Tuesday, January 28, 2014

Lost In Translation

“Bom dia” said the woman who opened the door.

“Bom dia,” I responded. That’s the limit of my conversational Portuguese. My heart sank as I looked around the room which contained a toddler but no adult male. Among foreign couples, the husband is much more likely to speak English.

The mother pointed at her child, made coughing noises, tapped his chest, and produced a thermometer which she waved significantly. Once she understood that I needed more information, she took up her cell phone. 

After some effort because her husband was apparently in a meeting she delivered a long recitation before handing me the phone.

“He have cough. He have the flu. He need something. She wants you to examine him.”

In response to my question, the father insisted that this was everything she had said, but I knew he was summarizing. This is a chronic problem with amateur interpreters. I asked more questions and received short versions of her long answers. The child looked happy and not at all sick, and my examination was normal. He had a cold. He’d coughed for four days and might cough for a few more, I explained. She was already giving him Tylenol, and no other medicine is safe for a two year-old. Luckily, he didn’t need medicine or bed rest or a special diet. It wasn’t even necessary to stay in the room.

If I had handed over medicine, every mother from Fiji to Mongolia to Nigeria would understand that I was behaving like a doctor. But I wasn’t. What was going on?

I’ve encountered this hundreds of times, so I work very, very hard to communicate that the child has a minor illness (husband’s translation: “Doctor says child is OK…”), that no treatment will help (husband’s translation: “Doctor does not want to give medicine…”) and that being stuck in a hotel room is boring, so she should try to enjoy herself (husband’s translation: “Doctor says go out; child is OK…”).

Tap, tap, tap…. The mother beat a tattoo on he child’s chest in a wordless appeal. Everyone knows that a sick child must be confined and given medicine. Why was I implying that he wasn’t sick?

I knew what she was thinking. I repeated my reassurance, and the husband translated. When, at the end, I asked if she understood she knew the correct answer: yes. She remembered her manners as I left and thanked me effusively.

I left feeling as discouraged as the woman. She was in a strange country, trapped in a hotel room with a sick child. Despite her best efforts, the foreign doctor didn’t understand that her son was sick.

Friday, January 24, 2014

A Preconceived Notion

Last week, I cared for a flight attendant suffering stomach flu. These are miserable episodes of vomiting, cramps, and diarrhea that rarely last long. She was better the following day, but on that day I returned to the hotel to see another flight attendant from the same airline with the same symptoms.

The visit ended an hour past lunchtime. I was hungry and decided to treat myself at restaurant near my home. I had parked when my phone rang. To my surprise, a third flight attendant at the same hotel had identical symptoms. I drove back, sucking on hard candy I keep for such occasions.

I repeated my stomach flu routine: examining her, delivering the usual advice, and handing over medication. She declined the medication, explaining that she might be pregnant.

Doctors are human. Having made a diagnosis, my inclination was to stick to it, but I asked a few questions. Her period was overdue. She admitted that her nausea, although worse today, had been present several weeks. Her cramps, also worse today, had been present a week.

OK… Maybe not a typical case of stomach flu plus an early pregnancy. She agreed to consult her doctor as soon as she returned home. I prepared to leave and then changed my mind. One of many rules medical students learn is that when a young woman of childbearing age has abdominal pain, one always considers an ectopic pregnancy. That’s a pregnancy in the fallopian tube which, unlike the womb, had no room for the growing fetus.

I told the flight attendant that she needed a test for an ectopic pregnancy which is an emergency. She did not object. I phoned the agency that handles airline crew, and its medical department promised to follow up.

I left unhappy with myself for being slow to discard a preconceived notion. It turned out she had a normal pregnancy but a chorionic hemorrhage, bleeding into the womb. This is not urgent but still….

Tuesday, January 21, 2014

A Brush With Disaster

A Beverly Garland guest phoned as I worked out at my gym one morning. I’m happy to cut this short to make a housecall, but the guest wanted me to come at one o’clock. I don’t like appointments, but this seemed an easy visit, and it was convenient because I could go after lunch.

After showering, I was walking to my car when a disturbing thought occurred. Exercise is boring, so I read the New Yorker while on the treadmill. When I finish an issue, I leave it in the locker room for anyone else. With a shock, I realized that I had scribbled the guest’s name and room number on that New Yorker which I later finished and absent-mindedly left behind. I rushed back, but the magazine had vanished. I prowled the gym, searching for anyone reading a New Yorker. No luck. I phoned the Beverly Garland to ask if anyone remembered referring a guest. No one remembered.

Now and then a competitor’s hotel calls when its doctor fails to show up, but I boast that this never happens at my hotels. I always tell a guest when I’ll arrive and make sure that I arrive on time. Now I had visions of the guest fuming as hours passed and eventually denouncing me to the staff.   

