Wednesday, December 31, 2014

Doing My Duty

“I can’t handle that in a hotel room,” I explained. “She probably needs an ultrasound.”

After consulting his superior, the dispatcher came back on the line to explain that they would like me to evaluate the guest, a flight attendant with vaginal bleeding, and deliver a recommendation.

If she had called directly, I would have sent her to an emergency room, but this request came from an agency that serves airline crew. It was paying the bill, and I had done my duty by warning that a housecall wasn’t appropriate. I was happy to make the visit. Once I confirmed her bleeding, I would simply call and report.

A young man opened the door. I entered, expecting to see a girl friend or wife, but he was alone, and he identified himself as the patient.

I checked the date of birth on my invoice. It was identical. He spoke excellent English, so there was no chance of a misunderstanding.

After dealing with his problem, I phoned the agency. Was there another flight attendant with vaginal bleeding waiting for me? After a long consultation, he assured me that no one knew. It was probably a mistake.

Sunday, December 28, 2014

You Don't Need a Better Medicine

“My doctor gave me amoxicillin a week ago, and my sinuses are still blocked. I need a stronger antibiotic.”

For perhaps the thousandth time, I responded: “You have a virus. Viruses can last a week, and antibiotics have no effect.” 

If a medicine isn’t working the next step is never to try another medicine but to discover why it isn’t working.

Sometimes the patient needs a better exam. Pain on urination usually means a bladder infection, and I’ve seen several women whose bladder infection didn’t go away after a course of treatment. They didn’t have a bladder infection but herpes. It was obvious when you looked, but the doctor hadn’t looked.

Sometimes the patient needs to wait. After rubbing cream on an insect bite, patients worry when it grows to an itchy patch several inches around. I explain that insect bites may worsen for two days and then resolve over the following days.

Sometimes the next step is to stop taking medicine. Treating pinkeye with drops usually helps, but patients occasionally return to complain that they’re worse. That’s because the drop has begun to irritate the eye. A few days after stopping, they feel better.

My malpractice lawyer warns me to warn you to read this purely for your own amusement. Only in mathematics are statements always true, my lawyer added. Even the best medical advice has exceptions.

So if a medicine isn’t working, don’t stay away from the doctor on the grounds that I said it was OK.

Tuesday, December 23, 2014

Japanese Never Travel Alone

The room contained four young men and extra beds, on one of which lay my patient looking miserable with a wet washrag on his forehead.

At my first question, several pulled out Japanese-American phrase books, a bad sign. It’s a fact that all Japanese study English in school, but all Americans study American history, and how much do they learn?...

Answers to my questions were on the order of “please perform a diagnostic evaluation” or “the reading of the thermometer seems excessive.” I had reluctantly decided to call their travel insurer’s 800 number (phone interpreting is tedious) when the tour leader entered. His English was rudimentary, and, loyal to his culture, he was too polite to tell me I was incomprehensible, but I managed to confirm my suspicion that the young man had influenza. Most likely it was Swine flu which, despite scary headlines, is no worse than regular flu but a terrible illness for young people who take for granted they’ll never be ill.

Friday, December 19, 2014

A Dog-eat-dog Business, Part 7

A travel insurer sent me to a large airport hotel that hasn’t called this year, so I decided to reintroduce myself.

“We don’t have a doctor,” said the lady in the security office.

“I’ve made hundreds of visits. Your office called me all the time.”

“I never did,” she insisted. She summoned a nearby officer who agreed that no one knew about a hotel doctor. She accepted my card and put it in a drawer.

My next stop was the concierge desk, but it was vacant. When times are tough, concierges are the first employees to go. The front desk clerks agreed that having a hotel doctor was a wonderful idea and thanked me for my cards.

“I guess no one’s been sick,” said the bellman cheerfully when I queried him. I had no doubt that whatever doctor he called tipped him $20 or $30 or $50 for the referral. This is illegal but a common practice. My veteran colleagues express outrage, and I have no reason to disbelieve them, but we all agree that several aggressive young doctors are paying generously. It’s the quickest way to break in. The bellman thanked me for my card and put it in a drawer.

If you assume that general managers hate choosing a doctor on the basis of his kickback, you’d be right. Sometimes. When I informed the GM of the Westin, he took action. When I informed the GM of a famous Beverly Hills Hotel he merely passed my letter on to the chief concierge who phoned to announce that I need expect no further calls from that hotel.

