Be Careful What You Ask For

He had been coughing for several days, a guest explained, adding that he probably needed a Z-pak. When a patient suggests he needs an antibiotic, a doctor feels one of two emotions.

(1) Pleasure because this guarantees an easy visit. Give the antibiotic, and the patient will make it clear that the doctor has done what a good doctor does. I doubt most of you realize the importance of your gratitude. No matter how you try to conceal it, if you’re disappointed, we feel depressed.

(2) Depression. In an otherwise healthy person, the only common illness with a cough that antibiotics cure is bacterial pneumonia which is not common. All others are viral infections. These affect fifteen percent of everyone who consults a doctor, so they are no trivial matter.

Over the phone, I quizzed him about his symptoms and then explained that he was suffering a self-limited illness requiring only over-the-counter remedies. When he insisted that he needed a doctor, I directed him to a nearby urgent care clinic where he would get his antibiotic.

How Doctor Oppenheim Met His Wife

In 1975 I and a friend were fresh out of internship. He had a job at a Los Angeles clinic that remained open during the weekend. Few patients came, so I often visited, and we sat talking. The only other employee, a nurse – really a young woman who wore a white coat and acted as receptionist -- joined us. After a few visits I got up the nerve to ask her on a date.

She was committed, she explained. But she worked at the Woman’s Building, a flourishing feminist arts center. She offered to give me some phone numbers.

I declined. I was too shy to call women I didn’t know.

“Then what’s the solution?” she asked.

“Maybe they could call me.” I meant this as a joke and forgot about it until a week later when a woman phoned. I did my duty by asking her to dinner, and it proved an excellent decision.

There is more to it. It turns out that she and the nurse were candidates for a college art teaching position in Oakland. Both flew up for an interview. My future wife later learned that the nurse had already sewn up the job, so there was no point in the interview. During the plane ride, she had given me an enthusiastic recommendation, perhaps as a consolation prize. 

When we discussed how our lives and the nurse’s had progressed over the years, we agreed that my wife had gotten the better deal. 

Good News. Or Maybe Not.

2 a.m. calls rarely thrill me, but this was from the Beverly West, a boutique hotel that never calls. Happily, I threw on my suit and drove off. Traffic was light. Parking was easy.

Afterward I introduced myself to the desk clerk.

“I remember you from the Beverly Garland,” he said. “I’ve only been here two months.”

It’s flattering that employees continue to call when they change hotels, but it also meant that the Beverly West was probably not switching doctors.

“So you got my number from the Beverly Garland?”

He shook his head. “You’re on the computer. I picked you because the name was familiar.”

That was good news. Sort of. I’m probably on every hotel’s computer.

As the wee-hour desk clerk, he had little contact with veteran employees, but they would soon clue him in. After caring for a guest, the Beverly West’s regular doctor gives a “referral fee” to the employee that called. This is illegal but a hotel doctor tradition as well as a superb marketing tool.  

Not Again!!!

“I have the European plague. I need a doctor.”

“Excuse me?...”

“I have the European plague. I need a doctor for the American plague.”

“I’m not sure what you mean. What’s the American plague?”

“My child is in the bathroom with the European plague. Can you bring the doctor for the American?”

What was he talking about?.... The exchange continued for some time until the light dawned. This was the fourth occasion this has happened in over thirty years and 30,000 phone calls. The guest had phoned the front desk because his electrical devices used European outlets which are different from ours. He needed an “adaptor.” The clerk, not listening carefully, had heard “a doctor” and forwarded his call to me.

But I was also not listening carefully. It’s human nature to hear what you expect to hear, so I assumed that the caller had a medical problem.

I had heard “European plague” when he had said “European plug.” He had not said “my child is in the bathroom” but “my shaver is in the bathroom….”

Christmas Season

In the Pasadena Sheraton last Sunday, my phone rang for a visit in Irvine. Pasadena is twenty miles from home, Irvine fifty miles. I would miss supper by several hours, but the month before Christmas is slow, so I was pleased at another visit.

