Examining a Danish hotel guest last month, I became uncomfortably aware of sweat dripping down my back. I hadn’t experienced this since the previous autumn.
Summer doesn’t arrive in Los Angeles until mid-June, and it was an average day with temperatures in the 80s. The hotel lobby and corridors felt comfortable, but a wave of hot air greeted me as the guest opened his door.
Entering, I recalled why I like Arabs so much. They appreciate air conditioning as much as Americans. Citizens of all other nations believe it spreads disease. They tolerate it as one of the perils of foreign travel, but when someone falls ill, the air conditioning stays off. Hip young hotel doctors dress in shirtsleeves, but hipness is a distant memory for me, so I wear a suit and tie. During a long summer visit, it’s debatable if I or the patient is suffering more.
I always explain that the machine that cools air in an air conditioner is identical to that in your refrigerator, and no one worries about disease from refrigerator air. This convinces no one, college graduates included.
Sunday, July 31, 2011
Wednesday, June 22, 2011
Sunday, April 10, 2011
The room stood at the end of the hall, the largest suite on the floor. Through the half-open door I smelled alcohol and cigarette smoke, never a good sign. At my knock a voice urged me to enter. The room was empty, but this was the sitting room. A doorway led to the bedroom containing a small figure in a huge bed, covers drawn up to his chin. Balding and past forty, his disheveled hair was the single unkempt feature, and a goatee the only evidence of his foreignness. He was Prince Abdul-Aziz from Saudi Arabia. Arabian princes are more common than you’d think.
“I have pain,” he announced.
“Where is the pain, Mr. Aziz?”
“Kidney. I have kidney stones in my kidney.” He threw the covers to one side and pointed to his right flank. “My doctor prescribes Dihydrolex.”
“That’s not a drug I’m familiar with.”
“It is from London. I live in London.”
“Do you need a prescription?”
“Yes, but also a shot.”
I examined the prince’s abdomen and tested his urine for blood. Both exams were normal but this can happen with a stone. I thumped his back in the kidney area, and he groaned.
“I’ll give you a Toradol injection, but if the pain comes back, you’ll have to go where they can do some tests.”
“Many thanks.”
Any doubt about the prince’s drug consumption vanished when my needle jerked to a halt half an inch beneath the skin. Fibrosis from hundreds of injections had given his gluteus the consistency of a block of wood. I forced the syringe down a further inch and delivered the injection. Anticipating the pleasures ahead, the prince whirled to thank me, clasping my hand in gratitude.
“Remember what I said if the pain returns…” I repeated. “Should I ask the hotel to pay and put it on your bill?”
“No, no no. I pay!” Keeping a grip on my hand, he yanked open the drawer of the bedside table which turned out to be stuffed with hundred dollar bills. He snatched a handful and held them out.
Grateful the prince had forgotten his request for a prescription, I thanked him and hurried off. Later I counted fourteen bills. I gave them to my wife who bought a small Chinese rug for our living room.
The following day a rival hotel doctor phoned. “The Nikko wants me to see a guest,” he said. “Apparently you saw him yesterday, but you don’t want to see him again. Naturally I’m curious to know why.”
“I’m pretty sure he’s a drug abuser.”
“They said he was difficult. Is there any reason for me to see him?”
“He’s a big tipper.”
“I have pain,” he announced.
“Where is the pain, Mr. Aziz?”
“Kidney. I have kidney stones in my kidney.” He threw the covers to one side and pointed to his right flank. “My doctor prescribes Dihydrolex.”
“That’s not a drug I’m familiar with.”
“It is from London. I live in London.”
“Do you need a prescription?”
“Yes, but also a shot.”
I examined the prince’s abdomen and tested his urine for blood. Both exams were normal but this can happen with a stone. I thumped his back in the kidney area, and he groaned.
“I’ll give you a Toradol injection, but if the pain comes back, you’ll have to go where they can do some tests.”
“Many thanks.”