Sick guests often call the operator, so I dialed the hotel.

“Hi, Doctor Oppenheim. It’s been a long time.”

That was a pleasant surprise. The operator explained that she had worked there for twenty years and spoken to me many times. She added that her directory contained no doctor's name. She would be happy to take down my number and pass it around.  

I left feeling pleased with myself because I hardly ever market myself to employees. But that was in August, and the hotel still isn’t calling.

Monday, December 15, 2014

A Glamorous Job

A five-year-old was coughing and congested.

His parents were guests at Loews in Hollywood, nine miles away through city streets. Nineteen miles on the freeway would take less time provided traffic moved smoothly, but this was unlikely at 4 p.m. on a Friday. I told the mother that it sounded like a routine virus, but she insisted the child needed attention.

Sometimes being hotel doctor to the stars is not so glamorous. Then I recalled a pediatrician colleague who had expressed interest in helping out. I phoned his office. He was finishing his last patient and, to my delight, agreed to make the housecall. I was so relieved that I forgot to tell him a few things.

That evening he phoned to let me know the visit had gone well.  

“But it took almost two hours to reach the hotel, and they charged me fifteen dollars to park.”

Thursday, December 11, 2014

Helping a Lady

A guest at Checkers, an upscale downtown hotel, had the flu with a 103 fever. I washed my hands before examining her; afterwards I washed again and included my stethoscope. I’ve had the flu shot, but I still worry about catching it. This happened in 1977 and I remember it as the worst illness of my life until I became old.

I finished just before midnight. Returning to my car, I passed two young women arguing bitterly on the sidewalk. One insisted on walking to their hotel, the other objected because she was wearing high heels.

At my age, no one considers me threatening. As I started the engine, one of the women tapped on my window and asked for a lift. I drove her to the Bonaventure, six blocks away. She had been drinking but was coherent and grateful for the favor.

Sunday, December 7, 2014

Why I Like Foreigners

“Do you take insurance?” asked a Biltmore guest after learning my fee. She was 26 years old and an American.

Hearing that she would have to pay up front and submit my invoice, she decided to wait. She was suffering an upset stomach which would probably clear up in a day. I gave advice and told her to feel free to call.

“Could I have your name and room number?” I asked before hanging up.

“Is that so you can charge me?” she asked.

“Phone calls are free,” I said. “I just need to keep a record.”  

An hour later she called to say she had changed her mind. Could I come?

Her vomiting had stopped but not her nausea and headache. After an exam, I gave her two packets of pills: one for nausea, one for the headache.

“How much are these?” she asked.

“Nothing.” I assured her that she was over the worst of her stomach virus.  

“So it’s a minor problem that will go away. You came, but you didn’t do much for me.”

I agreed that I hadn’t cured her but perhaps I had helped in other ways. I could have mentioned the convenience of a housecall and the medicines I handed over, my long drive to the hotel, and the fact that my fee is less than the going rate. None of this would have worked. I simply expressed satisfaction that she was improving and told her to phone if problems developed.

“And then you’ll come back and charge me again?” she asked.

I explained that I rarely make a second visit for the same problem, but I would try to help.

Wednesday, December 3, 2014

Tempting the God of Housecalls

I was mildly entertained during 45 minutes of the new movie, Interstellar. The physics was wrong, and the politics of its dystopian future defied logic, but the production held my interest.

Then my phone buzzed for a housecall. Theaters will refund my money, but I don’t ask unless the movie has just begun. Admission is cheap compared to my housecall fee, and I can always return. Half the time, I’m happy to leave. When I attend a play or live performance, I ask a colleague to cover but never for a movie, although I sit on the aisle so I can hurry out and answer without disturbing the audience.

Doctors agree that patients call at the most inconvenient time, but I look forward to calls, so I try to persuade the fickle God of Housecalls that I don’t want to be interrupted. Going to a movie or restaurant or the dentist seems to accomplish this. If I have no plans for the afternoon, I may lay down for a nap even if I’m not tired. It’s my hope, often achieved, that the phone will ring as soon as I fall asleep.

I saw the final two hours of Interstellar a week later and remained mildly entertained. I won’t give anything away, but when a Hollywood movie features a conflict between science and love, only one outcome is possible.