Jumping to Conclusions

Midafternoon is a slow time, so I take a history class at UCLA, and I’m rarely disturbed. But my phone buzzed.

“This is International Assistance about the patient you saw today. She has begun to vomit and wants another visit.”

That morning I had given ibuprofen to a woman with a headache. She was in Hollywood, a tedious eight mile drive through city streets with the rush hour beginning. After twenty minutes of stop-and-go, a sense of unease grew. Ibuprofen shouldn’t cause such a violent reaction. Then I remembered that the Hollywood patient was not from International Assistance but World Assistance.

International Assistance had called the previous night at 1 a.m. and sent me to the Airport Hilton for a guest suffering a backache. I’d given an injection and left strong pain pills for later. I checked caller ID on my cell phone and, sure enough, I’d jumped to the wrong conclusion.

The Hilton was in the opposite direction. It took another twenty minutes to reach the freeway and join the rush hour creep. 

I Don't Like Coughing

“I’ve been hacking up stuff for a couple days, and it’s turning green.”

“It sounds like the virus that’s going around,” I said. “It’ll last three or four or five or six more days. Medical science doesn’t do anything dramatic.”

“At home I’d tough it out. But I have meetings all week, and I need something to knock it out. When can you get here?”

If you read this blog you know my heart sinks when I hear “I need something to knock it out….” It guarantees an unsatisfying visit. Either the guest will feel resentful if he doesn’t get an antibiotic, or I’ll give an antibiotic (if it seems like he’ll blow his top, and sometimes I’m too slow), and I’ll leave hating myself.

Now, readers, you’re probably thinking: “Yes, isn’t it disgraceful that doctors give useless antibiotics so often that patients expect them. But sometimes you need an antibiotic. How can you tell?...”  The answer is so surprising that you and your doctor may not believe it. In an otherwise healthy person (infants and the elderly excepted) the only common disease with a cough that antibiotics cure is pneumonia. Everything else is a virus. ..in my opinion (my lawyer insisted I add that).

I Like Vomiting

A businessman at the Standard had been throwing up since the wee hours. I assured him I’d arrive within the hour. It was nine a.m., so the usual half-hour drive downtown might last longer.

Before leaving, from my medication closet I extracted a syringe, a packet of antinausea pills, and an antivomiting suppository and dropped them into my pocket. This enabled me to avoid restocking my bag after returning home. Sometimes I forget.

The drive was tolerable. The guest was miserable, but he hadn’t vomited in two hours, so I suspected he was over the worst. I left feeling good. I like vomiting.

People chuckle to hear this, but in an otherwise healthy person, most episodes don’t last long, rarely more than a day. My medicines help symptoms but don’t speed recovery. When guests feel better, often by the time the medicine wears off, they believe I've cured them. He felt better by evening.

A Stressful Life

I’m running low on ondansetron, the best antinausea pill.

Unfortunately, I’m not low on many other supplies. I buy through an internet pharmaceutical company that charges a fat handling fee for orders under $200. Eight bottles of ondansetron, 240 pills, will cost $25. I could use more tongue depressors, but 500 at $5.24 is not much help. I dispense large quantities of  cough medicine and lidocaine gargle for sore throats, but those cost only a few dollars a piece. My bottle of 500 Amoxicillin capsules ($28) is half empty; stocking up would help but medicines have expiration dates, so one must be careful.

A few years ago, after thirty years of use, my blood pressure cuff broke, but I had a spare. Should I buy another? Will I be practicing when I’m 108?....

One of my boasts is that, unlike other hotel doctors, the fee I announce is the fee I collect. I don’t charge extra for anything. It turns out that pills, injectables, and supplies for common ailments are so cheap that I struggle to assemble an order exceeding $200. Life is tough.

Dealing With Buenos Aires

“Can you make a visit to Palo Alto?”

“That’s four hundred miles away!”

“How much would you charge?”

“I’m in Los Angeles. Do you understand?”

“Yes. How much would you charge?”

In fact, she didn’t understand. To save money, many travel insurers have closed their US offices, so this call originated from the patient’s home country. Inevitably, dispatchers in Buenos Aires don’t speak English as well as their former colleagues in Miami. I carefully explained that the distance made a visit impossible.

Unlike American travel insurers who require clients to pay up front and submit a claim, South American insurers send a doctor and pay me directly. I’ve made over two thousand visits for them. They’re among my favorites because patients who don’t pay directly are less demanding. Also, these insurers send me to hotels that don’t call or, even better, to my competitor’s hotels. A downside is that, if I don’t listen carefully, they send me to the wrong address. In Spanish “v” and “b” have identical sounds; so do “y” and “ll.”  

Then there was the time an insurer called at midnight.

“Can you make a visit to Culver City tomorrow?”

“Yes… But why did you call so late?”

“Because it says on your profile that you are available 24 hours.”

Traffic

Bending over, a guest at the Georgian felt stabbing pain in his back. He could barely move.

Acute back pain usually doesn’t last long, so, over the phone, I assured him that he would be disabled for a day and then gradually improve. I was not anxious to make this visit because it was 4 p.m. I would be driving to Santa Monica and back during the rush hour, a tedious experience. But he wanted a visit.

It was a tedious drive, not improved by the sight of immobile traffic on the opposite side of the freeway. The guest answered the door himself, always a good sign in someone with back pain. I examined him, repeated what I had said over the phone, and handed over pain medication; it was an easy visit.

Returning, I settled into the rear of a nearly motionless stream of cars. I was in no hurry; it was suppertime, but I wasn’t hungry. After ten minutes, my phone rang. A guest at the Crowne Plaza in Beverly Hills asked for a doctor. His wife was vomiting.

I often delay visits, but people who are vomiting hate to wait. This would normally be a quick drive because the Crowne Plaza was only five miles away, and I was headed in that direction. But it was the rush hour. I left the freeway and crept for thirty minutes along Pico Boulevard to the hotel. The visit went well, and the drive home was tolerable.

Going to Disneyland

A child at the Disneyland Hotel had a fever. Disneyland is forty miles away, but the call arrived Sunday morning. Freeway traffic was light; a perfect time for a long drive.

It was nearly noon when I greeted the parents and three other children. Being stuck in a hotel room with a sick child was not part of their plans, so all looked depressed. The child had a fever and cold symptoms but did not seem ill. I explained that children catch half a dozen viral infections every year; they last from a few days to a week or two; one can treat the symptoms, but there is no cure. Rest does not help.

“You mean we can go to Disneyland?” asked the father.

“Saying in bed doesn’t make it go away quicker.”

The family erupted in cheers and followed me out the door.