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.

My Last Bad Check

A guest at the Hyatt had fallen ill and cancelled a flight. He had recovered, but the airline insisted on a doctor’s note before allowing him on board.

Determining if someone is healthy enough to fly usually requires only a few questions, but I do an exam. He delivered a steady patter as I worked, describing himself as a venture capitalist with an exciting but stressful life as he prepared for an important meeting in Japan.

As I composed the note, I saw him writing a check and immediately announced that I accept credit cards.

Apologizing, he told me that it would be a hassle unless payment came out of the company account. Seeing my hesitation, he added that he had credit cards and would give me a number in case there were a problem. He pulled one out and scribbled on my invoice, getting one number wrong. I noticed and made the correction. 

I’ve received a few dozen bad checks but only rarely after 2000 when I began accepting credit cards.

You can imagine my feeling later as I stood watching a teller fiddle at his computer…. and fiddle…. and fiddle… and finally explain that it wasn’t accepting the check.

Naturally, I felt stupid. Single males write almost all bad checks, and this guest fit the pattern.

Now came the tedious process of trying to recover the money which occasionally happens. As I expected, the address and phone number on the check were wrong. Asking the hotel for contact information sometimes helps, but in this case I learned that it must respect the guest’s privacy. The credit card was certainly worthless.

But it wasn’t! When I phoned the computer and entered the numbers, it approved. Some things are hard to explain.

The Occasional Surprise

A travel insurer asked me to see a lady in Mission Hills complaining of high blood pressure.

I drove off confident that this wasn’t her problem because high blood pressure causes no symptoms. Mostly patients are suffering a headache or anxiety or dizziness.

Now and then I’m surprised. In hotel doctoring, surprises are generally unpleasant but not in this case.

She didn’t have high blood pressure, admitted the lady apologetically. She’d lost her thyroid pills and only needed a prescription.

When I learn that a hotel guest needs a legitimate medicine, I phone a pharmacy to replace it, and I don’t charge. Guests with travel insurance don’t call me but their agency’s 800 number. Embarrassed to use insurance for a trivial problem, they lie. Sometimes hotel doctoring is easy.

The Most Difficult Calls

I stopped chopping an onion when the phone rang. A young man at the Airport Hilton was vomiting.

For a hotel doctor, a difficult call refers not to an illness but to traffic conditions. It was four o’clock, so I would drive eight miles both ways during the freeway rush hour, returning hungry and with no dinner prepared. I delay some visits but not for acutely miserable symptoms.

Before I left, the phone rang again. I yearned to hear that it was another airport hotel, but the guest was downtown, fifteen miles in the opposite direction. Worse, she had a migraine, so I couldn’t delay.

Delivering medical care is sometimes challenging. Always challenging and the mark of a seasoned hotel doctor is the ability to remain serene in gridlock.

Certain rules apply. Unless lanes are closed, leaving the freeway for city streets is a bad idea. Another rule is that blocking a lane at any hour stops traffic cold. Steady movement, however slow, is simply a sign of congestion.

“I wonder if there’s an accident,” I thought a dozen times after several minutes of immobility, but I never saw one. So much for rules.

Two housecalls which normally take two hours took four and a half, but I maintained my serenity, sucking on the hard candy I bring along to dull my hunger and listening to a novel on my CD.

"Wow! Hotel Doctors Charge That Much?"

Guests don’t say that. Mostly I hear: “Could I talk to my husband and call you back.…..?”

Unlike the competition, I don’t confine myself to upscale hotels. Plenty of Holiday Inns, Ramadas, and motels call, and I quote fees less than the going rate. Colleagues complain but admit that it’s not a competitive advantage because hotels don’t care what the doctor charges. Still, counting driving time, a hotel visit rarely takes less than an hour, so it’s not cheap.

Helpless in a strange country and forewarned that medical care in America requires vast sums, foreign guests are easier to deal with.

America medical insurance takes a dim view of housecalls. No hotel doctor accepts it, so Americans, already disoriented at finding a doctor willing to make a housecall, learn that they must pay out of their pocket. It’s a shock.

Like all doctors, I like to present myself as a humanitarian, and I often reduce my fee if the guest feels too miserable to leave the room, but mostly, when Americans object, I send them to an urgent care clinic.

Walking through a clinic door costs around $100. While this is much less than a housecall, clinics charge extra for tests, procedures, shots, and supplies, and the patient must find a pharmacy and then pay for the prescription. I don’t charge extra for anything. Telling all this to guests sounds too much like a sales pitch, so I simply send them to a clinic. Insurance might pay part of their bill.

