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Friday, March 30, 2012

Avoiding the Rush Hour

A guest with a respiratory infection was staying in a Whittier hotel, thirty miles away. The call arrived at 5:00. Driving sixty miles in rush hour traffic is an experience I prefer to avoid if the problem isn’t urgent. I told the insurance dispatcher I would arrive between 8 and 9.

Usually I explain that “I won’t get out of the office till 7.” That’s an excuse patients usually accept. This time I slipped up and merely explained that I didn’t want to get caught in the rush hour. This is less acceptable and, sure enough, the patient cancelled in favor of going to an emergency room. I felt bad, but that turned out to save me from a difficult evening.

At 6 o’clock, a guest in West Hollywood announced that he was having a gout attack. The rush hour was in full swing, but West Hollywood is only five miles away. Before I walked out the door, the phone rang again, and I agreed to see a Swede suffering flu symptoms at the Sheraton in Santa Monica. The Sheraton is ten miles from West Hollywood and not a convenient drive, but I hoped traffic would have diminished.

Gout is an easy visit, and I carry the treatment, so the visit ended happily for everyone. After a passable drive, I arrived at the Sheraton where I answered a call from the Hong Kong office of Cathay-Pacific Airlines. I care for their crew in Los Angeles, and they are a joy to work with. Being young, they suffer simple ailments; all are Asian but speak good English; best of all, every request comes with a credit card number, so I don’t have to send a bill. A mild downside is that every visit also comes with a sheaf of documents evaluating the employee’s fitness to work.

After caring for the Swede’s flu, I drove ten miles to the Airport Hilton to treat a flight attendant’s sore leg and fill out paperwork. I arrived home at 10:30, weary but pleased at the night’s work. No sooner had I taken my phone off call-forwarding than it rang with news that an elderly lady at a Sunset Strip hotel was ill. Not everyone who wants a doctor needs a doctor, and I often convince guests that a visit isn’t necessary. I yearned to do that in this case, but she was vomiting, not a symptom patients can tolerate.

In the room, I was prepared to diagnose a routine stomach virus until I pulled back the covers and saw her swollen abdomen.

“Is this how your stomach usually looks?” I asked.

She denied it. She also had more pain than I expected, and I heard loud intestinal noises through my stethoscope. It seemed like a bowel obstruction, I explained. She needed to go to the hospital. Immediately she reconsidered my question, remembering that she was constipated, a condition that often made her abdomen swell.

Hearing they must go to the hospital, guests often work hard to change my mind, but I persisted. She went off in an ambulance, and I left hoping I’d made the right decision (doctors worry about these things). I phoned the next day to learn she had been admitted to Cedars-Sinai where she remained several days.

Thursday, March 22, 2012

Worry

A guest had stumbled in the shower and thrown out her back. Could I make a visit to determine if she needed hospitalization?

Going to the hospital with back pain is a bad idea; even if the patient is in agony, no doctor will admit her without evidence of nerve damage such as paralysis or inability to urinate. He will order x-rays (worthless for acute back pain, experts agree, but an ER tradition), explain that she will recover in a few days, and prescribe pain medication.

My examination showed no nerve damage, so I explained that she would probably improve in a few days. I handed over pain pills, adding that, while it wasn’t essential, I could give an injection that would help for several hours. She agreed, so I gave it.

From there I drove to the Magic hotel in Hollywood where a Danish couple’s 18 month-old was vomiting. He looked fine, and looking is the most important part of a doctor’s exam: sick children look sick. Nothing abnormal turned up on an exam, so my diagnosis was a common stomach virus. I told the parents it might last a day or two and gave the usual dietary advice.

I check on the day’s patients before going to bed, but the Danish parents beat me to it. The child had vomited once again, they reported. He was still in no distress, so I told them it was OK to wait.

“Not so good,” the lady with the back pain replied when I asked how she was doing. She had been vomiting since the injection, and each vomit hurt her back. That’s an occasional side-effect. I assured her it would pass, but I worried. My assurance to the Danish parents was correct, but patients occasionally deliver unpleasant surprises, so I could not suppress more worry as I went to bed.

The lady’s back pain was no better the following morning, but she wanted to fly home. Could I provide medical clearance? Visits for “medical clearance” are a lucrative perk of hotel doctoring because they involve little more than writing the note. I resisted the temptation, explaining that there’s no medical reason why someone with back pain can’t travel. If she could hobble onto the plane, she should go.

Could I give a “mild” injection so she could move more easily. No such injection exists. I suggested she try the pain medicine. I phoned the Danes to learn that the child hadn’t vomited but was now feverish. This was to be expected, I explained, and I approved their decision to give Tylenol.

Later, the lady reported that the medicine made her nauseated. What should she do? I told her it would pass in a few hours. Should she try to make her plane, she asked. I repeated that rest is not helpful for treating back pain.

The Danish child was still feverish, his parents reported, and now he had diarrhea. I gave dietary advice.

