Insect Bites

A caller was suffering an itchy rash, present for a week. Three companions were also affected. That sounded good. When more than one person has a medical problem, it’s the same problem and not serious.

In the room, all four gathered to show me their skin which revealed the scattered, small pink pustules left by ectoparasites. I use that term to be accurate because not every bug that bites is an “insect.” Spiders, ticks, mites, scorpions, and centipedes aren’t.

Bedbugs (an insect) have become fashionable, but these travelers had been moving frequently from place to place. Where hygiene is reasonable, lice (an insect) limit themselves to hairy areas; I didn’t see any. My diagnosis was scabies, a mite (not an insect) that burrows under the skin. Scabies is hard to catch from clothes or bedding; mostly it requires rubbing against someone else with scabies, and it looked like these young people did a lot of that. 

Deception

A tour leader explained that one of his group wanted a doctor to look at her hand. She had fallen.

Minor injuries are easy, but I don’t want to collect money from someone who needs an x-ray and then send them off to pay more money somewhere else. 

I quizzed him. What happened? Where was the pain? Was there much swelling? He assured me that it was not a big deal. The lady just wanted a doctor to check it.

He was lying. When a member of a tour goes to an emergency room, the leader must go along. Anxious to avoid such a tedious job, tour leaders often hope a doctor will make the problem go away.

The lady had a swollen, painful left wrist. If you fall and instinctively catch yourself on your outstretched hand, you’re likely to break a specific spot at the end of your radius. It’s so common it has a name: the Colles fracture.

I was certain she had a Colles fracture, so off they went.

Gushing Blood

Someone at a Beverly Hills hotel had struck his head on the edge of a table. Blood was gushing, and he wanted a doctor.

Scalp lacerations bleed heavily, but my long experience with bumped heads reveals that the wound is rarely impressive. If victims are willing to apply pressure and wait, they usually agree.

He didn’t want to wait.

This was an upscale hotel, but I am not its doctor who was undoubtedly, this being midnight, fast asleep. Someone had searched the internet and found a housecall service which called me. That meant that I had to give the service forty percent of the fee. My wee-hour charge is not skimpy, but none of this mattered. He wanted a doctor.

I told him I would arrive in half an hour, and the manager expressed surprise when I turned up on time. He led me down a hall, through the kitchen to a large room where the patient was resting on a chair, a wet rag over his forehead. Half a dozen employees stood around.  

Removing the rag revealed that the bleeding had stopped. The wound was a shallow 1½ inch scratch. I delivered the good news and applied a band-aid. Everyone was relieved, and the guest peeled off my fee from a wad of bills.

When an Antibiotic Helps

If you receive an antibiotic for a respiratory infection, it’s probably a placebo because almost all respiratory infections are viruses.

If you receive an antibiotic for a skin infection, there’s a chance you have a bacterial infection that an antibiotic won’t help. A boil or other collection of pus will heal if the pus is drained. If the doctor gives an antibiotic but doesn’t drain the pus, it will also heal. That’s because most infections, boils included, eventually heal.

You’ll get an antibiotic if your doctor diagnoses an ear or sinus infection. It’s a bad idea to ask if this will help because (if he’s honest), he’ll admit that no one knows. In experiment after experiment, when researchers compare patients given and not given antibiotics for ear or sinus infections, the results are never dramatic. Often there’s no difference. Sometimes they help a little. Doctors in some nations don’t treat these with antibiotics.

That’s why urine infections are my favorites. It’s not controversial that antibiotics help. For infections in young women, help comes quickly, usually within a day. These are satisfying encounters for everyone concerned.

Delivering Medical Care is the Easy Part

Park La-Brea Towers is a huge apartment complex in West Hollywood. I’ve been there a dozen times. Inside, the buildings have numbers which follow a cryptic system that I have yet to decipher, and finding them is a chore. Since it’s an old complex with inadequate off-street lots, street parking is permitted.

You don’t want to visit Park La-Brea Towers during the wee-hours. Many streets are gated, and the gates are closed. Everyone is home, and so are their cars.

I went at 2 a.m. last week. I was in luck because someone was leaving as I arrived, so I could slip through the gate before it closed. Since the streets were empty, I was able to drive slowly and peer at the buildings to find the number. Then I searched and searched, but all street parking spots were occupied. I found spaces in the reserved lots, but signs warned of terrible consequences for wrongful parkers. I noticed a car parked directly in front of my building and decided to do the same.

Drawing near, I saw a ticket on its window. I wasn’t willing to take the chance. I couldn’t phone the apartment because the family didn’t have an American cell phone. I phoned the agency and woke up the person who sent me (it’s a boutique agency, so the owner sometimes takes calls). I told her to call the family and tell them to send someone down to watch my car and plead my case if parking enforcement arrived.

Someone duly appeared, and I went upstairs. As usual, delivering medical care was the easy part.

Overdressed for Summer

It’s August. Wearing a suit and tie, I’m reminded of how much I resent hotels that refuse to let me park free. I only learned that the Casa Del Mar didn’t when the clerk declined to validate, and I was stuck for $20. But the Casa Del Mar is on the beach where it’s cool enough to walk a few blocks without suffering.

The Sheraton in Pasadena is in Pasadena where it’s ten degrees warmer than Los Angeles. The average summer day in Los Angeles is tolerable but opening the car door in Pasadena is always a shock. Worse, I travel to the Pasadena Sheraton to see Virgin-Atlantic crew who are British. Foreigners, Arabs excepted, believe that air conditioning is bad for the health. When anyone gets sick, they turn it off, so not only do I arrive at the hotel in a sweat but go about my business in a hot room.

Another Free Service

A caller in Huntington Beach was having a panic attack. He had had them before, and he needed a doctor to come and make sure he wasn’t dying.

This was a bad call in many ways. Waking me at midnight was not one, because I don’t consider that a big deal. Making a housecall for a panic attack is risky because victims often improve while I’m driving and cancel, and Huntington Beach is 45 miles away. There’s not much a doctor on the spot can do with medicine for a panic attack  (“a shot” doesn’t exist).

Finally, the caller didn’t know the fee; I would have to tell him.

In his distress, he had searched the internet and found a national housecall agency. Most such agencies tell callers the fee, so by the time I hear from them, they’ve agreed to pay. But this particular agency specializes in foreign airline crew and tourists with travel insurance where the fee is already arranged. On the rare occasion when an American contacts the agency’s answering service directly, it simply passes the call onto me.

I knew that my fee to Huntington Beach at midnight including a 40 percent cut for the service would never pass. Worse, once I mentioned it the horrified patient would quickly get off the phone.  

That wouldn’t bother an operator, but once someone asks a doctor for help, he or she is obligated to help (ethically obligated; in reality maybe not). So I held off delivering the bad news and kept the conversation going. 

After forty minutes of soothing and reassurance he began running out of gas and admitted that maybe this wasn’t an emergency. He agreed to keep my number and call if he changed his mind.