My Norwegians, Part II

At midnight the Norwegian lady from the previous post phoned, begging for a housecall. Something terrible was happening. This was a full-blown panic attack, she informed me. She knew for certain that she was dying. When I assured her that she would not die, she did not deny it but pleaded tearfully for me to come. Victims of panic attacks are not psychotic. They know they’re behaving irrationally, but they can’t resist.

These calls are not rare, and I usually handle them without a visit. Ten minutes of soothing reassurance and the knowledge that I’m immediately available over the phone generally works. Reassurance also works when I visit a guest whose complaint unexpectedly turns out to be a panic attack. Unfortunately, these successes are guests who don’t know they’re having an attack or suffer them rarely. This lady was a hard-core, locked-in panic attack veteran. Her attacks followed a strict pattern, and no reassurance would change matters.

If I came, examined, and found everything normal, she would express gratitude, but even before I finished counting my money, she would be pleading for another exam. Yes (I know you’re asking) there are shots, and I give them, but they don’t work. I hate walking out on a guest who’s begging me to stay, and these attacks may last hours.

This guest’s conviction that she was dying was clearly wrong. Yet every doctor has heard of patients who announce that they’re dying and then proceed to die. No doctor wants to be the source of such an anecdote, so this lady needed at least one exam. As I was agonizing, she broke in to say she would ask the hotel to call an ambulance. Then she hung up. I phoned the front desk to make sure they had done so. Like me the paramedics have encountered plenty of panic attacks; in the unlikely event something bad happened, they were the last medical professionals the guest had seen.     

My Norwegians

Oil gives Norway the world’s highest standard of living because, unlike oil-rich countries in Africa and the middle-east, Norway has an honest government. Besides putting away money for the future, it invests heavily in infrastructure and services such as universal free medical care and college education. Many Americans consider such government programs soul-destroying, but Norwegians tolerate them pretty well.

A  Norwegian tour arrived in the city last year, and I cared for four members. Thanks to a good education, all spoke English.

They were guests at the Hollywood Heights hotel in my least favorite part of Los Angeles. Despite our legendary freeways, none reach from my neighborhood to Hollywood, so I drove nine miles through the city. Planned in the 1960s, the Beverly Hills freeway would have solved my problem, but it vanished from maps when the city insisted it be built underground, an excellent idea.

The first Norwegian suffered a urine infection, common and easy to treat. The second had a hacking cough, present several days, which tormented three roommates almost as much as the patient. I handed over cough medicine. The third had been vomiting. Everyone with an upset stomach blames their last meal, so I listened to a recital of everything he’d eaten. I gave medicine and told him he’d be better in a few hours.

The last had been to Universal Studios and thought she had sunstroke. Sunstroke is life-threatening, but there are lesser sun-related conditions, none of which she had. She did not even have the painful sunburn that northern Europeans acquire almost as soon as they get off the plane. Universal City is in an area hotter than Los Angeles proper, but weather hadn’t been abnormally hot.

Hearing my reassurance, she admitted that her nausea and anxiety may have represented a mild panic attack. She suffered them regularly. This one seemed to be receding…. The story continues in my next post.

Oppenheim's Rule

Less in high school, more in college, and even more in medical school, students agonized before a test, suffering during, and grumbled afterward about how badly they did.

At some point in life, I had an epiphany. It occurred to me that I was smarter than most people. If a test seemed hard to me, it was certainly harder for everyone else. So I would do fine. When I decided to think this way, a great weight lifted from my shoulders, and I stopped worrying about exams.

As a certified family practitioner, I must take a test every six years to keep my certification. With no office practice, I can’t take the shorter test given to colleagues. It takes three hours; later someone visits the office to evaluate their charts. I must take the same day-long written exam given residents fresh out of training.  It includes subjects I’ve long forgotten such as obstetrics and surgery, so I spend a lot of time guessing. But I did fine in exams I took at the age of 39, 45, 51, and 57. By the time I was 63, the questions seemed harder, and I was guessing more often. For weeks afterward I broke my rule and worried. Failure would be humiliating. Also, I’d have to pay $800 to take the test again. But the rule held. I passed.

Wee Hour Gridlock

The phone woke me at 11:30. A lady at a downtown hotel was suffering an allergic reaction. This was not bad news; downtown is not too far, I charge extra for calls that get me out of bed, freeway traffic is light, and I can sleep late. I wrote down the information and dressed.

