"This Has to Go Into My Blog!"`

A dispatcher from the agency that handles airline flight crew mentioned a sore throat, but the guest mentioned an “unprotected sexual contact” two nights earlier. The sore throat appeared soon after, and he was worried. Very worried.

No problem. Unprotected sex with a stranger is a bad idea, but the odds of disaster are low. I settled back to learn what happened.

He seemed distracted. Asked for details of the contact, he didn’t remember. The phone rang. During the conversation, he mentioned to the caller (apparently his supervisor) that someone was in the room who claimed to be a doctor. Could he explain?

That sounded odd. When he hung up, I suggested he call the agency to confirm my identity. He did so and then handed me the phone. The dispatcher apologized and admitted that the guest had been calling since the previous day and seemed disturbed. He hoped I could help.

Confirming my identity did not improve matters. When someone knocked at the door, he told them to go away. Ignoring me, he dialed the hotel phone. Reaching voicemail he explained that he needed a clinic appointment but someone had sent a doctor. He needed an explanation. Hanging up, he dialed his cell phone, reaching a friend for a short chat during which he mentioned that there was a stranger in the room.

I suggested that if he wanted to go to a clinic, I could arrange it. Waving this off, he dialed another number. It wasn’t clear who or why he was phoning. Someone knocked, and he told them to go away. When I expressed a wish to leave, he stood at the door. For the first time I felt nervous. I repeated my request several times in a soothing voice. He opened the door a crack. I squeezed out, and he slammed it behind me.

In the lobby, I phoned the agency to explain that the guest needed a psychiatric evaluation. Minutes later, as I sat filling out forms, a noisy flotilla of fire trucks, police cars, and paramedic van pulled up.

I followed half a dozen men up to the room. Several of the guest’s crewmates were on the scene, trying to persuade him to open the door. They would have succeeded if given time, but the officers wanted to wrap things up.

If I were paranoid, I would not want to hear strange men pounding on my door demanding that I open. They broke in and hauled him off. Acute psychotic breaks rarely last long, and he was back in a few days, much better according to the dispatcher. He needed another visit to clear him to fly.   

Does Everyone Live Like That?

The Beverly Garland is a sixteen mile freeway drive. The guest had phoned at 8 a.m. on Wednesday. I avoid distant housecalls during the rush hour; guests rarely object to waiting.

But I had finished breakfast. I had no plans for several hours. Why not get the visit out of the way? I checked my traffic app. North on the 405 was not bad; the second leg, east on the 101 was solid red. Maybe it would ease by the time I reached it.

Driving north on the 405, I shared my fellow drivers’ relief that we were not on the immobile southbound side. Half a mile before the connector to the 101, the right lane stopped cold. 

It took another 45 minutes to reach the hotel. I hate being late, but I had warned the guest, giving myself plenty of time. I listened to a tape. I paid close attention to driving, moving at a steady few miles per hour instead of braking and accelerating constantly. Doing that requires allowing the car in front to move ahead some distance. Cars from the adjacent lane occasionally pulled into that space, infuriating the driver behind me. I hoped he wasn’t armed.

Getting stuck in the rush hour was my decision, but millions of people have no choice. They do it ten times a week. How can they live like that?.....

Extremely Easy Housecalls

The desk clerk at an upscale hotel informed me that a guest wanted my services. The call arrived at 3 o’clock on a Sunday afternoon. I had no plans till dinner. Freeway traffic would be no problem. It was a perfect time for a housecall. What a great job….

The desk clerk added that the guest was not actually in the hotel. He would check in at midnight. Could I come then? So I set the alarm that evening and dozed until it went off.

                                                                                                                          

I regularly complain of how far I drive, but sometimes I hit the jackpot. I once saw a patient in my own neighborhood, a mile away. He suffered a minor illness, so I was there and back in half an hour. As I was faxing my bill, the phone rang.

“Did the patient pay the deductible?” asked the dispatcher for the insurance service.

“You didn’t mention a deductible.”

“I forgot. There’s a $75 deductible.”

That was annoying. Cheap travel insurance requires a deductible, and guests never remember to pay. When dispatchers forget to tell me to collect it, I insist the carrier pay the full amount. They always agree but, being cheap services, it requires several pestering phone calls until the check arrives. Since this patient wasn’t far, it was easier to get in my car and make a second trip.

