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.

"This Has to Go Into My Blog!"`

A dispatcher from the agency that handles airline flight crew mentioned a sore throat, but the guest mentioned an “unprotected sexual contact” two nights earlier. The sore throat appeared soon after, and he was worried. Very worried.

No problem. Unprotected sex with a stranger is a bad idea, but the odds of disaster are low. I settled back to learn what happened.

He seemed distracted. Asked for details of the contact, he didn’t remember. The phone rang. During the conversation, he mentioned to the caller (apparently his supervisor) that someone was in the room who claimed to be a doctor. Could he explain?

That sounded odd. When he hung up, I suggested he call the agency to confirm my identity. He did so and then handed me the phone. The dispatcher apologized and admitted that the guest had been calling since the previous day and seemed disturbed. He hoped I could help.

Confirming my identity did not improve matters. When someone knocked at the door, he told them to go away. Ignoring me, he dialed the hotel phone. Reaching voicemail he explained that he needed a clinic appointment but someone had sent a doctor. He needed an explanation. Hanging up, he dialed his cell phone, reaching a friend for a short chat during which he mentioned that there was a stranger in the room.

I suggested that if he wanted to go to a clinic, I could arrange it. Waving this off, he dialed another number. It wasn’t clear who or why he was phoning. Someone knocked, and he told them to go away. When I expressed a wish to leave, he stood at the door. For the first time I felt nervous. I repeated my request several times in a soothing voice. He opened the door a crack. I squeezed out, and he slammed it behind me.

In the lobby, I phoned the agency to explain that the guest needed a psychiatric evaluation. Minutes later, as I sat filling out forms, a noisy flotilla of fire trucks, police cars, and paramedic van pulled up.

I followed half a dozen men up to the room. Several of the guest’s crewmates were on the scene, trying to persuade him to open the door. They would have succeeded if given time, but the officers wanted to wrap things up.

If I were paranoid, I would not want to hear strange men pounding on my door demanding that I open. They broke in and hauled him off. Acute psychotic breaks rarely last long, and he was back in a few days, much better according to the dispatcher. He needed another visit to clear him to fly.   

"I Can't Afford That!

I hear this now and then when a guest learns my fee, more often in the form of a hint (“I’ll talk to my husband and call you back…”).

My routine when hotels call is to listen to a patient’s symptoms, deliver an opinion and advice, and discuss options (only half my callers require a housecall). Once a guest agrees to a visit, I reveal the cost.

Hearing a reluctance to pay, I mention local walk-in clinics. Their basic charge is less than mine, although that difference disappears if the doctor does anything (i.e. orders a test, gives a shot, writes a prescription, applies a dressing).

I feel uncomfortable suggesting leaving the hotel room if it’s a struggle – for example if someone is vomiting or dizzy. This guest had been dizzy all day. In these cases, I insist on coming, telling them they can pay whatever they feel is fair. Many guests end up paying the usual, but I’ve taken as little as $5.00.

Since she had already protested the fee, my expectations were low. They dropped to zero when I approached the hotel and saw paramedics loading her into an ambulance.

The guest’s symptoms were not life-threatening, but paramedics lean over backwards to take patients to the hospital, having been burned in the past when they didn’t. 

I wondered if she had called them because of worries about my fee. She may not have realized that paramedics will send a whopper of a bill.

Paramedics Versus Doctors

My personal encounter with paramedics occurred the day I fell (ironically during my morning health walk) and broke my leg. I might have lain there for some time because pedestrians in my middle-class neighborhood pay little attention to the occasional bearded old man lounging on the sidewalk. Luckily, I had taken a detour through an alley behind a restaurant where two Hispanic workers noticed and came to my aid.

I was not in great pain as long as the leg remained immobile. Any movement hurt terribly. When the paramedics approached with their gurney, I was frightened, but they scooped me up, drove to a hospital, and shifted me to another gurney with hardly a twinge. Never mind their medical skills; that showed talent.

While I admire paramedics, they have little use for me in my capacity as a hotel doctor. Paramedics almost never encounter a physician on their calls, and they don’t like it when they do. Most likely, they worry he might pull rank. As a result, when paramedics arrive at my hotels, I sit quietly, never speaking unless spoken to. In turn, they go about their business, pretending I’m not there.

