Eighty Gouty Patients

A man’s foot began hurting one evening. By the following morning pain was excruciating.

That sounded like gout, one of my favorite diseases. The diagnosis is easy, and I can quickly make it better. What’s not to like?

I carry a treatment for gout, but once I hand it over, I have to remember to restock my bag. So I went to my drug closet, made up another bottle of pills, and threw it in my pocket. 

Sometimes I’m surprised when I arrive at the hotel but not this time. He had gout. I produced the pills from my pocket, and everyone was satisfied.

It occurs to me that I’ve seen so many victims – this was my 80^th – that I can check the experts. They claim that it attacks men overwhelmingly. Sure enough, only seven of my patients were women. They say it’s a disease of older people. 67 cases were over 40, none under 30.

Until a few years ago, treatment was a powerful anti-inflammatory drug such as indomethacin which produced unpleasant side-effects. Then experts decided a large dose of cortisone for a short period worked as well with less unpleasantness. I already carry an identical course to treat severe poison ivy. Patients feel better within a day.

A Difficult Hotel

The J.W. Marriott is not a regular, but its doctor is not a friend, so I don’t turn down its calls which arrive now and then.

Driving downtown, I had no worries about the patient but recalled that visiting the J.W. Marriott was often an unpleasant experience. Sure enough, the valet ignored a request to hold my car, gave me a parking slip, and drove the car deep into the bowels of the hotel.

The elevator required a room key. I waited for a guest, but apparently new technology makes it impossible to piggy-back on another’s key. I walked to the front desk and asked to use the elevator. This struck the clerk as a suspicious request.

An elderly man in a suit, carrying a doctor’s bag, and claiming to be a doctor might or might not be telling the truth. She politely quizzed me on my motives, phoned the room to confirm, and then asked me to wait while she summoned a security officer.

The officer remained at my side until the guest opened the door. After the visit, I returned to the lobby and handed over the parking slip. The desk clerk stared at it as if she had never seen one and then excused herself to consult the manager.

I waited several minutes until she returned to hand back the slip and explain that the hotel “was unable” to validate parking.

Downtown hotel parking is brutally expensive, and I remembered the same difficulty during earlier visits. Everyone hates hotel parking, so its cashiers are immune to arguments. I scribbled “hotel doctor” on the slip, shoved it through the window, and hurried away to stand at the curb. No one ran after me, and after a few minutes my car appeared. I don’t do that often, but so far it’s always worked. 

Summer, and Life is Easy

A blast of hot air greeted me when the guest opened the door. As I complain regularly, foreigners believe air conditioning spreads disease, so when someone falls ill, they turn it off. They dress for the heat, but I wear a suit and tie. Asking them to turn on the air conditioner is like asking a Moslem to eat a hot dog, so I pretend nothing is amiss and go about my business ignoring the sweat soaking my shirt.

Most of the year, I have no objection to leaving my car a few blocks away to avoid the hassle of hotel parking. I don’t do this when it rains, but rain is rare in Los Angeles. Summer is guaranteed; I dislike making the walk in hot weather and regret it even more if the guest has turned off the air conditioning.

Beaches exist in Northern Europe, but they’re chilly with the sun not much in evidence. Southern California beaches seem more inviting, so Britons, Germans, et al relax, doze off, and acquire gruesome sunburns.

Summer is my busiest season. The phone wakes me three or four times per week, but I don’t mind wee-hour visits. Parking is easy, guests are grateful, and with no office waiting I can take a nap whenever I want.

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.