A Better Medicine

A 2 year-old was ill with vomiting, diarrhea, fever, and a rash. That sounded bad.

I know a pediatrician who makes housecalls, and I considered sending him. But the news came from the guest’s travel insurer, and their pronouncements are often exaggerated. I decided to go.

The guest greeted me at the door with a cheerful toddler at his side. That, to my relief, was the patient. He still had diarrhea, and a spotty rash was present but fading.

Suffering a respiratory infection, the child had seen the family doctor and received the traditional antibiotic. Instead of amoxicillin (the world’s most popular antibiotic for people who don’t need an antibiotic), he had prescribed Augmentin, excellent when necessary but a legendary stomach upsetter.

The parents took for granted that the solution was a better medicine and something for his rash and diarrhea. But this was one of those situations where stopping everything works best. 

Disaster Averted

“We have a situation with a guest…” explained the manager of the Georgian.

I love doing favors for hotel management, but this sort of announcement is not promising. Medical science cannot calm drunk, stoned, or disruptive guests, but hope springs eternal among hotel staff.

This turned out to be not so bad. A guest was taking an injectable medicine for rheumatoid arthritis. It required refrigeration, and the hotel had agreed to store it. Unfortunately, for unclear reasons, someone had left it on top of the refrigerator all night. What should he tell the guest? Could I call a pharmacy to replace it?

The medicine was Humira, a high-tech, genetically engineered monoclonal antibody. The internet pharmaceutical supplier that I patronize would sell me two doses for $7,000.

I did a Google search to find the manufacturer’s medication guide. While Humira should be kept in cold storage, leaving it at room temperature for a few days is OK. You can bet the manager was grateful for this news.

Easy Money

A Brazilian traveler had left her medication at home. Could I drive to Hermosa Beach and write some prescriptions? The caller was the guest’s travel insurer.

When hotel guests call directly, I tell them to go to a pharmacy and explain what they need. I would approve over the phone. It’s free; everyone is happy.

Before I could offer to do the same, the dispatcher informed me that, as a new service, the insurance would pay for visits to replace prescriptions. I could not turn down easy money.

It turned out not to be so easy. Helpfully, the traveler’s family doctor had faxed his prescriptions, but the writing was illegible and in Portuguese. There followed half an hour of phone calls to pharmacies and to Brazil and Google searches before I found the American equivalent of three of the four. The fourth never turned up, but it was probably an herbal remedy.

 

Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him to check and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.

Sickness Makes You Sick

“Normally I wouldn’t bother with this cough, but when I started to bring up green mucus I knew I had to do something…..”    

Hotel guests tell me this regularly, and it’s wrong. Everyone’s respiratory tract makes a quart of mucus a day. When the respiratory tract is irritated, it makes more, and the mucus may turn yellow or green. In an otherwise healthy person, this has no ominous significance.

No one stares at their throat when they feel fine, and a sore throat always looks suspicious. Everyone knows that white spots on your tonsils are a sign of Strep that requires urgent attention. In fact, plenty of ordinary viral infections make tonsils look bad.

 “The fever came back,” guests tell me as if this were a serious development. But Tylenol or aspirin only work for a few hours, and then you must take more. When patients tell me that they worry about a fever, my advice is “then don’t take your temperature.” They treat this as a joke, but the truth is that fever is just another symptom.

 All bets are off if you suffer a chronic illness or serious immune deficiency or are extremely old or extremely young, but this is not the case with almost everyone I see. When people in good health get sick, they feel sick.

 

 

Luckless Americans

 Ailing US airline crew are out of luck. They must travel to a clinic in a strange city, present their insurance card, and hope for the best.

 Foreign airlines do better, sending a doctor to care for crew when they lay over. In Los Angeles that’s often me. Being young, crews suffer common ailments. Even better, company rules forbid work if they have a cold, a digestive upset, or a minor injury.

 On my own, I often handle minor ailments over the phone, but airlines demand a doctor on the spot to confirm the ailment and name a date when the employee may fly again. I enjoy those visits. These patients are never demanding; their priority is getting home. They hate being stuck in a hotel room. Airlines permit them to return as passengers, and I’m liberal about allowing them, so those visits usually end happily for both of us.   

 

The Decline of Civilization

The desk clerk tried to hand back my parking slip, but I made no move to accept it.

“We are unable to validate” she said. “It’s twenty dollars. You pay at the cashier’s window.”

“As I explained, I’m the hotel doctor. They let me park.”

“Unfortunately, the hotel doesn’t own our parking service, so we have no control over the charges.”

“That’s true for most hotels, but they let me park.”

“Let me speak to my manager.”

It was a stretch to call myself that hotel’s doctor. The Mondrian was not a regular although I’d been there a dozen times over the years with no problem. Several minutes passed before the clerk returned.

“Regretfully, my manager says we’re unable to validate. The hotel doesn’t own our parking service, so we have no control over the charges.”

Not willing to hassle hotel staff, I took the slip. I’m not poor, but paying twenty dollars at a fraction of my hotel visits per year, say a hundred, is serious money. This is happening more often.

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.

Sometimes a Thankless Job

A three year-old at the Ramada was fussy and congested, but my exam was normal. She had a cold, I explained. It might last a few days, and staying in bed wouldn’t make it go away quicker. They were already giving Tylenol for the fever, and that was fine. They should try to enjoy themselves.

“So she doesn’t need anything,” said the father. I assured him she didn’t.

They thanked me as I left, but I was not fooled.

Understand their point of view. They were in a strange city on an expensive vacation, and their child was sick. Naturally, all fun was cancelled, and the doctor summoned fix things.

Had I written a prescription, I would be doing what a proper doctor does. They would have given the medicine and waited. Not giving “anything” meant that I considered the illness trivial.

Mind you, I had carefully explained that the child would feel under the weather for several days. They had listened and nodded.

I intended to call in 24 hours, but the following morning their travel insurer phoned to say the parents were requesting another visit. I explained that that wasn’t necessary. I would call.

“She’s the same. The cough hasn’t gone away,” said the mother.

I repeated that this was to be expected and that she should wait. She thanked me for calling.

No one answered when I phoned the next day. The insurance agency dispatcher explained that the mother had called earlier to demand another visit, so he had sent her to an urgent care clinic.

The child had barely swallowed the first spoonful of Amoxicillin when she began to improve. By the following day she was fine, and the parents were congratulating themselves. Who knows what might have happened if they hadn’t found a competent doctor? 

A Hotel Doctor Has His Car Serviced

I scheduled it for 8 a.m., hoping it wouldn’t be out of commission for long because my wife and her car were out of town. I cancelled the appointment when a hotel called at 7 a.m.

I delivered my car to the shop at 8 a.m. the following day. A hotel called at 10. The service manager said my car wouldn’t be available till the afternoon, but he would be happy to provide a loaner.

Auto shops pay little attention to loaners. Mine was a battered 1999 Volvo station wagon with 176,000 miles, the gas needle on empty, and an automatic transmission that paused for a few seconds before delivering power. Driving was a frightening experience compared to my tiny, nimble Honda.  

I bought gas and lumbered onto the freeway, praying that Swedish engineering deserved its reputation. VIP parking at a downtown hotel was out of the question because valets refused to believe that an important person would arrive in such a disreputable vehicle. But everything worked out.

No hotel doctor should live alone.