Another Death

 “He’s over there! I think it’s an emergency!”

Emerging from the elevator, I did not want to hear this. Despite the impression left by television, cardiac arrests are usually fatal. Outside a hospital, between six and eleven percent survive.

The survival rate of the few I encountered is zero, and this did not look like an exception. An overweight security officer was kneeling clumsily on the bed, bouncing up and down as he pounded an old man’s chest. The guest’s false teeth had jarred loose and protruded from his mouth; I plucked them out.

Security officers learn CPR but rarely use it, so they forget the details. Cardiac massage on a soft bed doesn’t work. The officer should have dragged the guest onto the floor. One of his colleagues should have been giving mouth-to-mouth respiration, but it was almost impossible to persuade laymen to perform something they considered disgusting. Mouth to mouth respiration was essential until 2010 when experts decided that chest compression alone was OK.

I asked how much time had passed since the arrest.

“I don’t know. He was out when I got here.” gasped the officer.

I found no pulse, heartbeat, or respiration, and it was obvious the man had been dead for some time, so I told the officer to stop. Hearing this, an elderly lady in a nightgown hovering nearby burst into tears. At that moment, two paramedics and two firemen clumped noisily into the room accompanied by a man in a suit and a young woman, apparently the manager plus the concierge. Cardiac arrests attract too many people.

Observing the corpse and the weeping woman, the senior paramedic flipped through his clipboard. “Is that your husband, ma’am? Could you give me his name?”

She couldn’t. Disobeying my rule about staying out of the way in the presence of paramedics, I comforted her. Lowering his clipboard, he waited patiently. This is the single activity paramedics are happy to leave in the hands of a physician. After a few minutes, she became calmer.

Disposing of the dead guest took a while. Two police arrived and transcribed the wife’s story a second time. One by one, the staff left, followed by the police and paramedics. The medical examiner’s ambulance drove off with the body. The lady couldn’t find her sleeping pills, so I provided some. I left my phone number and promised to call in the morning.

Recovering From Cocaine

He had turned bright red, a frightened guest informed me. His search of the internet revealed that this indicated dangerously high blood pressure. Could I come…?

This was as accurate as most internet medical advice, so I was not alarmed. In response to my questions, he admitted using cocaine earlier but emphasized that he had never turned red before. His heart was pounding, his skin tingling, and his head pulsating but he denied having a headache or chest pain. Could I come?

What to do…. Allergic reactions turn patients red, but this is accompanied by itching which he didn’t have. Otherwise, his symptoms were typical of cocaine use. They didn’t sound life-threatening, but it’s a bad idea for a doctor to dismiss the possibility.

I do not like to make housecalls to frightened hotel guests. Waiting often becomes intolerable, so they dash off to an emergency room or call the paramedics before I arrive. When I suggested these possibilities, he refused, urging me to come quickly. I asked him to count his pulse. It was 100:  not terribly fast. I kept him talking, and he grew more calm.

A hotel doctor’s nightmare is a guest dying after he leaves the room, but dying before he arrives may be worse. It was a stressful drive.

When he opened the door, he didn’t appear bright red, perhaps faintly pink. When I took him to a mirror, he agreed that he had improved. His blood pressure was high, but not too high. His heart sounded normal. He was recovering from the cocaine.

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. 

Stuck in Liberalism

Walking along Pico, a busy street, I passed a man lying face down on the sidewalk. His head lay on the curb; one leg remained on a bus bench, so he had clearly toppled off. Even prosperous Los Angeles neighborhoods possess a few resident homeless, and this was probably one. He looked disheveled.

Naturally, I continued past. After a dozen paces I stopped because my conscience was hectoring me. “You have to help this fellow,” it pointed out.

“Someone else will notice,” I replied.

“Not good enough.”

“I do fine with patients,” I pointed out. “But this is not a professional situation.”

“Doctors have a moral obligation to help anyone in distress!” said my conscience.

“That’s flattering, but many doctors disagree. You should read the physicians on internet forums. Most are very conservative.”

“You have to help.”

“….They hate Obamacare. They think welfare patients are deadbeats. They don’t even like patients with private insurance. Their idea of heaven is a cash-only practice.”

