The Glamorous Life of the Call Girl

At one a.m. in 1994, I received a call from Le Montrose, a boutique hotel in West Hollywood. The guest told me the problem was “personal.”

The man who opened the door was past sixty, short, plump, balding, and tieless, wearing a rumpled suit which I suspected he’d put on to greet me. Across the room, wearing a bathrobe, a young woman sat on the bed, staring sullenly at the floor.

“There’s been an accident,” he said.

Neither guest seemed injured, so I knew I wasn’t going to get off easy. This proved true as he explained that his friend seemed to have an object in her rectum. He provided no details.

Bizarre incidents fascinate doctors no less than laymen. Around the cafeteria table, interns compete in relating the latest. Outside of working hours, they remain a mainstay for impressing girls at parties.

Central to this adolescent obsession is the genre of things-that-end-up-in-people’s-rectums. I no longer find these amusing, not only because I’m a grown-up but because they make me nervous. I hate situations that I might not be able to handle. Removing something from the rectum often requires tools such as a proctoscope which I didn’t carry. Also practice. I had never done it.

But I had to try. After introducing myself to the woman, I put on a rubber glove and went to work. There is more space than you’d think inside a rectum; I felt a hard object touch my fingertip and then drift away. When something lies out of reach, it’s natural to stretch, and my desperate efforts caused her to groan with pain.

Suddenly, I snagged something and pulled out a shot glass. I almost danced with joy and relief. Although I expected an outpouring of gratitude, none appeared. Gathering up her clothes, the woman disappeared into the bathroom. The man nodded agreeably as if this were routine business. Filling out my invoice, I asked the woman’s name.

“Elizabeth Anderson.” He hesitated before answering, revealing that he had invented the name. Call girls lead a glamorous life in the movies, but the reality is often miserable. I handed him the invoice. He examined it thoughtfully. “That’s a lot of money,” he said. “You only spent five minutes here.”

In 1994 my fee for a wee-hour call was $180. He had not objected when I had informed him over the phone. When guests balk, I say I’ll accept whatever they consider fair. They often reconsider and pay my regular fee.

I told him I’d accept whatever he considered fair. He handed over $80. I don’t want to think how the woman made out.

Lost in Translation Again

“Bom dia” said the woman who opened the door.

“Bomn dia,” I responded. That’s the limit of my conversational Portuguese. My heart sank as I looked around the room which contained a toddler but no adult male. When I see a couple from a foreign country, the husband is likely to speak some English.

The mother pointed at her child, made coughing noises, tapped his chest, and produced a thermometer which she waved significantly. Once she understood that I needed more information, she took up her cell phone. 

After some effort because her husband was in a meeting she delivered a long recitation before handing me the phone.

I heard “He have cough. He have flu. He need medicine.”

In response to my question, the father insisted that this was everything she had said, but I knew he was summarizing. I asked more questions and received short versions of her long answers. The child looked happy and not at all sick, and my examination was normal. He had a cold. He’d coughed for four days and might cough for a few more, I explained. She was already giving him Tylenol, and no other medicine is safe for a two year-old. Luckily, he didn’t need medicine or bed rest or a special diet. It wasn’t even necessary to stay in the room.

If I had handed over a bottle of medicine, every mother from Fiji to Mongolia to Nigeria would understand that I was behaving like a doctor. But I wasn’t. What was going on?

I’ve encountered this hundreds of times, so I work very, very hard to communicate that the child has a minor illness (husband’s translation: “Doctor says child is OK…”), that no treatment will help (husband’s translation: “Doctor does not want to give medicine…”) and that being stuck in a hotel room is boring, so she should try to enjoy herself (husband’s translation: “Doctor says go out; child is OK…”).

Tap, tap, tap…. The mother beat a tattoo on he child’s chest in a wordless appeal. Everyone knows that a sick child must be confined and given medicine. Why did the doctor keep saying that he wasn’t sick?

I repeated my reassurance, and the husband translated. When, at the end, I asked if she understood she knew the proper answer: yes. She remembered her manners as I left and thanked me effusively.

I left feeling as discouraged as the woman. She was in a strange country, trapped in a hotel room with a sick child. Despite her best efforts, the foreign doctor didn’t understand that her son needed help.

An Untypical Case of Stomach Flu

I once cared for a Fiji Airline flight attendant suffering stomach flu. These are miserable episodes of cramps, vomiting, and diarrhea that rarely last long. She was better the following day, but on that day I returned to the hotel to see another flight attendant with similar symptoms.

In the hotel room, I repeated my stomach flu exam, delivered the usual advice, and handing over medication. She asked if the medication was safe if she were pregnant.

Doctors are human. Having made a diagnosis, my inclination was to stick to it, but I asked a few questions. Her period was overdue. She admitted that her nausea, although worse today, had begun a week ago. Her cramps, also worse today, had also been present.

One of many rules medical students learn is that when a young woman has abdominal pain, one always considers an ectopic pregnancy. That’s usually a pregnancy in the fallopian tube which, unlike the womb, had no room for the growing fetus.

I told the flight attendant that she needed a test to see if she had an ectopic pregnancy which is an emergency. She did not disagree. I phoned the agency that handles airline crew. Their medical department agreed that this was appropriate, and it turned out positive.

