Having the Proper Credentials

A Brazilian woman suffered abdominal pain, but her doctor in Rio found nothing wrong. It went away, so she flew to the US where it recurred.

Her host lived in the Hollywood Hills and spoke excellent English. She may have been a show business personality because her walls were covered with celebrity photographs and posters. After examining the guest, I explained that she needed a further evaluation, perhaps including an ultrasound, because one possible diagnosis was gallstones.

Her host spoke up. “You are ordering an ultrasound? Where must we go?”

I explained that I wasn’t ordering an ultrasound but referring her to a doctor who could do whatever tests were necessary. I added that my next step was to go home, fax my report to the insurer’s American office in Miami, and follow it up with a call to alert the dispatcher. He would phone doctors in Los Angeles, preferably the ones I recommended, until he found one willing to accept the Brazilian insurance and then call her. It might take a few hours.

“I have a fax machine. Why not do it now?”

I didn’t know the insurer’s fax number. It was at home.

“Then I will call.” Examining her guest’s insurance papers, she found a phone number, but it looked foreign. As she dialed, I warned that the Brazilian office probably didn’t handle referrals, but she waved me off. 

There followed a long conversation in Portuguese. Afterward, she explained that she had laid out the problem. They promised to get back to her.

I returned home, faxed my report, and called the Miami office. Before I could report back to the Brazilian lady, she called me.

“What is your license number?” she asked.

“Why do you want that?”

“Brazil never called, so we came to Cedars-Sinai. The ultrasound department needs your license for the test.”

“Don’t do that!” I said. “The first step is to see a specialist. And the test will be very expensive unless the insurance approves.”

I phoned the Miami office to urge them to settle matters with Cedars-Sinai. Within minutes my phone rang. It was the Brazilian lady again.

“There is something serious…. Cedars-Sinai has no record of you.”

“I’m not on their staff.”

“They cannot find your name. I am very disturbed.”

I assured her I was a real doctor.

“How do I know that? When I called for a doctor, you came in an hour.”

She could Google me, I suggested.

I phoned Miami to warn that the patient had gone to Cedars. The dispatcher delivered equally bad news. He had phoned Brazil to obtain approval for the expense. Unfortunately, the Brazilian office had had an earful from the Brazilian host who emphasized her friend’s past suffering. This provided an irresistible excuse to claim a pre-existing condition and deny approval. 

After hearing this news, the patient and her host went home. I warned that she still needed an evaluation and offered to refer her to a colleague. The Brazilian host remained polite but informed me that the next doctor she consulted would have to have better credentials.

Long Time No See

 Hey, Doctor! It’s been a while.”

I love it when parking valets recognize me. That was the good news. The ‘it’s been a while’ was not so good. This was my first visit of the year to Le Parc, an upscale West Hollywood hotel. It was once a regular, calling 20 to 40 times per year since 1993.

Hotel doctoring is viciously competitive, and another doctor had worked his magic. But hope springs eternal; hotels occasionally realize their mistake and return to the fold. Maybe this was a sign.

The guest had injured her leg five days earlier. X-rays in an emergency room were negative, but since yesterday her pain had worsened. I didn’t find anything abnormal except for a huge black-and-blue mark. This may have been normal healing, but she needed another X-ray.

“Doctor O! How’s business!” The desk clerk also recognized me. When I ask why a hotel has stopped calling, employees always respond that no one has been sick, so I’ve stopped asking. But I couldn’t resist. The desk clerk assured me that no one had been sick.

Not Being a Bad Person

On a plane returning to Los Angeles, a flight attendant asked if a doctor were on board. Reluctantly, I raised my hand.

Walking up the aisle, I relieved my fears by recalling that hotel employees who tell me a guest is seriously ill are usually wrong. 

The passenger complained of a tight chest and difficulty breathing. He was forty with no medical problems, and his only medication was a tranquilizer which he didn’t have. He had no objection to my diagnosis of anxiety attack; he’d had them before. I reassured him and reassured the flight attendant that he’d be OK until the plane arrived. This turned out to be true.

Hearing the story, my wife said that she expected no less of me because I’m a caring, compassionate doctor. She often says things like that.

