Vomiters Hate Waiting

A hotel guest phoned to ask when I’d arrive.

“In about fifteen minutes.”

On her initial call, I had told her I would arrive in an hour, and I was on schedule, so the call meant that she was still vomiting. Vomiters are impatient.

My database shows 2,328 entries for “gastroenteritis” (the common stomach flu). It’s my second leading diagnosis and far more satisfying than “upper respiratory infection” (4,584). Both are almost always incurable, but gastroenteritis rarely lasts more than a day; patients give me credit when it goes away.

The guest greeted me at the door, a good sign. A guest in bed is OK, sprawled on the bathroom floor is not good.

I asked the usual questions and did not interrupt as she delivered a precise, item by item, account of dinner. Everyone blames an upset stomach on their last meal, a belief as correct as most popular health beliefs. I gave the usual advice which included telling her to stop what she was doing (putting fluid into her stomach as fast as it came out) and to suck on ice and wait.

I gave the usual antivomiting injection and two packets of pills which I had pocketed before leaving so I wouldn’t have to remember to restock my bag.

When I phoned later, she told me that she had recovered and thanked me for curing her.

 

 

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.

Don't Get On the Plane!

“My flight leaves tonight” is a phrase I like to hear because it means the guest will return to the care of the family doctor. Until then he or she is my responsibility. Now and then, I don’t like to hear it. 

A guest awoke feeling well but soon noticed some abdominal pain.

When I hear “abdominal pain” I ask about vomiting and/or diarrhea and hope it’s present. That points to a stomach virus, usually a short-lived and not very serious problem.

Abdominal pain alone can mean a stomach virus, but I also consider serious conditions (gallstones, diverticulitis) and potentially fatal ones (ectopic pregnancy, blood clots). I prefer to send these guests directly to an emergency room, but sometimes I end up at the hotel.

This guest considered my question before deciding that he had diarrhea. Maybe… My abdominal examination turned up nothing requiring urgent attention. He was young, so several life-threatening problems were unlikely. The pain itself was unpleasant but not quite excruciating.

It was a difficult decision, but doctors are paid generously to make difficult decisions.

I told him that he probably had a stomach virus, but I couldn’t rule out something serious. I would give him something for the diarrhea and check back. I added that he might need some tests and that he must not get on the plane if the pain persisted.

When I phoned after three hours, he had checked out.

An Untypical Case of Stomach Flu

I once cared for a Fiji Airline flight attendant suffering stomach flu. These are miserable episodes of cramps, vomiting, and diarrhea that rarely last long. She was better the following day, but on that day I returned to the hotel to see another flight attendant with similar symptoms.

In the hotel room, I repeated my stomach flu exam, delivered the usual advice, and handing over medication. She asked if the medication was safe if she were pregnant.

Doctors are human. Having made a diagnosis, my inclination was to stick to it, but I asked a few questions. Her period was overdue. She admitted that her nausea, although worse today, had begun a week ago. Her cramps, also worse today, had also been present.

One of many rules medical students learn is that when a young woman has abdominal pain, one always considers an ectopic pregnancy. That’s usually a pregnancy in the fallopian tube which, unlike the womb, had no room for the growing fetus.

I told the flight attendant that she needed a test to see if she had an ectopic pregnancy which is an emergency. She did not disagree. I phoned the agency that handles airline crew. Their medical department agreed that this was appropriate, and it turned out positive.

Historical Diseases

Standby MD asked me to see a guest at the Doubletree – in Santa Ana. That’s fifty miles away, but it was Sunday morning; freeway traffic was light, a perfect time to go to Orange County.

The guest was an elderly Canadian man suffering diarrhea and vomiting. He mentioned that half a dozen members of his tour were affected; several had gone to the emergency room.

That brought back memories of a guest in 1991 with the same symptoms. Stomach viruses are the second most common ailments a hotel doctor encounters. They’re miserable but short-lived; I had delivered the usual advice and remedies, but when I called to check the next day, I learned that he was in the hospital with cholera. I remembered that he had flown in from Peru.

Cholera also causes diarrhea and vomiting. It’s extremely rare in the US. In fact, if an American patient turns up with any of the major historical diseases (cholera, malaria, rabies, leprosy, typhoid, typhus, plague, even tuberculosis) it’s almost certain that the American doctor will get it wrong on the first visit.

The Canadian gentleman was already recovering, but my phone rang before I left with a request to see another tour member. She was sick enough to send to an ER where she stayed until the evening. There is little cholera in Canada, so this was a stomach virus.