A Dog-Eat-Dog Business, Part 6

People ask what sort of contract I have with hotels. The answer is none. Staff call because I’m easy to reach and quick to respond. Once they’ve called a few times, they’re not inclined to change.

But hotel doctoring is a glamorous occupation, so plenty of doctors yearn to break in.

How can they do this? Guests who want help ask a concierge, desk clerk, operator, or bellman. You might think that they’re given the name of the house doctor, but there is often no such person. Except in luxury hotels, selecting a doctor is not a priority, so the choice may be up to the employee.

This is no secret, so entrepreneurial doctors know who to approach. But how can he phrase a sales pitch? Proclaiming that he is caring, compassionate, and skilled sounds creepy. Doctor web sites and housecall agencies always proclaim this, but you should be skeptical. I’ve worked for dozens; they may check my license and malpractice history but never my competence.

The new doctor might offer to charge less, but he never does. The free market doesn’t apply to a medical fee, and hotels don’t care about it.

So what’s left? Services selling to a hotel (florists, tours, masseurs, limousines) often pay a kickback, and there is a long tradition of hotel doctors doing the same. It’s illegal for a doctor to pay for a referral, and I hasten to admit that I have no evidence that anyone is doing that, but when I start hearing “have you forgotten something?....” hints from bellmen et al, I wonder if a new competitor is making the rounds.

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.

No Income Today

A guest dropped an ice bucket on her toe. Pain was excruciating, and blood oozed out. Holding the toe under the tap didn’t help.

Over the phone, I explained that running water won’t stop bleeding. She should apply pressure and add ice to dull the pain. When I called an hour later, she was having dinner in the hotel restaurant.

A man had developed a slight cough, in his opinion a prelude to full-blown bronchitis. He wanted something to knock it out. I explained that, in a healthy person, viruses cause almost all coughs. I could come, but I couldn’t promise an antibiotic. The man said he would get a second opinion.

A toddler bumped his head against a bedpost and developed a lump the size of an egg. He felt fine, but the parents asked that I check him for brain injury. That requires a CT scan, I explained. He would certainly get one if he went to an emergency room, but the injury didn’t seem serious enough for that. It was OK to wait.

A guest had missed his flight because of an upset stomach. He was well now but needed a doctor’s note to avoid an expensive ticket-exchange fee. These requests put me in a difficult position. I can’t write “The patient was unable to travel because of an upset stomach” because I don’t know if that’s true (sometimes the patient admits that it isn’t). So I offer to write the truth: “The patient states that he suffered an upset stomach and could not travel.” I sweeten the pot by offering to fax it to the hotel at no charge.

Guests usually accept. To date, no one has complained, so it’s possible that the note works.

How Much Does an Emergency Room Cost?

A lady had been vomiting for three days. She had felt better that morning but then relapsed. She sounded weary.

This was tricky. Stomach viruses are the second leading ailment a hotel doctor encounters. I consider them good visits because they rarely last more than a day. I deliver advice as well as an injection and pills. The guest recovers and gives me the credit.

When vomiting persists, doctors worry about more ominous digestive disorders. Worse, three days of vomiting produces some dehydration. This is not dangerous in a healthy person, but drugs don’t work well in its presence and recovery slows. Victims perk up when dehydration is relieved. 

I explained that it was probably too late for a house call. She needed intravenous fluids. After agreeing to go to the local emergency room, she mentioned that she was Canadian and had no travel insurance. I repeated that she should go.

I’ve found that it’s a bad idea to tell guests to go to an ER and then tell them how much it might cost.

My restraint was in vain because she googled the subject, perhaps turning up http://www.theatlantic.com/health/archive/2013/02/how-much-does-it-cost-to-go-to-the-er/273599/ to read that the average was over $2,000. Giving IVs would take hours and cost extra.

When I called the hotel that evening, I learned that she hadn’t gone, and she was still ill. She admitted that the cost had shocked her. I sympathized but told her she had no choice.

When I called later to reinforce this advice, there was no answer. When I called the following morning, she had checked out.

Losing the Chateau Marmont

The Chateau Marmont is a funky art-deco apartment converted to a hotel in the 1930s with nine nearby cottages acquired during the 1940s.  John Belushi died in a cottage in 1982, a few years before I became its doctor. 

I made 157 visits. My last, in 2002, was not at the request of the hotel but of a national house call agency, Concierge Care. Agencies pay me my usual fee, but they charge a good deal more. It rarely causes a problem because the guest has agreed to pay by the time I arrive.

Unfortunately, the dispatcher answering Concierge Care’s 800 number did not like to deliver bad news. As a result, he took down the caller’s information and cheerfully announced that a doctor would arrive but neglected to mention the fee.