Any doubt about the prince’s drug consumption vanished when my needle jerked to a halt half an inch beneath the skin. Fibrosis from hundreds of injections had given his gluteus the consistency of a block of wood. I forced the syringe down a further inch and delivered the injection. Anticipating the pleasures ahead, the prince whirled to thank me, clasping my hand in gratitude.
“Remember what I said if the pain returns…” I repeated. “Should I ask the hotel to pay and put it on your bill?”
“No, no no. I pay!” Keeping a grip on my hand, he yanked open the drawer of the bedside table which turned out to be stuffed with hundred dollar bills. He snatched a handful and held them out.
Grateful the prince had forgotten his request for a prescription, I thanked him and hurried off. Later I counted fourteen bills. I gave them to my wife who bought a small Chinese rug for our living room.
The following day a rival hotel doctor phoned. “The Nikko wants me to see a guest,” he said. “Apparently you saw him yesterday, but you don’t want to see him again. Naturally I’m curious to know why.”
“I’m pretty sure he’s a drug abuser.”
“They said he was difficult. Is there any reason for me to see him?”
“He’s a big tipper.”
Wednesday, January 26, 2011
A guest at a Beverly Hills hotel was sitting in the hotel restaurant when her chair collapsed. Unfortunately, her hand was resting underneath. The desk clerk asked if I could come immediately.
During my early years, I often hurried over, took care of the problem, and presented my bill only to have the guest insist that the hotel was responsible. Management sometimes disagreed, leaving me unpaid, so I quickly learned to settle matters over the phone.
“Who’s responsible for the bill?” I asked. “If it’s the guest, I have to talk to her.”
The clerk hadn’t thought of this, so she put me on hold, returning to announce that the hotel would take care of it. This would be my 139th medicolegal visit, my name for a housecall when the hotel pays. The majority involve minor injuries that occur on the premises. There were also thirteen upset stomachs, purportedly from hotel food, and nine insect bites, always bedbugs according to the guest.
I arrived at the restaurant to greet a pleasant young Englishwoman, her hand in a bowl of ice. My examination revealed a torn and bloody middle fingernail but no laceration that required suturing. I explained that her nail might fall off but that another would grow. Unfortunately her ring finger, while not bloody, was exquisitely painful. She needed an x-ray.
If there were a fracture, an emergency room or perhaps even a family doctor would refer her to an orthopedist, so I decided to send her directly. If someone needs a referral, I want to make sure that they go, so I make the appointment myself. I didn’t know anyone locally, so I found an orthopedic group on the internet and phoned. When the receptionist asked about insurance, I said she would be a cash patient, a rare phenomenon even in Beverly Hills.
“An initial visit is $500,” the receptionist said. “She should have it when she comes in.”
“Wow!” said the patient when I passed this on. This was probably not a comment on the size of the fee (which the hotel would pay) but the traditional European amazement-cum-horror at American doctors’ preoccupation with money.
Both fingertips were fractured, she announced over the phone the next day before asking how long the pain would last. I sympathized; fingers are sensitive. She should apply ice and take ibuprofen and see her doctor in a few days. She planned to fly home.
During my early years, I often hurried over, took care of the problem, and presented my bill only to have the guest insist that the hotel was responsible. Management sometimes disagreed, leaving me unpaid, so I quickly learned to settle matters over the phone.
“Who’s responsible for the bill?” I asked. “If it’s the guest, I have to talk to her.”
The clerk hadn’t thought of this, so she put me on hold, returning to announce that the hotel would take care of it. This would be my 139th medicolegal visit, my name for a housecall when the hotel pays. The majority involve minor injuries that occur on the premises. There were also thirteen upset stomachs, purportedly from hotel food, and nine insect bites, always bedbugs according to the guest.
I arrived at the restaurant to greet a pleasant young Englishwoman, her hand in a bowl of ice. My examination revealed a torn and bloody middle fingernail but no laceration that required suturing. I explained that her nail might fall off but that another would grow. Unfortunately her ring finger, while not bloody, was exquisitely painful. She needed an x-ray.
