A Big Tipper

Le Meredien in Beverly Hills has a firm policy against recommending a doctor. This does not mean that it never calls, only that a call from Le Meredien means a guest making trouble, and the harassed employee has chosen Doctor Oppenheim as the lesser of two evils, the greater being burdening his boss with the problem.

 “I’m here to see the gentleman in 499,” I informed the concierge. “Is there anything I should know?” 

She made a show of checking her computer. “That would be Prince Mahmel. He’s been asking for a doctor. Repeatedly. The Saudi consulate had your number.” 

Concealing my pleasure at that news, I thanked her and headed for the elevator. 499 stood at the end of the hall, the largest suite on the floor. Its door stood open. Knocking and then pushing it further, I encountered the smell of alcohol, never a good sign when the patient is Moslem. No one was in sight, but a doorway led to the bedroom and the prince, a small figure in a huge bed, covers drawn up to his chin. Balding and past forty, his disheveled hair was the single unkempt feature, and a goatee the only evidence of his foreignness

“Pain. Terrible pain,” he announced loudly.

“Where is the pain, Mr. Mahmel?”

“Kidney. I have kidney stones in my kidney.” He threw the covers to one side and pointed to his right flank. “My doctor prescribes Dihydroco, but I have no more.”

“That’s not a drug I’m familiar with.”

“It is from London. I live in London.”

“Do you just need a prescription?”

“Also a shot. The pain is unbearable.”

I examined the prince and tested his urine for blood. Everything was normal but this can happen with a kidney stone. I thumped his back over his kidneys, and he groaned. I was not convinced. Le Meredien wasn’t a potential client, so I could expect no advantage from pacifying the prince, and no damage from a complaint.

“I’ll give you a Toradol injection.” An excellent pain remedy, Toradol is similar to ibuprofen but probably not what he expected.

“Many thanks.”

Any doubt about the prince’s drug consumption vanished when my needle jerked to a halt half an inch beneath the skin. Fibrosis from hundreds of injections had given the prince’s buttock muscle the consistency of wood. I forced the syringe down and delivered the injection. Anticipating the pleasures ahead, the prince clutched my hand in gratitude.

Yanking open the drawer of the bedside table which turned out to be stuffed with hundred dollar bills, he snatched a handful and pushed them into my grasp.

Grateful the prince had forgotten his request for a prescription, I thanked him and hurried out. Later I counted fourteen bills. I gave them to my wife who bought a Chinese rug for our living room.

A Better Shot

 “Is he a VIP?”

“All our citizens are VIPs” said the consul for Qatar, referring to a countryman at the Airport Hilton.

Sick guests from small nations often call the local consul. Asked to find a doctor, he usually phones the hotel.

Once a consul has my number, he tends to remember it, so these calls are good news. On the other hand, guests who phone the consul feel worse than usual.

A woman in a headscarf answered door, and indicated a young man, curled up in bed. It was their honeymoon. Back pain is usually an easy visit from my point of view. Most acute backs are not so bad after the first day, and they steadily improve.

Unfortunately, this was not the first day. Pain had come on three days earlier in Las Vegas. A hotel doctor had dispensed the usual remedies, and pain had diminished only to return the following day.

I delivered the largest injection and strongest pills in my possession, adding that he would need more evaluation if this didn’t work.

At midnight, he phoned to say that he had improved, but now pain made it difficult to sleep. He agreed to go to an ER but wanted to wait until morning. There was no answer when I called that morning or that afternoon.

The ER doctor had performed the usual tests and then given a shot, the guest said that evening, but it was not as good as mine. Desperate to return home, he had booked a flight. Would I give another shot before he checked out?

So I did. Handing over a business card, he urged me to visit if I came to Qatar. Then, supported by the wife and a cane, he hobbled off.

A Good Call

A singer felt a sore throat coming on, his manager explained. He needed a shot of cortisone. I’ve given many; singers seem to think they work, and they’re harmless.

These are good calls. I drive to a hotel, give an injection, collect money, and return home. What’s not to like?

