24 Hour Duty

As a hotel doctor, I’m on duty 24 hours a day. This sounds oppressive until you realize that even a busy week – say twenty visits – requires about thirty hours of actual work. A downside is that calls can arrive at precisely the wrong time.

This one came one hour and twenty minutes before a dinner reservation with friends.

I calculated furiously and decided I could make it. My destination, the Mondrian, was on the Sunset Strip, six miles away. It was Sunday, so traffic was tolerable, but street parking on the Strip is difficult. The Mondrian is not one of my regulars, so parking attendants would probably not accommodate me. The hotel possesses only a skimpy open space around the entrance, so the valet might drive my car deep into the garage where it might take ten minutes to retrieve. Worse, there was a chance they would charge.

Making a snap decision, I drove past, but no street parking materialized. I turned down a side street but no luck, so I returned to the hotel, handed over my keys, and announced (incorrectly) that I was the hotel’s doctor.

I arrived at the room and introduced myself only to hear the discouraging words: “Spik Spanish?”…

I shook my head regretfully and proceeded in English. This usually works because most Latin American males speak enough English to get along (women don’t do so well). Sadly, he proceeded to perform the Zero-English pantomime: pointing to his throat, pointing to his head, making coughing noises.

No problem. Peering outside the door, I appealed to a group of maids on their cleaning rounds, but they were recent arrivals and spoke no English. Luckily, a bellman pushing a food cart was bilingual.

Delivering medical care was, as always, the easiest part. To my delight, the valets had held my car, and I arrived at the restaurant not excessively late.

No Income Today

A lady at the Westin wanted a housecall for her cough and fever. This seemed reasonable until I learned that she was under treatment for multiple myeloma, a serious blood disease. It affects the immune system, so any sign of infection is a red flag.

I explained that she needed more than I could provide in a hotel room and gave directions to the nearest emergency room.

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Two hours later I spoke to a guest at the Airport Holiday Inn who was experiencing stabbing chest pains. Chest pain is worrisome, but significant chest pain lingers. Fleeting pain in an otherwise healthy person is almost never a serious sign. I looked forward to the visit when, after my exam, I would deliver reassuring news. That anticipation disappeared when the guest mentioned that he had suffered several blood clots in his lung and was taking blood thinners. He added that these chest pains were different.

Different or not, it was a bad idea to assume that these were trivial. I sent him to a facility that could perform tests.

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A travel insurance agency asked me to see a hotel guest in Encinitas.

“That’s near San Diego,” I pointed out. “It’s a hundred miles.”

I’ve traveled that far in the past and charged accordingly, but I didn’t want to quote a fee and risk having it accepted because I wasn’t in a mood for the grueling drive. A local clinic would be cheaper, I informed the dispatcher. 

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“I’m a physician in the U.K., and my wife has conjunctivitis in both eyes. I went to the chemist for antibiotic drops, but apparently I have to see an American doctor.”

“It’s unusual to have bacterial conjunctivitis in both eyes,” I said. “If you’re certain, ask the pharmacist to phone, and I’ll approve the prescription.”

Later the pharmacist phoned. When it comes to their own illness or that of their family, doctors are no more accurate than laymen, but they have no interest in my opinion. 

A Mystery

Universal Assistance asked me to see a young woman with abdominal pain at the Airport Hyatt. According to the dispatcher, she had no other symptoms.

Arriving in the room, I learned things the insurance dispatcher hadn’t mentioned. The woman was three months pregnant and had noticed vaginal bleeding. It’s surprising how often doctors know the diagnosis as soon they set foot in the room, but it looks bad to blurt it out, so I asked questions, performed an exam, and then delivered my conclusions. She was having a miscarriage and had to go to an emergency room. 

The following afternoon, the lady’s husband called. They were back in the hotel. The emergency room doctor had diagnosed a miscarriage. Then he had discharged her. But she was still bleeding. Was that normal?...

Bleeding stops when a miscarriage is complete; if it continues, a doctor performs a D&C to scrape away remaining tissue. I have no explanation of why the doctor sent her out still bleeding. I told the husband that, sadly, he would have to take her back. The second time she received her D&C.  

Is It Annoying?

 "My other son is coming down with something. Do you mind taking a quick look?”