Disappointment

Loews guest was suffering flu symptoms, but mostly he worried about his temperature. I explained that the fever was not an ominous sign. If he wanted to check, he could buy a thermometer. Or I could come to the hotel. He opted for the visit. I told him how much it would cost.

“Oh… I thought it was free,” he said.

I’d heard that before. Your doctor doesn’t answer when you dial, but I do. Naïve guests think I’m downstairs awaiting their call.

He was from Chile. Did he buy travel insurance before coming to the US, I asked. He did. I explained that travel insurance pays for housecalls, and most insurance agencies call me. However, he must phone the insurance first to obtain approval. He promised to do so. 

Half an hour later my phone rang. It wasn’t Loews but the Doubletree. An elderly man had undergone electrical cardioversion for atrial fibrillation – an irregular heartbeat – a month earlier, and he was worried. His heart didn’t feel right. I asked him to count his beats; he counted 80 per minute. That is not particularly fast. I assured him that he wasn’t describing anything dangerous. He wanted me to check him.

These are the best visits. A guest is worried, and I’m already convinced that there’s nothing to worry about. Sure enough, the exam was normal. He was delighted at the news, and I was delighted to deliver it. Everyone was happy.

I was even more delighted to drive to the Doubletree because it’s only a few blocks from Loews. At any minute, I expected a call from the Loews guest’s insurance agency for another easy visit. But it never came.

My Career as a Diet Doctor

Long before taking up hotel doctoring, I answered an ad from a physician who offered “weight control.”

Every era has a weight loss miracle. During the 1970s it was human chorionic gonadotropin, HCG, a respectable hormone involved in reproduction. There were the usual flurry of bestsellers and HCG clinics, and then it went into a decline although it remains in the armamentarium at plenty of shady clinics.  

My doctor was a regular GP who merely made it known that he offered HCG. I doubt diet patients made up ten percent of the practice, but they provided an impressive cash flow. The women (only a rare male) came in weekly for a shot, a diet sheet, and a pep talk from the nurse. The doctor saw them monthly, but they paid the regular fee for every visit. He never claimed (to me) that HCG worked, only that patients believed in it, so it inspired them to stick to the diet.

But it didn’t inspire them. Any motivated patient who starts a diet, legitimate or silly, will lose ten or twenty pounds before the gnawing of hunger becomes tiresome. Losing more is much harder. This was no news to the HCG patients, but they were not paying good money to hear it. Their stubbornness amazed me. They signed up with the usual enthusiasm, came in for their shots, followed the diet, and lost their ten or twenty pounds. Then they stopped losing, but most continued to come in, month after month, taking the weekly shot and paying the fee.

Despite the universal opinion among the thin that dieters fail because they cheat, most of these women were trying hard. Alas, they were butting up against the ten-twenty pound limit. Losing more requires a tighter diet, self-denial, and regular exercise, a difficult feat.

Dropping that initial weight turns out to be a good thing. Ninety percent of dieting’s health benefits (reduced risk of diabetes, lower cholesterol, less heart disease) are achieved by a ten percent weight loss. Alas, few patients thrilled to that knowledge because better health was not their goal. Many asked if the shot worked. At first, loyal to my employer, I admitted that opinion was divided. Eventually my answers grew blunt. This never offended the patients who were already suspicious. Many did not even drop out, but the news got back to my boss.

A Disorder I've Never Seen

“I’ve been trying to pick up stuff, and I can’t,” said a Ramada guest over the phone.

“You mean your arm is weak?” I asked.

“No. Once I grab it, it’s OK.”

“Is it numb?”

“It feels fine. But when I reach out for something, I miss it. It’s weird.”

The guest was elderly but in good health. I suspected I knew the problem.

“Take your forefinger and touch your nose,” I suggested. “Can you do it?”

“No,” he said. “I keep hitting my face.”

This was something I’d never encountered but luckily I remembered medical school neurology. This lady had suffered a cutoff of blood to her cerebellum, a structure at the base of the brain that controls coordination.

When you reach out, the brain instructs muscles to move your arm in the general direction of your goal. That’s the best it can do. The last few inches don’t require strength or mobility but fine, precise movements. That’s where the cerebellum takes over.

With the cerebellum out of action, you’d have normal consciousness, strength, and sensation but no coordination. You could walk but only slowly with a clumsy, wide-based gait. If you reached for something, your hand would wobble wildly as it approached. The classic test is to ask a patient to put a finger on her nose. With the cerebellum out of action, it’s almost impossible.

It could have been a temporary loss of blood supply, a “transient ischemic attack” (TIA) or a permanent loss, a stroke. Waiting to see which would be unwise, so I urged her to go to a hospital.