The manager added that the singer would need his shot the day of his performance the following Saturday. Early Saturday he phoned to inform me that the singer was free at midday. He would call to give an hour’s notice. Midday passed without a call.

As I prepared for dinner at six p.m. the manager phoned to announce that his client was ready. But there was a hitch. The singer was not in Los Angeles but at a resort hotel in La Puente thirty-five miles away. Although weekend freeways are usually fast, this trip took an hour. The resort was hosting an event called The Urban Music Festival; it was packed with black people, the women in dazzling gowns, the men dressed as gangsters.

No one answered when I knocked on the singer’s door. I phoned the singer’s manager and heard voicemail. I paced the hall for fifteen minutes, knocking and phoning now and then. I checked with the concierge who obligingly offered to call the room.

My phone rang as I was driving off. I retraced my steps to the room, now packed with the singer’s colorful entourage. I gave the shot, collected my money, and returned home to supper.

Shots Guests Need and Shots They Request

Long ago a man phoned to inform me that he was on his honeymoon and would like a shot of testosterone. I explained that this was unlikely to solve his problem. 

He did not want to leave any stone unturned, and I’m happy to make a housecall to deliver a harmless injection, but I couldn’t because I didn’t carry testosterone. I bought some on my next drug order. Sadly, I never received another request. I discarded the vial after it expired and never replaced it.

Also long ago, a woman whose hot flashes were acting up asked for an estrogen injection. I explained that pills work as well, but she was willing to pay for an injection which I couldn’t provide. I ordered estrogen, but no one has asked for it since.

I carry two sorts of medication: those guests need and those they ask for. The second category is tricky as these examples illustrate. Another: bereaved guests or those in great emotional distress often beg for a shot to “put them out.” Unfortunately, although movie doctors use it regularly, there is no injection that makes you go to sleep.

B12 remains a hotel doctor’s only reliable moneymaking placebo. I’ve never encountered an illness that required it, but requests arrive several times a year. Celebrities often ask for an injection before a performance, always a thrill.

Another Shot Request

The guest had the medicine and syringes; all I had to do was draw it up give the injection. The drug was a blood thinner she needed after hip surgery, so it was a legitimate request (some guests, usually from third world nations, arrive with weird stuff).

Giving a shot is easy, but most guests don’t want to pay my fee. Long ago, I explained that a hotel doctor spends ninety percent of his time driving and parking, so delivering a shot takes as long as other routine visits. This never convinced anyone, so I offer a discount.    

It’s a mystery to me why doctors prescribe injections and then – hearing that the patient is traveling – advise them to find a doctor or nurse to administer it. A nurse won’t give an injection without a doctor’s order, and most doctors will refuse.

In our suit-happy society, why would a doctor give medicine to someone he’s never seen strictly on the patient’s say-so? As a result, I hear from plenty of guests steaming from frustrating encounters at local clinics. They remain convinced that giving a shot shouldn’t cost much, so these are not visits that produce much gratitude.   

Irritating Things that Movie Doctors Do

Give miracle shots. Whenever a movie character is crazy or really upset, a doctor delivers a shot that calms him. I wish I knew what it contained… Movie doctors are always putting characters to sleep, but no shot does that. An anesthetic delivered intravenously makes you unconscious, but that’s dangerous outside an operating room as Michael Jackson’s doctor learned.

Livesaving pills. I see this less often today, but in older movies a character would suddenly be dying. He wouldn’t have “his pills.” Everyone would look frantically for “his pills.” Someone would find them. He would take one and recover. I can’t think what disease does that.

Movie doctors are always saying “You have six months to live.”  We can predict average life expectancy for a fatal disease by tracking a few hundred victims, but that’s meaningless for an individual who could live a week or years.

“Tests show that you have incurable cancer.” Movie doctors who say this are never portrayed as incompetent, although they are. Delivering bad news is a skill no different from diagnosing a heart murmur. A movie buff will explain that the screenwriter can’t spend the time required for a realistic interchange, and I agree on the problem. But here’s the solution: a better writer. A bad writer uses these dumb shortcuts.

