Wednesday, February 25, 2015

A Miracle

The sales manager of the Hyatt Regency was preparing to address a convention when her head turned to the right and stuck.

I had no idea what to do. Her head seemed immovable. She was in perfect health. Hysterical conversion was a possibility, but I was too polite to mention it.

The consultation took place in an alcove off the hotel’s main ballroom. I could hear the crowd murmur. Inside gathered half a dozen worried employees including the general manager who had phoned another hotel to get my name. Failure in this situation would be distressing. The sales manager vehemently denied feeling upset, and I had no reason to doubt her.

“Did you do anything recently you don’t ordinarily do?” I asked, grasping at straws.

She considered then admitted she had felt queasy an hour earlier and taken a pill a colleague had offered. It was Compazine, a common nausea treatment.

That meant nothing. Then it did. I could barely contain my exhilaration. Phenothiazine drugs - Compazine, Thorazine - occasionally cause a weird dystonic muscle spasm. It’s so rare most doctors never see one, but I remember a case that arrived when I was hanging out at the Bellevue emergency room as a first year medical student in 1969. In that incident, the patient’s tongue stuck out, and he insisted he couldn’t retract it. The residents confidently diagnosed hysteria, and it took a while before they changed their mind. Treatment is the familiar antihistamine, Benadryl.

I carry Benadryl. Within minutes of the injection, her head came unstuck. Everyone was delighted.       

Saturday, February 21, 2015

A Serious Liability

After shaving, a guest at the Ramada in Beverly Hills reached for a hairbrush and struck his nose on a clothes hook with enough force to bring tears to his eyes and blood to his nose. He noticed that the hook had been installed at nose level -- clearly a poor design decision and dangerous. A hotel that tolerated such an unsafe condition was irresponsible and perhaps legally liable. The guest was, of course, a lawyer.

As I entered the general manager’s office, the guest interrupted a harangue as we exchanged introductions.

This was awkward. My sole obligation is to my patient, but it was obvious the manager wanted help in fending off the furious guest. When I suggested privacy for our consultation the guest told me to take care of things on the spot.

Young doctors love to blurt out a diagnosis as soon as the patient walks through the door (which is possible more often than you think). Not only do patients find this offensive, they don’t believe it, so doctors learn to give the impression they are thinking deeply before announcing an opinion.

I examined the nose from several angles. I carefully palpated it. I pulled out my otoscope and peered up his nostrils. Finally I announced that he had suffered a nasal contusion that, fortunately, had done no harm. He needed no X-ray, no treatment. He could go about his business.

According to the law, a person has no grounds to sue unless he has suffered damage, but any competent lawyer can discover damage in any situation. I doubt visions of profit had brought him to the manager’s office. He was upset at his pain and wanted sympathy. The manager had offered to comp the guest’s bill but had maintained his dignity when a humble apology would have worked better.

Still fuming, the guest asked my opinion of the public health hazard in installing clothes hooks at precisely nose level. I agreed the matter deserved attention but pointed out that noses come at many levels.

Tuesday, February 17, 2015

I Save a Life

After apologizing for waking me, the caller explained that his companion couldn’t sleep because she felt short of breath. Shortness of breath in an otherwise healthy person is either anxiety or a serious matter. The caller added that she was prone to respiratory infections. Maybe she has pneumonia, I thought. I can cure pneumonia.

She didn’t seem in great distress, but she was English, and Britons are not a demonstrative people. She had no fever. Her heart was racing at 180 beats per minute. Listening to her lungs, I heard the crackle of fluid which is audible in pneumonia but also in heart failure. I suspected heart failure. When the heart weakens, blood backs up into the lungs waiting to pass through, so victims have trouble breathing.

Calling paramedics was risky because they might decide she wasn’t sick enough to transport. Leaving after obtaining her promise to go to an ER was not an option because I would worry. If something dreadful happened while she was considering, I was the last doctor she had seen, never a comfortable position. Long experience has convinced me that if guests need to go to a hospital, I must make sure – with my own eyes – that they go. So I drove the couple in my car. Watching them disappear through the emergency entrance made it certain they were now another doctor’s responsibility. 

