A Doctor Gets Sick

Years ago I suffered a stomach virus, not a serious illness but unpleasant. I was resting after a night of vomiting when the Beverly Garland called. I could have stalled or asked a colleague to make the visit, but symptoms were improving.

I had not entirely recovered, so my wife agreed to drive. As we approached the hotel, my nausea returned. It grew intense by the time the guest opened his door.

I remain proud of delivering an Academy Award-worthy performance, sitting quietly, focusing entirely on the guest, not hurrying, providing sympathy, advice, and medication as well as collecting my fee.

As soon as the door closed behind me, I dived into the nearest rest room and resumed vomiting. Several guests entered, saw my distress, and fled. But I got better. Most sick people get better.

Sometimes a Thankless Job

A three year-old at the Ramada was fussy and congested, but my exam was normal. She had a cold, I explained. It might last a few days, and staying in bed wouldn’t make it go away quicker. They were already giving Tylenol for the fever, and that was fine. They should try to enjoy themselves.

“So she doesn’t need anything,” said the father. I assured him she didn’t.

They thanked me as I left, but I was not fooled.

Understand their point of view. They were in a strange city on an expensive vacation, and their child was sick. Naturally, all fun was cancelled, and the doctor summoned fix things.

Had I written a prescription, I would be doing what a proper doctor does. They would have given the medicine and waited. Not giving “anything” meant that I considered the illness trivial.

Mind you, I had carefully explained that the child would feel under the weather for several days. They had listened and nodded.

I intended to call in 24 hours, but the following morning their travel insurer phoned to say the parents were requesting another visit. I explained that that wasn’t necessary. I would call.

“She’s the same. The cough hasn’t gone away,” said the mother.

I repeated that this was to be expected and that she should wait. She thanked me for calling.

No one answered when I phoned the next day. The insurance agency dispatcher explained that the mother had called earlier to demand another visit, so he had sent her to an urgent care clinic.

The child had barely swallowed the first spoonful of Amoxicillin when she began to improve. By the following day she was fine, and the parents were congratulating themselves. Who knows what might have happened if they hadn’t found a competent doctor? 

A Hotel Doctor Has His Car Serviced

I scheduled it for 8 a.m., hoping it wouldn’t be out of commission for long because my wife and her car were out of town. I cancelled the appointment when a hotel called at 7 a.m.

I delivered my car to the shop at 8 a.m. the following day. A hotel called at 10. The service manager said my car wouldn’t be available till the afternoon, but he would be happy to provide a loaner.

Auto shops pay little attention to loaners. Mine was a battered 1999 Volvo station wagon with 176,000 miles, the gas needle on empty, and an automatic transmission that paused for a few seconds before delivering power. Driving was a frightening experience compared to my tiny, nimble Honda.  

I bought gas and lumbered onto the freeway, praying that Swedish engineering deserved its reputation. VIP parking at a downtown hotel was out of the question because valets refused to believe that an important person would arrive in such a disreputable vehicle. But everything worked out.

No hotel doctor should live alone.

Caring for the King

The Airport Marriott is not a hotel that comes to mind at the mention of royalty, but that was where I saw the King of Tonga whose entourage took up the entire top floor.

Tonga is a group of Polynesian islands, an independent country and UN member. It contributed a few dozen troops to President Bush’s “Coalition of the Willing” that invaded Iraq in 2003. It’s also one of the few remaining hereditary monarchies, and the king is a person of influence and great wealth.

Everyone in the room wore Western clothes. The king himself was tall and fat but otherwise unremarkable, and he spoke English. Still, he was a royalty.

I'm Under a Doctor's Care

“I parked illegally, and they towed my car. It’s in an impound lot, and, wouldn’t you know.….”

Tales of misfortune (as opposed to complaints of illness) at one a.m. are a routine tactic of drug abusers.

“…My prescriptions were in the glove compartment. I don’t know when I can get them. I’m under a doctor’s care for….”

I declined his request for Oxycontin. The call had come from the desk clerk who had immediately handed the phone to the guest. As a result, when I hung up, I knew the guest might inform clerk of his disappointment with the hotel doctor. 

Under those circumstances, I phone the clerk and explain that the guest has made a request that I cannot, in good conscience, grant. Remembering his manners, the clerk expressed sympathy, but you never know…. 