In fact, I raised my hand because I believe that a physician asked for help has a moral obligation to respond. If he doesn’t, he’s a bad person. Responding did not make me feel good, but not responding would feel worse.

Plenty of doctors keep quiet under those circumstances and comfort themselves with excellent reasons. It was unlikely that I could handle a genuine emergency. I haven’t performed CPR in decades; in any case doing so in that packed cabin was impossible. Standing by helplessly would make me look foolish. Doctors hate that. The passenger might sue. This has happened. You’ve probably heard of the “good Samaritan” law, but any competent lawyer can find a reason it doesn’t apply.

More Easy Visits

“A bee stung my wife. That was two days ago, but today it’s more swollen.”

I explained that bee stings usually get worse for 48 hours before they improve.

“We catch a plane tomorrow, so we’d like to see a doctor.”

Before I left, the phone rang again. A man’s ears had become plugged when his plane descended the previous day. He worried about an infection. I explained that pressure changes while flying don’t cause infections, and the discomfort often persists for a day or two. I suggested a decongestant, but he wanted someone to look in his ears.

A visit from the hotel doctor is not cheap, and I’m liberal with phone advice. Only about half my calls turn into a visit. Now and then I have the delightful experience of making a housecall because the guest wants one despite my assurance that it’s not necessary. In this blog, I’ve recounted occasions where what seemed like a no-brainer turned out to be no such thing. That rarely happens, and it didn’t happen this time.

The bee sting turned out to be a bee sting, and the guest’s ears looked normal. Sometimes hotel doctoring is a snap.

A Not-So-Easy Visit

A Biltmore guest with a sore foot had a meeting after breakfast. Could I come now?

I rise early, so the 5:50 a.m. call found me writing this blog. Reaching the Biltmore, ten miles distant downtown, is no problem if traffic is moving, but it wouldn’t be moving soon, and I hate driving during the rush hour.

I considered sending him to a nearby 24-hour clinic. But a sore foot was an easy visit (i.e. not serious and not a respiratory infection). If I hurried, I might escape gridlock, so I told him to expect me around 6:30. 

I left my car at the entrance and hurried to the room. As expected, it was an easy visit. Leaving the hotel, I saw that my car had vanished. Most Biltmore parking valets recognize me; this one hadn’t, so I had delivered my mantra (“I’m the hotel doctor. I’ll be here twenty minutes. They hold my car.”) He nodded and smiled and then proceeded to follow orders and drive my car deep into the building. Then he dropped my keys off at the parking kiosk whose attendant demanded the usual spectacular fee.

I returned to the lobby to track down a manager willing to overrule the attendant. Following this, I waited my turn for the valet to retrieve my car. Those delays pushed me past a critical point, morphing the half hour drive downtown into more than an hour to return.

A Good Call

A singer felt a sore throat coming on, his manager explained. He needed a shot of cortisone. I’ve given many; singers seem to think they work, and they’re harmless.

These are good calls. I drive to a hotel, give an injection, collect money, and return home. What’s not to like?

The manager added that the singer would need his shot the day of his performance the following Saturday. Early Saturday he phoned to inform me that the singer was free at midday. He would call to give an hour’s notice. Midday passed without a call.

As I prepared for dinner at six p.m. the manager phoned to announce that his client was ready. But there was a hitch. The singer was not in Los Angeles but at a resort hotel in La Puente thirty-five miles away. Although weekend freeways are usually fast, this trip took an hour. The resort was hosting an event called The Urban Music Festival; it was packed with black people, the women in dazzling gowns, the men dressed as gangsters.

No one answered when I knocked on the singer’s door. I phoned the singer’s manager and heard voicemail. I paced the hall for fifteen minutes, knocking and phoning now and then. I checked with the concierge who obligingly offered to call the room.

My phone rang as I was driving off. I retraced my steps to the room, now packed with the singer’s colorful entourage. I gave the shot, collected my money, and returned home to supper.

Catching the Flight Home

A tour leader informed me that a 70 year-old in his group had severe abdominal pain.

I explained that this was probably not something a housecall would solve. He would almost certainly need an emergency room visit.

“They understand,” said the tour leader. “But they want a doctor to come to make sure.”