“Not good enough.”

While I paced in a circle, debating this irritating voice, a hundred cars and dozens of pedestrians passed by. Finally, I gave up. The 911 dispatcher listened to my report and then transferred me to the fire department. The fire department dispatcher listened and then transferred me to the paramedics.

“How old is he?” asked a paramedic.

“Middle-aged.”

“What do you mean ‘middle-aged’?  he snapped. “Forty… Fifty… Sixty?”

“Fifty,” I guessed.

After several more questions designed to show that I was bothering him, he told me to wait until the ambulance arrived. As I waited, the man stirred.

“That’s all I need!” I thought. “For him to get up and walk away.”

But he didn’t. The ambulance arrived within five minutes, and the paramedics went to work. When they ignored me, I walked off.

My Norwegians, Part II

At midnight the Norwegian lady from the previous post phoned, begging for a housecall. Something terrible was happening. This was a full-blown panic attack, she informed me. She knew for certain that she was dying. When I assured her that she would not die, she did not deny it but pleaded tearfully for me to come. Victims of panic attacks are not psychotic. They know they’re behaving irrationally, but they can’t resist.

These calls are not rare, and I usually handle them without a visit. Ten minutes of soothing reassurance and the knowledge that I’m immediately available over the phone generally works. Reassurance also works when I visit a guest whose complaint unexpectedly turns out to be a panic attack. Unfortunately, these successes are guests who don’t know they’re having an attack or suffer them rarely. This lady was a hard-core, locked-in panic attack veteran. Her attacks followed a strict pattern, and no reassurance would change matters.

If I came, examined, and found everything normal, she would express gratitude, but even before I finished counting my money, she would be pleading for another exam. Yes (I know you’re asking) there are shots, and I give them, but they don’t work. I hate walking out on a guest who’s begging me to stay, and these attacks may last hours.

This guest’s conviction that she was dying was clearly wrong. Yet every doctor has heard of patients who announce that they’re dying and then proceed to die. No doctor wants to be the source of such an anecdote, so this lady needed at least one exam. As I was agonizing, she broke in to say she would ask the hotel to call an ambulance. Then she hung up. I phoned the front desk to make sure they had done so. Like me the paramedics have encountered plenty of panic attacks; in the unlikely event something bad happened, they were the last medical professionals the guest had seen.     

A Risky Housecall

A lady at the Holiday Inn in North Hollywood reported that her husband was suffering diarrhea. She added that he had fainted during the last several episodes. I had never heard that before. Doubting that I could solve the problem, I told her we needed to call the paramedics. Sure enough, they took him to the hospital for a day of rehydration.

Paying for Paramedics

Hotel guests, Americans above all, do not like paying for a housecall. Many, if they are feeling bad, decide to “call an ambulance.”

Paramedics know their business. If the guest requires urgent attention, they’ll take him to a hospital. If not, they might still transport him because they don’t like to take chances. If the situation is clearly not urgent, they’ll tell him to consult a doctor. Sometimes I end up making the visit.

Paramedics are city employees, so their services are free. But for reasons unclear to me, transportation in an ambulance is not free. If paramedics take you to a hospital, the city will send you a bill. Like all medical services in America, the cost will take your breath away.

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.  

Paramedics

My personal encounter with paramedics occurred the day I fell (ironically during my morning exercise walk) and broke my hip. I might have lain there for some time because pedestrians in my middle-class neighborhood ignore the occasional bearded old man lounging on the sidewalk. Luckily, I had taken a detour through an alley behind a restaurant where two Hispanic workers noticed, came to my aid, and called 911.

I was not in great pain as long as the leg remained immobile. Any movement hurt terribly. When the paramedics approached with their gurney, I was frightened, but they scooped me up, drove to a hospital, and shifted me to another gurney with hardly a twinge. Never mind their medical skills; that showed talent.

While I admire paramedics, they have little use for me in my capacity as a hotel doctor. Paramedics almost never encounter a physician on their calls, and they don’t like finding one. Most likely, they worry he might pull rank. As a result, when paramedics arrive at my hotels, I sit quietly, never speaking unless spoken to. In turn, the paramedics go about their business, pretending I’m not there.