Tricky Problems

 It upsets me to collect a fee and then send a patient to a clinic or emergency room for care I can’t provide in a housecall. I try to anticipate these.

Many guests phone after a painful accident, hoping I can do an exam and tell them whether or not they have a fracture. Sadly, unless it’s visible to the naked eye, I can’t. It turns out that medical science does little for broken toes, ribs, or noses, and most common fractures (arms, wrist, hand, finger, foot, ankle) are not emergencies. If a guest is willing to wait till office hours, I can make them an appointment with an orthopedist.

Upset stomachs make up the second most common ailment that I hear about. These usually don’t last long, and I carry medicines that help. Stoics often prefer to wait. This is not unreasonable, but the longer symptoms – usually vomiting – last, the less likely that medicine will help. After about a day of vomiting this becomes so unlikely that I send the guest to where they can receive IV fluids.

Abdominal pain is usually benign in a young person but less so as the years pass, and it’s tricky. Entire books have been written on it. I recommend the shortest:  Early Diagnosis of the Acute Abdomen by Zachary Cope, a British surgeon. He wrote it in 1921, and revised it every few years till he died in 1971. 

You can download it free. He’s a droll and witty writer, easy for laymen to understand.

When the Doctor Needs Your Help

 Almost every hotel guest that I see is working or taking an expensive vacation, so illness is more inconvenient than usual. Everyone agrees that doctors have no magical powers…. except… maybe… if you really need magic…..

What if you’re scheduled to deliver an important speech or attend a wedding or visit Disneyland, and you absolutely can’t be sick? In that urgent situation, a smart doctor might come up with a cure that he or she keeps in reserve for such situations.

Doctors love to help you, but they also want you to feel helped. If we do our best, but you’re unhappy, that hurts more than you realize.

So if you want the doctor to prescribe a placebo make it absolutely clear that you will be disappointed unless you get “something.” This happens so often that many doctors assume every patient yearns for magic. That’s why, for example, giving useless antibiotics for respiratory infections is not a sign of incompetence. Even good doctors do it.

Really, I don’t hold anything back for especially deserving patients. It sounds odd, but if you don’t want a placebo, let the doctor know. Say something like “I just want to know what’s going on. If a prescription won’t help, that’s fine with me.”

That sounds like you’re telling the doctor how to do his job, but many need your help.

Not Again! Again.

I was minding my own business on a plane returning to Los Angeles when I heard the elderly man in the adjacent middle-seat say:  “Victoria... Victoria?.... Victoria?...    VICTORIA!!...” Turning, I saw that he was shaking his wife who had passed out.

I informed the flight attendants who produced the traditional oxygen bottle plus a stethoscope and blood pressure cuff and made the usual request for any doctor on the plane. The wife began responding, if groggily. Her blood pressure was undetectable, but engine noise made listening difficult.

By this time, another doctor arrived. She was about forty years younger than I and anxious to be involved. She suspected it might be necessary to land the plane. This is not a decision airlines make lightly. Headphones and a long cord appeared, and, after some delay, she spoke to a doctor on the ground who advised taking the wife to the rear of the plane, laying her on the floor, starting an intravenous line, and observing. With the other doctor leading the way, everyone trundled up the aisle. I wasn’t required.

The couple returned to their seats when the plane began its approach two hours later. The wife seemed all right although she had no memory of what had happened. Paramedics came on board at the gate and led the couple away.

I waved off the flight attendants’ thanks, but they insisted on giving me five thousand frequent flier miles.     

What Makes Travelers Sick

 American water.

Travelers worry that our fierce advocacy of the free market includes opposition to government meddling in the water supply. I regularly assure them that all American tap water is drinkable.

American food.

No one believes that Taco Bell or McDonald’s sell healthy food, but foreigners worry that these exotic, colorful substances are toxic. We Americans are warned about eating in nations with poor sanitation; about one in three American tourists in these areas get sick. If we’re careful, our sickness rate drops to… Actually, it doesn’t drop. No one knows how to prevent traveler’s diarrhea. The Swiss get sick when they come to the US.

Air conditioning

Americans accept air conditioning with even more enthusiasm than personal firearms, but most of the world has never caught on. They tolerate it as an odd American custom but believe that air from a machine is unhealthy whether it’s automobile exhaust or a box in a window. When someone gets sick, they turn it off. I wear a suit, so caring for foreign tourists during the summer is a painful experience.

Air Travel

Travelers blame the airline for any illness that occurs within a week of flying. This is not so for aches and pains and unlikely for an upset stomach but true for respiratory infections.

