A Rule of Medicine That Didn't Apply

I give out medicines gratis. Mostly, they’re cheap, but exceptions exist. For unclear reasons my supplier charges $17 for antibiotic ear drops but $1.50 for antibiotic eye drops. Experts agree that it’s OK to use antibiotic eye drops in the ear, so that’s what I do.

I felt pleased handing over a bottle to a lady with swimmer’s ear. Ear infections are easy visits, and guests appreciate that they do not have to hunt for a pharmacy.

My heart sank when the guest’s insurer called the following day. She wanted another visit. I phoned the guest who admitted that her ear was no worse, but now she had a fever, headache, and sore throat. That was disturbing. Had I missed something?

I returned to the hotel. She had a 102 temperature with swollen tonsils and swollen neck glands. Since she was barely out of her teens, Strep throat was a reasonable diagnosis.

It’s a rule of medicine that a doctor who makes two separate diagnoses is not thinking clearly. Patients have one thing, but this woman definitely had swimmer’s ear and Strep throat. 

Relentless Time

Melrose Avenue is hip and upscale as it passes through West Hollywood. Further east, toward downtown, businesses tend toward pawnbrokers, bodegas, and Kentucky Fried Chicken. At least that’s how I remembered it.

If you live long enough, everything familiar vanishes, and I parked among a chic collection of freshly painted boutiques, restaurants, and fashionable clothing shops. Plus a beautiful new hotel that I’d never heard of.    

It was the Hollywood Historic Hotel, converted from a 1920s apartment a few years ago, I learned from the desk clerk. He insisted that I was the first doctor that had appeared, and he seemed happy accept my card.

Even better, there was no answer when I knocked. Since I’d come at the request of a travel insurer, I’d be paid. I tell the insurer that if the guest wants to drive to my home, I’ll take care of him at no charge. No one has taken me up on it.

Goose Chases

I knocked at room 777 of the Hyatt Regency, downtown. The guest who answered denied calling a doctor.

Did I get the room number wrong? It’s happened, but this seemed unlikely. Did I get the hotel wrong? There is only one Hyatt Regency in Los Angeles but many Hyatts. The only one that calls regularly is at the airport. I phoned. Sure enough, room 777 at the Airport Hyatt wanted a doctor.

“You’re at the Hyatt,” I said. “Why did you say you were at the Hyatt Regency?”

“Aren’t they the same?”

They aren’t. I drove the fifteen miles to the airport and took care of him.

A Medicolegal Visit

A guest was eating lunch in the hotel restaurant when the chair collapsed. Unfortunately, her hand was resting underneath. The desk clerk asked if I could come immediately.

During my early years, I would hurry over, take care of the problem, and present my bill only to have the guest insist that the hotel was responsible. Management sometimes disagreed, so I learned to settle matters over the phone.

“I need to know who’s paying,” I said.

The clerk she put me on hold, returning to announce that the hotel would take care of it. This would be my 146^th  medicolegal visit, my name for a housecall when the hotel offers to pay. Most involve minor injuries that occur on the premises. There were also thirteen upset stomachs, purportedly from hotel food, and nine insect bites, always bedbugs according to the guest.

I arrived to greet a young Englishwoman, her hand in a bowl of ice. Two fingers were exquisitely painful. She needed an x-ray. I found a local orthopedic group on the internet and phoned.

“An initial visit is $500,” said the receptionist. “She needs to pay when she comes in.”

“Wow!” said the guest when I passed this on. This was probably not a comment on the size of the fee (which the hotel would cover) but the traditional European amazement-cum-horror at American doctors’ preoccupation with money.

Both fingers were fractured. Fortunately, her visit was ending, and she flew home the next day.

I Just Need a Shot

A woman under treatment for infertility needed a progesterone shot every month. She had the vial. Could I send a nurse?...

Why do doctors cheerfully give patients medicine and send them off on their travels? It guarantees a hassle.

I don’t have a nurse, but I quoted $50, drove to the hotel and gave the shot. It was not a short drive, but she wouldn’t have paid my regular fee, and I wasn’t doing anything at the time.

This lady was lucky. In any other city, she would be in for a rude, expensive shock. I do hotel doctoring fulltime. My colleagues have other jobs, and they're not likely to drop what they're doing and make a visit at a discount.

Some guests think they can call a nursing service. Nurses earn less than doctors, but a visit from a nursing service is not cheap. It also won’t happen. A nurse won’t give medicine without a doctor’s order.

Going to a clinic or doctor’s office is not likely to work. In today’s malpractice climate, few doctors will give an injection on a patient’s say-so. Carrying a note is also a crapshoot. As I have recounted more than once, doctors look with deep suspicion on patients who arrive with notes. See my post from April 20.

I Encounter a Rare Disease

A man suffered a headache on his flight. After arriving at the hotel, his left ear began hurting and soon became excruciating.

When he opened the door, I noticed that the left side of his face drooped.

Nothing pointed to the usual ear infection. He had no cold symptoms. The plane’s descent did not aggravate symptoms. He didn’t swim or use q-tips. He did not have a fever.

When I looked inside the ear canal, I saw blisters.

Painful blisters in the canal and a droopy face….  In forty years of practice, I have never seen a case of Ramsay-Hunt syndrome, but there it was. The poor man had shingles inside his ear.

Shingles is a viral infection of skin nerves. It’s fairly common and usually appears as a patch of blisters on the chest, abdomen, or back, sometimes the face. But there is skin in your ear canal. An additional complication occurs because the nerve supplying the ear canal also feeds muscles of the face, so victims suffer facial weakness on that side.

Treatment is an antiviral drug and a course of cortisone which is modestly but not dramatically effective. Chances are he would recover completely, but he would have an uncomfortable few weeks.

Blood Clots

Jogging on Santa Monica’s beach, a traveler twisted his ankle. He went to a clinic where an X-ray revealed no fracture.

That was two days ago, he informed me, and the ankle was healing. He was to fly home tomorrow, and his doctor in Switzerland had suggested he get an injection to prevent a blood clot. I receive a sprinkling of these requests, all from foreign travelers. They began a few years ago when the media began reporting clots in travelers after long plane flights. The risk in healthy people is tiny but not zero and concentrated among those who fly more than four hours.

Drugs to thin the blood such as Coumadin and heparin have been around for decades but are too dangerous for healthy people. In 1993, the FDA approved Lovenox, a refined form of heparin, safe enough for use outside a hospital. My wife gave me six weeks of daily injections after I broke my leg in 2003. It was still under patent and wildly expensive, but generics have appeared, so it may soon become fashionable to get a shot before a long flight.

So far no Americans have mentioned the subject, and I give foreigners the traditional advice: walk around and drink plenty of fluids. Techniques that don’t work include compression stockings (unless fitted by a professional they may make things worse) and taking aspirin. Aspirin prevents clots in arteries, but clots from immobility occur in veins.