Stuck in Liberalism

Walking along Pico, a busy street, I passed a man lying face down on the sidewalk. His head lay on the curb; one leg remained on a bus bench, so he had clearly toppled off. Even prosperous Los Angeles neighborhoods possess a few resident homeless, and this was probably one. He looked disheveled.

Naturally, I continued past. After a dozen paces I stopped because my conscience was hectoring me. “You have to help this fellow,” it pointed out.

“Someone else will notice,” I replied.

“Not good enough.”

“I do fine with patients,” I pointed out. “But this is not a professional situation.”

“Doctors have a moral obligation to help anyone in distress!” said my conscience.

“That’s flattering, but many doctors disagree. You should read the physicians on internet forums. Most are very conservative.”

“You have to help.”

“….They hate Obamacare. They think welfare patients are deadbeats. They don’t even like patients with private insurance. Their idea of heaven is a cash-only practice.”

“Not good enough.”

While I paced in a circle, debating this irritating voice, a hundred cars and dozens of pedestrians passed by. Finally, I gave up. The 911 dispatcher listened to my report and then transferred me to the fire department. The fire department dispatcher listened and then transferred me to the paramedics.

“How old is he?” asked a paramedic.

“Middle-aged.”

“What do you mean ‘middle-aged’?  he snapped. “Forty… Fifty… Sixty?”

“Fifty,” I guessed.

After several more questions designed to show that I was bothering him, he told me to wait until the ambulance arrived. As I waited, the man stirred.

“That’s all I need!” I thought. “For him to get up and walk away.”

But he didn’t. The ambulance arrived within five minutes, and the paramedics went to work. When they ignored me, I walked off.

No Good Deed Goes Unpunished

An Austrian lady had left home without her medication. Could I come and write some prescriptions?

These requests arrive regularly. In the past, I offered to phone a pharmacy, but this took a long time as guests scrambled to find the name, dose, and instructions. Nowadays I tell them to go to a pharmacy, explain exactly what they need, and give my number. I would approve over the phone.

Guests are pleased that it is so simple and more pleased to learn that I don’t charge for this.

Later, a caller explained that he was the tour leader for an Austrian group. “You gave a prescription for one of our members. Could you tell me where is the pharmacy?”

The lady’s English was poor, so she had misheard me. I repeated that the guest had to go to the pharmacy and describe precisely what she needed. An hour later, I answered another call from the tour leader. He was at a pharmacy near the hotel; he had given the names of the lady’s medication, but they had refused to accept them. Again, I explained that the lady had to tell the pharmacist precisely what she needed.

An hour later, a pharmacist informed me that a foreign customer was requesting several medications. He wanted to know the dose and instructions. I told him that he would have to get this information from the guest.

Several hours passed before the pharmacy called again because the lady had had to phone her doctor in Austria. One of her drugs was not available in the US. What would I advise?... I had no idea but suggested that he probably knew an equivalent. After some research, he found one and called back. I agreed with his suggestion.

Don’t forget to pack your pills.

Worry, Part 2

I drove to the Magic hotel in Hollywood where a Danish couple’s 18 month-old was vomiting. He looked fine, and looking is essential:  sick children look sick. Nothing abnormal turned up on an exam, so my diagnosis was a common stomach virus. I told the parents it might last a few days and gave the usual dietary advice.

I check on patients before going to bed, but the Danish parents beat me to it. The child had vomited once again, they reported. He was still in no distress, so I told them it was OK to wait.

My assurance was proper, but patients occasionally deliver unpleasant surprises, so I worried a little as I went to bed.

I phoned the Danes the following day to learn that the child hadn’t vomited but was now feverish. This was to be expected, I explained, and I approved their decision to give Tylenol.

The Danish child was still feverish, his parents reported the next day, and now he had diarrhea. I gave dietary advice.

There was no answer the following morning. From the front desk I learned that they had checked out. I had just returned from seeing a young man with abdominal pain at a youth hostel. He was worried about appendicitis; my exam made that unlikely. Since he had no health insurance, I did not want to make my life easier by sending him to an emergency room where a workup including CT scans would run to about $5,000. His symptoms hadn’t improved when I called, but they still didn’t seem like appendicitis. He promised to phone if there was any change. I worried a little as I went to bed.

Worry, Part 1

A guest had stumbled in the shower and thrown out her back. Could I make a visit to decide if she needed hospitalization?

Going to the hospital with back pain is a bad idea; even if you’re in agony, no doctor will admit you without evidence of nerve damage such as paralysis or inability to urinate. He will order x-rays (worthless for acute back pain but an ER tradition), explain that you will recover in a few days, and prescribe pain medication.

My examination showed no nerve damage, so I explained that she would probably improve in a few days. I handed over pain pills, adding that, while it wasn’t essential, I could give an injection that would help for several hours. She agreed, so I gave it. 

 “Not so good,” she replied when I called to ask how she was doing. She had been vomiting since the injection, and each vomit hurt her back. That’s an occasional side-effect. I assured her it would pass, but I worried.

She was marginally better the following morning and the morning after that. She wanted to fly home. Could I provide medical clearance? Visits for “medical clearance” are a lucrative perk of hotel doctoring, but I resisted the temptation, explaining that there’s no medical reason why someone with back pain can’t travel. If she could hobble onto the plane, she should go.

Could I give a “mild” injection so she could move more easily. No such injection exists. I suggested she try the pain medicine.

Later, the lady reported that the medicine made her dizzy. What should she do? I told her it would pass. Rest is not helpful for treating back pain. She should try to make her plane. When I called later she had checked out. I worried that I might hear from her, but I didn’t.