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.

 

Medicine is Easy; Parking is Hard, Part 1

 A foreign student at the University of California had bronchitis. I live three miles from UCLA but this was the University of California at Irvine, 52 miles away. I quoted a fee that took this into account and was not overjoyed when it was accepted.

Navigating inside a huge campus is tricky, but Siri directed me to the correct address. It was, as I suspected, the administration building. No one lived there. I phoned the student to ask where he was and where to park because the streets were forbidden. He said he would come out and direct me.

When I phoned again in ten minutes, he assured me he was on his way. He arrived and guided me through winding streets to a parking lot with signs threatening serious consequences to anyone without a permit. He swore that it was OK. It was August; the campus was deserted, so I took the chance.

He wore shorts and t-shirt, appropriate for a hot summer day. Sweating in my suit, I trudged at his heels for several blocks, passing building after building until we reached his. It was a student dormitory, so there was no air conditioning. The visit went fine.   

Girls Are the Best

 “’allo!” a little girl shouted from her bed as I walked into the room, but that was her only English. Her French parents had called because she was running a 101 fever.

She seemed delighted to see me and jumped to sit on the edge for her exam. Smiling happily she waited as I quizzed the parents, opened her mouth widely at my request and made no complaint when I poked my otoscope into her ears.

I found everything normal. She had a virus that might last a few days and required only Tylenol. Staying in bed was not necessary. Everyone seemed pleased, the child most of all; she waved goodbye as I left.

I enjoyed that visit. Readers are familiar with my admirable qualities, but I admit that I am not the sort of jovial physician who enchants young children. Mostly I do fine, but I’ve endured plenty of encounters with apologetic parents and a screaming, struggling toddler.

These are almost all boys. Adult male pugnaciousness has not made the world a comfortable place, and it works equally badly in children. They get the exam regardless, but it’s drawn out and painful. The parents are embarrassed, the doctor relieved when it’s over.

Little girls rarely make a scene. If frightened, they keep quiet. If not, they realize, almost from birth, that charm works wonders. Everyone relaxes and takes care of business. Women should run the world.  

A Dog-Eat-Dog Business, Part 9

I keep an eye on the competition, searching the internet for various combinations of “hotel doctor,” “house call doctor,” “housecall,” etc.

Once I came upon International Medical Services which promised to send a highly qualified doctor to a home, office, or hotel at a moment’s notice. When I phoned, its medical director knew my name, having dealt with me at previous jobs.

Like all new arrivals, he insisted that business was thriving. In fact, as we spoke, a hotel guest needed a visit, and I was welcome to go. I asked about the fee.

“We charge between $1600 and $2000. The doctor gets half.”

“Guests won’t pay that!”

“We don’t have trouble. These are generally foreigners with travel insurance. Foreign travel insurance knows about American doctors.”

He suggested I quote $1200 and then add a few hundred dollars for medicines and supplies. That was his doctors’ routine.

I visited a young woman at the Hampton Inn with a simple urine infection. She handed over her credit card without complaint.

That felt creepy. I mailed $600 with a note asking him not to call again.

The Hampton Inn is not an upscale hotel. How did he persuade its staff to refer guests? My legal advisor warns me not to speculate.

 

Another Incident in a Hotel Doctor's Glamorous Life

Younger, cooler, more expensive doctors own the franchise on Los Angeles film shoots, but I go now and then.

A European director staying at the Langham in Pasadena asked for my services and then went off to work.

After driving miles through suburbs I encountered the usual cluster of trailers, street barriers, and police. It was a hot summer day in Los Angeles, but Pasadena is always ten degrees hotter.

Workers hurried about, but I was the only one wearing a suit, so I stood only a few minutes baking in the sun before an assistant approached. Like every aide I’ve met on film sets, she was young and beautiful. I hate to imagine the hiring procedures of production companies. 

She led me into a trailer, thankfully air-conditioned, where I waited fifteen minutes until the director made time. He showed me a rash and worried about bed bugs.

Many foreigners believe Americans fall below civilized standards of cleanliness. We think of personal hygiene in terms of body odor, but they notice that we allow dogs free run of our houses, and we don’t take off our shoes when we come inside. That the Langham is very expensive does not rule out bedbugs, but I diagnosed hives, an allergic reaction.

I’m not sure my reassurance convinced him, but he was a workaholic like so many of my patients. He hurried back to the set with the box of pills I handed out, and I considered it likely that he put it out of his mind.

Lost in Translation Again

 6 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher that I would be at the hotel in an hour.

The freeway was clear. Parking, even downtown, would be easy. My phone rang as I drove. It was the guest’s travel insurer warning that there was no answer when he phoned to tell her when I’d arrive. When guests request my services directly and then vanish, I don’t get paid, but this is not the case with travel insurers, so I drove on. It was unlikely she had left the hotel.

