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.

Calling Paramedics

If you want reach a hospital as fast as possible, get in your car and drive.

Paramedics are slower. They’re essential if a problem might be life-threatening or requires special handling such as a fracture. They sometimes transport even if their expertise isn’t required, but it’s not guaranteed. If you have a bellyache or high fever, they might leave and tell you to take a cab.

Phoned in the middle of the night, some hotel doctors determine that everyone requires paramedics. With no office job I don’t mind getting out of bed and do so regularly, but if the guest sounds like a genuine emergency, I have difficulty persuading the hotel that it has an urgent problem.

“I just talked to a guest, Mr. Elwood, in 435. He’s confused and can’t get out of bed. He needs paramedics.”

“I’ll send a bellman up right away.”

“No, you have to call the paramedics.”

“I’ll call Security. They’ll send someone to the room.”

“You have to call the paramedics.”

“Maybe you should talk to the manager on duty.”

At any hour, the noisy arrival of the ambulance followed by a train of fire engines disturbs everyone, so convincing a hotel to make the call often takes an effort.

I Save a Life

After apologizing for waking me, the caller explained that his companion couldn’t sleep because she felt short of breath. Shortness of breath in an otherwise healthy person is either anxiety or a serious matter. The caller added that she was prone to respiratory infections. Maybe she has pneumonia, I thought. I can cure pneumonia.

She didn’t appear ill, but she was English, not a demonstrative people. She had no fever. Her heart was racing. Listening to her lungs, I heard the crackle of fluid which is audible in pneumonia but also in heart failure. I suspected heart failure. When the heart beats weakly, blood backs up into the lungs waiting to pass through, so victims have trouble breathing.

Calling paramedics was risky because they might decide she wasn’t sick enough to transport. Leaving after obtaining her promise to go to an ER was not an option because I would worry. Long experience has convinced me that if guests need to go to a hospital, I must make sure – with my own eyes – that they go. So I drove the couple in my car. Watching them disappear through the emergency entrance made it certain they were now another doctor’s responsibility. 

When I phoned later, the doctor explained that she was suffering rapid atrial fibrillation, an irregular, inefficient cardiac rhythm. He had performed cardioversion – delivering an electric shock to the heart – and she was now in a regular rhythm and feeling better. They were scheduled to fly to Las Vegas the day after my visit, and when I called they had checked out.

Disappointment

“A guest needs a doctor. Are you available?”

“I am. If you connect me to his room, I’ll try to help.”

My tone was businesslike, but joy filled my heart. The caller was the Airport Renaissance which never called. Acquiring a competitor’s hotel is a rare and delightful event.

A male voice answered after two rings. “There’s something in my eye.”

“Tell me what happened.”

“It’s no big deal. If you give me tweezers, I’ll take it out myself.”

“You mean it’s visible?”

“There’s a sliver stuck in my eyeball… Don’t tell me to go to a hospital. I’ll sign anything. Come to the room. Or get me tweezers.”

He interrupted my response.

“No hospital! No emergency room! Bring legal documentation to protect your liability. I’ll sign. Come alone. Don’t bring any FBI or CIA.”

I called the concierge to report that this was a matter for the police or paramedics. She admitted that the guest was causing a disturbance.

Sadly, I realized that the Renaissance was not changing doctors. Hotels hate dealing with crazy, drunk, or disruptive guests. When the regular doctor refused to come, the staff, in desperation, began calling other doctors in hopes that one would make the problem go away. This happens once or twice a year.

Not Hitting the Jackpot

“Our client had a heart attack,” explained the dispatcher from Universal Assistance. “He wants to go home, but the specialist says he needs a doctor. We have hired a medical flight, and we want to know if you can go to New York. You come back the same day.”

Experts advise waiting a week or two after a heart attack to fly, but no one knows the risks of flying earlier because no one does. An expert who suggests that a physician go along is covering his ass, not delivering advice based on evidence.

Still, the insurer had agreed, no minor matter when an air ambulance coast to coast costs about $40,000. I had no idea what I would earn; nor did the dispatcher, but it would be breathtaking. Hiring a doctor for a day to testify in a malpractice trial runs to $7000.

I still remember with pleasure the single occasion I flew first class. Flying in a private jet while earning the price of a European vacation might leave an even better memory.

But would the patient require a doctor’s skills? It was unlikely, but I could not dismiss the possibility. Like most doctors, I can perform basic CPR, but I and most doctors have long since forgotten advanced CPR: complex drugs and techniques required for various cardiac malfunctions. Emergency room doctors, paramedics, and ICU nurses deal with these.

Wistfully, I informed the dispatcher that those were the appropriate escorts. 

A Mystery

Universal Assistance asked me to see a young woman with abdominal pain at the Airport Hyatt. According to the dispatcher, she had no other symptoms.

