Sometimes This Job is a Snap

I saw a man at the Hollywood Roosevelt with a numb arm. That’s an odd complaint but unlikely to represent something serious in a 26 year-old.

He had fallen asleep on the plane, resting his head on his palm with an elbow on the arm rest. On awakening he felt numbness down his forearm. This was easy.

The ulnar nerve that supplies the hand passes under your medial epicondyle, the knob you can feel inside your elbow. It’s a poor design because the nerve is exposed. Hitting it produces tingling down your arm to the little finger. It’s the “funny bone.”

Cab drivers who spend the day with one arm resting on the door often suffer the same symptom. Once they change position, the discomfort disappears in a few days.

Drugs are Cheap

Getting a syringe from my supply closet, I noticed that only a dozen remain. I’d better order more. A hundred syringes costs $12.

I buy from an internet medical supply company. For orders under $200 it charges a fat “handling fee,” so I try to order enough to exceed it. Most of my purchases are drugs, but that presents a problem because they’re so cheap.

I notice other hotel doctors charging $50 to $150 for an injection. I carry seven injectables. The content of a single shot of all seven rarely cost more than a dollar.  

What do I need?..... I stock B12 not because it’s necessary but because guests ask for it. This doesn’t happen often, so my bottle is almost out of date. The price has gone up, but it’s still $31 for a 30cc vial. That’s thirty injections.

I’m down to a few dozen Ondansetron tablets, the best nausea remedy. Ten bottles of thirty will set me back $37.

It never hurts to stock up on loperamide (Imodium is the brand), my favorite diarrhea treatment, but I was surprised to discover the price has jumped to ten times what I paid a few years ago: $104 for five hundred. Many old but important drugs such as penicillin that once cost pennies a pill have skyrocketed to dazzling levels. The weird thing about loperamide: it’s sold over-the-counter. Walmart charges $5.00 for a bottle of 72. That works out to $35 per five hundred. I’ll buy loperamide from Walmart.

I’m not short of many drugs, and buying too many is dangerous. At over ten dollars a bottle, my most expensive is antibiotic drops for swimmer’s ear. Swimmer’s ear has been unexpectedly rare, and I recently discarded five bottles that expired in January. My remaining three expire in May. Should I buy more?  Doctors have to make tough decisions…

A Miracle

The sales manager of the Hyatt Regency was preparing to address a convention when her head turned to the right and stuck.

I had no idea what to do. Her head seemed immovable. She was in perfect health. Hysterical conversion was a possibility, but I was too polite to mention it.

The consultation took place in an alcove off the hotel’s main ballroom. I could hear the crowd murmur. Inside gathered half a dozen worried employees including the general manager who had phoned another hotel to get my name. Failure in this situation would be distressing. The sales manager vehemently denied feeling upset, and I had no reason to doubt her.

“Did you do anything recently you don’t ordinarily do?” I asked, grasping at straws.

She considered then admitted she had felt queasy an hour earlier and taken a pill a colleague had offered. It was Compazine, a common nausea treatment.

That meant nothing. Then it did. I could barely contain my exhilaration. Phenothiazine drugs - Compazine, Thorazine - occasionally cause a weird dystonic muscle spasm. It’s so rare most doctors never see one, but I remember a case that arrived when I was hanging out at the Bellevue emergency room as a first year medical student in 1969. In that incident, the patient’s tongue stuck out, and he insisted he couldn’t retract it. The residents on duty confidently diagnosed hysteria, and it took a while before they changed their minds. Treatment is the familiar antihistamine, Benadryl.

I carry Benadryl. Within minutes of the injection, her head came unstuck. Everyone was delighted.                                                                                                  

A Serious Liability

After shaving, a guest at the Ramada in Beverly Hills reached for a hairbrush and struck his nose on a clothes hook with enough force to bring tears to his eyes and blood to his nose. He noticed that the hook had been installed at nose level -- clearly a poor design decision and dangerous. A hotel that tolerated such an unsafe condition was irresponsible and perhaps legally liable. The guest was, of course, a lawyer.

