A Bilingual Doctor at Midnight

A guest wanted a doctor who spoke French.

“I don’t speak French, and it’s midnight,” I pointed out. “You won’t find a bilingual doctor to make a housecall at this hour.”

The operator promised to inform the guest and call back. Waiting for people to call back is one of my least favorite activities especially if I have been aroused from sleep. Fifteen minutes passed before the phone rang. The operator apologized for the delay, explaining that the guest wasn’t answering, and she didn’t want to keep me up. When she reached him, she would suggest a housecall for the following morning.

I agreed, adding that I could arrive around ten. The hotel was in Norwalk, thirty miles away, and I prefer to avoid the rush hour.

I went back to bed. Half an hour later the phone rang. It was the operator announcing that the housecall was on for 10 a.m.

Freeway traffic was in the category of “could have been worse,” but I arrived on time. No one answered my knock. According to the desk clerk, the guest was part of a tour group that had checked out earlier.

There is no lesson here. It’s part of a hotel doctor’s life.

I Save a Life

The phone rang at 5 a.m. but I am an early riser. April Travel Insurance told me of a lady with a cough at the Residence Inn in Manhattan Beach. Vacationers hate to get sick, so even a bad cold produces wee-hour calls.

This sounded easy. It was a fifteen mile drive, but the freeways were clear, and I would return before the rush hour.

Guest often feel obligated to demonstrate how miserable they feel, and this lady coughed loudly from the time I walked in. Listening to her lungs was difficult because she wouldn’t stop, but what I heard was not reassuring. A bad cough doesn’t necessarily mean a bad disease, but this patient had one ominous sign: she was my age.

I phoned April Insurance to explain that the lady needed a chest x-ray and possible hospitalization. This is bad news for an insurer. An ordinary emergency room visit costs over a thousand dollars, a hospital admission for pneumonia twenty times that. Some insurance services work hard over their fine print to avoid paying for expensive incidents, and I occasionally urge guests to go to the hospital after they’ve learned that their insurance won’t cover it.

April doesn’t do that. The dispatcher explained that he would arrange matters. Later that day, the husband informed me that his wife had been admitted for pneumonia.

The No-Housecall Mode

Several times per year, a hotel guest suffers a bloody nose. I don’t make housecalls for nosebleeds because there’s nothing I can do. Treatment is to pinch the nose, releasing pressure every five minutes to check if bleeding has stopped. I tell guests to repeat until they get bored. If bleeding persists, the next step is cautery or nasal packing, both of which require expertise.

I regularly hear “I can move it, so I know it’s not broken…” but this is as true as most popular medical theories.  Examining a wrist, finger, ankle, foot, or ribs I can suspect a fracture, but I’m never certain. Most common fractures aren’t urgent, so I tell guests it’s OK to wait to see if there’s quick improvement. If not, they need an X-ray.

All insect bites look the same, bee stings included. Redness and itching spread, peaking at two days before slowly fading. I explain this over the phone, but guests often want me to take a look.

When a guest suggests he has bronchitis, I immediately go into no-housecall mode because this is a fake diagnosis doctors use when they prescribe an antibiotic as a placebo (other fake diagnoses are “sinus infection” and “bacterial infection” and sometimes “strep”). You may be surprised to read that bronchitis is not a disease but a medical term for coughing. 

Lost on Campus

It was after nine when I left for Long Beach, thirty miles away. Freeway traffic moved swiftly; the patient was a sixteen year-old with a sore throat, usually an easy visit.

Google maps guided me to 1250 Bellflower Boulevard which was the student union of California State University in Long Beach. That also turned out to be the address of the university. The student union was deserted. It was the summer break. I left messages at a phone number that may or may not have been the patient’s.

A couple walking nearby pointed me in the direction of distant residence halls which, when I arrived, seemed endless. I phoned the travel insurer who had sent me. The dispatcher managed to contact the patient in her room and then passed on her directions. She was not familiar with the campus, so these were unhelpful. It took persistence, but I convinced the dispatcher that, since the patient was an adolescent, she was undoubtedly part of a group with a group leader.

The patient agreed that such a person existed and went off to find him. After a considerable delay he came on the line, determined my location, and talked me through a complex warren of streets to the proper building. As usual, delivering medical care was the easiest part.

Don't Get On the Plane!

“My flight leaves tonight” is a phrase I like to hear because it means the guest will return to the care of the family doctor. Until then he or she is my responsibility. Now and then, I don’t like to hear it. 

A guest awoke feeling well but soon noticed some abdominal pain.

When I hear “abdominal pain” I ask about vomiting and/or diarrhea and hope it’s present. That points to a stomach virus, usually a short-lived and not very serious problem.

Abdominal pain alone can mean a stomach virus, but I also consider serious conditions (gallstones, diverticulitis) and potentially fatal ones (ectopic pregnancy, blood clots). I prefer to send these guests directly to an emergency room, but sometimes I end up at the hotel.

This guest considered my question before deciding that he had diarrhea. Maybe… My abdominal examination turned up nothing requiring urgent attention. He was young, so several life-threatening problems were unlikely. The pain itself was unpleasant but not quite excruciating.

It was a difficult decision, but doctors are paid generously to make difficult decisions.

I told him that he probably had a stomach virus, but I couldn’t rule out something serious. I would give him something for the diarrhea and check back. I added that he might need some tests and that he must not get on the plane if the pain persisted.

When I phoned after three hours, he had checked out.

I'm Not in It For the Money

The phone rang at 3:30 a.m. An airline pilot at the Costa Mesa Hilton needed a doctor, explained the caller. Could I go?

That Hilton is 46 miles away, but I drive there regularly for an agency that provides medical care to foreign airline crew when they lay over (American crew are on their own). It’s an easy drive at this hour. I accepted for several seconds until I woke up and remembered that the 405 freeway closes at the Orange County border during the wee hours for major construction. Despite the hour, closing the freeway produces an immense backup, and the detour through city streets is slow and tedious. Forced to go, I take a different freeway which is ten miles longer and only slightly less tedious.

I was in luck. Wee-hour patients usually suffer intense symptoms such as vomiting; they don’t like to wait. This guest had a cold and didn’t object to a visit later that morning.

I breathed a sigh of relief and went back to sleep. The delay would cost me $150 because the agency pays less for daytime housecalls, but it was worth it.

Is Murder Cost-Effective?

At a medical conference, a speaker came up with a radical proposal.

People regularly come to an emergency room complaining of chest pain, he said. Most are not having a heart attack, but doctors do a careful exam and many tests and often observe them for hours. Even if little turns up, doctors lean over backwards to admit someone with a possible heart attack. In the end, some are so obviously not having a heart attack that the doctor sends them home.

But medicine is not perfect, he added. Three percent of those sent home are having a heart attack. They sue the hospital and win.

Over the years, hospitals have become more liberal about admitting patients with chest pain. But, in the end, some are sent home.

No matter. Three percent are having a heart attack, and they sue. The average payout is over $400,000.

“It’s an impossible situation. What can a hospital do?” asked the speaker. He went on to suggest a tactic for a doctor who decides that a patient isn’t having a heart attack and can be sent home. Current hit-man rates are $10,000 per.

“Do the math,” he said.