“You need plenty of rest and absolute calm.” This is so Victorian…. Bed rest is wildly unhealthy. Bones dissolve. Blood clots. The bowel falls silent. Today patients are dragged out of bed a day or two after major surgery. Doctors once believed that excitement damaged the heart. Intense emotion might cause a heart attack, so people with heart disease should stay calm. We don’t believe that anymore.

"I Need a Shot"

Mostly, these callers are wrong, but now and then I hear from a guest undergoing legitimate treatment – usually for infertility – who needs a regular injection. They have the vial in their possession.

Invariably, they told their doctor that they must leave town, and the doctor messed up. He didn’t teach them how to self-inject or (if they recoiled at this) warn that finding someone to give an injection in a strange city guarantees frustration, wasted time, and massive expense.

Hotel doctors are in it for the money. Most guests are not terribly sick, and delivering an injection is only a little easier than the usual visit, so there’s no great reason to give a discount.

A walk-in clinic is less convenient and cheaper but probably futile. The doctor (a G.P. like me) is likely to examine the vial of medicine and say to himself:

1.     This is a medicine I don’t prescribe.

2.     I’m supposed to give it on the patient’s say-so.

3.     If she sues me, (1) and (2) will not help my defense.

If you think a letter from your doctor will change his mind, read my blog post “A Letter from His Doctor.” (April 20, 2016).

Nurses earn less than doctors, but nurses do not give medicine without a doctor’s order. A guest must convince a doctor to order the shot (good luck with that). Then a nursing service will send one of its nurses to give the injection. This will cost more than a hotel doctor’s visit.

If the medicine seems reasonable and being a nice fellow, I give injections free if the guest comes to my house. Don’t depend on that anywhere else. 

Things Guests Ask For That I Can't Provide

“A shot to put her out.”

More than once I’m called when a guest suffers a tragic loss such as the death of a child or spouse. Distressed to witness the misery, family members want me to put her to sleep. This works in the movies, but in real life tranquilizers can’t do more than make someone drowsy. Only a general anesthesia produces sleep. No one except celebrity doctors uses it on a housecall, and you’ve read the headlines describing what happened when Michael Jackson's doctor tried it.

“A note to change my flight.”

Now and then guests call after recovering from an illness and realizing that it’s expensive to replace a cancelled ticket. They offer to pay my fee if I’ll come and write a note, but I don’t like claiming that a patient is sick if he isn’t. My tactic is to fax a note that tells the truth:  “Mr. Jones states that he was ill and unable to travel.” No one has complained, so it might work. 

“A placebo!”

No guest asks for a placebo. What they say is “You absolutely have to give something to make me better!”

In most areas of life, it’s important to tell people what you want, but it’s risky in a medical situation. Doctors want to do the right thing, but they also want you to be happy with the encounter. Don’t tempt them.

I Just Need a Shot

A woman under treatment for infertility needed a progesterone shot every month. She had the vial. Could I send a nurse?...

Why do doctors cheerfully give patients medicine and send them off on their travels? It guarantees a hassle.

I don’t have a nurse, but I quoted $50, drove to the hotel and gave the shot. It was not a short drive, but she wouldn’t have paid my regular fee, and I wasn’t doing anything at the time.

This lady was lucky. In any other city, she would be in for a rude, expensive shock. I do hotel doctoring fulltime. My colleagues have other jobs, and they're not likely to drop what they're doing and make a visit at a discount.

Some guests think they can call a nursing service. Nurses earn less than doctors, but a visit from a nursing service is not cheap. It also won’t happen. A nurse won’t give medicine without a doctor’s order.

Going to a clinic or doctor’s office is not likely to work. In today’s malpractice climate, few doctors will give an injection on a patient’s say-so. Carrying a note is also a crapshoot. As I have recounted more than once, doctors look with deep suspicion on patients who arrive with notes. See my post from April 20.