Monday, October 29, 2012


I saw a young Australian couple traveling with an infant. A placid sleeper in Australia, the infant had been screaming through the night since arriving six days earlier, attracting complaints from other guests, driving the poor parents to desperation. They wanted to go home.

This was colic, a surprisingly common affliction of healthy infants. In theory, they are suffering abdominal pain, but all tests are negative, and none of the innumerable treatments work well. It disappears after a few months. I wrote them a note. 

Friday, October 26, 2012

Another Death

When I arrived at the hotel, a father explained that his daughter was under treatment for leukemia. They were visiting relatives when, a few hours before, she had refused to speak.

Except that she was bald from chemotherapy, the daughter looked fine. She was sitting up in bed, arms folded, looking glum. When her parents appealed to her to talk to me, she obviously heard but merely shook her head and remained silent. She did not resist when I examined her, and nothing abnormal turned up. I was faced with a sullen teenager who didn’t appear sick.

This was another occasion when, for no obvious reason, things didn’t seem right. I told the parents she needed to go to an emergency room. They obeyed, and the daughter died soon after being admitted.     

Sunday, October 21, 2012

A Death

A guest at the Park Sunset complained of the flu. His temperature was 101; my examination was normal, but patients with influenza have a normal exam.

He looked miserable, but he was forty-one and in good health, and everyone with the flu looks miserable. There was no reason not to give the usual remedies and check back later. This happened long ago, but I still remember the inexplicable feeling that something was not right. I couldn’t bring myself to leave him in the room.

Leaving after extracting a guest’s promise to go to an emergency room is a bad idea. If the guest decides not to go and something dreadful happens, I’m the last doctor he’s seen. Calling paramedics was another option, but they might not share my vague unease.  

Explaining that he required further attention, I took him to my car and drove to the nearest hospital. The next day I phoned. He had been admitted and died a few hours later. The doctor who cared for him was as mystified as I. We theorized he was suffering an overwhelming infection from an unknown source. Perhaps he took drugs. This was early in the AIDS epidemic, and victims sometimes died abruptly when their immunity vanished. We never found out.

Monday, October 15, 2012

Not Hitting the Jackpot

“Our client had a heart attack,” explained the dispatcher from Universal Assistance last week. “He wants to go home to Portugal, but the specialist says he must have a doctor. We have hired a medical flight, and we want to know if you can go to New York. You come back the same day.”

Experts advise waiting a week or two after being discharged for a heart attack, but no one knows the risks of flying earlier because almost no one does. An expert who suggests that a physician go along is covering his ass, not delivering advice based on evidence.

Still, the insurer had agreed, no minor matter when an air ambulance coast to coast costs about $40,000. I had no idea what I would earn; nor did the dispatcher, but it would be breathtaking. Hiring a doctor for a day to testify in a malpractice trial runs to $7000.

I still remember with pleasure the single occasion I flew first class. Flying in a private jet while earning the price of a European vacation might leave an even better memory.

But would the patient require my skills? It was unlikely, but, not being young and stupid, I could not dismiss the possibility. Like most doctors, I can perform basic CPR, but I and most doctors have long since forgotten advanced CPR: complex drugs and techniques required for various cardiac malfunctions. Emergency room doctors, paramedics, and ICU nurses deal with these routinely.

Wistfully, I informed the dispatcher that those were the appropriate escorts. 

Monday, October 1, 2012

Perks of Getting Old

Getting old is a nuisance although there are benefits. Police in passing patrol cars no longer eye me suspiciously late at night. Lone women in hotel elevators have stopped looking uneasy when I join them.

As a college student in 1965, I wrote a one-act play that won a national award. It was never produced professionally, but a few years ago, a theater group in New York chose it for a staged reading. This was not a big deal, but I wanted to attend.

As soon as I entered the small theater, everyone perked up. I became the center of attention; people introduced themselves; they sat me in the place of honor. For reasons I still puzzle over, the group boasted that its public readings were cold (i.e. unrehearsed). The performance made this only too clear.

Later I realized why everyone treated me so well. No one in that theater appeared older than forty. Since I was past middle-age they assumed I was an agent or producer – an important person. They did not forget their manners on learning I was merely the writer.