Tuesday, October 13, 2015

Not Again!!

I was minding my own business on a plane returning to Los Angeles last week when I heard the elderly man in the adjacent middle-seat say:  “Victoria... Victoria?.... Victoria?...    VICTORIA!!...” Turning, I saw that he was shaking his wife who had passed out.

I informed the flight attendants who produced the traditional oxygen bottle plus a stethoscope and blood pressure cuff and made the usual request for any doctor on the plane. The wife began responding, if groggily. Her blood pressure was undetectable, but engine noise made listening difficult.

By this time, another doctor arrived. She was about forty years younger than I and anxious to be involved. The wife had never fainted, and she was recovering too slowly to blame a heart irregularity. The leading possibility was a stroke – either a transient ischemic attack (TIA) which resolves completely or a full-fledged stroke. We wouldn’t know which for hours, so my suggestion was to land the plane.

This is not a decision airlines make lightly, and my physician colleague did not express an opinion. Headphones and a long cord appeared, and, after some delay, she spoke to a doctor on the ground who advised taking the wife to the rear of the plane, laying her on the floor, starting an intravenous line, and observing. With the other doctor leading the way, everyone trundled up the aisle.

The couple returned to their seats when the plane began its approach two hours later. The wife seemed all right although she had no memory of what had happened. Paramedics came on board at the gate and led the couple away.

I waved off the flight attendants thanks, but they insisted on giving me five thousand frequent flier miles.      

Friday, October 9, 2015

Getting Help, Part 2

My relations with other Los Angeles housecall doctors are civilized but not close. As a result, when I leave town there’s only one colleague I trust to cover. Mostly this works out. I schedule my trips so they don’t conflict with his.

When I’m in town I’m always available. That includes after bedtime, in the movies and restaurants, and during social events. It includes concerts and live theater, but I sit on the aisle, so I can hurry to the lobby when my phone buzzes. None of this bothers me greatly (my wife is another matter).  

One event causes problems: baseball games. One of my brothers has Dodger season tickets, and we attend a dozen times during the season. We go to a restaurant and then the game: almost the only time we get together; I love it and don’t want to be interrupted. I’m out of commission only about six hours, and occasionally my colleague can’t cover.

I could continue to answer the phone, but crowd noise in the stadium makes conversation difficult. It also reveals that I’m having fun, and patients hate disturbing a doctor during his leisure time. My solution is to change my phone message to announce that I’m unavailable until (whatever time the game ends) and then turn off the phone. Genuine emergencies are very rare in a hotel doctor’s practice, and so far it’s turned out all right. But I’m always looking for help.

Monday, October 5, 2015

What Makes a Hotel Guest Sick?

American water.

Travelers worry that our fierce advocacy of the free market includes opposition to government meddling in the water supply. I regularly assure them that all American tap water is drinkable.

American food.

No one believes that Taco Bell or McDonald’s sell healthy food, but foreigners worry that these exotic, colorful substances are toxic. We Americans are warned about eating in nations with poor sanitation; about one in three American tourists get sick. If we’re careful, our sickness rate drops to… Actually, it doesn’t drop. No one knows how to prevent traveler’s diarrhea. The Swiss get sick when they come to the US.

Air conditioning

Americans accept air conditioning with even more enthusiasm than personal firearms, but most of the world has never caught on. They tolerate it as an odd American custom but believe that air from a machine is unhealthy whether it’s automobile exhaust or a box in a window. When someone gets sick, they turn it off.

Sitting in the Plane

Travelers blame the airline for any illness that occurs within a week of flying. This is not so for aches and pains and unlikely for an upset stomach but true for respiratory infections.


Vacations are stressful, particularly if children are involved. They miss their friends; they hate the food; they prefer watching TV to sight-seeing; they refuse to adjust their sleeping hours.  It turns out that stress makes everything worse, but it doesn’t cause anything, so there’s no reason for the parents to get sick. When they do, it’s a respiratory infection and the children’s fault.

Thursday, October 1, 2015

Keeping a Child Safe

On days I don’t go to the gym, I take a brisk one-hour walk through my neighborhood.
One of my favorite routes passes an elementary school a mile away.