I've Quit Doing Telemedicine

Organizations like Amwell or Teladoc or Doctor on Demand pay doctors to answer phone calls. Sitting at home, we can earn $40 for a conversation that lasts a few minutes. It’s easy money, and I’ve had many satisfying experiences answering questions, helping with minor illnesses, assuring callers that something that seems ominous is not ominous, or sending them for medical care if they need it.

What spoils the experience is that nearly half of these callers are suffering a respiratory infection: cough, sore throat, congestion, “sinus,” “bronchitis.” Since their doctors routinely prescribe antibiotics, these callers know what they need. Phoning saves a trip to the office. What a convenience!

When, after discussing their symptoms, I give my diagnosis and explain how to help, many are puzzled. When, in answer to their hints, I assure them that antibiotics don’t help, most remember their manners, but they don’t believe me. Some point out that their family doctor takes their illness more seriously. A few question my competence or suspect they’ve fallen for another internet scam (“Are you a real doctor?.... What am I paying this money for?!!...).

When guests at my hotels phone, respiratory infections are also the leading complaint. But phone calls to me are free, and I spend a good deal of time answering questions and giving advice. By the time guests agree to a housecall, they understand that I know my business. If they don’t understand, I direct them to another source of care.

Telemedicine guidelines forbid doctors from prescribing narcotics and tranquilizers but say nothing about antibiotics which are far more toxic. If you sign up for one of these services and want an antibiotic but have the bad luck to reach a doctor like me, simply thank him, hang up, call again, and tell whomever answers that you want a different doctor. That should work.

A Message From a Stranger

“A guest would like to meet you at 4:15 in the lobby.”

The caller was a concierge at the L.A. Hotel.

“Is that all?”

“I’m sorry, Doctor Oppenheim. The guest just made the request and walked off.”

This really happened a few years ago. Doesn’t it sound like a bad novel? Retired CIA agent, Skip Oppenheim gets a message from a mysterious stranger as he unwinds at a luxurious hotel. The adventure begins.

As a hotel doctor, I am allergic to adventures. Sick guests rarely schedule a consultation in a public place. Most likely he had a request. I prefer to handle these over the phone at no charge. This is good P.R. but it’s also self-defense. If I travel to the hotel, and the guest makes a request I have to refuse, the consequences may not be life-threatening but they are not pleasant. Also, it’s hard to collect my fee.

“I don’t make appointments without talking to the guest first. Do you have his number?”

“I’m afraid not.”

“Have him call when he gets back. I’m sure we can work out something.”

The concierge agreed. Sadly for this post, there is no punch line. I never heard from him.

How a Hotel Doctor is Like a Prostitute

I make the majority of my calls at the request of national housecall agencies, international travel insurers, airlines, and a sprinkling of miscellaneous sources including other hotel doctors. That’s fine with me.

A few dozen Los Angeles area hotels call me exclusively. That leaves over a hundred, all of whom have my number but who call another doctor or no doctor and sometimes me. Competition for these hotels has become so cutthroat that I’m happy to leave it to others.

If you’ve followed my posts you’ve learned about my excellent skills and low fees. Why would a hotel bother with anyone else? The answer is that service and price are useless marketing tools in medicine where the law of supply and demand doesn’t work. 

Providing a doctor produces no revenue for the hotel, and guests don’t demand one, so most general managers pay no attention. Asked for help by a guest, employees are on their own. 

They may simply give out a number, but many prefer the traditional arrangement once used to summon a prostitute. A bellman made a phone call. As the lady left, she stopped at the bell desk to drop off a portion of her fee.

It’s illegal for a doctor to pay for a referral, but what are the options for someone yearning to break in to the glamorous and lucrative world of hotel doctoring? Claiming to deliver superior medical care sounds weird. Advertising a low fee is vulgar. Whoring works better.

Good Doctors Do It

“I’m coughing my head off. My head is plugged. I have a fever. I’m on vacation, and I need something.”

I’ve seen over 4,000 guests with respiratory infections. To the average hotel doctor, this is an easy visit. He arrives, performs the traditional exam, prescribes the traditional antibiotic, and accepts his fee and the guest’s thanks. What’s not to like?

That the antibiotic is unnecessary doesn’t bother the doctor, but it would bother me. Despite my colleagues’ insistence that patients demand an antibiotic, most of mine don’t. A small minority appear disappointed when I don’t prescribe one, and a tiny number make it painfully clear that I’ve missed the boat.

For decades, solemn editorials in medical journals have urged us to stop prescribing useless antibiotics, warning that they’re poisoning the environment, producing nasty, drug-resistant germs that are already killing thousands. 

Despite this, giving antibiotics for viral respiratory infections remains almost universal. Almost every doctor whose prescribing habits I know – admittedly a limited sample – does it. None believe they help. All tell me that patients expect them.

“I don’t want an antibiotic if I don’t need it,” patients often tell me. “But how do I know?”

“You don’t, but bacterial respiratory infections are rare in healthy people.”

“What if it’s bronchitis? I get that a lot.”

“Antibiotics don’t help bronchitis.”

“That’s what my doctor gives me. Are implying he’s incompetent?”

“No. Prescribing unnecessary antibiotics is so common that one could call it the standard of practice – meaning competent doctors do it.”