Neither guest answered my call that evening. Both had checked out, I learned from the front desk. I had just returned from seeing a young man with low abdominal pain at the USA Youth Hostel. He was worried about appendicitis; my exam made that unlikely but not impossible. Since he had no health insurance, I did not want to make my life easier by sending him to an emergency room where a workup including CT scans would run to about $5,000. His symptoms hadn’t improved when I called, but it still didn’t seem like appendicitis. He promised to phone if there was any change. I worried as I went to bed but only a little.

Friday, March 16, 2012

Brave New World

The Andaz Hyatt had given my number, explained the caller. Could I see a member of their cast who was suffering an earache? Unfortunately, he was on location and wouldn’t return to the hotel until late evening.

She was delighted at my suggestion that I come to the film shoot, and I’m as eager as anyone to mingle with film people. On the downside, I live six miles from the Hyatt; the film was shooting at the far end of the San Fernando Valley, twenty-five miles away, and I’d quoted my fee before learning this.

The producers had taken over a run-down motel on a seedy suburban strip, painted it pink, and restored the coffee shop to its mid-twentieth century interior. I drove past warning “closed to the public” signs and parked among the cabins and scattered 1950s cars.

Several dozen people stood around, none over forty. You should realize that shooting a movie is dull work. Actual filming takes up perhaps two percent of the day. The remainder involves setting up, technical changes, errands, and standing around. Almost everyone spends most of the day waiting. Everyone looks forward to lunch. I also attracted attention, being far older and much better dressed.

Earaches are easy. I followed a young man into the empty 1950s diner, made the diagnosis, handed over medicine, and took my leave.

As usual, one aspect of the experience seemed strange. The assistant who had phoned and greeted me on my arrival was a young, attractive woman. Other attractive women were setting up the lunch buffet. Almost every actress in costume was beautiful; there were no exceptions for those in street clothes.

Who was hiring for this project…? Some creepy frat guy?

In fact, film sets resemble a Brave-New-World culture where every human is prefabricated. While a well-designed male has many features, everyone knows that the perfect woman is…well….

All this is essential because movies reproduce this bizarre world.

During an episode of the fine TV series, Breaking Bad, I blinked at the sight of a young prostitute, meth addict. She was skeletally skinny with bad teeth and a terrible complexion. She looked horrible, but I was delighted because that’s what a real-life hooker, meth addict looks like. Movie prostitutes, no matter how cheap or unhealthy, look pretty. Movie women dying of cancer remain beautiful to the end. Take your eyes off the action and observe the background of any movie – the passersby on the street, the revelers at a party, every student in the sorority, other customers at the restaurant – all the women are lovely. In a supreme irony, I read an article in which a TV star describes the agonies of makeup before each shoot. She plays “Ugly Betty,” but, of course, she’s beautiful.

My wife is beginning to “shush” me at the movies when I point out absurdities.

“There must be fifty women in that lecture hall. They all look like movie stars!!”

No one else seems to notice, so this is probably my own oddball perception.

Thursday, March 1, 2012

Loyalty

As long as they do good work, doctors assume patients will remain loyal, but hotel doctors learn not to be so trusting. Helping sick guests produces no income for the hotel. Ninety percent are not terribly ill; if rebuffed they rarely make a fuss, so the manager never hears about them. Paramedics deal with emergencies. Years may pass before a GM encounters an imbroglio that only a doctor on the spot can defuse; I’ve recounted a few. Although the best marketing tool, they never happen when I need them.

So how does a doctor keep a hotel’s loyalty? You might think that practicing good medicine is the best P.R. That’s not necessarily so because, ironically, people take for granted that doctors are good. In fact, most are competent, and that includes my competitors. Patients are usually grateful after seeing me, and over thirty years I’ve acquired plenty of flattering letters, but when patients feel the urge to tell the world about a doctor, they are generally less happy. When a GM hears from a guest, it’s almost always a complaint.

Assuring bellmen and concierges of $20 for every referral is a long tradition. It’s illegal, and my last competitor who definitely took advantage lost his license in 2003, but hotel staff continue to drop hints.

Other doctors tour hotels to extol their virtues to the staff, but I don’t. Three or four times a year I write to a hundred GMs but stop once a hotel starts calling. I dislike merchants who keep telling me how much they love my business, so I assume this feeling is general. Perhaps fifty hotels call during a typical year, but I doubt if five GMs know me by sight.

In 1994, I bumped into the doctor who serves a dozen crème de la crème luxury hotels around Beverly Hills. As we talked shop, he mentioned that he knew most of his general managers since he encountered them at social engagements. That’s a marketing tool I can’t match. It turns out that, when a hotel opens, he chats up the manager, and matters are settled. I send my usual letter of introduction, but I never acquire a new hotel in his territory.

During that conversation, he grumbled that a colleague who covered for him recently had left a business card at every hotel. I sympathized, adding that I’d be happy to cover, and I promised not to solicit afterward. Since my leisure time activities are reading and writing, I rarely decline his calls, so we’re both pleased with the arrangement. I still have no answer to the question at the beginning, but at least someone else is responsible for keeping the loyalty of many hotels I visit.