I often drive to Irvine but not from Pasadena, so I consulted Siri from my I-Phone. She directed me toward the nearest freeway but told me to turn off as I reached it. That didn’t seem right, but disobeying Siri is usually a bad idea. A drive through city streets to the Long Beach Freeway saved several miles but probably not much time.

I settled down for the trip before realizing with a shock that she was directing me toward the Santa Ana freeway. No one takes the Santa Ana freeway. It’s always jammed. Sure enough, as soon as I drove on, traffic slowed to a crawl.

I arrived after 1½ hours to face another irritation. The address, 2120 Waterbury, wasn’t a street address but suite 2120 at the Waterbury Apartments. Siri found the complex but getting to 2120 among the buildings was my job.

It was night. The guest was a traveler and unfamiliar with the area. There was no parking except in locked underground garages, so I couldn’t wander far from my car. Also (and I’m not making this up) it was raining. In the end, she came out and searched the streets until we encountered each other. The visit, as usual, was the easy part.

Leaving, I drove to the San Diego freeway, the sensible, if not the shortest, route from my house to Irvine. To my dismay, traffic was crawling. Weekends are usually OK, but I should have remembered that this was the Sunday before Christmas.

How to Get the Best of Both Worlds

A lady with a cold phoned for a doctor at 4 p.m. on a Tuesday.

From my home to hers in the Hollywood Hills required a thirteen mile drive through city streets (twice that on the freeway). I go during the rush hour but only for patients a good deal sicker. In her case, I would schedule a visit for 9 or 10 p.m.

Sadly, the lady hadn’t called me but Get Heal, a new service that promises a housecall within an hour and charges a flat $99.

It pays doctors $75 an hour, lower than the going rate, but provides a medical assistant who drives, a delightful perk. Unfortunately, the dispatcher explained, the medical assistant lived near my destination. Would I make the drive myself? Heal would pay extra. If not, Heal would send a cab.

I chose a cab. Fifteen minutes later an Uber car pulled up. We crept through traffic. The medical assistant was there when we arrived. I cared for the patient. We crept back.

Heal earned $99 for my two hours’ work, but I earned $150. The Uber driver earned half that. The driver, dispatcher, and a dozen other employees collected their salaries. Get Heal has an office in Santa Monica and an impressive web site.

Everyone agrees that $99 for a housecall is a money-loser. Perhaps this patient was an outlier, but none of the eight Heal housecalls I’ve made has taken less than an hour door-to-door.

If you need a housecall in Los Angeles, phone Get Heal and ask for Doctor Oppenheim. You’ll get the best of both worlds until one of us goes out of business.

Discovering a Normal Part of your Body

A young woman at the Georgian Hotel felt a cold coming on, so she inspected her throat and discovered a dozen bumps on the far end of her tongue. I reassured her, but she wanted a doctor to see them.

I love housecalls where I know the diagnosis as soon as I hang up the phone. This qualified because the guest had discovered a normal part of her body. When you examine your tongue in the mirror, it seems smooth. People rarely stick it out far enough to reveal a clump of wart-like taste buds deep inside.

I also love telling a fearful patient that he or she has nothing to worry about, so this was a satisfying encounter for both of us.

It may save you some anxiety to memorize the following normal parts of your body.

- Put a finger inside your mouth and feel the gums behind your lower teeth. Moving just to the left and right reveals two hard lumps which may not be the same size. These are part of your mandible, the jawbone.

- With thumb and forefinger, pinch your neck just below the jaw to feel two lumps that mark either end of the hyoid bone that circles the front of your windpipe. You can wiggle them from side to side.

- Run your finger down the middle of your breastbone to an inch beyond the lower end, then push. You’ll feel a hard mass. That’s another bone, the xyphoid process. One guest was certain had a stomach tumor.

- Feel your major lymph node areas (neck, armpit, groin), and remember what you find. Part of the immune system, lymph nodes swell in response to an infection then shrink after it passes - except sometimes a node or two won’t shrink but remains forever as a pea-sized, moveable granule beneath the skin.