As I entered the general manager’s office, the guest interrupted a harangue as we exchanged introductions.

This was awkward. My sole obligation is to my patient, but it was obvious the manager wanted help in fending off the furious guest. When I suggested privacy for our consultation the guest told me to take care of things on the spot.

Young doctors love to blurt out a diagnosis as soon as the patient walks through the door (which is possible more often than you think). Not only do patients find this offensive, they don’t believe it, so doctors learn to give the impression they are thinking deeply before announcing an opinion.

I examined the nose from several angles. I carefully palpated it. I pulled out my otoscope and peered up his nostrils. Finally I announced that he had suffered a nasal contusion that, fortunately, had done no harm. He needed no X-ray, no treatment. He could go about his business.

According to the law, a person has no grounds to sue unless he has suffered damage, but a competent lawyer can discover damage in any situation. I doubt visions of profit had brought the guest to the manager’s office. He was upset at his pain and wanted sympathy. The manager had offered to comp the guest’s bill but had maintained his dignity when a humble apology would have worked better.

Still fuming, the guest asked my opinion of the danger in installing clothes hooks at precisely nose level. I agreed the matter deserved attention but added that noses come at many levels.

I Save a Life

After apologizing for waking me, the caller explained that his companion couldn’t sleep because she felt short of breath. Shortness of breath in an otherwise healthy person is either anxiety or a serious matter. The caller added that she was prone to respiratory infections. Maybe she has pneumonia, I thought. I can cure pneumonia.

She didn’t appear ill, but she was English, not a demonstrative people. She had no fever. Her heart was racing. Listening to her lungs, I heard the crackle of fluid which is audible in pneumonia but also in heart failure. I suspected heart failure. When the heart beats weakly, blood backs up into the lungs waiting to pass through, so victims have trouble breathing.

Calling paramedics was risky because they might decide she wasn’t sick enough to transport. Leaving after obtaining her promise to go to an ER was not an option because I would worry. Long experience has convinced me that if guests need to go to a hospital, I must make sure – with my own eyes – that they go. So I drove the couple in my car. Watching them disappear through the emergency entrance made it certain they were now another doctor’s responsibility. 

When I phoned later, the doctor explained that she was suffering rapid atrial fibrillation, an irregular, inefficient cardiac rhythm. He had performed cardioversion – delivering an electric shock to the heart – and she was now in a regular rhythm and feeling better. They were scheduled to fly to Las Vegas the day after my visit, and when I called they had checked out.

A Contagious Disease

I cared for a flight attendant in an airport hotel suffering a cough, high fever, runny nose, and sore throat. It seemed like the usual upper respiratory infection until I saw the spotty rash over her body. She had measles.

Does that ring a bell?... Measles may be the world’s most contagious disease. If you’re susceptible and enter a room someone with measles passed through hours earlier, you’ll probably catch it.

It’s also nasty. Even today, one or two per thousand victims die and a larger number are left deaf or brain damaged. I grew up before children were vaccinated against most childhood illnesses; we actually caught them. I had measles in 1946 and still remember how sick I felt; my chicken pox and mumps were trivial by comparison.

I informed the airline that a flight attendant fresh from a crowded plane had measles and also told the hotel management. You can imagine the reception.

Burned

A guest in a hotel restaurant asked a waiter to light her cigarette. When he complied, her forefinger burst into flame. She had recently put on acrylic nails, and the fresh cement is very flammable. Drunk and enraged, the guest refused to go to an emergency room. By the time I appeared, she had grown tired of hurling abuse. Head resting on the table, she was sobbing. Spilled drinks and broken glass littered the area.

Security officers had cleared the room. Near the entrance, a crowd of clerks, patrons, and the night manager parted to allow my passage and observe my performance. Although not a master at handling drunks, I understood the soothing effect of an old man with a grey beard and carrying a doctor’s bag.

Patting her shoulder until she looked up, I introduced myself and suggested we go to her room. After dressing the burn, I stayed long enough for her pain to give way to the effects of alcohol, and I could assure everyone she would cause no more trouble.