Why You Get Sick, Part 2

You do get sick because:

        1.  No one is perfect.  The healthiest human is full of clumsy design defects.  Our back muscles are too weak, so even normal activity can injure them.  Human veins are too flabby to resist a normal blood pressure; that’s why we get hemorrhoids and varicose veins.  Roughage may be good for you, but humans can’t digest some carbohydrates.  That’s why a high fiber diet causes gas.

        2.  Your “resistance” is too strong.  Don’t blame a fever on that infection you caught.  Your body itself generates extra heat whenever an invader is present.  Some experts claim fever is good for you, but the evidence is thin.

        The human immune system is too strong for its own good - and trigger happy!  Allergies occur when it tries to defend you against an innocent pollen, drug, or food.  Even worse, it may decide one of your own organs is the enemy.  Thyroiditis, the most common cause of thyroid deficiency, is an “autoimmune” disease.  An overactive immune system may also assault the heart (rheumatic fever), liver (autoimmune hepatitis), kidney (glomerulonephritis), joints (rheumatoid arthritis), or skin (eczema, hives).

        3.  Nature plays no favorites.  It assumes germs and viruses have as much right to exist as you.  Catching the flu, for example, is not a sign of weakness.  Most healthy people exposed to a new flu virus get sick.  Then they recover, but this is not a defeat for the virus.  Multiplying during the illness, many escape into the air to infect others.  The flu virus normally infects a victim for a week or so, then moves on.  That’s the role it plays in nature.  Your role is to get the flu now and then.

        Medical science works to give humans an advantage in this competition, and we’ve done pretty well.  But nature is impartial.

Why You Get Sick

When I walk into a hotel room, guests often tell me why they fell ill. They also blame themselves. In both cases they’re usually wrong.

You don’t get sick because:

        1.  Your “resistance” is low.  You got that cold because another person gave it to you.  If it’s your fifth cold of the year, this is a sign of what we in the medical profession call bad luck.  It’s not a defect in your immune system.  People with poor resistance suffer terrible diseases.  There is no immune defect that gives victims too many minor infections.

        2.  Your diet is missing something.  Americans suffer plenty of nutrition-related ailments, but most result from too much rather than too little of some element.  Examples are obesity, high blood pressure, coronary artery disease, and tooth decay.

        3.  You don’t get enough (sleep, exercise, water, leisure).  Researchers have proved beyond a doubt that lack of sleep makes you sleepy.  Subjects kept awake for days become very drowsy.  They don’t get sick.  Exercise improves your sense of well-being and strengthens muscle and bone, and it probably slows osteoporosis.  Vigorous, long-term activity may protect against coronary artery disease and prolong life.  Among younger people, sloth is not responsible for any disease.  Drinking x glasses of water a day is a harmless folk remedy. Doctors often suggest it to prevent bladder infections, but that’s common sense (i.e. it sounds good, but there’s no evidence that it works).   

The Time I Didn't Care for Woody Allen

“Woody Allen needs a doctor. How quickly can you get here?” The caller was the concierge from the J.W. Marriott.

                                                                                                                 

“Ten minutes,” I replied. The J.W. Marriott was in Century City, near Beverly Hills, a five minute drive.

“I don’t know….” She seemed doubtful. “I guess you should come.”

That sounded strange. How many doctors would appear at your door that quickly…? I threw on my suit and raced to my car. Turning into the hotel entrance drive, I encountered a sight that made my heart sink: a paramedic ambulance.

                                                                                                                 

“We couldn’t wait,” the concierge called out as I hurried past. There was still a chance. Most 911 calls are not emergencies. Long ago, paramedics declined to transport anyone who didn’t seem seriously ill. Sadly, they were burned in several cases when someone died after they left. Thereafter, their refusal rate plummeted, but I never lost hope.

Leaving the elevator, I headed for the inevitable crowd. As I approached, it parted providing a fleeting glimpse of Woody Allen rolling past on a gurney. I returned home, disappointed and unpaid.

                                                                                                                 

My experience with movie stars is that their screen personality owes much to reality, so I theorized that he had suffered an anxiety attack. Agitated guests make hotel employees nervous, so they’re quick to call paramedics, but this is overkill. I have a soothing manner, white hair, and a white beard (less white when I saw Woody Allen in 1993). Once I arrive and settle into a chair, I rarely fail to calm a panicky guest. Phoned in the middle of the night, I do the same without getting out of bed. Woody Allen should have waited for me.

Having the Proper Credentials

A Brazilian woman suffered abdominal pain, but her doctor in Rio found nothing wrong. It went away, so she flew to the US where it recurred.

Her host lived in the Hollywood Hills and spoke excellent English. She may have been a show business personality because her walls were covered with celebrity photographs and posters. After examining the guest, I explained that she needed a further evaluation, perhaps including an ultrasound, because one possible diagnosis was gallstones.

Her host spoke up. “You are ordering an ultrasound? Where must we go?”