Traffic was minimal, but as I approached the freeway interchange leading to downtown, a line of traffic cones forced me to the outside lane. The ramp heading north was closed. The highway department schedules inconvenient maintenance for the wee hours, and I occasionally encounter these obstructions. No problem, I thought. I continued on to the next exit and re-entered the freeway to retrace my route. Cones appeared, so the other north ramp was also blocked. By the time I learned this, I was forced onto the freeway heading south. Again I left at the first exit only to discover no on-ramp in the opposite direction.

Fortunately, there was Figueroa, the main street through downtown, so I decided to follow it. That turned out to be everyone’s idea, so I joined a gridlock that crept north.

I apologized for arriving an hour late, and the patient was too polite to express skepticism that heavy traffic at 1 a.m. was responsible.

The Pleasures of the Beverly Hills Hotel

My September 3 post brings back memories of the Beverly Hills Hotel.

I love it. The hotel sits in a residential area of a city with benign parking laws, so I can leave my car on adjacent Crescent Drive. Because management ignores the tiresome obsession with security, even during the wee hours, I walk to the nearest door and never find it locked. I’ve made 135 visits.

I’m not the only doctor who loves the Beverly Hills Hotel. Although the oldest (built in 1912), later arrivals – Bel Air, Peninsula, Sofitel, and L’Hermitage share its reputation for opulence and expensiveness. However, something about it attracts the fawning attention of doctors, including those who don’t serve hotels.

I’ve never met the general manager. He has the authority to designate a hotel doctor, but GMs tend to leave that decision to guest service personnel. That works out fine for me – over the long term. Over the short term, aggressive doctors exert their charms. I’ve acquired and lost the Beverly Hills Hotel four times.

For an exciting year during the eighties, it called, and I visited Leonard Bernstein twice (I can mention his name because he’s dead). Then calls ceased. They resumed several years later before stopping again; this was probably the work of the unhappy celebrity whose visit I may have mentioned earlier. The hotel closed for renovations in 1994, reopening a year later with concierges who knew me from previous jobs -- always a good sign. Sure enough, calls began arriving. By this time, Doctor Lusman was on the scene (google “Jules Lusman”; you won’t regret it). He took over until he lost his license in 2002.

All luxury hotels call now and then, and a few call regularly, but I lack the key to winning their ongoing loyalty. This might involve something as straightforward as charming the general manager or as devious as money changing hands. I don’t know.

An Encounter at the Beverly Hills Hotel

In 1995, a man wearing only pajama bottoms dashed into the lobby of the Beverly Hills Hotel as I stood at the concierge’s desk.

“Don’t pay him!” he screamed.

Without lowering his voice, he denounced my competence and asserted that, once he informed the general manager, I would never again enter the Beverly Hills Hotel.

He had consulted me for a painful anal condition. I didn’t find anything wrong but gave some suppositories from my bag. He showed no interest in suggestions for sitz-baths and stool softeners, finally interrupting to declare that he needed substantial pain relief, preferably by injection. He heard my explanation for declining in sullen silence.

I left the room without the usual pleasantries and made a beeline for the concierge but not to get paid. I never ask for money after a visit turns out badly. If the guest isn’t planning to complain, the sight of my charge on the bill might change his mind. In these situations I try to neutralize damage by warning that I’d seen a guest who might cause difficulties. I had barely begun when the man’s entrance made this superfluous.

I kept quiet, and he eventually ran out of gas and stalked off. To my relief, several amused employees urged me not to worry. This guest was well known to them. 

Flying and Blood Clots

I hear from travelers who notice puffy legs after a long flight. Some worry about a blood clot, but this almost never causes both legs to swell.

Your heart has no trouble pushing blood to the far end of your body but plays no role afterwards. Blood returns to the heart slowly, squeezed along by surrounding muscles. If you don’t move, it returns even more slowly. In the absence of movement, gravity induces blood to settle in the legs where plasma leaks through the distended veins into surrounding tissue. You can make the diagnosis if pressing a finger makes a visible dent. Veins grow leakier with age, but I see plenty of guests in the prime of life. The swelling should diminish after you begin moving or eliminate the effect of gravity. A night in bed usually helps.

Textbooks list dozens of serious causes “peripheral edema.” I can’t recall a hotel guest who had one, but it’s possible that a traveler with swollen legs may learn that he has heart, kidney, or liver disease and remember that I downplayed its seriousness.

So, my legal advisor insists I warn you not to feel reassured by what I’ve written. It’s just my opinion; you might be dangerously ill. Consult your family physician. Go to an urgent care clinic. Call the hotel doctor.