The Occasional Surprise

A travel insurer asked me to see a lady in Mission Hills complaining of high blood pressure.

I drove off confident that this wasn’t her problem because high blood pressure causes no symptoms. Mostly patients are suffering a headache or anxiety or dizziness.

Now and then I’m surprised. In hotel doctoring, surprises are generally unpleasant but not in this case.

She didn’t have high blood pressure, admitted the lady apologetically. She’d lost her thyroid pills and only needed a prescription.

When I learn that a hotel guest needs a legitimate medicine, I phone a pharmacy to replace it, and I don’t charge. Guests with travel insurance don’t call me but their agency’s 800 number. Embarrassed to use insurance for a trivial problem, they lie. Sometimes hotel doctoring is easy.

Lost in Translation Again

As I stepped out of the elevator, a Japanese man was waiting. “Are you the doctor for the hotel?” he asked.

I was pleased. “Yes. Are you going to interpret for me?”

He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the father, and the patient.

The patient had complained of fatigue the previous day. He was otherwise in good health with no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in a child. I suspected an emotional problem, perhaps from the stress of foreign travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.

Luckily these were Japanese, so they listened with unfailing courtesy, through the interpreter, to my reassurance and advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted), nodding approval, and thanking me effusively as I left.

A Rule of Medicine That Didn't Apply

I give out medicines gratis. Mostly, they’re cheap, but exceptions exist. For unclear reasons my supplier charges $17 for antibiotic ear drops but $1.50 for antibiotic eye drops. Experts agree that it’s OK to use antibiotic eye drops in the ear, so that’s what I do.

I felt pleased handing over a bottle to a lady with swimmer’s ear. Ear infections are easy visits, and guests appreciate that they do not have to hunt for a pharmacy.

My heart sank when the guest’s insurer called the following day. She wanted another visit. I phoned the guest who admitted that her ear was no worse, but now she had a fever, headache, and sore throat. That was disturbing. Had I missed something?

I returned to the hotel. She had a 102 temperature with swollen tonsils and swollen neck glands. Since she was barely out of her teens, Strep throat was a reasonable diagnosis.

It’s a rule of medicine that a doctor who makes two separate diagnoses is not thinking clearly. Patients have one thing, but this woman definitely had swimmer’s ear and Strep throat. 

Free Services

A few years ago, Quantas abruptly cancelled flights after an engine exploded. Other airlines followed.

Passengers were stuck in hotels. Within days calls began arriving from guests running out of heart or blood pressure or diabetes medication. They had brought only enough for their trip or the bottles were packed in luggage which the airlines refused to release.

Aware of horror stories about America’s medical system, they were counting their money, hoping to have enough for the necessary king’s ransom. The lucky ones (those in my hotels) were pleased to hear that I don’t charge for replacing legitimate prescriptions.

Most drugs are available worldwide but in different formulations and with different names. Rather than try to figure things out, I tell guests to go to a drug store where the pharmacist will research the matter and phone for my approval.

Guests regularly forget to pack medication, so I do this routinely. My record occurred after 9/11 when all flights stopped, and hotels were packed. Some travelers also fell ill, so my paying business jumped for several weeks. Then everyone returned home, and tourism plunged for a year. That was a bad time for hotel doctors, too. 

Getting Help, Part 2

My relations with other Los Angeles housecall doctors are civilized but not close. As a result, when I leave town there’s only one colleague I trust to cover. Mostly this works out. I schedule my trips so they don’t conflict with his.

When I’m in town I’m always available. That includes after bedtime, in the movies and restaurants, and during social events. It includes concerts and live theater, but I sit on the aisle, so I can hurry to the lobby when my phone buzzes. None of this bothers me greatly (my wife is another matter).  

One event causes problems: baseball games. One of my brothers has Dodger season tickets, and we attend a dozen times during the season. We go to a restaurant and then the game: almost the only time we get together; I love it and don’t want to be interrupted. I’m out of commission only about six hours, and occasionally my colleague can’t cover.

I could continue to answer the phone, but crowd noise in the stadium makes conversation difficult. It also reveals that I’m having fun, and patients hate disturbing a doctor during his leisure time. My solution is to change my phone message to announce that I’m unavailable until (whatever time the game ends) and then turn off the phone. Genuine emergencies are very rare in a hotel doctor’s practice, and so far it’s turned out all right. But I’m always looking for help.

Girls Are the Best

 “...allo!!” shouted a little girl from her bed as I walked in, 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 when asked 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 loved 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.   

Lost in Translation, Part 2

5:30 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher 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 call 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’s English is not good. 

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, hotel guests usually have uncomplicated problems. It worked out fine.