When I phoned later, the doctor explained that she was suffering rapid atrial fibrillation, an irregular, inefficient cardiac rhythm. He had performed cardioversion – delivering an electric shock to the heart – and she was now in a regular rhythm and feeling better. They were scheduled to fly to Las Vegas the day after my visit, and when I called they had checked out.

Friday, February 13, 2015

The Current Epidemic

When I returned from out of town last week, the colleague who covered had a story.

He had cared for flight attendant in an airport hotel suffering a cough, high fever, runny nose, and sore throat. It seemed like the usual upper respiratory infection until he saw the spotty rash over her body. She had measles.

Does that ring a bell?... Measles may be the world’s most contagious disease. If you’re in a room someone with measles passed through hours earlier, you may catch it.

It’s also nasty. Even today, one or two per thousand victims die and a larger number are left deaf or brain damaged. I grew up before children were vaccinated against childhood illnesses; we actually caught them. I had measles at six and still remember how sick I felt. My chicken pox and mumps were trivial by comparison.

My colleague informed the airline that a flight attendant fresh from a crowded plane had measles; he also alerted hotel management. You can imagine the reception. Being much younger than I, he had been immunized, but he hurried to get another measles shot.

Monday, February 9, 2015

A Finger that Caught Fire

A guest in a hotel restaurant asked a waiter to light her cigarette. When he complied, her forefinger burst into flame. She had recently put on acrylic nails, and the fresh cement is very flammable. 

Drunk and enraged, the guest refused to go to an emergency room. By the time I appeared, she had grown tired of hurling abuse. Head resting on the table, she was sobbing. Spilled drinks and broken glass littered the area.

Security officers had cleared out the bar. Near the entrance, a crowd of clerks, patrons, and the night manager parted to allow my passage. Although not a master at handling drunks, I understood the soothing effect of an old man with a grey beard and carrying a doctor’s bag.

Patting her shoulder until she looked up, I introduced myself and suggested we go to her room. After dressing the burn, I stayed long enough for her pain to give way to the effects of alcohol, and I could assure everyone she would cause no more trouble.

Thursday, February 5, 2015

Paying My Fee

It’s less than the going rate, but no one considers it cheap.

When guests phone, I focus on their problems. Half the time, a housecall isn’t necessary. Once we’ve agreed that I should come, I mention the fee. About ten percent of callers reconsider, but almost no one does so directly. I hear….

“Let me talk to my husband and get back to you.”

“Our tour leaves in half an hour. I’ll call when we’re back and set up the appointment.”

“I’m going to try to ride this out, but I’ll let you know.”

“I need to check with my insurance.”

All doctors maintain that they never turn away a patient unable to pay. This is not an actual lie - provided we’re the ones who decide.

I’m generous with guests from motels and youth hostels who are clearly not affluent, but plenty of callers are paying a hotel bill well in excess of mine. They object to my fee just as they hesitate at $5.00 coffee at Starbucks or $200 for an orchestra seat at a hit play. They know that $1.00 coffee at McDonald's or a $50 balcony seat provides a similar experience, more or less. I direct them to urgent-care clinics that accomplish this.

Monday, February 2, 2015

Hotel Doctor to the Stars

An agent has expressed interest in my memoirs.

You don’t think I have memoirs?... I’ve been hotel doctoring for over thirty years, and I had literary ambitions long before.

My book proposal has been making the rounds for a decade, and agents regularly respond. Our conversation tends to cover the same ground.

“‘Memoirs of a Los Angeles hotel doctor.’ That’s a great idea! It sounds like you’ve seen celebrities.”

“A few.”

“Did you see Michael Jackson?”

“Many hotel doctors saw Michael Jackson.”

“Tell me about him.”

“Doctors can’t do that.”

I’m beginning to think agents don’t like to hear that my memoirs don’t discuss famous people who consulted me, including those who’ve died. It’s correct that you can’t libel the dead, but you can anger surviving loved-ones; they’ve been known to sue. 

My book proposal continues to make the rounds, but it’s possible that readers of this blog will be my only audience. I add to it every few days, and when no stories come to mind, I dip into my memoirs.