Stress

Vacations are stressful, particularly if children are involved. They miss their friends; they hate the food; they prefer watching TV to sight-seeing; they refuse to adjust their sleeping hours.  It turns out that stress makes everything worse, but it doesn’t cause anything, so there’s no reason for the parents to get sick. When they do, it’s a respiratory infection, usually the children’s fault.

Keeping a Child Safe

 On days I don’t go to the gym, I take a brisk one hour walk through my neighborhood.

One route passes an elementary school a mile away. Except for dog-walkers, the streets are deserted at this early hour, but a few blocks from the school the sidewalks gradually fill with children in their colorful outfits and backpacks accompanied by a parent. Passing the school I overtake the adults, often in chatty groups, as they head home.

Parents taking their children to school…. When did that start?...

I entered first grade in Cleveland, Ohio, in 1946. The school was three blocks away. My mother dressed me and showed me the door and, even in the dead of winter, I walked alone. I met friends along the way. I never saw an adult.

No big deal. But halfway through the year I took a test. Afterward my parents agreed that I could attend a special school for gifted children.

It required a six block walk and then a long streetcar ride. I made the trip alone every day. The school had a cafeteria, but, for reasons lost in history, I left the campus at noon and ate lunch, usually a hamburger, at a nearby diner. It cost a dime. Remember, I was six years old. I never regarded this as odd, and no adult I encountered gave me trouble except once on the streetcar when the conductor accused me of not paying the fare (I’m sure I did). When I burst into tears he did not pursue the matter.   

It was not all smooth sailing. Years later in Los Angeles on the way to junior high, I encountered a bully my own age who cuffed me around painfully. But it was only one episode.

Another Spiked Drink

 It was one a.m. as I drove Santa Monica Boulevard, but crowds packed the sidewalks in West Hollywood, lining up to hear the latest band. A few blocks beyond, I parked at the Ramada.

A guest led me to the bathroom where her companion lay in the empty tub, clutching a towel and moaning. This was not the first time I cared for a patient in a bathtub or even the tenth.

“We’ve been out drinking,” explained the guest. “But not more than usual, and she didn’t have more than me. Do you think they put something in her drink?”

This was not the first time I heard that – or the tenth. I’m puzzled at how often guests suspect foul play when someone becomes violently ill after drinking.

I examined the patient as best I could without moving her because she insisted she could not move. Afterward I explained that alcohol is a toxin that messes up the brain, usually in pleasant ways but occasionally not. After delivering medication for vomiting, I told her to suck on ice chips and phone if she wasn’t better in a few hours. So far everyone has recovered.     

An Exotic Travel Destination

 Tourists come to America expecting a strange foreign land. They usually leave satisfied, but encountering an American doctor is an unexpected bonus, so everyone on the tour gathers round, and I often go about my business in front of a large attentive audience. 

My largest consisted of the entire company of the Chinese Peking Opera lined up along the wall of a ballroom in the Hollywood Roosevelt. One of its members had begun behaving bizarrely. I concluded he was suffering an anxiety attack which a tranquilizer might help.

 This took place well before Chairman Mao’s influence became passé, so it was likely the Opera’s resident physician had no Western training. Etiquette demanded I treat him as a colleague, so I presented my advice as a suggestion.

 After consulting other senior figures, he gave his approval. No one except the interpreter spoke English, so many subtleties were lost, but everyone seemed satisfied, and the entire troupe lined up to shake my hand.

 

Doctors Are Always Late

At 6 p.m. on a Friday, I learned that a flight attendant in Costa Mesa had a cold. I prefer not to drive 46 miles during the rush hour, so I promised to be there between nine and ten. That was acceptable. Airline crew are not demanding.

Five minutes later a guest at the downtown Doubletree asked for a visit. This was a bad juxtaposition. Scheduling it for after Costa Mesa meant an arrival time near midnight.

Reluctantly I told her to expect me at around eight. I gave myself over an hour for a 25 minute drive, but traffic was not so bad, and I arrived early, but she was there. The freeway to Costa Mesa was also not so bad, and this time no one answered my knock at 8:30. The front desk was unhelpful. 

Airlines have strict rules about sick crew, so this guest required a visit. If I waited an hour and then left, I might get a call on the way home. If she was out partying, I might get it several hours later. I did not acquire my peerless reputation by refusing calls, so I’d have to make the return trip.

As I fumed and paced, the guest returned. I expressed relief, but she did not apologize. She was present at the appointed time, and no one expects a doctor to be early.