Why I Hate Appointments, Part 2

“I need you to look at a rash,” said a Loews guest. “But I have meetings all day and dinner tonight. Could you be at my room at 9?”

He meant 9 p.m. His call arrived at 9 a.m. Appointments more than a few hours ahead end badly more often than not, so I avoid them.

“I’m always available,” I said. “But we’re both busy people. Phone just before you get to your room, and I’ll come over.”

He phoned at 7 p.m. to say he’d be delayed till 10. I waited at home. He phoned at 9:30 to say he was on his way. I arrived at 10. No one answered when I knocked. He appeared at 10:20 with apologies.

As If I Didn't Need Reminding

She was a model, a Ritz-Carlton guest informed me. The previous week she had undergone half a dozen plastic surgery procedures on her buttocks and lower abdomen. Now she needed the sutures removed. After she asked for “an appointment,” I told her when I would arrive. 

“Well… OK….” she said. I could sense her reluctance. She had assumed I’d see her in my office. If guests ask for an office visit, I know colleagues who will accommodate them. But I love visits for suture removals. They’re easy, and guests appreciate the convenience. 

When the door opened, I saw a tall, slim, strikingly beautiful woman who nearly jumped with joy when she saw me. 

“Oh, good!” she exclaimed with relief. “I’m glad you’re not one of those young doctors!”

Unsettling News

The guest I had seen the previous day was found dead, I learned from the manager of a downtown hotel.

A hotel doctor’s worst nightmare is a patient dying in the room after he leaves. This has never happened to me although several died soon after I sent them to the hospital. It turned out that this guest was not my first.

She was an elderly lady complaining of palpitations whom I had seen the night before. On my examination, her heart was beating too rapidly, so I took her to an emergency room. After the usual delays, the emergency room doctor found the heart beating normally, so he told her to mention it to her family doctor and then sent her back to the hotel where she died.

Frustration

An Emirate Airline flight attendant was suffering severe back pain. 

Emirate crew stay the Hilton in Costa Mesa, 46 miles away in Orange County. There is an Orange county doctor, but she had not responded. It was 2:40 a.m.

I didn’t complain. Freeway traffic is light. I have no office hours, so I can go back to bed if I want. I earn extra for long drives and late hours. The Orange County doctor enjoys a rich social life, so she’s often unavailable. I made 42 housecalls to her territory in a single year.

I dressed and drove off. As I entered the freeway my phone rang. The visit was cancelled. The Orange County doctor had checked in and reported that she was on her way. 

I pointed out that once the agency assigns a doctor, he or she should take priority. The dispatcher agreed and promised that it would not happen again

Another Celebrity Injection

A VIP was flying in from San Francisco. He was under the weather and needed a shot before the night’s performance. 

Someone else has the Los Angeles franchise on celebrity injections, but I handle the occasional request.

There were the usual inconveniences. I was told to be at the hotel at 2 p.m. but his flight was delayed. The new time was 3 p.m. I waited at home. It was 3:20 when a phone call announced that he was on his way, so I drove off.

He was a singer but not an A-list. I’ve long since forgotten his name. I met him in a suite at an upscale (but not luxury) hotel on the Sunset Strip accompanied by only three assistants. Unlike international stars, he shook my hand, thanked me for coming, and allowed me to ask about his illness and examine him. Major celebrities nod a greeting and then resume communing with their entourage, pausing momentarily for the injection. 

He had a cough, and his doctor had recommended cortisone. Unlike B12, the traditional celebrity injection, cortisone works but probably not by the time of his performance in a few hours.

A Costly Mistake

Since 1984, twelve hotel guests cleaned their ear with a Q-tip, extracted it, noticed that the cotton had vanished, and called for a doctor.

These were stressful visits because I worried that the cotton might be too far inside to reach, and I don’t like poking with needle-nosed tweezers. Mostly, I was lucky, but one visit didn’t work out as planned.

“I don’t see anything,” I said after looking in the ear. The guest insisted that I must be in error. I looked again. Nothing that didn’t belong.

While he thought this over, I looked in the bathroom. On the floor near the sink lay a tiny ball of cotton.

