A Bright High School Student

The Kentucky legislature recently required doctors to pass a course in abusive pediatric head injuries. I’m licensed in Kentucky as well as California.

With an afternoon to spare, I found an approved course on the internet, paid $30, and spent an hour reading a mass of information on the causes, symptoms, treatment, prevention, and my legal obligations when I encounter babies with brain injuries from abuse. I can’t remember any, but doctors regularly miss them.

I couldn’t possibly recall more than a fraction of that material, but there would be mass confusion if too many doctors failed, so the test at the end was easy. I printed a certificate of completion and filed it in case the Medical Board checked. They do that but not very often.

California requires every physician to pass a course on domestic violence and another on care of the elderly. After finishing Kentucky's mandatory AIDS course, I discovered that the Board had cancelled the requirement.

Doctors grumble about activists who persuade states to add their favorite subject to the education hours that we must all fulfill. But no one has solved the problem of keeping us up-to-date. Ninety percent of problems a G.P. sees are easy. A bright high school student could handle them. The remaining ten percent require thought, but even if we mess up, most patients do OK over the short term. That’s why fakes with no medical training but a professional manner can practice for years before a disaster unmasks them.

Drilling a Hole

A guest stubbed her toe.

Her big toenail turned black. This was a subungual hematoma: bleeding under the nail. If blood can’t escape, pressure builds, and it hurts.

The solution is to make a hole. Medical books have long told us to heat the end of a paper clip until it is red-hot and then burn through the nail.  

I don’t know about you, but I wouldn’t allow anyone near my flesh with a red-hot instrument. One can also dig with something sharp such as a scalpel. That takes work.

The solution is an electrical drill. One can buy one with a tiny bit, but I don’t see many subungual hematomas, so I borrow my wife’s. The smallest bit is 1/16^th inch which is larger than necessary.

It’s a hefty instrument that makes a loud noise. Guests look uneasy when I approach, but the operation is painless, and when the breakthrough produces a spurt of blood, pain vanishes.

How To Tell a Bad War Movie

It’s easy. Look for the gasoline bombs.

I reminded myself of this last week watching Hacksaw Ridge which received ecstatic reviews and tells a genuinely inspiring story but seems aimed at young adults. I found it too full of stereotypes but, far worse, historically inaccurate.

Everyone remembers the first twenty minutes of Saving Private Ryan because Steven Spielberg made an immense effort to get it right. Mel Gibson’s crew had other priorities in Hacksaw Ridge, most likely staying within budget.

World War II battles featured lots of explosives – shells, grenades, mortars, bombs. When explosives explode, debris and dirt fly into the air. Fire may appear later when flammable stuff burns, but explosives don’t produce flames. Special effects people can duplicate an explosion with explosives, but it’s tricky and expensive and probably dangerous.

Much easier is a gasoline bomb. Pour a little gasoline in a can. Allow the fumes to collect and ignite them with a spark. Poof!! A ball of flame. It doesn’t make much noise, but you can add that later.

A cheap battle scene features a crowd of soldiers running across a field of gasoline bombs. Flames shoot up everywhere. Some soldiers fall down. It looks spectacular. Teenage boys like that. 

Sorry.... Sometimes I get distracted from hotel doctoring.... 

Trying to Reach the Doctor

A flight attendant in Costa Mesa was suffering flu symptoms. The news arrived at 7:30 a.m. After writing down the information, I delivered my mantra to the dispatcher.

Costa Mesa is 45 miles away in Orange County. I can go but not during the freeway rush house. Was it OK with the patient if I arrived between 10 and 11? Usually it’s OK. If not, I suggest calling one of the Orange country doctors.  

The airline agency knows doctors in Orange County, but when its dispatcher calls one, she reaches voicemail or a receptionist or an answering service. She leaves a message and waits…and waits… You know how it is when you want to talk to your doctor.

I’m probably the only doctor in the world who answers his own phone. Harassed dispatchers from all my clients soon learn this, so they ask me to make housecalls throughout California.

Some destinations are too far. When they’re not, some agencies don’t want to pay extra. I don’t solicit distant hotels for the same reason. But the airline agency pays generously, so I go regularly to Orange County.

Noise is Everywhere

“Could you please turn down the television?”

“Huh…?”

I repeated the question – not because the guest didn’t hear but because the request seemed to strike him as peculiar. He turned down the volume but not a great deal.

This happens routinely. Families from around the world check into a single hotel room, turn on the TV, and go about their business. Some watch, others ignore it. All would consider it rude to talk while I interview a patient but most make no move to the yammering television unless I mention it.

Going Blind

Late one evening, a guest called to say his son had gone blind. That was beyond my expertise, I explained, but the guest insisted on a housecall.

Sure enough, the son, age 18, seemed blind although my exam was otherwise normal. He seemed only mildly upset. A stroke affecting a tiny area of the optic nerve can cause blindness with no other symptoms, but this would be extremely odd. It could be psychosomatic, but it’s risky to jump to this conclusion, and the family insisted that nothing stressful was happening.

I sent them to an emergency room. The doctor found nothing abnormal and summoned an ophthalmologist who concluded that the blindness was psychosomatic. You’re probably wondering if he was right, but this is a real story. They checked out, and I never learned what happened. 

Temptation

“Could you check out my ankle? I don’t want to go to an emergency room.”

These are tempting calls. I could make the housecall, solemnly examine the painful, swollen ankle, express sympathy, wrap it in an Ace bandage (universally agreed to be not much use), and tell the guest to see a doctor if he’s not dramatically better in a day or two. Happy to avoid rushing to an emergency room, the guest would consider his money was well spent.

Of course, I could have told him this over the phone. If walking on an injured ankle is painful, it requires medical attention. But unless pain is unbearable or the skin is mangled, it’s not an emergency.  

Furthermore, the medical attention should be delivered by a doctor who knows ankles such as an orthopedist. Going to an emergency room is a bad idea. You’ll get an x-ray, a bill for around a thousand dollars, and advice to see a doctor if you’re not better in a day or two.