Night in a Hotel Room

Patients are often suicidally reluctant to wake a doctor, but I don’t object. Traffic is light, parking is easy, and since I have no office, I can sleep late. I’ve made a thousand housecalls that got me out of bed.

Callers awaken in the dark, certain something terrible is about to happen. I try to handle anxiety attacks over the phone using sympathy and calm reassurance. I never point out that nothing terrible will happen because guests know that; it’s why they’re upset. I explain that no one is perfect; sometimes our brains go haywire, but it never lasts long. If I keep the guest on the line, this almost always works. Making a housecall is risky because guests often feel better and cancel before I arrive or feel worse and insist that the hotel call paramedics.

Some hotel doctors use paramedics as a substitute for getting out of bed, but I reserve them for emergencies. Mostly, these are obvious. Heart attacks can rouse victims from sleep, but they are not subtle. Niggling chest discomfort doesn’t qualify, and chest pain in a young person is probably something else. 

I see a cross-section of ailments, but guests with an upset stomach seem overrepresented. I consider a wee-hour visit for vomiting a good call (i.e. not life-threatening; I can help; patients are especially grateful). The latest antivomiting drug, ondansetron, is superior to the old standby, Compazine. It was once wildly expensive and used only for vomiting after cancer chemotherapy, but its patent expired a few years ago, and the price has plummeted.

Most upset stomachs don’t last long. I assure guests they’ll probably feel better when the sun rises, and (a perk of being a doctor) when that happens, guests believe I’ve cured them.

You Can't Make a Diagnosis Over the Phone

I talk to guests before making a housecall, so I have a good idea of what’s happening before I drive off or decide that a visit isn’t necessary. 

“Of course, you can’t make a diagnosis over the phone,” guests tell me.

But I can. Doctors do it all the time. I’d estimate my accuracy at ninety percent. It may be one hundred for some problems: respiratory infections, urine infections, backaches, most rashes, injuries, anxiety attacks. Driving to the hotel, it’s relaxing to know in advance that the guest has chicken pox, gout, herpes, a bladder infection, or the flu. I can deliver my diagnosis, advice, and medication, collect my money and thanks, and drive home. What an easy job!

Jumping to conclusions is a major reason doctors get into trouble, so I pay attention. If a fifty year-old describes chest pain that doesn’t sound like a heart attack, it’s unlikely I’ll tell him that it’s OK to wait. It’s also unlikely that I’ll make a housecall because an examination rarely helps. On the other hand, chest pain in a twenty year-old is hardly ever a serious matter.

Abdominal pain is tricky at any age. Guests suggest gas, indigestion, and constipation, none of which cause severe pain. I worry about a dozen conditions that require a surgeon. Oddly, it’s reassuring when vomiting or diarrhea accompanies the pain. Provided the guest is in good health, it’s usually a short-lived stomach virus, my second most common reason for a housecall. Without vomiting or diarrhea, I’m likely to suggest a clinic visit where a doctor can get more information than a housecall provides.

“I can walk on it, so it’s not broken…” “I can move it, so it’s not broken….”  These are as accurate as most popular health beliefs. I walked on a painful foot for a week before an X-ray that revealed a fracture. Hotel guests yearn to hear that their injury is not serious, and I sometimes comply. Doctors do little for cracked ribs and broken toes except to relieve pain, so X-rays aren’t essential. All bets are off with the elderly, but it requires a good deal of violence to break a young bone. Lifting a heavy suitcase won’t do it; experts urge doctors (in vain) not to order spinal x-rays unless pain persists for weeks.

My greatest service is not in diagnosing fractures which is usually impossible but saving guests the misery of spending hours in an emergency room. Most injuries are not emergencies, even if a bone is fractured. If the guest is willing to wait, I can send him to the more civilized atmosphere of an orthopedist’s office. 

Stuck in Liberalism

Walking along Pico, a busy street, I passed a man lying face down on the sidewalk. His head lay on the curb; one leg remained on a bus bench, so he had clearly toppled off. Even prosperous Los Angeles neighborhoods possess a few resident homeless, and this was probably one. He looked disheveled.

Naturally, I continued past. After a dozen paces I stopped because my conscience was hectoring me. “You have to help this fellow,” it pointed out.

“Someone else will notice,” I replied.

“Not good enough.”

“I do fine with patients,” I pointed out. “But this is not a professional situation.”

“Doctors have a moral obligation to help anyone in distress!” said my conscience.

“That’s flattering, but many doctors disagree. You should read the physicians on internet forums. Most are very conservative.”

“You have to help.”

“….They hate Obamacare. They think welfare patients are deadbeats. They don’t even like patients with private insurance. Their idea of heaven is a cash-only practice.”

“Not good enough.”