Except for dog-walkers, the streets are deserted at this early hour, but a few blocks from the school the sidewalks gradually fill with children in their colorful outfits and backpacks accompanied by a parent. Past the school I overtake the adults, often in chatty groups, as they head home.

Parents taking their children to school…. When did that start?...

I entered first grade in Cleveland, Ohio, in 1946. The school was three blocks away. My mother dressed me and showed me the door and, even in the dead of winter, I walked alone. I met friends along the way. I never saw an adult.

No big deal. But halfway through the year I took a test. Afterward my parents agreed that I could attend a special school for gifted children.

It required a six block walk and then a long streetcar ride. I made the trip alone every day. The school had a cafeteria, but, for reasons lost in history, I left the campus at noon and ate lunch, usually a hamburger, at a nearby diner. It cost a dime. Remember, I was six years old. I never regarded this as odd, and no adult I encountered gave me trouble.

It was not all smooth sailing. Once, years later in Los Angeles, I encountered a bully my own age who cuffed me around painfully.

Sunday, September 27, 2015

Another Spiked Drink

It was one a.m. as I drove Santa Monica Boulevard, but crowds packed the sidewalks in West Hollywood, lining up to hear the latest band. A few blocks beyond, I parked at the Ramada.

A guest led me to the bathroom where her companion lay in the empty tub, clutching a towel and moaning. This was not the first time I cared for a patient in a bathtub or even the tenth.

“We’ve been out drinking,” explained the guest. “But not more than usual, and she didn’t have more than me. Do you think they put something in her drink?”

This was not the first time I heard that – or the tenth. Guests often suspect foul play when someone becomes violently ill after drinking.

I examined the patient as best I could without moving her because she insisted she could not move. Afterward I explained that alcohol is a toxin that messes up the brain, usually in pleasant ways but occasionally not.

After delivering an injection for vomiting, I told her to suck on ice chips and phone if she wasn’t feeling better in a few hours. So far everyone has recovered.     

Wednesday, September 23, 2015

An Exotic Travel Destination

Tourists come to America expecting a strange foreign land. They usually leave satisfied, but encountering an American doctor is an unexpected bonus, so everyone on the tour gathers round, and I often go about my business in front of a large attentive audience.
My largest consisted of the entire company of the Chinese Peking Opera lined up along the wall of a ballroom in the Hollywood Roosevelt. One of its members had begun behaving bizarrely. I concluded he was suffering an anxiety attack which a tranquilizer might help. 

This took place well before Chairman Mao’s influence became passé, so it was likely the Opera’s resident physician had no Western training. Etiquette demanded I treat him as a colleague, so I presented my advice as a suggestion.

After consulting other senior figures, he gave his approval. No one except the interpreter spoke English, so many subtleties were lost, but everyone seemed satisfied, and the entire troupe lined up to shake my hand.

Saturday, September 19, 2015

Doctors Are Always Late

At 6 p.m. on the Friday before Labor Day, I learned that a flight attendant in Costa Mesa had a cold. I prefer not to drive 46 miles during the rush hour, so I promised to be there between 9 and 10. That was acceptable. Airline crew are not demanding.

Five minutes later a guest at the downtown Doubletree asked for a visit. This was a bad juxtaposition. Scheduling it for after Costa Mesa meant an arrival time near midnight.

Reluctantly I told her to expect me at around eight. Since it was the evening before a holiday, I gave myself over an hour for a 25 minute drive. To my surprise, the freeway flowed freely, so I was early. I worried the guest might not be in the room. When I say I’ll arrive “around eight” guests often hear “eight.” They leave, planning to return at eight or a little after. But the guest answered the door.

The freeway to Costa Mesa was also fast, and this time no one answered my knock at 8:30. The front desk was unhelpful.  

This was a situation I hate. Airlines have strict rules about sick crew, so this guest required a visit. If I waited until 9 and then left, I might get a call on the way home. If she was out partying, I might get it several hours later. I did not acquire my peerless reputation by refusing calls, so I’d make the return trip.

As I fumed and paced, the guest returned. I expressed relief, but she did not apologize. She was present at the appointed time, and no one expects a doctor to be early.