I explained that I wasn’t ordering an ultrasound but referring her to a doctor who could do whatever tests were necessary. I added that my next step was to go home, fax my report to the insurer’s American office in Miami, and follow it up with a call to alert the dispatcher. He would phone doctors in Los Angeles, preferably the ones I recommended, until he found one willing to accept the Brazilian insurance and then call her. It might take a few hours.

“I have a fax machine. Why not do it now?”

I didn’t know the insurer’s fax number. It was at home.

“Then I will call.” Examining her guest’s insurance papers, she found a phone number, but it looked foreign. As she dialed, I warned that the Brazilian office probably didn’t handle referrals, but she waved me off. 

There followed a long conversation in Portuguese. Afterward, she explained that she had laid out the problem. They promised to get back to her.

I returned home, faxed my report, and called the Miami office. Before I could report back to the Brazilian lady, she called me.

“What is your license number?” she asked.

“Why do you want that?”

“Brazil never called, so we came to Cedars-Sinai. The ultrasound department needs your license for the test.”

“Don’t do that!” I said. “The first step is to see a specialist. And the test will be very expensive unless the insurance approves.”

I phoned the Miami office to urge them to settle matters with Cedars-Sinai. Within minutes my phone rang. It was the Brazilian lady again.

“There is something serious…. Cedars-Sinai has no record of you.”

“I’m not on their staff.”

“They cannot find your name. I am very disturbed.”

I assured her I was a real doctor.

“How do I know that? When I called for a doctor, you came in an hour.”

She could Google me, I suggested.

I phoned Miami to warn that the patient had gone to Cedars. The dispatcher delivered equally bad news. He had phoned Brazil to obtain approval for the expense. Unfortunately, the Brazilian office had had an earful from the Brazilian host who emphasized her friend’s past suffering. This provided an irresistible excuse to claim a pre-existing condition and deny approval. 

After hearing this news, the patient and her host went home. I warned that she still needed an evaluation and offered to refer her to a colleague. The Brazilian host remained polite but informed me that the next doctor she consulted would have to have better credentials.

Long Time No See

 Hey, Doctor! It’s been a while.”

I love it when parking valets recognize me. That was the good news. The ‘it’s been a while’ was not so good. This was my first visit of the year to Le Parc, an upscale West Hollywood hotel. It was once a regular, calling 20 to 40 times per year since 1993.

Hotel doctoring is viciously competitive, and another doctor had worked his magic. But hope springs eternal; hotels occasionally realize their mistake and return to the fold. Maybe this was a sign.

The guest had injured her leg five days earlier. X-rays in an emergency room were negative, but since yesterday her pain had worsened. I didn’t find anything abnormal except for a huge black-and-blue mark. This may have been normal healing, but she needed another X-ray.

“Doctor O! How’s business!” The desk clerk also recognized me. When I ask why a hotel has stopped calling, employees always respond that no one has been sick, so I’ve stopped asking. But I couldn’t resist. The desk clerk assured me that no one had been sick.

Not Being a Bad Person

On a plane returning to Los Angeles, a flight attendant asked if a doctor were on board. Reluctantly, I raised my hand.

Walking up the aisle, I relieved my fears by recalling that hotel employees who tell me a guest is seriously ill are usually wrong. 

The passenger complained of a tight chest and difficulty breathing. He was forty with no medical problems, and his only medication was a tranquilizer which he didn’t have. He had no objection to my diagnosis of anxiety attack; he’d had them before. I reassured him and reassured the flight attendant that he’d be OK until the plane arrived. This turned out to be true.

Hearing the story, my wife said that she expected no less of me because I’m a caring, compassionate doctor. She often says things like that.

In fact, I raised my hand because I believe that a physician asked for help has a moral obligation to respond. If he doesn’t, he’s a bad person. Responding did not make me feel good, but not responding would feel worse.

Plenty of doctors keep quiet under those circumstances and comfort themselves with excellent reasons. It was unlikely that I could handle a genuine emergency. I haven’t performed CPR in decades; in any case doing so in that packed cabin was impossible. Standing by helplessly would make me look foolish. Doctors hate that. The passenger might sue. This has happened. You’ve probably heard of the “good Samaritan” law, but any competent lawyer can find a reason it doesn’t apply.

More Easy Visits

“A bee stung my wife. That was two days ago, but today it’s more swollen.”

I explained that bee stings usually get worse for 48 hours before they improve.

“We catch a plane tomorrow, so we’d like to see a doctor.”

Before I left, the phone rang again. A man’s ears had become plugged when his plane descended the previous day. He worried about an infection. I explained that pressure changes while flying don’t cause infections, and the discomfort often persists for a day or two. I suggested a decongestant, but he wanted someone to look in his ears.

A visit from the hotel doctor is not cheap, and I’m liberal with phone advice. Only about half my calls turn into a visit. Now and then I have the delightful experience of making a housecall because the guest wants one despite my assurance that it’s not necessary. In this blog, I’ve recounted occasions where what seemed like a no-brainer turned out to be no such thing. That rarely happens, and it didn’t happen this time.

The bee sting turned out to be a bee sting, and the guest’s ears looked normal. Sometimes hotel doctoring is a snap.