If you wonder if it annoys doctors to see an extra patient at the last minute, it does. They grumble regularly on physician internet forums which, like forums in general, are full of petty complaints.

In an office, that second patient generates a second bill, but I rarely charge double in a hotel. Driving takes up 80 percent of my housecall time, so an extra consultation doesn’t add much. I’m also aware of one rule of medicine that may come as a surprise.

Rule:  If one member of a family is ill, it might be serious. When two members are ill, it’s never serious.

A guest with chest pain, vertigo, or difficulty breathing is probably the only one in the room suffering. When two people are sick, it’s a respiratory infection: cough, congestion, fever, sore throat… These are not serious.

No medical rule is one hundred percent accurate, but I’d rate this near 99. In an otherwise healthy person, the only common, serious respiratory infection is bacterial pneumonia. Since pneumonia is not generally contagious, I’ve never seen two cases in the same room.

Special Treatment

“Our general manager’s husband has an eye problem. Could you see him this morning?”

“I could.”

“She’s wondering how much you’d charge?”

“There will be no charge.”

The concierge sounded delighted. I was also pleased. She worked at a large West Hollywood hotel that didn’t call.

I’m happy to care for staff gratis. A lower level employee will certainly tell colleagues about the experience. This is important because, even at my regular hotels, many employees are unaware that I exist, and guests who ask for help usually ask only once.

Hotel managers, of course, have the power to make important decisions.

I’ve never been asked to see a general manager’s spouse, but it seemed wise to give him special treatment. He was staying in the penthouse. The eye problem presented no difficulty; I suggested soothing eye drops, and informed him that symptoms should vanish once he began wearing goggles when riding his motorcycle.

On my way out, the general manager expressed gratitude. I nodded modestly and kept my hopes to myself.

Waiting for the Second Call

"This is the Shore hotel,” I heard after answering the phone.

That sounds routine, but it brought joy to my heart. It was a first call!... I almost never acquire new hotels, and the Shore, an upscale boutique on the Santa Monica beach, had opened a month earlier.

I keep an eye on hotels under construction. As the opening nears, more aggressive doctors approach the general manager or visit the staff to extol their virtues. I send a dignified letter of introduction to the GM. This rarely works, but after more letters and the passage of time – perhaps a decade or two – calls often materialize.

Before leaving the Shore, I stopped at the front desk to introduce myself, give thanks for the referral, and pass out business cards. The clerks responded with enthusiasm, accepted my cards, and promised to keep me in mind, but it was clear they had no idea who I was. When asked who had contacted me, they scratched their heads, consulted colleagues, and admitted they had no idea.

This reminded me that over thirty years, every Los Angeles hotel has called at least once. First calls always excite me, but it turns out they mean little. If I get a second, more follow. 

So far the Shore has been silent.

Fatal Diarrhea

Coris USA, a travel insurer, sent me to see an Argentinean lady with diarrhea at the Beverly Hills Hotel. Diarrhea is usually an easy visit.

Arriving, I learned that her illness was entering its sixth day: too long to be the ordinary stomach virus. She felt weak and feverish, and she had recently taken antibiotics, so I wondered this was Clostridium difficile colitis, an occasional consequence of the avalanche of antibiotics consumed by humans everywhere.

Every antibiotic you swallow kills trillions of germs, mostly harmless, living in your bowel. They are immediately replaced by other germs that can grow in the presence of that antibiotic. Most bowels don’t harbor C. difficile, but if yours does, antibiotics may convert a small population into a large one, and it produces an irritating toxin that causes a severe, occasionally fatal diarrhea. 

Diagnosing Clostridium requires more than suspicion, and there were other possibilities. She needed a thorough evaluation.

Fortunately, Coris USA is a good travel insurer: meaning that it (a) pays promptly and (b) takes my advice. These sound unrelated, but I’ve found that good insurers do both, bad ones do neither.

I phoned Coris’s Miami office with the news and the name of the doctor I recommended. The dispatcher contacted the main office in Buenos Aires for authorization; it appeared within the hour, and the patient went off. If I were dealing with a bad insurer, authorization would be denied or remain pending indefinitely. I often send patients off, warning that they will have to pay up front and try for reimbursement later.

Tests were positive, and she began improving after a few days of treatment: an antibiotic but one different from the one that caused the problem.