"I Need Oxygen!"

Hearing this from a hotel guest, I know that (a) the guest is short of breath and (b) the guest probably doesn’t need oxygen – unless everyone in the room is short of breath in which case this is not a medical problem.

If you suffer an illness that produces shortness of breath such as asthma or heart failure breathing oxygen will not help much. Other treatments work much faster. If you have obstructive lung disease and become short of breath you certainly need oxygen, but you’re an emergency. Call the paramedics. All these problems require lengthy observation until symptoms improve, so making a housecall is a bad idea.

Anxiety is the leading cause of shortness of breath in a hotel guest. This is never fatal, and I have good success treating it, but making a housecall is risky. Between the time I hang up and arrive, many guests recover and cancel or leave the room and hide out until certain that I have come and gone.

Running Out of Medication

A guest at the Doubletree had run out of insulin. I could have made a housecall, written a prescription, and a pharmacist would have filled it. Instead I explained that insulin doesn’t require a prescription. She should go to the pharmacy and ask for it. The same is true for the morning-after pill, another request that arrives now and then.

An Italian guest at the Four Seasons brought a migraine prescription from her doctor. Pharmacies wouldn’t accept it. Could I come and write an American prescription? I told her to have the pharmacist phone, and I would approve it.

When national housecall services or competitors send me to guests who need a prescription, I write it, collect money, and leave. Those are easy visits, but guests are never grateful. Americans look sullen; foreigners understand that American doctors require immense fees for any service. When guests call me directly, I handle these requests over the phone, gratis. It’s no great sacrifice and good public relations.

It may even be good business. Long ago, when I returned from a day off, the doctor who covered told me a guest at the Casa Del Mar had phoned. That was exciting news; this was an upscale Santa Monica beach hotel which had never called. The guest obviously had a bladder infection, so the doctor had phoned a prescription to a pharmacy. I nodded. Treating an infection over the phone is not a good idea, but simple bladder infections are an exception. He added that he had charged $30 for the service. I mention this only because it happened during the 1990s, and I haven’t heard from the Casa del Mar since.

When Everything Works Out

A call arrived as I was eating dinner at the home of friends. A gentleman at the Biltmore needed a doctor. The meal was ending, so I took my leave.

Driving the twelve miles downtown, I parked and opened the trunk to retrieve my black bag. Dismayed, I realized I had left it at home.

I usually keep the bag in my car. My driveway is outside, and during hot weather I take the bag into the house to keep the heat from melting my pills. Getting a housecall jogs my memory, and I retrieve the bag, but I had driven to friends without giving it a thought.

I phoned the guest to explain that I’d have to return home. Before I could apologize, the guest apologized, explaining that he had run out of his blood pressure pills and only needed a refill. He knew his travel insurance would not pay for this, so he claimed to feel ill. He wasn’t ill. I phoned a prescription to a pharmacy and went home.

This blog is full of incidents whose entertainment value is based on things going wrong. But sometimes everything works out.

"Uno Momento..."

As I was brushing my teeth one night, the phone rang for a housecall in Torrance, twenty miles distant.

Traffic was no problem, and Google maps guided me to the correct address which turned out to be a massive apartment complex behind high walls. Now and then I drove past a locked gate with no guard and no evidence that it was the correct entrance. I phoned.

The patient’s husband answered. He was Italian and spoke rudimentary English, and his efforts to direct me were incomprehensible.

“Uno momento…” There followed several minutes of silence. Just before I decided he had hung up, he came on the line and resumed his unintelligible instructions. Then my headlights illuminated a distant figure in the middle of the deserted street waving a flashlight.

He guided me to a gate, punched the code to open it, and directed me to visitor’s parking. I followed him through a maze of sidewalks to the correct building. After I cared for his wife, he guided me back to my car.

Hotel Visits I Don't Make

I try not to make housecalls for shortness of breath, chest pain, loss of consciousness, or severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, although possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you might sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when the guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind. 

Medical science has no cure for drunkenness, but hope springs eternal, so my phone continues to ring.