The No-Housecall Mode

Several times per year, a hotel guest suffers a bloody nose. I don’t make housecalls for nosebleeds because there’s nothing I can do. Treatment is to pinch the nose, releasing pressure every five minutes to check if bleeding has stopped. I tell guests to repeat until they get bored. If bleeding persists, the next step is cautery or nasal packing, both of which require expertise.

I regularly hear “I can move it, so I know it’s not broken…” but this is as true as most popular medical theories.  Examining a wrist, finger, ankle, foot, or ribs I can suspect a fracture, but I’m never certain. Most common fractures aren’t urgent, so I tell guests it’s OK to wait to see if there’s quick improvement. If not, they need an X-ray.

All insect bites look the same, bee stings included. Redness and itching spread, peaking at two days before slowly fading. I explain this over the phone, but guests often want me to take a look.

When a guest suggests he has bronchitis, I immediately go into no-housecall mode because this is a fake diagnosis doctors use when they prescribe an antibiotic as a placebo (other fake diagnoses are “sinus infection” and “bacterial infection” and sometimes “strep”). You may be surprised to read that bronchitis is not a disease but a medical term for coughing. 

Lost on Campus

It was after nine when I left for Long Beach, thirty miles away. Freeway traffic moved swiftly; the patient was a sixteen year-old with a sore throat, usually an easy visit.

Google maps guided me to 1250 Bellflower Boulevard which was the student union of California State University in Long Beach. That also turned out to be the address of the university. The student union was deserted. It was the summer break. I left messages at a phone number that may or may not have been the patient’s.

A couple walking nearby pointed me in the direction of distant residence halls which, when I arrived, seemed endless. I phoned the travel insurer who had sent me. The dispatcher managed to contact the patient in her room and then passed on her directions. She was not familiar with the campus, so these were unhelpful. It took persistence, but I convinced the dispatcher that, since the patient was an adolescent, she was undoubtedly part of a group with a group leader.

The patient agreed that such a person existed and went off to find him. After a considerable delay he came on the line, determined my location, and talked me through a complex warren of streets to the proper building. As usual, delivering medical care was the easiest part.

Don't Get On the Plane!

“My flight leaves tonight” is a phrase I like to hear because it means the guest will return to the care of the family doctor. Until then he or she is my responsibility. Now and then, I don’t like to hear it. 

A guest awoke feeling well but soon noticed some abdominal pain.

When I hear “abdominal pain” I ask about vomiting and/or diarrhea and hope it’s present. That points to a stomach virus, usually a short-lived and not very serious problem.

Abdominal pain alone can mean a stomach virus, but I also consider serious conditions (gallstones, diverticulitis) and potentially fatal ones (ectopic pregnancy, blood clots). I prefer to send these guests directly to an emergency room, but sometimes I end up at the hotel.

This guest considered my question before deciding that he had diarrhea. Maybe… My abdominal examination turned up nothing requiring urgent attention. He was young, so several life-threatening problems were unlikely. The pain itself was unpleasant but not quite excruciating.

It was a difficult decision, but doctors are paid generously to make difficult decisions.

I told him that he probably had a stomach virus, but I couldn’t rule out something serious. I would give him something for the diarrhea and check back. I added that he might need some tests and that he must not get on the plane if the pain persisted.

When I phoned after three hours, he had checked out.

I'm Not in It For the Money

The phone rang at 3:30 a.m. An airline pilot at the Costa Mesa Hilton needed a doctor, explained the caller. Could I go?

That Hilton is 46 miles away, but I drive there regularly for an agency that provides medical care to foreign airline crew when they lay over (American crew are on their own). It’s an easy drive at this hour. I accepted for several seconds until I woke up and remembered that the 405 freeway closes at the Orange County border during the wee hours for major construction. Despite the hour, closing the freeway produces an immense backup, and the detour through city streets is slow and tedious. Forced to go, I take a different freeway which is ten miles longer and only slightly less tedious.

I was in luck. Wee-hour patients usually suffer intense symptoms such as vomiting; they don’t like to wait. This guest had a cold and didn’t object to a visit later that morning.

I breathed a sigh of relief and went back to sleep. The delay would cost me $150 because the agency pays less for daytime housecalls, but it was worth it.