Flying and Blood Clots

I hear from travelers who notice puffy legs after a long flight. Some worry about a blood clot, but this almost never causes both legs to swell.

Your heart has no trouble pushing blood to the far end of your body but plays no role afterwards. Blood returns to the heart slowly, squeezed along by surrounding muscles. If you don’t move, it returns even more slowly. In the absence of movement, gravity induces blood to settle in the legs where plasma leaks through the distended veins into surrounding tissue. You can make the diagnosis if pressing a finger makes a visible dent. Veins grow leakier with age, but I see plenty of guests in the prime of life. The swelling should diminish after you begin moving or eliminate the effect of gravity. A night in bed usually helps.

Textbooks list dozens of serious causes “peripheral edema.” I can’t recall a hotel guest who had one, but it’s possible that a traveler with swollen legs may learn that he has heart, kidney, or liver disease and remember that I downplayed its seriousness.

So, my legal advisor insists I warn you not to feel reassured by what I’ve written. It’s just my opinion; you might be dangerously ill. Consult your family physician. Go to an urgent care clinic. Call the hotel doctor.

The Celebrity B12 Franchise

Many singers and celebrities insist on a vitamin injection before a performance. That vitamin is almost always B12 because of (don’t jump to conclusions…) its color. Most drugs resemble water, but B12 is vivid red. Since everyone knows that injections trump pills, the same reasoning suggests that a brightly colored injection works even better.

My B12 experience impresses me with how closely celebrities resemble royalty. Arriving, I approach in stages – passing through rooms containing bodyguards, groupies, publicists, media, dressers. When I finally reach the room containing the celebrity and his intimates, he turns and drops his pants (women hold out an arm). I give the injection and depart. No one makes a move to pay, but I can expect a lesser person to come forward as I retrace my steps.

These requests don’t arrive often, so I wonder who owns the franchise on celebrity B12 shots in Los Angeles. It’s a gold mine. I also carry a vial of B complex – half a dozen B vitamins not including B12. It’s colorless, and I can’t remember anyone requesting it.

The Proper Role of Women Doctors

I was a medical student at NYU shortly after New York became the first state to legalize abortions in 1970. The big change, from a student’s point of view, was that deliveries at Bellevue plummeted. To ensure that we received training in obstetrics, NYU began sending us to Booth Memorial Hospital in Queens which served a middle-class population who wanted children. It was much nicer than Bellevue and the staff obstetricians were congenial.

During NYU’s obstetric rotation, students divided up into teams; mine consisted of me and two women.

One evening after midnight at Booth Memorial we were waiting for a delivery when the legendary Doctor Epstein arrived, an elderly obstetrician with an immense practice who had graduated medical school in 1928. With time on his hands, he gave my companions career advice.

They shouldn’t go into surgery, he warned. Surgeons must stand for hours. Being prone to varicose veins, women cannot tolerate that. He suggested anesthesiology because it’s so boring. Women are better at boring stuff. Since women have a natural love of children they couldn’t go wrong with pediatrics or child psychiatry.

This being a prefeminist era, the women were more amused than offended. But both went into pediatrics.       

A Few Celebrities

A famous actor at the Four Seasons showed me a pimple on his eyelid. This was a sty, I explained, a blocked gland. It wasn’t serious. There was no treatment except hot compresses. It would go away in a week or so.

He needed it to go quickly, he said. He had a television interview the following day. A previous doctor had stuck a needle into an earlier sty, and he’d be grateful if I did the same. He endured it stoically.

“You wouldn’t have any Oxycontin?” asked a guest. He was consulting me for a rash.

“I’m the doctor you call when you feel sick,” I said. “For Oxycontin you need a different sort of doctor.”

We parted on good terms. My refusal did not offend him; from his point of view there was no harm in making the request.

It’s wrong to divide celebrities into upstanding citizens and the drug-addled exceptions. They are a cross-section. Many work hard at their careers but enjoy the occasional drug if it’s available, and they move in circles where scoring requires only a modest effort. Wrecking your life with drugs, as with alcohol, takes persistence.  

Flying and Your Ears

Flying doesn’t cause ear infections, but getting on a plane if you’re stuffy can end painfully. My records show only a few dozen visits for ear pain because I handle most over the phone. If a guest felt fine before boarding, pain that begins afterward generally disappears after a few days, but it’s an unpleasant experience.

