I drove to the Magic hotel in Hollywood where a Danish
couple’s 18 month-old was vomiting. He looked fine, and looking is essential: sick children look sick. Nothing abnormal
turned up on an exam, so my diagnosis was a common stomach virus. I told the
parents it might last a few days and gave the usual dietary advice.
I check on patients before going to bed, but the Danish
parents beat me to it. The child had vomited once again, they reported. He was
still in no distress, so I told them it was OK to wait.
My assurance was proper, but patients occasionally
deliver unpleasant surprises, so I worried a little as I went to bed.
I phoned the Danes the following day to learn that the
child hadn’t vomited but was now feverish. This was to be expected, I
explained, and I approved their decision to give Tylenol.
The Danish child was still feverish, his parents
reported the next day, and now he had diarrhea. I gave dietary advice.
There was no answer the following morning. From the
front desk I learned that they had checked out. I had just returned from seeing
a young man with abdominal pain at a youth hostel. He was worried about
appendicitis; my exam made that unlikely. Since he had no health insurance, I
did not want to make my life easier by sending him to an emergency room where a
workup including CT scans would run to about $5,000. His symptoms hadn’t
improved when I called, but they still didn’t seem like appendicitis. He
promised to phone if there was any change. I worried a little as I went to bed.