He tried to laugh this off, but I could see his pain. I’d made the visit at the request of a housecall service that had already collected on his credit card, so there was no way I could give him a discount. It was an expensive mistake.

Another Arab Prince

It seemed a routine visit for an upset stomach until I knocked at what turned out to be the penthouse suite of a Beverly Hills hotel. The man who answered identified himself as “the prince’s personal assistant.” I followed him into another large room where the prince, an elderly Saudi, lay in bed. It was five in the morning.

The assistant indicated the patient – not the prince but a young woman sitting nearby, looking wan. I took her into another room to deliver my care. She was an American in her twenties, and I wondered why she was in the prince’s room at this hour. Perhaps she was a prostitute, but she seemed nice.  

When I returned to the bedroom, the prince thanked me for coming, adding that he had a personal problem. He suffered crippling back pain and had run out of medication. Could I help? As we talked, I noticed the assistant waggling his finger in a gesture indicating that I should not pursue the matter. I took the hint.

Accompanying me to the elevator, the assistant explained that everyone preferred that the prince’s doctor handle the prince’s drugs. Then he pulled out a sheaf of bills and paid me far too much. I don’t decline tips from the very rich.

Most Arabs that I see are ordinary people, but over thirty years the occasional prince turns up. They pay generously and provide material for this blog .

Losing Two Out of Three

A guest at the Hollywood Heights with an upset stomach requested my services. I had barely hung up when an Englishman at the Shangri-La wanted a doctor for a respiratory infection. These hotels were not convenient – the Hollywood Heights is ten miles east, the Shangri-La in Santa Monica five miles west. But two visits make for a good day, so I drove off in a pleasant mood.

As I approached Hollywood, the phone rang. My heart sank when I learned the caller was the Sheraton in Pasadena, twenty miles away – thirty from Santa Monica.  
  

Having visits pile up, especially those with long drives, oppresses me, so this was one I’d prefer to skip.

This guest’s husband, who was driving to the hotel from the airport, was suffering a cough and sore throat and wanted a doctor when he arrived. Launching my no-visit effort, I explained that viral infections cause these symptoms in almost all cases, so a doctor can do little except relieve symptoms. I suggested that she discuss this with her husband when he arrived. She agreed. With that weight off my shoulders, I continued on to the Hollywood Heights.

After finishing, I reversed my course and headed for Santa Monica. As I neared the hotel my phone rang. “A friend of mine found a bottle of amoxicillin,” said the Shangri-La guest. “I think I’ll give it a try and save you the trip.”

Having lost that visit, I immediately called the Pasadena Sheraton. The husband had arrived, and they had decided to wait.

The Kiss of Death

Malpractice insurers look with suspicion on doctors who operate pain clinics or diet clinics or who perform botox injections or liposuction. My brother saved $12,000 on his premium when he gave up obstetrics – and that was thirty years ago. Doctors pay a fat surcharge if they engage in controversial practices, perform legitimate if risky procedures, or have personal difficulties such as numerous malpractice suits.

None of this applied to me. From a malpractice carrier’s viewpoint, I was easy money. I saw perhaps one fifth as many patients as an office doctor. Being travelers, they were younger and healthier than average. Even better, most were foreigners who don’t sue.

Except writing for a large check every year, I ignored this area until a letter arrived in 2003 from my malpractice carrier. It was a routine survey with questions about the nature of my practice: hours of operation, employees, office locations, number of patients, hospital affiliations, procedures.

I made certain they understood that I was a full-time housecall doctor who cared for a small number of healthy, nonlitigious patients.

A few weeks later I opened a certified letter cancelling my insurance. It was a terrible shock. When I applied to other carriers, all turned me down. I contacted an insurance agent who was very helpful and obtained a policy from a company in Illinois that specializes in difficult cases. It cost three times what I had been paying.

Each year when she applied to the regular malpractice carriers, they declined. They won’t insure a housecall doctor, she explained.

How did this affect my competitors? It didn’t. They cared for hotels as a sideline, usually from an office practice. If asked, none would deny that they make housecalls, but no carrier forbids them, and they’re so uncommon that applications for malpractice insurance don’t ask about them.

Boasting that I was America’s only fulltime housecall doctor produced flattering feedback but got me the kiss of death from my malpractice carrier. Perhaps they remember celebrities from Michael Jackson to Elvis Presley whose lurid final moments involved a doctor who made home visits.