Before beginning this entry, I googled “ear pain on flying.” Internet medical advice is unreliable, and even reputable sites such as the Mayo Clinic and WebMD solemnly recommend feeble preventatives such as antihistamines and drinking fluids plus dangerous ones such pinching your nose and blowing (they warn you to do it “gently”). All deliver traditional advice: chew gum, suck on hard candy, yawn frequently, take oral decongestants. Traditional advice sometimes works but never dramatically.

The best preventative is a straightforward, chemical nasal spray (Afrin, Dristan, Sinex). When you’re sitting the plane before takeoff, spray, wait five minutes for it to work, and spray again. That sends the spray far up your nose to, hopefully, reach the eustachian tube opening, the only connection between your middle ear and the outside world. If the flight lasts more than a few hours, do the same before the plane begins its descent, an hour before landing. I give the same advice when guests call afterward. It’s not as effective then, but waiting works.

Doctor Oppenheim's Screenplay

During the 1990s, I was called to the Bel Air hotel to care for a screenwriter working for Francis Ford Coppola. Chatting before I left, I revealed that I was a full-time hotel doctor.

“I bet you have great stories,” he said.

“Well…. As a matter of fact…”

At his urging, I mailed him a screenplay.

Does this surprise you? I work in Los Angeles. Why shouldn’t I write screenplays? Everyone else does.

I was reminded of this incident because my mail recently included a short story I’d submitted to the New Yorker. Across the inevitable rejection slip was a handwritten scrawl “great read but not quite...” That produced a surge of pleasure, but there is less there than meets the eye. Although the preprinted rejection is signed “the editors,” no New Yorker editor reads stories as they pour in, thousands per month. All are screened by low paid young English majors, happy to be on the first rung of the journalism ladder. They pass a minuscule handful on to editors who choose one or two for each issue.

I’m proud to have caught the eye of an overworked reader at America’s premier market for short stories, but there is no telling who will read my next submission. Even if it were the same person, she would not remember me, having read hundreds in the interval. Nevertheless, that rejection marks the highlight of my literary career since 2010. The highlight that year was an actual publication, but it was in the Wisconsin Literary Review. You won’t find it on the newsstand.

Everyone who learns I’m a hotel doctor urges me to write my memoirs, so I wrote them. I wrote a novel about a hotel doctor. I even wrote a proposal for a TV pilot featuring a Los Angeles hotel doctor. All those are, as we say in the business, making the rounds. The TV hotel doctor is not entirely based on me because, among his amusing quirks, he cannot resist extolling his screenplays to sick celebrities. I never do that. The writer mentioned above took the lead.

You may be curious for the upshot. He never replied.  

The Law

A Finnish man with a fever was staying in a Hollywood Hotel. Treating flu symptoms is rarely satisfying, but I was pleased to learn that he was taking nothing for the fever. I handed over some Tylenol, and when I called back that evening he felt better. 

The following day was July 4. Hotel doctors look forward to holidays because freeway traffic is lighter. Sadly, no calls arrived. None arrived the day following or the day after that.

Deep down, no one believes in the law of averages. If you flip a coin heads ten times in a row, that’s not a fluke but as likely as any other combination. And the odds that the next flip will be heads remains fifty/fifty. It’s guaranteed that someone will win the lottery, but the winner always credits God. After several days with a silent phone, I conjure up images of a rival sweeping up my hotels with irresistible charm or fifty-dollar bills. But calls resumed

Against Medical Advice

A friend has had his gall bladder removed. He’s recovered, and you’ve agreed to drive him home. He is dressed and ready when you arrive. Hospital rules require the surgeon to examine him and approve the discharge, but after two hours the surgeon has not appeared. When asked, the nurse says he has been delayed. Asked an hour later, the nurse admits that no one knows where he is. They must wait.

An hour later, the exasperated friend announces that he will leave. You can’t do that says the nurse. If you do, you must sign this. She produces an impressive document that relieves the hospital of responsibility and lists terrible things that might happen when the signer leaves Against Medical Advice.

“Another thing,” adds the nurse. “If the doctor doesn’t sign the discharge, your insurance won’t pay.” Naturally, your friend decides to stay.

This happens all the time, but it’s nonsense.

First, you don’t have to sign an Against Medical Advice form. You can just leave.

Second, according to surveys, almost all doctors and nurses believe that medical insurance doesn’t pay if a patient leaves AMA, but it’s not true. Insurance pays.

Surveys also show that patients who leave AMA have a much higher rate of complication and readmission. Generally, it’s not a good idea. But, except for certain psychiatric cases, hospitals have no legal right to keep you.