the experience seemed strange. The assistant who had phoned and greeted me on my arrival was a young, attractive woman. Other attractive women were carrying messages, answering phones, setting up the lunch buffet. Almost every actress in costume was beautiful; there were no exceptions for those in street clothes.

Somewhere in Los Angeles there is a creepy frat guy who handles hiring for film sets.

Tuesday, December 26, 2017

Getting Help, Part 3

If hotel doctoring seems romantic to you, it has the same effect on the medical profession, so a want-ad I placed in the Los Angeles County Medical Journal produced an avalanche of responses.

Many callers had a day job. If they worked at a clinic, they couldn’t help because clinic malpractice insurance never covers work outside the office. Buying their own policy was impossible because none are cheap enough to cover the modest income I could provide. For this reason, residents also couldn’t work for me. Nor could retired doctors who’d dropped their insurance.

Some callers had a practice and their own insurance, but that meant they couldn’t leave during office hours. Most assured me they’d love to make visits afterward – to hotels in their area. Since doctors live in prosperous neighborhoods, but hotels are often downtown or near the airport, this would make my life too complicated.

I never considered myself unique until I tried to find a helper. My ideal would be competent, likeable, available 24 hours a day, and willing to travel anywhere. That describes me but no applicant so far. I enjoy friendly relations with a few other hotel doctors who cover when I leave town, but it’s never ideal to turn your business over to a competitor.

A surprising number of doctors announced they were free during the day and eager to make visits anywhere. All made me suspicious. Why didn’t they have a job? Doctors have no trouble finding work. Quizzing them provided no reassurance. They had just arrived in town; they were unwilling to settle down just yet; they were searching for a congenial position… 

I take for granted any doctor with a day job possesses at least marginal competence, but what about these fellows? Every doctor scratches his head over a few colleagues, wondering how they slipped through medical school and into practice without anyone noticing. So I’m still looking.

Friday, December 22, 2017

Karma Will Find You!

My wife and I were shopping at Trader Joe’s at 5 o’clock. For all its superior features, Trader Joe’s is bagger-deprived, so check-out lines move slowly. They were very long at 5 o’clock.

Searching for the mythical shortest line, we found one that qualified but only because an overflowing cart stood at the end with no one nearby. We considered. Most likely its owner had rushed off for a forgotten item. After a minute when no one appeared, we wondered if someone had abandoned it. The line moved forward, opening a substantial gap in front of the ownerless cart. We decided that sufficient time had elapsed and took our position. Immediately, a woman appeared.

“Excuse me! I was in line,” she said.

“You were gone a long time,” said my wife.

“Not true! I wasn’t away twenty seconds. You’re in my spot.”

 “We’ll stay,” I said, provoked by her mendacious defense.

She seemed about to make a scene, but before anything developed, my wife told me to shut up and moved our cart to the end of the line. As far as we were concerned, that ended the matter. We began discussing the evening’s activities. The lady with the cart couldn’t overhear, but (in retrospect) she probably thought we were muttering about her. After a minute, she whirled angrily.

“This is clearly very important to you! So I’m going to let you have the precious position you yearn for.” She pushed her cart away but not before turning to wave her finger and add: “Bad Karma! But sooner or later it will find you.”

Having the last word in these disputes equals victory, so we were left feeling defeated.

Then miraculously, Karma found us. A clerk opened an empty register, waved us over, and suddenly we were first in line!