Neither Rain Nor Snow

My phone rang as I was driving to the Langham in Pasadena. Coris USA, a travel insurer, had another housecall. Since I was on the freeway, I couldn’t write, so I asked for the address, planning to collect the remaining information from the patient. I hate to be late, so I told the dispatcher I might not arrive for several hours. 

The Langham guest had a sore throat, an uncomplicated visit. I reached the Coris destination, a private house in Hollywood, an hour after the call. The gate in the surrounding fence was locked. The buzzer felt loose in its housing, giving the impression that it was broken. This seemed the case because no one appeared.

What to do… Usually I phone the patient, but I didn’t have a number. I considered phoning Coris, but whoever answered would ask for the patient’s name which I also didn’t have. She might or might not succeed in tracking down the original dispatcher, but it was guaranteed I’d spend a long time on hold in a chilly drizzle.

The railing was my height, and there were footholds. Passerbys certainly wondered at an elderly man in a suit struggling over a fence, but I succeeded without tearing my clothes.

The woman who answered the door denied that anyone wanted me. It turned out this was not a private house but a youth hostel. The woman consulted other residents; one remembered someone who wanted a doctor, but she had left. 

The resident didn’t have her phone number but offered to leave a message on Facebook. I called Coris to warn them that matters were not looking well.

Then the door burst open, revealing the patient, gasping for breath after running several blocks. The visit itself was uncomplicated. 

Fatal Diarrhea

Coris USA, a travel insurer, sent me to see an Argentinean lady with diarrhea at the Beverly Hills Hotel. Diarrhea is usually an easy visit.

Arriving, I learned that her illness was entering its sixth day: too long to be the ordinary stomach virus. She felt weak and feverish, and she had recently taken antibiotics, so I wondered this was Clostridium difficile colitis, an occasional consequence of the avalanche of antibiotics consumed by humans everywhere.

Every antibiotic you swallow kills trillions of germs, mostly harmless, living in your bowel. They are immediately replaced by other germs that can grow in the presence of that antibiotic. Most bowels don’t harbor C. difficile, but if yours does, antibiotics may convert a small population into a large one, and it produces an irritating toxin that causes a severe, occasionally fatal diarrhea. 

Diagnosing Clostridium requires more than suspicion, and there were other possibilities. She needed a thorough evaluation.

Fortunately, Coris USA is a good travel insurer: meaning that it (a) pays promptly and (b) takes my advice. These sound unrelated, but I’ve found that good insurers do both, bad ones do neither.

I phoned Coris’s Miami office with the news and the name of the doctor I recommended. The dispatcher contacted the main office in Buenos Aires for authorization; it appeared within the hour, and the patient went off. If I were dealing with a bad insurer, authorization would be denied or remain pending indefinitely. I often send patients off, warning that they will have to pay up front and try for reimbursement later.

Tests were positive, and she began improving after a few days of treatment: an antibiotic but one different from the one that caused the problem.