Dodging a Bullet

The army does not hand out generous transportation allowances, so it housed this officer’s family in a single room of a Days Inn. Arriving, I squeezed past stacks of luggage and between three rollaway beds where the children slept.

I suspected the officer’s wife had pneumonia. Although rarely serious in a young patient, she looked sicker than usual: feverish and short of breath. 

Doctors make most decisions based on evidence or gut feeling, but sometimes a third factor intervenes: inconvenience. For example, as a patient it’s risky to be the final appointment before lunch or at the end of the day. There’s a small chance the desire to get out of the office will influence the doctor. Rarely, this leads to a decision that comes back to haunt him. I’ve been around long enough to think twice before making a decision that saves aggravation.

Leaving after giving an antibiotic for pneumonia was a reasonable option, but, reluctantly, I announced that the wife needed to go to an emergency room.

Aggravation followed. The father did not normally care for the children, so I sat patiently for half an hour as he woke them, struggled with their clothes, made several phone calls to reschedule his flight, and then shifted a dozen boxes between his wife’s bed and the door. After this was well under way, I left to fetch my car, parked two blocks away. Fitting six people into a tiny Honda took additional effort.

It was a relief to usher them into the waiting room, explain matters to the clerk, and say my goodbyes. It was a greater relief to learn, when I called the hospital later, that the wife lay in the intensive care unit and on a respirator, fighting a catastrophic pulmonary infection.

Can I Submit This to My Insurance?

The guest’s symptoms suggested a urine infection, one of my favorite diseases. They’re miserable but respond quickly to antibiotics. This looked like a good visit. I quoted my fee.

“Oh… I didn’t realize it would be so much.”

This happens. I remember guests from the Four Seasons where room rates start at $600 who didn’t want to pay half that. In any case, once I mention the fee, I consider it tacky to refuse someone who complains. I quoted a lower fee. That was OK.

It was a good visit. I tested her urine, announced she had an infection, and handed over her medicine. She was grateful. As I left, she indicated my invoice.

“Can I submit this to my insurance?”

“You have travel insurance?”

“I think so. They made us buy something for this trip.”

It was too late to ask why, if she had insurance, she had objected to my fee. But this also happens. In every developed country except Russia and China, if you need a doctor you don’t first decide if you can afford it, so foreign tourists often pay little attention to insurance.

Really Good Luck

I was leaving the Universal City Hilton when the elevator stopped. The door opened, and a young man rushed in, blood dripping down his face.

“I have to get to a hospital. How do I get to a hospital?” he cried.

I told him to calm down and peered at his bloody scalp, but the light was too dim to make out anything. “I hit my head on the edge of a table,” he added. “I have to get to an emergency room!”

We left the elevator at the ground floor, and I looked more closely but couldn’t see anything alarming. Introducing myself as a doctor, I led him to the men’s room, and cleaned away the blood. There was no laceration, just a long scratch along his scalp that was oozing blood. I patted it dry, applied a dressing, and assured him that it was not serious and didn’t require a trip to an ER. He felt better.

Happiness is Fleeting

The owner of a West Hollywood boutique hotel called to explain that he was suffering another herpes outbreak and needed a prescription for Zovirax. He added that, since outbreaks occurred every few months, he’d like five refills. Would I fax the prescription? After sending it off, I decided I needed to examine him to justify such a large amount. He agreed, adding that he was staying at the Beverly Hills Hotel.  

I perked up. I’ve been the doctor for the Beverly Hills Hotel four separate times since the 1980s. But I don’t market myself aggressively, so four times a more enterprising doctor has snatched it away. It’s been years since it called. I hurried to the hotel; afterward the owner thanked me for my concern. Naturally, I didn’t charge him. Leaving, I stopped by the concierge to inform him that I’d seen a guest and to mention my availability.

“I remember you, Doctor Oppenheim. From the Bel Age a long time ago.” We had a short, pleasant exchange, and he accepted my business card. I walked to my car with a light step. Not only had I pleased the owner of one hotel, there was a chance I’d acquire the Beverly Hills again.

