Sunday, May 22, 2011

Several hundred Norwegians arrived in the city last week, and I cared for four who fell ill. Not all Norwegians are good-looking or blonde, but I didn’t see any who were overweight, and they spoke English.

They were guests at the Hollywood Heights hotel in my least favorite part of Los Angeles. Hollywood's tourist glitz is a minor matter; I dislike the drive. Despite our legendary freeways, none reach from my part of Los Angeles to Hollywood, so I travel nine miles through the city. Planned in the 1960s, the Beverly Hills freeway would have solved my problem, but it vanished from maps when the city insisted it be built underground, a good idea.

The first Norwegian suffered a urine infection, common and easy to treat. The second had a hacking cough, present several days, which tormented three roommates almost as much as the patient. I handed over a bottle of cough medicine. The third had been vomiting. Everyone with an upset stomach blames their last meal, so I listened to a recital of everything he’d eaten.

The last had been to Universal Studios and thought she had sunstroke. Sunstroke is life-threatening, but there are lesser sun-related conditions, none of which she had. She did not even have the painful sunburn that northern Europeans acquire almost as soon as they get off the plane. Universal City is beyond the Hollywood Hills, an area hotter than Los Angeles proper, but it hadn’t been abnormally hot.

Hearing my reassurance, she admitted that her nausea and anxiety may have represented a mild panic attack. She suffered them regularly. This one was receding.

At midnight two days later she phoned, begging me to come immediately. Something terrible was happening, and she needed me to take her blood pressure and examine her and tell her she was OK. This was a full-blown panic attack, she informed me. She believed she was dying. When I assured her that she would not die, she did not deny it but pleaded tearfully for me to come. Victims of panic attacks are not psychotic. They know their fears are irrational, but they can’t resist them.

These calls are not rare, and I try to handle them without a visit. Ten minutes of soothing reassurance and the knowledge that I’m immediately available over the phone usually works. It also works when I visit a guest whose complaint unexpectedly turns out to be a panic attack. Unfortunately, these successes are guests who don’t know they’re having an attack or suffer them only rarely. This lady was a hard-core, locked-in panic attack regular. Her attacks followed a strict pattern, and no reassurance would change matters.

If I came, examined, and found everything normal, she would express gratitude, but even before I finished counting my money, she would be pleading for another exam. Yes (I know you’re asking) there are shots, and I give them, but they never work. I hate walking out on a guest who’s begging me to stay, and these attacks may last hours.

This guest was young and healthy. Her conviction that she was dying was clearly wrong. Yet… Every doctor has heard stories of patients who announce that they’re dying and then proceed to die. No doctor wants to be the source of such an anecdote, so this lady needed at least one exam. As I was agonizing, she broke in to say she would ask the hotel to call an ambulance. Then she hung up. I phoned the front desk ten minutes later to make sure they had done so. The paramedics would examine her and, if the results were normal, leave despite any pleas.

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