Goodbye to the Shangri-La

“I’m not calling for a guest,” explained a desk clerk from the Shangri-La in Santa Monica. “I have a question…. In your arrangement with hotels, do you ever pay anything when we call?”

“That’s illegal,” I said. “I’m happy to give employees free medical care, but it’s against the law for a doctor to pay to get a patient.”

“Is that so? Are you sure?”

“Google it. It’s called a referral fee; it’s unethical and also against the law in California. If you use a doctor who’s breaking one law, what other laws might he break?....”  

“Oh, this is just for our own information. I appreciate your help, doctor. Thanks.”

Goodbye to the Shangri-La, I said to myself after she hung up. I’ve been going there since 1985, but the Shangri-La is not large. Since I give plenty of free phone advice, months may pass before I make an appearance, so most employees have never seen me. I don’t market myself, and most general managers leave the choice of a doctor up to the employee, so I regularly lose hotels when a competitor offers his services with the promise of a referral fee.

Sometimes, often years later, they return. Google “Doctor Jules M. Lusman.” He took a number of hotels away from me, but I regained them.    

Caring For a Physician

Having a doctor as a patient is stressful. They often suggest their diagnosis, and it’s awkward if I disagree. When I make a housecall, American doctors sometimes hint that I shouldn’t charge them.

This patient was an anesthesiologist, a good thing because he almost wasn’t a doctor at all – i.e. he’d long since forgotten how to deal with illnesses. He was foreign, another good thing. And he was Danish: the best sort of foreigner because Scandinavians speak good English. 

He had a headache and a 101 degree fever but no respiratory symptoms. I diagnosed a viral infection, perhaps even Dengue fever because he had flown in from the South Pacific. He did not object to taking pain medicine and waiting, and he recovered after a few days.

More Unsatisfied Guests

The son of two Viceroy guests was suffering a severe sore throat and fever.

I drove off in a good mood because it sounded like an easy visit. This combination often indicates “strep” which an antibiotic cures. Patients like that, so I like it, too.

In fact, sore throat and fever in a grown-up is usually a simple viral infection, my least favorite illness. Strep is overwhelmingly a disease of children and adolescents, but this patient was fourteen, so my hopes were high.

They were dashed when the boy admitted that he had a cough. Strep is strictly a throat infection; coughing is not part of the picture. Sure enough, his throat looked normal.

Rummaging thoughtfully in my bag, I pulled out a packet of acetaminophen (Tylenol), handed it to the parents, and explained that this would help his fever. I extracted a plastic bottle of Lidocaine, a gargle intended to relieve his throat pain. I gave them a cough medicine is similar to the popular Robitussin but in an immense eight-ounce bottle.

I assured them that bed rest would not help, so he should try to enjoy himself. He could eat whatever he wanted. But it was likely that he’d feel under the weather for a few days before recovering.

The parents seemed happy to receive the medicine. They expressed gratitude for my service, and thanked me effusively as I left, but I knew that this was mostly good manners.  They were on vacation. The doctor had come, given some not-very-powerful medicine, and told them the child would continue to be sick. Did the doctor realize how important this trip was to them? Maybe if he had tried harder…. Or if they’d called a better one…. 

Not a Bad Job

Awakened at night, most hotel doctors prefer to give advice, and, if that fails, they discover that the guest requires the paramedics.

I don’t mind wee-hour calls. Traffic is light, parking is easy, and since I have no office, I can sleep late. With TIVO, I can leave whatever television show I’m watching. I don’t mind calls during meals, even restaurant meals, because finishing doesn’t take much time. Calls during a movie are problematic although I’m happy to leave at least half the time. If the call arrives soon after the credits, I ask for a refund, and no one has yet refused. I credit much of my success as a hotel doctor to the rarity of occasions where I’m reluctant to make a visit.

Mostly, I dislike driving during the rush hour. Hotels between Beverly Hills and the ocean are close enough to be tolerable, but traveling downtown or further is tedious. Mostly, guests are willing to wait a few hours provided they are not vomiting or hurting.

Two For the Price of Two

An insurance service informed me that two sick children awaited in Orange. It’s a rule that if one child is sick, there’s a small chance it’s serious; for two children, never. They almost always have a simple virus.

The major difficulty was the distance, nearly fifty miles, and the fact that my wife was preparing dinner. To my delight she offered to delay it and accompany me on the visit, something she rarely does. We had a pleasant hour’s drive to Orange where I cared for two children with a simple virus, and we ate dinner at the hotel.

Lost in Translation, Part 3

“I am constipated.”

“’Constipation’ means different things to different people. What exactly bothers you?”

Silence…. When a caller doesn’t answer, it usually means he doesn’t understand.

“Do you have pain?”

Silence.  I knew the word for pain in French is ‘douleur.’

“Pain….douleur?”

“Yes.”

“So you have pain in the abdomen.”

“Yes,” he answered without conviction. He made it clear he wanted a visit, so I quoted my fee (“yes”) and made the trip.

Half of my hotel guests are foreign, but usually one person in the group speaks enough English to get along. Men do better than women. Guests from Asia cause the most trouble. South Americans are the easiest because every hotel has Hispanic workers. I can’t remember the last time I drew a blank from a European male.

“When was your last bowel movement?”

Incomprehension. The wife handed me an Ipad with a translation app. I typed “bowel movement” and the screen obligingly displayed “movement de l’intestine.” Even I knew that this meant “movement of the intestine” in French. He looked blank.

He had no fever, and my examination of his abdomen was normal. His urinalysis was unremarkable. He wasn’t old enough to be at risk for the many abdominal catastrophes that affect the elderly. I concluded that it wasn’t an urgent problem. He seemed to understand that he should go to the hospital if he weren’t better in a few hours. The hotel promised to keep an eye on him. Everything worked out.

A Stoic Patient

This patient lived on the edge of Beverly Hills, far up Topanga Canyon Road. Turning into a side street, I stopped at a guard house. It was not impressive – a tiny shack next to a commercial port-a-potty, but a genuine uniformed guard asked my business. According to Google, the street beyond held only a dozen houses, but they were big. Really big.

Following the lady who greeted me at the door, I walked and walked, passing through room after room with polished wooden floors, high ceilings, exquisite furnishings, bookshelves and paintings lining the walls. Movie stars and Arab princes live in such places. Visit Hearst’s Castle to share the experience.

But sick people are just sick. A lady was suffering excruciating right eye pain. She hadn’t injured it. My diagnosis was acute glaucoma, an emergency.

You may know about glaucoma, a disease where fluid drainage from the eye is blocked, increasing pressure, eventually causing blindness. Experts advise you to have a yearly check, but this is for common, chronic glaucoma where pressure rises slowly, so doctors can make an early diagnosis and treat it with eye drops. It’s painless. Acute glaucoma, where drainage stops abruptly, is rare and very painful.

This was not news to the patient who explained that many family members were blind from the disease. She agreed to go to UCLA’s emergency room but asked for something to help her vomiting; severe pain often causes vomiting. I gave an injection and took my leave.

Phoning the next day, I was flabbergasted to learn she had stayed home. She didn’t want to travel because of the vomiting, she explained. By evening it had diminished, but so had the pain. She decided to wait. She had an appointment at the ophthalmologist for the afternoon.