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.

 

Major and Minor Tranquilizers

Guests often ask for something to calm them, and I try to comply by stocking Valium.

Tranquilizers relieve anxiety but not the pain of a terrible event such as a family death. Unhappy victims regularly ask for something to “put me to sleep,” but only general anesthesia does that. Even sleeping pills merely produce drowsiness; if you’re miserable, sleep comes hard.

I give a Valium injection if asked, but I have a low opinion of its tranquilizing properties. Valium pills work better because the more you take, the drowsier you get. The effect of the maximum Valium injection does not impress me. I prefer Thorazine.

Valium and its relatives are minor tranquilizers; the Thorazine family belongs to the major tranquilizers. “Major” and “minor” have nothing to do with strength; they refer to the seriousness of problem they treat. Thorazine helps schizophrenia, a major mental illness. The first of a numerous class of drugs called phenothiazines, its US approval in 1954 marked a huge advance because it calmed schizophrenics enough so most could leave mental hospitals and live on the street, thus saving tax money.

People who deny that schizophrenia is a brain disease claim Thorazine works because it makes patients somnolent. In fact, many newer phenothiazines aren’t sedating but work as well. Thorazine and its family turn off the positive symptoms of schizophrenia:  hallucinations, delusions, bizarre behavior. Movie schizophrenics seem to enjoy themselves, but hearing a voice inside your head frightens most people even if it’s God.

Despite their dramatic effects, phenothiazines don’t cure schizophrenia because they don’t eliminate the negative symptoms such as apathy, social withdrawal, and self-neglect. Being around a well-behaved schizophrenic remains an uncomfortable experience. Something is missing.

The Time I Didn't Care for Woody Allen

“Woody Allen needs a doctor. How quickly can you get here?” The caller was the concierge from the J.W. Marriott.

                                                                                                                 

“Ten minutes,” I replied. The J.W. Marriott was in Century City, near Beverly Hills, a five minute drive.

“I don’t know….” She seemed doubtful. “I guess you should come.”

That sounded strange. How many doctors would appear at your door that quickly…? I threw on my suit and raced to my car. Turning into the hotel entrance drive, I encountered a sight that made my heart sink: a paramedic ambulance.

                                                                                                                 

“We couldn’t wait,” the concierge called out as I hurried past. There was still a chance. Most 911 calls are not emergencies. Long ago, paramedics declined to transport anyone who didn’t seem seriously ill. Sadly, they were burned in several cases when someone died after they left. Thereafter, their refusal rate plummeted, but I never lost hope.

Leaving the elevator, I headed for the inevitable crowd. As I approached, it parted providing a fleeting glimpse of Woody Allen rolling past on a gurney. I returned home, disappointed and unpaid.

                                                                                                                 

My experience with movie stars is that their screen personality owes much to reality, so I theorized that he had suffered an anxiety attack. Agitated guests make hotel employees nervous, so they’re quick to call paramedics, but this is overkill. I have a soothing manner, white hair, and a white beard (less white when I saw Woody Allen in 1993). Once I arrive and settle into a chair, I rarely fail to calm a panicky guest. Phoned in the middle of the night, I do the same without getting out of bed. Woody Allen should have waited for me.

Night in a Hotel Room

Patients are often suicidally reluctant to wake a doctor, but I don’t object. Traffic is light, parking is easy, and since I have no office, I can sleep late. I’ve made a thousand housecalls that got me out of bed.

Callers awaken in the dark, certain something terrible is about to happen. I try to handle anxiety attacks over the phone using sympathy and calm reassurance. I never point out that nothing terrible will happen because guests know that; it’s why they’re upset. I explain that no one is perfect; sometimes our brains go haywire, but it never lasts long. If I keep the guest on the line, this almost always works. Making a housecall is risky because guests often feel better and cancel before I arrive or feel worse and insist that the hotel call paramedics.

Some hotel doctors use paramedics as a substitute for getting out of bed, but I reserve them for emergencies. Mostly, these are obvious. Heart attacks can rouse victims from sleep, but they are not subtle. Niggling chest discomfort doesn’t qualify, and chest pain in a young person is probably something else. 

I see a cross-section of ailments, but guests with an upset stomach seem overrepresented. I consider a wee-hour visit for vomiting a good call (i.e. not life-threatening; I can help; patients are especially grateful). The latest antivomiting drug, ondansetron, is superior to the old standby, Compazine. It was once wildly expensive and used only for vomiting after cancer chemotherapy, but its patent expired a few years ago, and the price has plummeted.

Most upset stomachs don’t last long. I assure guests they’ll probably feel better when the sun rises, and (a perk of being a doctor) when that happens, guests believe I’ve cured them.

A Special Service

“Someone needs to check my nephew. He’s shaking and really upset. How quick can you be here?”

This was a bad call in many ways. I managed to learn that the child was in good health before a fire alarm roused everyone from bed at 11 p.m. He seemed to be frightened, perhaps more than usual. I had no doubt that he would recover, but that was hard to communicate.

I try not to make housecalls for anxiety attacks because many guests begin recovering while I’m on the freeway and cancel. Keeping the guest on the phone works better. After a half hour of to-and-fro and reassurance they admit they’re not feeling so bad.

This was one time that being reliable got me into trouble. The lady had called the front desk pleading for a doctor. Within seconds she was talking to a doctor. Weird!

She undoubtedly assumed that I was a special service provided by the hotel. Perhaps I was sitting by a phone in the lobby.

In any case, my efforts to keep her talking didn’t work. People are very protective of children. She insisted that a doctor must come. Reluctantly, I agreed. Then I had to mention something I never mention until it’s necessary. When I make a housecall, there’s a fee….. 

She was shocked. “I’m not going to pay that!” she said. “We’ll take him to the hospital!” She slammed down the phone.

This has happened before. I had to speak to her, not only to negotiate the fee but to assuage my fear that she would denounce me to the hotel. But the fire alarm was still in progress. She was not in her room, and it took fifteen minutes before the hotel could track her down. By that time she admitted that the child was feeling better.