Arriving in the room, I learned things the insurance dispatcher hadn’t mentioned. The woman was three months pregnant and had noticed vaginal bleeding. It’s surprising how often doctors know the diagnosis as soon they set foot in the room, but it looks bad to blurt it out, so I asked questions, performed an exam, and then delivered my conclusions. She was having a miscarriage and had to go to an emergency room. 

The following afternoon, the lady’s husband called. They were back in the hotel. The emergency room doctor had diagnosed a miscarriage. Then he had discharged her. But she was still bleeding. Was that normal?...

Bleeding stops when a miscarriage is complete; if it continues, a doctor performs a D&C to scrape away remaining tissue. I have no explanation of why the doctor sent her out still bleeding. I told the husband that, sadly, he would have to take her back. The second time she received her D&C.  

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.

Worry, Part 1

A guest had stumbled in the shower and thrown out her back. Could I make a visit to decide if she needed hospitalization?

Going to the hospital with back pain is a bad idea; even if you’re in agony, no doctor will admit you without evidence of nerve damage such as paralysis or inability to urinate. He will order x-rays (worthless for acute back pain but an ER tradition), explain that you will recover in a few days, and prescribe pain medication.

My examination showed no nerve damage, so I explained that she would probably improve in a few days. I handed over pain pills, adding that, while it wasn’t essential, I could give an injection that would help for several hours. She agreed, so I gave it. 

 “Not so good,” she replied when I called to ask how she was doing. She had been vomiting since the injection, and each vomit hurt her back. That’s an occasional side-effect. I assured her it would pass, but I worried.

She was marginally better the following morning and the morning after that. She wanted to fly home. Could I provide medical clearance? Visits for “medical clearance” are a lucrative perk of hotel doctoring, but I resisted the temptation, explaining that there’s no medical reason why someone with back pain can’t travel. If she could hobble onto the plane, she should go.

Could I give a “mild” injection so she could move more easily. No such injection exists. I suggested she try the pain medicine.

Later, the lady reported that the medicine made her dizzy. What should she do? I told her it would pass. Rest is not helpful for treating back pain. She should try to make her plane. When I called later she had checked out. I worried that I might hear from her, but I didn’t.

Better to Be Right Than Wrong

A guest told me she had a stomach virus, so I drove off in a relaxed mood. This is the second most common complaint that a hotel doctor sees and easy to deal with.

But it wasn’t easy. The guest was huddled on the bed, looking very ill. I could barely touch her abdomen. I wondered if she had acute pancreatitis or a gallstone.

The paramedics arrived and took her off.

When I called that evening, the husband answered. I learned that by the time the emergency room doctor saw her, she wasn’t feeling so bad. After several hours and many tests, he sent her out with a prescription and the diagnosis of a stomach virus. She was now better.

Naturally, I expressed pleasure at her recovery. He thanked me for my concern, but I admit to a touch of chagrin. A doctor must send a patient to an emergency long before he’s 100 percent certain there’s an emergency. Otherwise, he’d decide not to send some who needed to go: a much worse scenario. Still, it feels better to be right than wrong.  

Bad Credit Cards

A member of an Argentine soccer team fell while roller staking, wrenching his ankle.  A doctor from their travel insurer in Buenos Aires determined that he needed an orthopedist but that this could wait until office hours the following day. However, the doctor wanted someone to examine him that evening, so my phone rang.

The team was staying in Long Beach, 35 miles away, but the rush-hour had passed, and the agency did not object to the extra fee. This was International Assistance. I’ve made 896 of its visits, but after an ownership change, it became extremely slow to pay. Losing patience, I insisted it give me a credit card number, so I could pay myself. This is always a critical request, because some agencies refuse and disappear from my radar. But International Assistance agreed.

As soon as I hung up, I remembered that IA’s current credit card had expired in August. When I called back, the dispatcher put me on hold to consult her superior. After a few minutes, she returned with a new number.

I phoned the credit card company and entered my identification and the credit card number only to hear the computer declare: “Do not honor! Do not honor!” I phoned IA again, awaited the consultation, and received another card. “Do not honor!” intoned the computer a second time.

“Invalid credit card number” I heard on my third attempt. This turned out to be my mistake; in my increasing frustration, I made an error entering her third number. After correcting it, I heard the satisfying: “Approved” following by a confirmation number. Insurance agencies often give me bad credit cards. I suspect their business is as competitive as mine, so many are in perilous financial condition.

My patient was reclining on a couch, an ice pack on his ankle, his teammates gathered around. The ankle was massively swollen, and he was in pain. Waiting would not have caused permanent harm, but people with painful injuries deserve quick attention.

Fortunately, IA is an agency that takes my advice even when it costs money, so his companions took him to an emergency room to deal with fractures of both leg bones.