Happiness is fleeting. A few hours later, the owner called. Angrily, he informed me that he’d gone to three pharmacies which had refused to fill the prescription. I was puzzled, and then I realized what had happened. Early that year I had purchased the new, high-tech prescriptions that the law now requires. They look like ordinary prescriptions, but if a thief tries to duplicate one, “void” appears faintly on the copy. Faxing apparently triggers the same process. I apologized and telephoned a pharmacy to give him his medication.

A Guest From Hell

As I introduced myself, the guest suggested we not shake hands because he didn’t want to give me lice. He had lice.

I settled myself to listen. He explained that when he stayed in a hotel he always asked Housekeeping for the temperature at which they laundered bedding. To save money, they often kept it under 150 degrees, too low to kill the eggs. He was susceptible to lice, an affliction that mystified doctors. Treatment only worked for a short time, but this was a cross he had to bear. At home he laundered bedding and clothes daily. Although he fumigated his house once a month, this barely kept the infestation at bay. He concluded by handing me a sheaf of printouts from internet medical sites discussing lice and their treatment.

This was delusions of parasitosis: rare but not terribly rare. I’ve encountered half a dozen over thirty years. Confronted with a delusion, no one, doctors included, can resist the urge to point out the facts, a useless tactic. As anyone familiar with the debate over vaccination knows, faced with a deeply held belief, facts are worthless.

“Can you show me a louse?” I asked.

“I pick them off so fast they’re hard to find. But let’s look.”

I pulled out my flashlight, and together we peered at his pubic area.

“There’s a nit (egg),” he said after a long search.

“That’s a flake of skin.”

We turned up other bits of debris. Finally, I straightened up. “A louse infestation isn’t subtle, and I don’t find one.”

Having heard this from every doctor, he was not offended. “I need a prescription. Over-the-counter remedies don’t work.”

I wrote the prescription and held it out.

“Give it to the hotel,” he said. “They’ll pick it up and pay for it.”

“I’m not sure they will,” I said.

“They’ll do it. I’ve already told them I plan to sue.”

Doctors hate hearing that word. “That costs a lot of money,” I said. “And I doubt you’ll win.”

“Right on both counts,” he responded pleasantly. “It costs five or ten thousand dollars to hire the lawyer and file the suit, and usually the hotels won’t settle. But I can’t let them get away with filthy bedding.”

How Many Pills Were in the Bottle?

“I came back to the room, and my Vicodin was gone.  The maid threw it out when she cleaned.”

“And how many pills were in the bottle?”

“Almost two hundred. I’ve had four back operations.”

“That’s a lot of Vicodin.”

“Check me out. I’ll show you the scars. I need your help.”

Plenty of drug abusers lead productive lives although it depends on the drug. You can’t do this for long with speed. Amphetamines and cocaine poison tissues, the brain most of all. Alcohol is also a toxin; alcoholics wreck their health. This doesn’t seem true for narcotics (Vicodin, Percodan, Oxycontin, heroin, etc). One can consume high doses for a lifetime with no noticeable harm except chronic constipation. Street addicts die from overdoses, contaminated drugs, disease, and violence. In countries that provide clean narcotics to addicts, they have a normal life expectancy.

Narcotics are probably OK for selected patients with chronic pain and a competent doctor. But there’s no denying that too many people are taking more narcotics than they need. Good doctors object because there are better ways of treating chronic pain. Moralists object on the grounds that doctors should make patients feel normal but never better than normal.

“As a hotel doctor, I encounter this problem now and then...”

“I swear I’m not a junkie, Doctor Oppenheim. I have chronic spinal pain, and I’m under a doctor’s care.”

“I’m glad to hear that, because I’ll have to speak to him.”

“He’s in New York. It’s midnight in New York.”

“I know. So I’m going to phone ten Naproxyn to the Walgreen’s at Santa Monica and Lincoln. Tell your doctor to call me tomorrow.” 
  
“The damn hotel threw out two hundred pills! They said you’d replace them!”

“I don’t work for the hotel. It sounds like the Naproxyn is unacceptable to you. So…”

“I’ll take the ten.”

This would satisfy him temporarily, but the odds were one hundred percent that his doctor wouldn’t call, but he would. There was a small chance he’d be in another hotel and pester another doctor. There was a large chance he’d behave in a sufficiently obnoxious manner that the staff would take any complaint about me with a grain of salt.