He was not being honest, as I discovered. Anxious to avoid accompanying the man and his wife to the hospital, he had insisted on a housecall hoping that I would make the problem go away.

He had also not passed on my suspicions, so the couple was shocked when, after an examination, I repeated it. The husband refused to go, pointing out that their return flight left the following day. He added that he was merely constipated. Telephoned, his doctor at home had agreed and recommended an enema.

I responded that being on the spot gave me priority. The guest assured me he would think it over and go to an ER if the pain persisted.

I passed a worried night. In the morning, the wife declared that her husband felt a littler better. Feeling “a little better” in response to a doctor’s query means “no better.” I warned them not to board the plane if the husband had any abdominal pain. Two hours later the wife phoned to announce that he was entirely better, and they were leaving for the airport.

The Miracle Game

A guest’s ankle injury didn’t seem serious, so I told her we’d wait a day before deciding on an x-ray. At her request, I wrapped the ankle in an elastic bandage while explaining that orthopedists believe that elastic bandages accomplish little. 

As I wrapped, I mused on the superiority of western medicine. I have little respect for alternative, complementary, holistic, herbal, or natural healing systems, but I admit that all popular and media doctors disagree, and they enjoy a far larger audience than this obscure blog.

My reasons have something to do with the fact that we genuinely help patients, but I prefer to stress how often we don’t. Alternative healers never say: “This treatment could be better…” or “We thought we understood this disease, but we were wrong…” or “We screwed up…” Scientific training hasn’t prevented me from making mistakes, but I hope I learn from them. 

When I’m feeling particularly hostile, I challenge alternative medicine fans to play the miracle game. I’ll name one of our miracles; then it's your turn. No fair using a secret cure. It has to be something we all agree on.   

My first western medicine miracle: the appendectomy. Appendicitis victims once died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. We take this for granted, but it’s a miracle that's saved millions of lives. Now let’s hear yours….

Getting Their Money's Worth

Dentists don’t make housecalls, and many disappear after office hours, so I hear about problems for which I am not trained.

During a weekend, a woman explained that her daughter had undergone dental work before they left town two days earlier. She was still in pain, and her jaw was swollen. She needed a visit.

So I felt stress driving to the hotel. I don’t like making a housecall where I might not solve a problem.

The daughter’s jaw didn’t appear swollen, but any painful part of the body looks abnormal to the sufferer. The tension rose as I washed my hands after putting a thermometer in her mouth. What would I say if I didn’t know what was happening?

Those situations have occurred but not this time. When I peered at the affected tooth, it looked normal, but on the nearby gum I saw an angry half-centimeter ulceration. She had a canker sore. They’re excruciating, but they heal in a week. I used to suffer them after accidentally striking my gum while brushing my teeth, so her dental work might have provoked it.

I reassured the parents and handed over a bottle of liquid Lidocaine to alleviate the pain.

“I’m sorry I called you out over something so trivial,” said the father as he paid me.

Men often feel they’re not getting their money’s worth if the problem turns out to be minor.

Bizarre Encounters

“A guest has cut off his ear and would like to see a doctor.” This was from the Westin at the airport.

“I can’t sew an ear back in a hotel room,” I explained. “You should send him to the Centinella E.R.” This seemed to satisfy the caller, and he hung up.

This call arrived at 1:05 a.m. After some nervous minutes hoping he wouldn’t call again, I went back to sleep.

In fiction, the doctor would make the housecall and have a bizarre encounter. Bizarre encounters are more fun to read about than experience, so I work hard to avoid them. Before agreeing to a visit, I talk to the guest, so I can detect drunks, drug abusers, and the mentally ill. Medical science has no antidote for alcohol and, despite what you see in the movies, no injection will pacify a crazy person. I regularly assure hotel employees that it’s OK to call the police when a guest is out of control. Violent behavior isn’t necessary. 

Now and then I answer a sad call after a tragedy such as the death of a spouse or child. Relatives regularly beg for something to “put her to sleep,” but (again, despite the movies) no such drug exists. A general anesthetic works, but it’s risky to use one in a housecall as Michael Jackson’s doctor learned. I respond to these calls and usually hand over a tranquilizer, but mostly I spend a long time sitting at the bedside and delivering sympathy.