While I paced in a circle, debating this irritating voice, a hundred cars and dozens of pedestrians passed by. Finally, I gave up. The 911 dispatcher listened to my report and then transferred me to the fire department. The fire department dispatcher listened and then transferred me to the paramedics.

“How old is he?” asked a paramedic.

“Middle-aged.”

“What do you mean ‘middle-aged’?  he snapped. “Forty… Fifty… Sixty?”

“Fifty,” I guessed.

After several more questions designed to show that I was bothering him, he told me to wait until the ambulance arrived. As I waited, the man stirred.

“That’s all I need!” I thought. “For him to get up and walk away.”

But he didn’t. The ambulance arrived within five minutes, and the paramedics went to work. When they ignored me, I walked off.

No Good Deed Goes Unpunished

An Austrian lady had left home without her medication. Could I come and write some prescriptions?

These requests arrive regularly. In the past, I offered to phone a pharmacy, but this took a long time as guests scrambled to find the name, dose, and instructions. Nowadays I tell them to go to a pharmacy, explain exactly what they need, and give my number. I would approve over the phone.

Guests are pleased that it is so simple and more pleased to learn that I don’t charge for this.

Later, a caller explained that he was the tour leader for an Austrian group. “You gave a prescription for one of our members. Could you tell me where is the pharmacy?”

The lady’s English was poor, so she had misheard me. I repeated that the guest had to go to the pharmacy and describe precisely what she needed. An hour later, I answered another call from the tour leader. He was at a pharmacy near the hotel; he had given the names of the lady’s medication, but they had refused to accept them. Again, I explained that the lady had to tell the pharmacist precisely what she needed.

An hour later, a pharmacist informed me that a foreign customer was requesting several medications. He wanted to know the dose and instructions. I told him that he would have to get this information from the guest.

Several hours passed before the pharmacy called again because the lady had had to phone her doctor in Austria. One of her drugs was not available in the US. What would I advise?... I had no idea but suggested that he probably knew an equivalent. After some research, he found one and called back. I agreed with his suggestion.

Don’t forget to pack your pills.

Worry, Part 2

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.

Worry, Part 1

A guest had stumbled in the shower and thrown out her back. Could I make a visit to decide if she needed hospitalization?

Going to the hospital with back pain is a bad idea; even if you’re in agony, no doctor will admit you without evidence of nerve damage such as paralysis or inability to urinate. He will order x-rays (worthless for acute back pain but an ER tradition), explain that you will recover in a few days, and prescribe pain medication.

My examination showed no nerve damage, so I explained that she would probably improve in a few days. I handed over pain pills, adding that, while it wasn’t essential, I could give an injection that would help for several hours. She agreed, so I gave it. 

 “Not so good,” she replied when I called to ask how she was doing. She had been vomiting since the injection, and each vomit hurt her back. That’s an occasional side-effect. I assured her it would pass, but I worried.

She was marginally better the following morning and the morning after that. She wanted to fly home. Could I provide medical clearance? Visits for “medical clearance” are a lucrative perk of hotel doctoring, but I resisted the temptation, explaining that there’s no medical reason why someone with back pain can’t travel. If she could hobble onto the plane, she should go.

Could I give a “mild” injection so she could move more easily. No such injection exists. I suggested she try the pain medicine.

Later, the lady reported that the medicine made her dizzy. What should she do? I told her it would pass. Rest is not helpful for treating back pain. She should try to make her plane. When I called later she had checked out. I worried that I might hear from her, but I didn’t.

A Creepy Frat Guy

The Andaz Hyatt had given my number, explained the caller. Could I see a member of their cast who was suffering an earache? Unfortunately, he was on location and wouldn’t return until evening.

She was delighted at my suggestion that I come to the film shoot, and I’m as eager as anyone to mingle with movie people. On the downside, I live six miles from the Hyatt; the film was shooting at the far end of the San Fernando Valley, twenty-five miles away, and I’d quoted my fee before learning this. 

The producers had taken over a run-down motel, painted it pink, and restored the coffee shop to its mid-twentieth century interior. I drove past warning “closed to the public” signs and parked among the cabins and scattered 1950s cars.

Several dozen people stood around, none over forty. You should realize that shooting a movie is boring. Filming takes up perhaps two percent of the day. The remainder involves setting up, technical changes, errands, and waiting around. Everyone looks forward to lunch. I attracted attention, being far older and much better dressed.

Earaches are easy. I followed a young man into the empty 1950s diner, made the diagnosis, handed over medicine, and took my leave.

As usual, one aspect of the experience seemed strange. The assistant who had phoned and greeted me on my arrival was a young, attractive woman. Other attractive women were carrying messages, answering phones, setting up the lunch buffet. Almost every actress in costume was beautiful; there were no exceptions for those in street clothes.

Somewhere in Los Angeles there is a creepy frat guy who handles hiring for film sets.