At this hour, I check at the desk to make sure I don’t knock at the wrong door. The clerk confirmed the room, called, and reported that someone had answered and then hung up.

It was good news that she was present, not so good that she had immediately hung up. That’s a sign that a guest doesn’t speak English. 

A young Japanese woman greeted me at the door, ushered me inside, consulted her Ipad, then announced in triumph: “......stomach!!....”

One advantage of travel insurance is that dispatchers will interpret. Despite my admonition, they prefer to edit, abridge, and summarize rather than simply translate; their English is often rudimentary, and passing the phone back and forth makes for a long, tedious visit.

On the plus side, these guests usually have uncomplicated problems. It worked out. 

A Black Spot

  “You’ve got a black spot,” said my wife when I asked her to scratch my back.

“Black as the tar in the road?” I asked. She confirmed this, but as I quizzed her she realized that a black spot was bad and began retreating. Maybe it was dark brown.

She took a picture with her cell phone. It was half an inch in diameter, dark, and lumpy but not obviously malignant looking. Wives are always discovering things on their husbands which, being men, they ignore. Later the husbands die.

I decided I needed to see an expert. It was Friday, and I didn’t want to spend an anxious weekend, so it had to be today.

My favorite dermatologist in Los Angeles is Pamela Rand. She does not accept insurance, Medicare included, so I use others for routine skin problems. She was on vacation.

I like the doctor I see at the UCLA dermatology clinic in Santa Monica, but the clerk reported no openings until Tuesday. When I pressed, she transferred me to a nurse who, after consulting for several minutes, reported she could move me up to Monday. I would have tried to pull rank as a physician had I been really frightened, but I was only uneasy.

A few dermatologists phoned at random were not helpful. I phoned the main UCLA clinic in Westwood and learned that there were no openings except in distant suburban facilities. Thousand Oaks and Westlake were about forty miles; Porter Ranch seemed closer.

The drive was long, but parking was free. The dermatologist took a quick look and told me it was benign. I sat patiently as she educated me on seborrheic keratoses (age spots) and accepted her handout. Doctors don’t learn that I’m a physician unless they ask. It doesn’t get me better medical care, and some doctors feel uncomfortable having one as a patient. 

 

A Pure Source of Natural Energy

 A yoga instructor was attending a convention of like-minded devotees when one vendor gave him a sample of a natural energy pill. Within half an hour, he became certain that his blood pressure was out of control.

Patients who believe they know when their blood pressure is high are wrong because high blood pressure causes no symptoms. But he was certainly jittery.

In fact, his pressure was higher than I’d like in a 43 year-old man, but he admitted that his family doctor had also found this. He had been trying to control it through yoga.

I read the label on the bottle. Each pill contained a mixture of herbals and vitamins and a large dose of caffeine. I never drank coffee, and my first experience with caffeine – in a wake-up pill in college – was dramatic. I loved feeling super-alert, but I understand why a more mellow personality might not.

The effect was already wearing off, and he had no objection to my explanation. When I suggested that it was time to treat his hypertension, he promised to ramp up his yoga. 

A Medicolegal Housecall

Stepping out of the shower, a Doubletree guest stumbled and cut his leg. He had paid little attention, but now, two days later, the wound had grown painful.

That sounded like a good visit until he delivered the bad news: the hotel would pay my fee.

I label these “medicolegal” visits and I don’t collect. When a hotel offers to pay, it’s usually because the guest is making a fuss, and management has already agreed to other expenses such as comping the bill.

I don’t want to be part of the problem, and it’s a chance to remind upper management of my value. During my usual visits I never see a general manager. Most managers are only vaguely aware of my existence, and a few are surprised to learn that the hotel can call a doctor.

The guest’s shallow, one-inch, laceration was healing normally. I doubt he would have called if he had had to pay. I reassured him.

I shook hands with the general manager and assured him that there was no significant problem. I added that, as the hotel’s doctor, I was always available, and he should feel free to consult me under any circumstance. I waved off his offer to pay. He expressed gratitude.

Don’t assume that this guarantees a hotel’s loyalty. It’s been years since Loews in Hollywood and the Adventure hotel called. My last visits to both were medicolegal freebies.

A Better Medicine

A 2 year-old was ill with vomiting, diarrhea, fever, and a rash. That sounded bad.

I know a pediatrician who makes housecalls, and I considered sending him. But the news came from the guest’s travel insurer, and their pronouncements are often exaggerated. I decided to go.

The guest greeted me at the door with a cheerful toddler at his side. That, to my relief, was the patient. He still had diarrhea, and a spotty rash was present but fading.

