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Saturday, October 2, 2010

Hitting the Jackpot

This week the Adventure called. An inexpensive motel two miles from the airport, it's a collection of single rooms and dormitories with an outdoor restaurant on the premises. Guests are mostly colorful, raffish, college-age, and from around the world. Many are traveling so cheaply they have no insurance, so I spend a great deal of time giving phone advice and making visits at a discount.

Conventional tourists also stay, and this was one. The guest called at 8:30 as I was preparing breakfast, and I told her I’d arrive between 9:30 and 10. Later, as I was preparing to leave, the phone rang again. The caller was the Miami office of Coris USA, a travel insurance agency that mostly serves Latin Americans. Half my calls from hotels require only phone advice, but insurance calls are 100 percent paying visits, so I answered in a happy frame of mind, almost certain that I could skip the gym. I don’t search for reasons to avoid my daily workout, but I like to exercise before the noon rush, and two morning housecalls make that impossible. This doesn’t happen often, so I reward myself without guilt. Keeping fit is essential, but an hour of exercise is as exciting as an hour brushing your teeth, and I’m deeply suspicious of anyone who claims to enjoy it.

It’s not rare to drive thirty miles between hotels, so I awaited the location of my second visit with anticipation. My jaw dropped to hear that it was the Adventure. Two visits at the same hotel, a rare treat!

A downside was that both patients seemed to be suffering the most difficult medical problem I encounter. You might guess that this is heart disease or cancer but it’s the common viral upper respiratory infection – cough, congestion, sore throat, fever. These make up twenty percent of a family doctor’s traffic and mine as well. The source of my difficulty is that (a) patients yearn for a cure and (b) doctors yearn to cure, but we can’t cure these. Doctors everywhere in the world solve this problem by prescribing antibiotics. It works perfectly. Patients believe they're being cured, and the doctor doesn't contradict them. Prescribing antibiotics for viral infections is too common to be the sign of bad medicine; good doctors do it, too. Experts denounce this avalanche of useless drugs as a massive environment pollutant, responsible for the epidemic of nasty infections resistant to all antibiotics which are killing more and more people. This argument does not impress doctors; all agree that environment pollution is deplorable, but it happens outside the office. A patient in the office must never leave disappointed; given antibiotics, he never does.

Having gotten this off my chest, I’ll admit that neither of those patients turned out to have a virus. When I arrived, I discovered the first, a young Australian with a severe cough and high fever, probably had pneumonia because I heard abnormal noises on listening to his chest. In an otherwise healthy person, pneumonia is the only common respiratory infection that medical science can cure. So I cured him.

Walking upstairs, I examined the Coris patient, a middle-aged man from Brazil who explained that he had bronchiectasis. This is an uncommon disease in which a small area of the lung becomes obstructed with frequent infections. He was suffering an exacerbation, so I gave him antibiotics in good conscience.

These were satisfying encounters. That both patients were guests at the same hotel was a delightful bonus although there was a downside. With no travel between visits, I finished at 11 o’clock, too early for me to skip the gym without guilt.

1 comment:

  1. I have been so curious about what it must be like to do this work. The lack of routine is incredibly attractive, although some of the venues are obviously not.

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