A Miracle Drug

Handing me a vial of an injectable medication, a guest explained that he needed a refill. Its label was in Spanish, but technical terms are recognizable in any language, so I had no trouble deciphering its mixture of vitamins and minerals. And cortisone.

That was disturbing. The guest’s wife’s rheumatoid arthritis occasionally flared up, and her doctor in Argentina wanted to make sure this didn’t spoil their vacation.

Discovered in the 1940s, cortisone seemed miraculous. Patients crippled with arthritis saw their pain melt away. Ugly psoriatic plaques disappeared. Hay fever vanished. Eczema victims who had been scratching for years stopped after a few doses of cortisone.

A cure for cancer could not have produced more excitement. The Nobel committee, which prefers to wait decades, rewarded cortisone in 1950 - just as doctors were realizing that symptoms return with a vengeance when the effect wears off, and repeated use produced disastrous side-effects.

Creams are fairly safe, and cortisone taken internally remains a life-saver for many serious diseases but a bad idea for ongoing symptoms (generalized pain, itching, inflammation). Large amounts for a short period are safe provided the problem is also short-lived. I give a huge dose for poison ivy but stop after two weeks. By that time the poison ivy has run its course.

A rare shot is probably OK for arthritis, but this family’s G.P. used it generously, a common tactic because the short-term effect is so good. There are no benign treatments for rheumatoid arthritis, but many are safer than cortisone. I prescribed enough for one shot.  

A Treatment Better Than the Best

She had a fourteen hour flight to Australia, explained a woman with a thick French accent. Unfortunately, she had thrown her back out again. Would I come and give something to relax her muscles for that long journey?

I don’t know any medicine that does that, but she was certain that, in the past, her French doctor had prescribed something that did the trick. 

She was already taking the usual pain remedies, so there was no point in a housecall. The woman agreed, but she was clearly disappointed. I know she wondered if I was truly on the ball.

It’s a popular medical belief (remember reader: all popular medical beliefs are wrong) that if you are sick, the doctor will do his best. But if you absolutely must feel well – you have a vacation, important business, a wedding – a smart physician will make a special effort and come up with something even better.   

As a hotel doctor, I deal with this yearning all the time. Since doctors are tenderhearted, it’s tempting to prescribe a placebo if no useful medicine exists. Placebos work although not as dramatically as enthusiasts claim.

The problem is that they’re not available. Decades ago, drug companies sold pills labeled “placebo,” but, perhaps for medicolegal reasons, they stopped. The result is that when a doctor decides you need a placebo, he prescribes a real medicine in the full knowledge that he’s doing something wrong. As I’ve written repeatedly, the advantage of alternative, folk, holistic, and herbal healing is that their medicines are a hundred percent safe. Medicines from real doctors have side-effects, so we’re not supposed to prescribe them unless they’ll help.

Life is easier for doctors who ignore this, so many do.

An Unwelcome Visitor from the Past

A young man at the Chateau Marmont had been coughing for two weeks. He had a fever, and my stethoscope revealed lung noises typical of pneumonia.

I enjoy diagnosing pneumonia because, in an otherwise healthy person, it’s the only common illness with a cough that doctors can cure. Everything else is a virus. 

I didn’t like this particular diagnosis. It takes a tough germ to cause pneumonia in most people, so unpleasant symptoms begin quickly. This man’s cough had persisted for some time. Furthermore, he was gay and admitted to having unprotected sex. I suspected that he had a pneumocystis infection. Pneumocystis is a fungus so benign that it lives in the lungs of most of us, causing no trouble.

Until forty years ago, it was rare, affecting patients already sick with cancer or serious diseases requiring drugs that suppressed immunity. Doctors were mystified when Pneumocystis began attacking previously healthy young men during the 1980s. It turned out to be the most common sign of AIDS.

It’s rare again today because we track immune cells of HIV patients and prescribe preventive drugs when the numbers drop. This young man had not been tested, but he was no fool. He cut short his visit and returned home.

The Glamorous Life of the Call Girl

At one a.m. in 1994, I received a call from Le Montrose, a boutique hotel in West Hollywood. The guest told me the problem was “personal.”

The man who opened the door was past sixty, short, plump, balding, and tieless, wearing a rumpled suit which I suspected he’d put on to greet me. Across the room, wearing a bathrobe, a young woman sat on the bed, staring sullenly at the floor.

“There’s been an accident,” he said.

Neither guest seemed injured, so I knew I wasn’t going to get off easy. This proved true as he explained that his friend seemed to have an object in her rectum. He provided no details.

Bizarre incidents fascinate doctors no less than laymen. Around the cafeteria table, interns compete in relating the latest. Outside of working hours, they remain a mainstay for impressing girls at parties.

Central to this adolescent obsession is the genre of things-that-end-up-in-people’s-rectums. I no longer find these amusing, not only because I’m a grown-up but because they make me nervous. I hate situations that I might not be able to handle. Removing something from the rectum often requires tools such as a proctoscope which I didn’t carry. Also practice. I had never done it.

But I had to try. After introducing myself to the woman, I put on a rubber glove and went to work. There is more space than you’d think inside a rectum; I felt a hard object touch my fingertip and then drift away. When something lies out of reach, it’s natural to stretch, and my desperate efforts caused her to groan with pain.

Suddenly, I snagged something and pulled out a shot glass. I almost danced with joy and relief. Although I expected an outpouring of gratitude, none appeared. Gathering up her clothes, the woman disappeared into the bathroom. The man nodded agreeably as if this were routine business. Filling out my invoice, I asked the woman’s name.

“Elizabeth Anderson.” He hesitated before answering, revealing that he had invented the name. Call girls lead a glamorous life in the movies, but the reality is often miserable. I handed him the invoice. He examined it thoughtfully. “That’s a lot of money,” he said. “You only spent five minutes here.”

In 1994 my fee for a wee-hour call was $180. He had not objected when I had informed him over the phone. When guests balk, I say I’ll accept whatever they consider fair. They often reconsider and pay my regular fee.

I told him I’d accept whatever he considered fair. He handed over $80. I don’t want to think how the woman made out.