Something to Knock It Out, Part 2

Influenza had afflicted a guest for five days with fever, body aches, and general misery. He had meetings, he said, and needed something to knock it out.

While antibiotics don’t affect influenza, antiviral drugs such as Tamiflu shorten the illness by a day or two. Sadly, they only work if taken within the first 48 hours; afterwards they are useless although doctors continue to prescribe them.  I gave him some useful medicine and told him that flu rarely lasts longer than five or six days, so he would feel better soon.

After I left, the patient went to a local clinic and received the traditional antibiotic which solidified his conviction that I did not know my business. A day after beginning the antibiotic he felt better which proved it. Confronting the hotel manager, he demanded his money back. Guests often believe that the hotel doctor works for the hotel.

The general manager phoned to pass on the request.

Something to Knock It Out, Part 1

An FBI agent was suffering a bad cough. He informed me that this happened every year, and his doctor knocked it out with an antibiotic.

My philosophy on prescribing a useless antibiotic is that I don’t unless the patient threatens to make a scene.

This FBI man seemed out of an old movie: dressed in suit and tie, composed and unemotional. He made eye contact, listened intently, answered succinctly, submitted to my exam, and did not interrupt as I spoke.

I explained that he had a virus that was incurable but would go away in a few days. As I delivered advice and handed over cough medicine and tablets for his fever, I could see him absorbing the news that I wasn’t prescribing the antibiotic.

He was not a person to quarrel with a figure of authority. He said nothing, but I could sense his inner turmoil….

Deciding the ice was getting very thin, I added: “You said your doctor gives you an antibiotic. This illness doesn’t require one, but I’ll write a prescription in case you want to call him and discuss it.”

He accepted it without comment. He also handed back the medical form that I had asked him to sign. In the hall, glancing at the paper, I saw that he had covered it with obscenities.

24 Hour Duty

As a hotel doctor, I’m on duty 24 hours a day. This sounds oppressive until you realize that even a busy week – say twenty visits – requires about thirty hours of actual work. A downside is that calls can arrive at precisely the wrong time.

This one came one hour and twenty minutes before a dinner reservation with friends.

I calculated furiously and decided I could make it. My destination, the Mondrian, was on the Sunset Strip, six miles away. It was Sunday, so traffic was tolerable, but street parking on the Strip is difficult. The Mondrian is not one of my regulars, so parking attendants would probably not accommodate me. The hotel possesses only a skimpy open space around the entrance, so the valet might drive my car deep into the garage where it might take ten minutes to retrieve. Worse, there was a chance they would charge.

Making a snap decision, I drove past, but no street parking materialized. I turned down a side street but no luck, so I returned to the hotel, handed over my keys, and announced (incorrectly) that I was the hotel’s doctor.

I arrived at the room and introduced myself only to hear the discouraging words: “Spik Spanish?”…

I shook my head regretfully and proceeded in English. This usually works because most Latin American males speak enough English to get along (women don’t do so well). Sadly, he proceeded to perform the Zero-English pantomime: pointing to his throat, pointing to his head, making coughing noises.

No problem. Peering outside the door, I appealed to a group of maids on their cleaning rounds, but they were recent arrivals and spoke no English. Luckily, a bellman pushing a food cart was bilingual.

Delivering medical care was, as always, the easiest part. To my delight, the valets had held my car, and I arrived at the restaurant not excessively late.

No Income Today

A lady at the Westin wanted a housecall for her cough and fever. This seemed reasonable until I learned that she was under treatment for multiple myeloma, a serious blood disease. It affects the immune system, so any sign of infection is a red flag.

I explained that she needed more than I could provide in a hotel room and gave directions to the nearest emergency room.

                                                 *          *          *

Two hours later I spoke to a guest at the Airport Holiday Inn who was experiencing stabbing chest pains. Chest pain is worrisome, but significant chest pain lingers. Fleeting pain in an otherwise healthy person is almost never a serious sign. I looked forward to the visit when, after my exam, I would deliver reassuring news. That anticipation disappeared when the guest mentioned that he had suffered several blood clots in his lung and was taking blood thinners. He added that these chest pains were different.

