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Friday, October 21, 2011

Hitting the Jackpot

Two miles from the airport, the Adventure resembles a youth hostel: a mixture 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 one called at 8:30 as I was preparing breakfast. I told her I’d arrive between 9:30 and 10. During breakfast, 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 almost all paying visits, so I answered in a happy frame of mind, certain that I could skip my daily workout. 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 healthy, 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. It was the Adventure. Two visits at the same hotel, a rare treat!

A downside was that both patients seemed to be suffering my least favorite illness: a respiratory infection. Almost all are viral, but prescribing antibiotics is so common that even good doctors do it, so patients are often puzzled and disappointed when I don’t. Doctors love their patients’ gratitude, but prescribing Tylenol and cough medicine get them very little.

Having gotten this off my chest, I’ll admit that neither of those patients had a virus. The first had a severe cough and high fever, probably pneumonia because listening to her left lung revealed abnormal noises. In an otherwise healthy person, pneumonia is the only common chest infection that medical science can cure. So I cured her.

Walking upstairs, I examined the Coris patient, a middle-aged man from Brazil who explained that he had bronchiectasis. This is an uncommon condition 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 staying at the same hotel was a delightful bonus, but there was a downside. With no travel between visits, I finished at 11 o’clock, too early to skip the gym without guilt.

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