Running Out of Medication

A guest at the Doubletree had run out of insulin. I could have made a housecall, written a prescription, and a pharmacist would have filled it. Instead I explained that insulin doesn’t require a prescription. She should go to the pharmacy and ask for it. The same is true for the morning-after pill, another request that arrives now and then.

An Italian guest at the Four Seasons brought a migraine prescription from her doctor. Pharmacies wouldn’t accept it. Could I come and write an American prescription? I told her to have the pharmacist phone, and I would approve it.

When national housecall services or competitors send me to guests who need a prescription, I write it, collect money, and leave. Those are easy visits, but guests are never grateful. Americans look sullen; foreigners understand that American doctors require immense fees for any service. When guests call me directly, I handle these requests over the phone, gratis. It’s no great sacrifice and good public relations.

It may even be good business. Long ago, when I returned from a day off, the doctor who covered told me a guest at the Casa Del Mar had phoned. That was exciting news; this was an upscale Santa Monica beach hotel which had never called. The guest obviously had a bladder infection, so the doctor had phoned a prescription to a pharmacy. I nodded. Treating an infection over the phone is not a good idea, but simple bladder infections are an exception. He added that he had charged $30 for the service. I mention this only because it happened during the 1990s, and I haven’t heard from the Casa del Mar since.

When Everything Works Out

A call arrived as I was eating dinner at the home of friends. A gentleman at the Biltmore needed a doctor. The meal was ending, so I took my leave.

Driving the twelve miles downtown, I parked and opened the trunk to retrieve my black bag. Dismayed, I realized I had left it at home.

I usually keep the bag in my car. My driveway is outside, and during hot weather I take the bag into the house to keep the heat from melting my pills. Getting a housecall jogs my memory, and I retrieve the bag, but I had driven to friends without giving it a thought.

I phoned the guest to explain that I’d have to return home. Before I could apologize, the guest apologized, explaining that he had run out of his blood pressure pills and only needed a refill. He knew his travel insurance would not pay for this, so he claimed to feel ill. He wasn’t ill. I phoned a prescription to a pharmacy and went home.

This blog is full of incidents whose entertainment value is based on things going wrong. But sometimes everything works out.

"Uno Momento..."

As I was brushing my teeth one night, the phone rang for a housecall in Torrance, twenty miles distant.

Traffic was no problem, and Google maps guided me to the correct address which turned out to be a massive apartment complex behind high walls. Now and then I drove past a locked gate with no guard and no evidence that it was the correct entrance. I phoned.

The patient’s husband answered. He was Italian and spoke rudimentary English, and his efforts to direct me were incomprehensible.

“Uno momento…” There followed several minutes of silence. Just before I decided he had hung up, he came on the line and resumed his unintelligible instructions. Then my headlights illuminated a distant figure in the middle of the deserted street waving a flashlight.

He guided me to a gate, punched the code to open it, and directed me to visitor’s parking. I followed him through a maze of sidewalks to the correct building. After I cared for his wife, he guided me back to my car.

Hotel Visits I Don't Make

I try not to make housecalls for shortness of breath, chest pain, loss of consciousness, or severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, although possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you might sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when the guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind. 

Medical science has no cure for drunkenness, but hope springs eternal, so my phone continues to ring.

Listomania

I once made sixty to eighty visits per year to the Crowne Plaza at the airport. Then they dropped to about five.

During a recent visit I noticed a printed handout on a bedside table, a long list of clinics and doctors which the reader was invited to peruse. Given a list, guests tend to call the first number first and then work down. My name was sixth.

When consulted, hotel lawyers always forbid staff from recommending a doctor. Should a guest ask for help, they insist, an employee should silently hand over a list, the longer the better. In this way, when the guest sues the doctor, he or she won’t sue the hotel. Lawyers admit that this doesn’t work, but they can’t help themselves. 

Told to make up a list, employees take the easy route by consulting the internet where they find clinics, local practices, and entrepreneurial physicians who charge spectacular fees. They won’t find me, so it’s a crapshoot where on the list I’ll end up.

Having produced the list, management forgets about it. Lists always contains doctors and clinics that don’t make housecalls. As time passes, some numbers no longer work; for the rest, guests who want to speak to a doctor end up speaking to an answering service or receptionist.

It might take years for calls to return to normal, but I am patient. 

Good News, Usually

A flight attendant with diarrhea is usually good news. Airline crew are young, so they suffer uncomplicated medical problems, and diarrhea qualifies. Her hotel in Costa Mesa was 46 miles away, but it was Saturday morning, so traffic was light, and I’m paid extra for the distance.

To my annoyance, this was one of those inexplicable weekend days when the freeway was jammed although it wasn’t a holiday, and I never saw an accident.

After caring for the guest, always the easiest part, I got back on the freeway and its creeping traffic. Five minutes later my phone rang. This was bad news because freeway driving is more tiring than practicing medicine, and I had had enough. The caller was a national housecall service, and, to my surprise, the patient was in Costa Mesa, a half mile from where I’d been.

Unaware that I was nearby, the service quoted its usual fee for a long drive, so I retraced my route, cared for the guest, and returned to the crowded freeway. I was weary when I finally arrived home, hours past lunch time, but it had been a lucrative day in the fascinating life of a Los Angeles hotel doctor.  

The Old Man's Friend

A guest was coughing and feverish, and I heard crackling noises when I listened to his lungs, a sign of fluid. I suspected pneumonia.

I prefer diagnosing pneumonia to an upper respiratory infection because I can prescribe an antibiotic and skip the stressful explanation of why I’m not prescribing an antibiotic.

Unfortunately, this guest was 85. Most victims of pneumonia don’t need hospitalization. Even without treatment, most recover. This is not the case with the elderly where, long ago, pneumonia was known as “the old man’s friend.” Dying of pneumonia when you’re already feeble is apparently not a bad way to go.

The son did not like hearing that his father must go to an emergency room, but they went. When I phoned the following morning, I learned that the diagnosis was pneumonia. The doctor had prescribed an antibiotic and sent them out.

I was shocked. Hospitals always admitted elderly patients with pneumonia. What incompetent was on duty?...  The son assured me that his father was resting comfortably and promised to return to the hospital if symptoms worsened. When I called that evening, they had checked out.

If something bad happens, they will sue the hospital, but they will also sue me. It takes a long time for a malpractice lawyer to organize a suit, so his letter wouldn’t arrive for about a year.