Monday, September 15, 2014

Good News, Usually

A flight attendant with diarrhea is usually good news. Airline crew are young, so they suffer uncomplicated medical problems, and diarrhea qualifies. Her hotel in Costa Mesa was 46 miles away, but it was Saturday morning, so traffic would be light, and I’m paid extra for the distance.

To my annoyance, this was one of those inexplicable weekends when the freeway was jammed although it wasn’t a holiday, and I never saw an accident.

After caring for the guest, always the easiest part, I got back on the freeway and its creeping traffic. Ten minutes later my phone rang. This was bad news because freeway driving is more tiring than practicing medicine, and I had had enough. The caller was a national housecall service, and, to my surprise, the patient was in Costa Mesa, a half mile from where I’d been.

The service agreed to my usual fee for a long drive, so I retraced my route, cared for the guest, and returned to the crowded freeway. I was weary when I finally arrived home, hours past lunch time, but it had been a lucrative day in the fascinating life of a Los Angeles hotel doctor.  

Saturday, September 6, 2014

The Old Man's Friend

A guest was coughing and feverish, and I heard crackling noises, a sign of fluid, when I listened to his lungs. I suspected pneumonia.

I prefer diagnosing pneumonia to an upper respiratory infection because I can prescribe an antibiotic and skip the stressful explanation of why I’m not prescribing an antibiotic.

Unfortunately, this guest was 85. Most victims of pneumonia don’t need to be hospitalized. Even without treatment, most recover. This is not the case with the elderly where, long ago, pneumonia was known as “the old man’s friend.” Dying of pneumonia when you’re already feeble is apparently not a bad way to go.

The son did not like hearing that his father must go to an emergency room, but they went. When I phoned the following morning, I learned that the diagnosis was pneumonia. The doctor had prescribed an antibiotic and sent them out.

I was shocked. Hospitals always admitted elderly patients with pneumonia. What incompetent was on duty?...  Answering my concerns, the son assured me that his father was resting comfortably and promised to return to the hospital if symptoms worsened. When I called that evening and the following day, he repeated his assurances that his father was resting comfortably. That afternoon they had checked out.

If something bad happens, he will sue the hospital, but he will also sue me. It takes a long time for a malpractice lawyer to organize a suit, so his letter wouldn’t arrive for about a year.

Tuesday, September 2, 2014

Preparing to Leave Town

I’ll take a vacation soon. When I leave, I call-forward my phone to a colleague. He’s covered for twenty years and does a fine job, but I have to prepare the ground.

I warn Virginia Mastey. When Frenchmen, tourists or residents, want a housecall in Los Angeles they call her, and she calls me. I have no idea how she built this business; it’s only a sideline, and she charges less than the going rate. The visits are easy, but no other hotel doctor will work for so little.

I warn Inn-House Doctor, a national housecall service that also cares for foreign airline crew laying over in Southern California. You might assume that airlines flying into Los Angeles board crew overnight at nearby hotels, but they often bus them twenty to fifty miles away to Long Beach or Orange County. I live eight miles in the opposite direction from the airport, but Inn-House pays generously for long drives, so I go. Sadly, my colleague lives fifteen miles even further, so Inn-House must make other arrangements.

I remind my colleague that if two international travel services (I won’t name them), call, he should not refuse them. I will mail him a check on my return and handle billing myself. These services take months to pay and require repeated, pestering phone calls. Other hotel doctors won’t work for them.

Friday, August 29, 2014

Another Glamorous Film Shoot

“We’re at 501 West Olympic,” explained my caller. “Come up to the seventeenth floor.”

That’s downtown, my least favorite neighborhood for street parking. I might find a spot within three or four blocks, but it was hot, and I wear a suit. No problem, said the caller, directing me to crew parking a mile away.

I pulled into a lot jammed with mobile dressing rooms, equipment, cars, and a line of vans. An attractive young woman led me to the leading van which chauffeured me through downtown traffic and pulled into another line of vans to let me off. After phoning a contact number, I waited for another young attractive woman (all assistants at film shoots are attractive young women) to conduct me to an elevator which let me out into a crowded corridor.

It takes a small army to shoot a film. Dozens of people under thirty rushed about. They were probably crew. Lounging about and getting in the way, another dozen, mostly over thirty, were probably actors. A person in charge noticed that I looked like a doctor and summoned the patient.

It was fortunate he wasn’t suffering hemorrhoids or jock itch because there was no privacy. We huddled in a corner and discussed his eye irritation. Afterward, the person in charge asked if I’d see someone who’d injured his neck in a fight scene. Leaving the building, I boarded the first of the line of vans and returned to the parking lot.  

Monday, August 25, 2014

Whether You Want Me or Not

If you want a housecall in Los Angeles, you’re likely to get me even if you don’t ask for me. 

I don’t have a web site, but searching the internet turns up several agencies and a few individuals that promise to send you a doctor at a moment’s notice. Many rely on me.

They also solicit hotels. Last week, the answering service for a national housecall agency informed me that a guest at the Marina International wanted a doctor. The Marina International is one of my regulars.

After I spoke to the guest, he asked me to come. I made a mental calculation before quoting the fee. The housecall agency keeps forty percent, so it was larger than usual. 

Since guests who call directly pay less, you might wonder why hotels don’t make sure they get the best price. The answer, of course, is that hotel management doesn’t know what doctors charge, nor do they care. Guests occasionally ask, but hotels never do.

Thursday, August 21, 2014

Eighty Gouty Patients

A man’s foot began hurting one evening. By the following morning pain was excruciating. That sounded like gout, one of my favorite diseases. The diagnosis is easy, and I can quickly make it better. What’s not to like?

I carry a treatment for gout, but once I hand it over, I have to remember to restock my bag. So I went to my drug closet, made up another bottle of pills, and threw it in my pocket. 

Sometimes I’m surprised when I arrive at the hotel but not this time. He had gout. I gave him the pills, and everyone was satisfied.

It occurs to me that I’ve seen so many victims – this was my 80th – that I can check the experts. They claim that it attacks men overwhelmingly. Sure enough, only seven of my patients were women. They say it’s a disease of older people. 67 cases were over 40, none under 30.

Until a few years ago, treatment was a powerful anti-inflammatory drug such as indomethacin which produced unpleasant side-effects. Then experts decided a large dose of cortisone for a short period worked as well with less unpleasantness. I already carry an identical course to treat severe poison ivy. Patients feel better within a day.

Sunday, August 17, 2014

A Tropical Disease

They had just flown in explained a father at 1 a.m. While in Hawaii, their two year-old had suffered mosquito bites followed after a few days by fever, restlessness, and refusal to eat. Checking the internet (my heart sank….) he learned about dengue fever.

I explained that dengue is a viral infection that produces the usual symptoms of a viral infection (fever, body aches, general misery) and has no cure. He agreed but pointed out that deadly complications, although uncommon, did occur, and he wanted the child examined.

Before leaving, I consulted a medical book to refresh my knowledge of dengue fever. I’ve never seen a case. The child did not seem terribly ill. Certainly there was no sign of shock or internal bleeding, the typical complication.

I reassured the parents.