If there were a fracture, an emergency room or perhaps even a family doctor would refer her to an orthopedist, so I decided to send her directly. If someone needs a referral, I want to make sure that they go, so I make the appointment myself. I didn’t know anyone locally, so I found an orthopedic group on the internet and phoned. When the receptionist asked about insurance, I said she would be a cash patient, a rare phenomenon even in Beverly Hills.
“An initial visit is $500,” the receptionist said. “She should have it when she comes in.”
“Wow!” said the patient when I passed this on. This was probably not a comment on the size of the fee (which the hotel would pay) but the traditional European amazement-cum-horror at American doctors’ preoccupation with money.
Both fingertips were fractured, she announced over the phone the next day before asking how long the pain would last. I sympathized; fingers are sensitive. She should apply ice and take ibuprofen and see her doctor in a few days. She planned to fly home.
Tuesday, January 11, 2011
Universal Assistance, a travel insurer asked me to visit an Argentinean teenager who was behaving oddly. When I arrived, her father explained that his daughter was under treatment for leukemia but was doing well. They were visiting relatives when, a few hours before, she had stopped speaking to them.
Except that she was bald from chemotherapy, the daughter looked fine. She was sitting up in bed, arms folded, looking glum. When her parents appealed to her to talk to me, she obviously heard but merely shook her head and remained silent. She did not resist when I examined her, and nothing abnormal turned up. I was faced with a sullen teenager who didn’t appear sick. This was another occasion when, for no obvious reason, things didn’t seem right. I told the parents she needed to go to an emergency room and then phoned Universal Assistance who would handle matters. The family obeyed. The daughter died soon after being admitted.
Except that she was bald from chemotherapy, the daughter looked fine. She was sitting up in bed, arms folded, looking glum. When her parents appealed to her to talk to me, she obviously heard but merely shook her head and remained silent. She did not resist when I examined her, and nothing abnormal turned up. I was faced with a sullen teenager who didn’t appear sick. This was another occasion when, for no obvious reason, things didn’t seem right. I told the parents she needed to go to an emergency room and then phoned Universal Assistance who would handle matters. The family obeyed. The daughter died soon after being admitted.
Sunday, January 2, 2011
The Christmas Rush
The last week of the year is my busiest. Competitors with whom I’m on speaking terms deny this, and I’ve long stopped theorizing why this is so. But calls begin pouring in at Christmas.
His teenage son had a terrible cough and sore throat, explained a caller from the Shangri-La, an upscale beach hotel. Maybe he needed an antibiotic.
The son had the usual virus. The father and mother were unfailingly polite as I delivered my explanation, handed over a bottle of cough medicine, and took my leave, but it was clear they would have been preferred an antibiotic. I urge patients to resist suggesting a treatment to a new doctor. If it’s unnecessary, the doctor may prescribe it anyway to make you happy. If he doesn’t prescribe it, and your thank-you at the end isn’t heartfelt (we are supersensitive to gratitude) he will feel he disappointed you.
Two hours later I drove to another Santa Monica hotel to see another teenager, this one with a sore throat. The father had seen white spots on her tonsils. Laymen believe “white spots on tonsils” is a sign of “strep,” but ordinary viral infections can make tonsils look bad. Some day I’ll write an article on ominous-signs-that-usually-aren’t (white spots on tonsils, cough with green mucus, yellow mucus, thick mucus, no mucus, fever more than … degrees, fever more than … days, green diarrhea, yellow diarrhea, funny smelling diarrhea, funny smelling urine….). Hearing this, patients invariably ask “then how do I know I’m sick?” My answer is: “because you’re sick.” Sickness makes you sick. If you don’t feel very sick, you’re probably not sick. Decide to see a doctor because you feel bad, not because a symptom.