I racked my brain. The guest sounded Australian and had a Slavic-sounding name. Dutifully, the desk clerk checked her computer and found nothing. I asked if I could come and examine it myself; she agreed.

Guests who make appointments occasionally change their minds, so I always phone to make sure they’re in the room. With great good sense, I had told the guest I would check at noon. To my immense relief, when 12:30 passed with no call, he phoned.

Thursday, January 16, 2014

Curing Hiccups

Every few years a hiccuping hotel guest appeals to me.

Hiccups rarely lasts more than a few hours, so a victim gives credit to his last effort and immediately rushes to his computer to proclaim its benefit. Literally hundreds of treatments exist: proof that all are worthless. Google “hiccups cure” to confirm that you must never look for health advice on the internet.

Long ago when an old doctor described a good treatment, I was skeptical. Even today, hotel visits for hiccups make me nervous, so I give a money-back guarantee. Once in the room, I take a tongue depressor and rub the soft palate at the back of the hiccuper’s throat. Sometimes he or she gags, sometimes not, but so far everyone has been happy to pay my fee.  

Sunday, January 12, 2014

How to Remove a Sliver Painlessly

Her son had a sliver in his palm, explained a caller from the Airport Marriott. Could I come and remove it? The child was two.

Two is the worst age for a dignified doctor-patient relationship. Infants love everyone, and older children listen to reason. At two, girls are often terrified into silence, but males who don’t like doctors make for a noisy consultation.

Removing a fresh sliver with tweezers is easy, but most victims pluck at it with their fingertips, breaking off the tip, leaving the remainder nestled out of reach under the skin. 

As I unwrapped a scalpel, the parents assured the child that it wouldn’t hurt. Long experience had taught that this was a lie, so his protests became deafening.

In fact, the parents were right. Both worked hard to immobilize the child at first, but when it became clear there was no pain, he calmed. Your epidermis is dead skin, so shaving the very surface with a scalpel should be painless. I shaved enough to expose the splinter. A new safety razor works as well.

Wednesday, January 8, 2014

A Doctor's New Year's Resolution

I’ve quit doing telemedicine.

Organizations like Dial-a-Doc or Teladoc or 1-800-MD pay doctors to answer phone calls. Sitting at home, we can earn $40 for a conversation that lasts a few minutes. It seems like easy money, and I’ve had many satisfying experiences answering questions, helping with minor illnesses, assuring callers that something that seems ominous is not ominous, or sending them for urgent medical care if they needed it.

What spoils the experience is that nearly half of these callers are suffering a respiratory infection: cough, sore throat, congestion, “sinus,” “bronchitis.” Since their doctors routinely prescribe antibiotics, these callers know what they need. Phoning saves a trip to the office. What a convenience!

When, after discussing their symptoms, I give my diagnosis and explain how to help, many are puzzled. When, in answer to their hints, I assure them that antibiotics don’t help, most remember their manners, but they don’t believe me. Some point out that their doctor takes their illness more seriously. A few question my competence or suspect they’ve fallen for another internet scam (“Are you a real doctor?.... What am I paying this money for?!!...).

When guests at my hotels phone, respiratory infections are also the leading complaint. But phone calls to me are free, and I spend a good deal of time answering questions and giving advice. By the time guests agree to a housecall, they understand that I genuinely want to help and that I know my business. If they don’t understand, I direct them to another source of care. If you follow this blog you know that this tactic occasionally fails with unhappy consequences for everyone concerned.   

Telemedicine guidelines forbid doctors from prescribing narcotics and tranquilizers but say nothing about antibiotics which are far more toxic. If you join one of these services and want an antibiotic but have the bad luck to reach a doctor like me, simply thank him, hang up, call again, and tell whoever answers that you want a different doctor. That should work.

Saturday, January 4, 2014

A Message From a Stranger

“A guest would like to meet you at 4:15 in the lobby.”

The caller was a concierge at the L.A. Hotel.

“Is that all?”

“I’m sorry, Doctor Oppenheim. The guest just handed me a note and walked out.”

This really happened on December 31. Doesn’t it sound like a bad novel? Retired CIA agent, Skip Oppenheim, jaded from a lifetime fighting international terrorism, gets a message from a mysterious stranger as he unwinds at a luxurious resort. The adventure begins.

As a hotel doctor, I am allergic to adventures. Sick guests rarely schedule a consultation in a public place. Most likely he had a request. These are fairly common, but I prefer to handle these over the phone at no charge. This is good P.R. but it’s also self-defense. If I travel to the hotel, and the guest makes a request I have to refuse, the consequences may not be life-threatening but they are not pleasant. Also, it’s hard to collect my fee.

“I don’t make appointments without talking to the guest first. Do you have his number?”

“I’m afraid not.”

“Have him call when he gets back. I’m sure we can work out something.”

The concierge agreed. Sadly for this blog, there is no punch line. I never heard from him.