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Thursday, May 17, 2012

Everything Feels Worse in the Middle of the Night

That’s my mantra during a wee-hour visit.

I’ve made a thousand housecalls that got me out of bed. Patients are often suicidally reluctant to wake a doctor, but I don’t object. Freeway traffic is light, parking is easy, and since I have no office, I can sleep late.

What happens in a hotel room when the lights go out? Mostly, guests stub their toes and bump into furniture. I bring a flashlight when I go on vacation.

Many callers have awakened in the dark certain something terrible is about to happen. Now and then life seems overwhelming, and everything feels worse in the middle of the night. I try to handle anxiety attacks over the phone using sympathy and calm reassurance. Logic is useless; I never point out that nothing terrible will happen because guests know that; it’s one reason they’re upset. I explain that no one is perfect; sometimes our brains go haywire, but it never lasts long. If I can keep the guest on the line, this almost always works. Making a housecall is risky because guests often begin to feel better and cancel before I arrive, or they feel worse and call paramedics.

Unlike many doctors, hotel doctors included, who use the paramedics as a substitute for getting out of bed, I reserve them for emergencies. Mostly, these are obvious. Heart attacks can rouse victims from sleep, but they are not subtle. Niggling chest discomfort doesn’t qualify, and severe pain in a young person is probably something else. 

I see a cross-section of ailments, but guests with an upset stomach seem overrepresented. I consider a wee-hour visit for vomiting a good call (i.e. not life-threatening; I can help; patients are especially grateful). The latest antivomiting drug, ondansetron, is superior to Compazine, the choice for the past fifty years. Ondansetron was once wildly expensive and used only for vomiting after cancer chemotherapy, but its patent expired a few years ago, and the price has plummeted, so I can afford it.

Most violent upset stomachs don’t last long. I assure guests they’ll probably feel better when the sun rises , and (a perk of being a doctor) when that happens, guests are convinced I’ve cured them.

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