Suffering a respiratory infection, the child had seen the family doctor and received the traditional antibiotic. Instead of amoxicillin (the world’s most popular antibiotic for people who don’t need an antibiotic), he had prescribed Augmentin, excellent when necessary but a legendary stomach upsetter.

The parents took for granted that the solution was a better medicine and something for his rash and diarrhea. But this was one of those situations where stopping everything works best. 

Disaster Averted

“We have a situation with a guest…” explained the manager of the Georgian.

I love doing favors for hotel management, but this sort of announcement is not promising. Medical science cannot calm drunk, stoned, or disruptive guests, but hope springs eternal among hotel staff.

This turned out to be not so bad. A guest was taking an injectable medicine for rheumatoid arthritis. It required refrigeration, and the hotel had agreed to store it. Unfortunately, for unclear reasons, someone had left it on top of the refrigerator all night. What should he tell the guest? Could I call a pharmacy to replace it?

The medicine was Humira, a high-tech, genetically engineered monoclonal antibody. The internet pharmaceutical supplier that I patronize would sell me two doses for $7,000.

I did a Google search to find the manufacturer’s medication guide. While Humira should be kept in cold storage, leaving it at room temperature for a few days is OK. You can bet the manager was grateful for this news.

Easy Money

A Brazilian traveler had left her medication at home. Could I drive to Hermosa Beach and write some prescriptions? The caller was the guest’s travel insurer.

When hotel guests call directly, I tell them to go to a pharmacy and explain what they need. I would approve over the phone. It’s free; everyone is happy.

Before I could offer to do the same, the dispatcher informed me that, as a new service, the insurance would pay for visits to replace prescriptions. I could not turn down easy money.

It turned out not to be so easy. Helpfully, the traveler’s family doctor had faxed his prescriptions, but the writing was illegible and in Portuguese. There followed half an hour of phone calls to pharmacies and to Brazil and Google searches before I found the American equivalent of three of the four. The fourth never turned up, but it was probably an herbal remedy.

 

Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him to check and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.

Sickness Makes You Sick

“Normally I wouldn’t bother with this cough, but when I started to bring up green mucus I knew I had to do something…..”    

Hotel guests tell me this regularly, and it’s wrong. Everyone’s respiratory tract makes a quart of mucus a day. When the respiratory tract is irritated, it makes more, and the mucus may turn yellow or green. In an otherwise healthy person, this has no ominous significance.

No one stares at their throat when they feel fine, and a sore throat always looks suspicious. Everyone knows that white spots on your tonsils are a sign of Strep that requires urgent attention. In fact, plenty of ordinary viral infections make tonsils look bad.

 “The fever came back,” guests tell me as if this were a serious development. But Tylenol or aspirin only work for a few hours, and then you must take more. When patients tell me that they worry about a fever, my advice is “then don’t take your temperature.” They treat this as a joke, but the truth is that fever is just another symptom.

 All bets are off if you suffer a chronic illness or serious immune deficiency or are extremely old or extremely young, but this is not the case with almost everyone I see. When people in good health get sick, they feel sick.

 

 

Luckless Americans

 Ailing US airline crew are out of luck. They must travel to a clinic in a strange city, present their insurance card, and hope for the best.

 Foreign airlines do better, sending a doctor to care for crew when they lay over. In Los Angeles that’s often me. Being young, crews suffer common ailments. Even better, company rules forbid work if they have a cold, a digestive upset, or a minor injury.

 On my own, I often handle minor ailments over the phone, but airlines demand a doctor on the spot to confirm the ailment and name a date when the employee may fly again. I enjoy those visits. These patients are never demanding; their priority is getting home. They hate being stuck in a hotel room. Airlines permit them to return as passengers, and I’m liberal about allowing them, so those visits usually end happily for both of us.   

 

The Decline of Civilization

The desk clerk tried to hand back my parking slip, but I made no move to accept it.

“We are unable to validate” she said. “It’s twenty dollars. You pay at the cashier’s window.”

“As I explained, I’m the hotel doctor. They let me park.”

“Unfortunately, the hotel doesn’t own our parking service, so we have no control over the charges.”

“That’s true for most hotels, but they let me park.”

“Let me speak to my manager.”

It was a stretch to call myself that hotel’s doctor. The Mondrian was not a regular although I’d been there a dozen times over the years with no problem. Several minutes passed before the clerk returned.

“Regretfully, my manager says we’re unable to validate. The hotel doesn’t own our parking service, so we have no control over the charges.”

Not willing to hassle hotel staff, I took the slip. I’m not poor, but paying twenty dollars at a fraction of my hotel visits per year, say a hundred, is serious money. This is happening more often.