It turned out that I treated her for strep. Good studies reveal that exudates on tonsils plus three other symptoms (fever, swollen neck glands, absence of cough) make the chance for strep fairly likely, and she had all four, so I handed over ten days of penicillin and received everyone’s heartfelt gratitude. Another pearl: if you’re not allergic to penicillin, and a doctor prescribes a different antibiotic for your sore throat (amoxicillin is acceptable), that’s excellent evidence you’re getting a placebo. After 70 years, penicillin is still the treatment of choice for strep; newer antibiotics work as well, but none work better, and all cost far more.
His teenage son had a terrible cough and sore throat, explained a caller from the Shangri-La, an upscale beach hotel. Maybe he needed an antibiotic.
The son had the usual virus. The father and mother were unfailingly polite as I delivered my explanation, handed over a bottle of cough medicine, and took my leave, but it was clear they would have been preferred an antibiotic. I urge patients to resist suggesting a treatment to a new doctor. If it’s unnecessary, the doctor may prescribe it anyway to make you happy. If he doesn’t prescribe it, and your thank-you at the end isn’t heartfelt (we are supersensitive to gratitude) he will feel he disappointed you.
Two hours later I drove to another Santa Monica hotel to see another teenager, this one with a sore throat. The father had seen white spots on her tonsils. Laymen believe “white spots on tonsils” is a sign of “strep,” but ordinary viral infections can make tonsils look bad. Some day I’ll write an article on ominous-signs-that-usually-aren’t (white spots on tonsils, cough with green mucus, yellow mucus, thick mucus, no mucus, fever more than … degrees, fever more than … days, green diarrhea, yellow diarrhea, funny smelling diarrhea, funny smelling urine….). Hearing this, patients invariably ask “then how do I know I’m sick?” My answer is: “because you’re sick.” Sickness makes you sick. If you don’t feel very sick, you’re probably not sick. Decide to see a doctor because you feel bad, not because a symptom.
It turned out that I treated her for strep. Good studies reveal that exudates on tonsils plus three other symptoms (fever, swollen neck glands, absence of cough) make the chance for strep fairly likely, and she had all four, so I handed over ten days of penicillin and received everyone’s heartfelt gratitude. Another pearl: if you’re not allergic to penicillin, and a doctor prescribes a different antibiotic for your sore throat (amoxicillin is acceptable), that’s excellent evidence you’re getting a placebo. After 70 years, penicillin is still the treatment of choice for strep; newer antibiotics work as well, but none work better, and all cost far more.
Saturday, December 18, 2010
"Do You Go To Ontario?"
“Do you go to Ontario?” asked the dispatcher for Expressdoc, an agency that sends doctors on housecalls. Travel insurers who don’t call me directly use Expressdoc. It’s a mystery why because it costs them extra, but I charge the same no matter who calls, so I don’t mind. Ontario is in San Bernardino County, fifty miles distant, but this is small potatoes. My record is ninety miles to Carpinteria. Freeway traffic, not distance, determines if I drive. I delay distant, late afternoon visits until the evening. Morning drives are acceptable; the hours between ten and noon are golden because traffic slows after the morning rush; it builds again after twelve, and there is no afternoon decline. The Ontario call arrived at 12:20, so I was not optimistic about the return. But it worked out fine. I took the Pomona freeway, bypassing downtown, and the hour’s drive passed with no significant slowing. I listened to Slaughterhouse Five on my CD; highly recommended.
The patient was a Brazilian lady visiting her son; her upset stomach presented no problem. Accompanying me to the elevator, the son he told me he was reevaluating his decision to remain in the US because the political atmosphere had grown so shrill and confrontational. I agreed. Did you ever think there’d come a time when South Americans considered their governments more stable than ours?
The patient was a Brazilian lady visiting her son; her upset stomach presented no problem. Accompanying me to the elevator, the son he told me he was reevaluating his decision to remain in the US because the political atmosphere had grown so shrill and confrontational. I agreed. Did you ever think there’d come a time when South Americans considered their governments more stable than ours?
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