Different or not, it was a bad idea to assume that these were trivial. I sent him to a facility that could perform tests.

                                                *          *          *

A travel insurance agency asked me to see a hotel guest in Encinitas.

“That’s near San Diego,” I pointed out. “It’s a hundred miles.”

I’ve traveled that far in the past and charged accordingly, but I didn’t want to quote a fee and risk having it accepted because I wasn’t in a mood for the grueling drive. A local clinic would be cheaper, I informed the dispatcher. 

                                                *          *          *

“I’m a physician in the U.K., and my wife has conjunctivitis in both eyes. I went to the chemist for antibiotic drops, but apparently I have to see an American doctor.”

“It’s unusual to have bacterial conjunctivitis in both eyes,” I said. “If you’re certain, ask the pharmacist to phone, and I’ll approve the prescription.”

Later the pharmacist phoned. When it comes to their own illness or that of their family, doctors are no more accurate than laymen, but they have no interest in my opinion. 

A Mystery

Universal Assistance asked me to see a young woman with abdominal pain at the Airport Hyatt. According to the dispatcher, she had no other symptoms.

Arriving in the room, I learned things the insurance dispatcher hadn’t mentioned. The woman was three months pregnant and had noticed vaginal bleeding. It’s surprising how often doctors know the diagnosis as soon they set foot in the room, but it looks bad to blurt it out, so I asked questions, performed an exam, and then delivered my conclusions. She was having a miscarriage and had to go to an emergency room. 

The following afternoon, the lady’s husband called. They were back in the hotel. The emergency room doctor had diagnosed a miscarriage. Then he had discharged her. But she was still bleeding. Was that normal?...

Bleeding stops when a miscarriage is complete; if it continues, a doctor performs a D&C to scrape away remaining tissue. I have no explanation of why the doctor sent her out still bleeding. I told the husband that, sadly, he would have to take her back. The second time she received her D&C.  

Is It Annoying?

 "My other son is coming down with something. Do you mind taking a quick look?”

If you wonder if it annoys doctors to see an extra patient at the last minute, it does. They grumble regularly on physician internet forums which, like forums in general, are full of petty complaints.

In an office, that second patient generates a second bill, but I rarely charge double in a hotel. Driving takes up 80 percent of my housecall time, so an extra consultation doesn’t add much. I’m also aware of one rule of medicine that may come as a surprise.

Rule:  If one member of a family is ill, it might be serious. When two members are ill, it’s never serious.

A guest with chest pain, vertigo, or difficulty breathing is probably the only one in the room suffering. When two people are sick, it’s a respiratory infection: cough, congestion, fever, sore throat… These are not serious.

No medical rule is one hundred percent accurate, but I’d rate this near 99. In an otherwise healthy person, the only common, serious respiratory infection is bacterial pneumonia. Since pneumonia is not generally contagious, I’ve never seen two cases in the same room.

Special Treatment

“Our general manager’s husband has an eye problem. Could you see him this morning?”

“I could.”

“She’s wondering how much you’d charge?”

“There will be no charge.”

The concierge sounded delighted. I was also pleased. She worked at a large West Hollywood hotel that didn’t call.

I’m happy to care for staff gratis. A lower level employee will certainly tell colleagues about the experience. This is important because, even at my regular hotels, many employees are unaware that I exist, and guests who ask for help usually ask only once.

Hotel managers, of course, have the power to make important decisions.

I’ve never been asked to see a general manager’s spouse, but it seemed wise to give him special treatment. He was staying in the penthouse. The eye problem presented no difficulty; I suggested soothing eye drops, and informed him that symptoms should vanish once he began wearing goggles when riding his motorcycle.

On my way out, the general manager expressed gratitude. I nodded modestly and kept my hopes to myself.