The visit went well, but the guest’s jaw dropped when I handed her my invoice for $400. This was 2002 when the dollar was worth something. Hearing that I only earned $150 did not relieve her distress. Worse, she phoned the front desk to ask the hotel to put it on her bill, adding her displeasure at the size of “the hotel doctor’s” fee.

As the desk clerk counted out my money (probably more than his weekly pay), I explained that I was making this visit for a house call agency which was responsible for the fee. He nodded politely, but the Chateau Marmont has not called since.

Paramedics Versus Doctors

My personal encounter with paramedics occurred the day I fell (ironically during my morning health walk) and broke my leg. I might have lain there for some time because pedestrians in my middle-class neighborhood pay little attention to the occasional bearded old man lounging on the sidewalk. Luckily, I had taken a detour through an alley behind a restaurant where two Hispanic workers noticed and came to my aid.

I was not in great pain as long as the leg remained immobile. Any movement hurt terribly. When the paramedics approached with their gurney, I was frightened, but they scooped me up, drove to a hospital, and shifted me to another gurney with hardly a twinge. Never mind their medical skills; that showed talent.

While I admire paramedics, they have little use for me in my capacity as a hotel doctor. Paramedics almost never encounter a physician on their calls, and they don’t like it when they do. Most likely, they worry he might pull rank. As a result, when paramedics arrive at my hotels, I sit quietly, never speaking unless spoken to. In turn, they go about their business, pretending I’m not there.

Another Death

 “He’s over there! I think it’s an emergency!”

Emerging from the elevator, I did not want to hear this. Despite the impression left by television, cardiac arrests are usually fatal. Outside a hospital, between six and eleven percent survive.

The survival rate of the few I encountered is zero, and this did not look like an exception. An overweight security officer was kneeling clumsily on the bed, bouncing up and down as he pounded an old man’s chest. The guest’s false teeth had jarred loose and protruded from his mouth; I plucked them out.

Security officers learn CPR but rarely use it, so they forget the details. Cardiac massage on a soft bed doesn’t work. The officer should have dragged the guest onto the floor. One of his colleagues should have been giving mouth-to-mouth respiration, but it was almost impossible to persuade laymen to perform something they considered disgusting. Mouth to mouth respiration was essential until 2010 when experts decided that chest compression alone was OK.

I asked how much time had passed since the arrest.

“I don’t know. He was out when I got here.” gasped the officer.

I found no pulse, heartbeat, or respiration, and it was obvious the man had been dead for some time, so I told the officer to stop. Hearing this, an elderly lady in a nightgown hovering nearby burst into tears. At that moment, two paramedics and two firemen clumped noisily into the room accompanied by a man in a suit and a young woman, apparently the manager plus the concierge. Cardiac arrests attract too many people.

Observing the corpse and the weeping woman, the senior paramedic flipped through his clipboard. “Is that your husband, ma’am? Could you give me his name?”

She couldn’t. Disobeying my rule about staying out of the way in the presence of paramedics, I comforted her. Lowering his clipboard, he waited patiently. This is the single activity paramedics are happy to leave in the hands of a physician. After a few minutes, she became calmer.

Disposing of the dead guest took a while. Two police arrived and transcribed the wife’s story a second time. One by one, the staff left, followed by the police and paramedics. The medical examiner’s ambulance drove off with the body. The lady couldn’t find her sleeping pills, so I provided some. I left my phone number and promised to call in the morning.

A Bad Year for Conjunctivitis

At one point years ago, I had to discard half a dozen bottles of antibiotic eye drops when they reached their expiration date.

I carry thirty-two drugs. I don’t like to send guests searching for a pharmacy in a strange city, so I hand out whatever they need whether it’s a week of antibiotics or a tube of cream. I’m also generous with cough medicines, decongestants, expectorants, laxatives, and other over-the-counter remedies. I know that many patients including you don’t expect medicine whenever you see a doctor, but we in the profession get that impression.

When I restock, my order must be large to avoid a big handling fee. This becomes awkward when I run low on a critical drug such as prescription eye drops. I can’t allow myself to run out, and I can’t order other essentials such as antibiotics or injectables until I need them because of the expiration date. 

This is where useless drugs come in handy (I’m stretching a point; it’s not certain that cough remedies, decongestants, expectorants et al don’t work, but researchers who conduct studies have trouble showing that they’re superior to placebos).

As I run low on important drugs, I become more generous with these. This is easy because respiratory infections are every family doctor’s most common ailment. For weeks, I loaded up guests with sniffles, colds, “sinus,” “bronchitis,” flu, and similar bugs with every elixir, gargle, capsule, or lozenge in my possession. Soon I ran low on enough medication to eliminate the handling fee when I restocked.