Something to Knock It Out, Part 3

Her vacation had been a disaster so far. Worse, when she tried to buy amoxicillin to knock out her bronchitis, the pharmacist told her she needed a prescription. This was obviously a scam to line the pockets of American doctors, the guest added. She didn’t need my services except to provide the amoxicillin, so I should not take up her time.

This monologue occurred in Spanish. I don’t speak Spanish, but I’ve seen thousands of Latin American travelers, so I got the drift.

This lady appeared upset as soon as she opened the door. Apparently accustomed to this behavior, her husband and a child sat in a corner, trying to look inconspicuous. Following my rule (see the post from March 16) I had no plans to refuse the amoxicillin, but first I had to deliver good medical care. I phoned the travel insurance office, and the dispatcher agreed to interpret.

I asked the usual questions; she answered at great length.

The dispatcher translated but summarized her interruptions with: “she’s mad about something.”

The guest rolled her eyes when I put a thermometer into her mouth and seemed impatient during my exam.

When I concluded that she would recover in a few days with or without an antibiotic but that I would give her amoxicillin, she slammed down the phone and waved off my prescription.

“If you don’t think I need an antibiotic then I don’t want an antibiotic. According to you I should continue to suffer. Thank you very much!….”  I’m not certain those were her exact words, but they were close.

I laid the prescription on the bed. The door closed behind me with a deafening slam.

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.

Waiting for the Second Call

"This is the Shore hotel,” I heard after answering the phone.

That sounds routine, but it brought joy to my heart. It was a first call!... I almost never acquire new hotels, and the Shore, an upscale boutique on the Santa Monica beach, had opened a month earlier.

I keep an eye on hotels under construction. As the opening nears, more aggressive doctors approach the general manager or visit the staff to extol their virtues. I send a dignified letter of introduction to the GM. This rarely works, but after more letters and the passage of time – perhaps a decade or two – calls often materialize.

Before leaving the Shore, I stopped at the front desk to introduce myself, give thanks for the referral, and pass out business cards. The clerks responded with enthusiasm, accepted my cards, and promised to keep me in mind, but it was clear they had no idea who I was. When asked who had contacted me, they scratched their heads, consulted colleagues, and admitted they had no idea.

This reminded me that over thirty years, every Los Angeles hotel has called at least once. First calls always excite me, but it turns out they mean little. If I get a second, more follow. 

So far the Shore has been silent.

Fatal Diarrhea

Coris USA, a travel insurer, sent me to see an Argentinean lady with diarrhea at the Beverly Hills Hotel. Diarrhea is usually an easy visit.

Arriving, I learned that her illness was entering its sixth day: too long to be the ordinary stomach virus. She felt weak and feverish, and she had recently taken antibiotics, so I wondered this was Clostridium difficile colitis, an occasional consequence of the avalanche of antibiotics consumed by humans everywhere.

Every antibiotic you swallow kills trillions of germs, mostly harmless, living in your bowel. They are immediately replaced by other germs that can grow in the presence of that antibiotic. Most bowels don’t harbor C. difficile, but if yours does, antibiotics may convert a small population into a large one, and it produces an irritating toxin that causes a severe, occasionally fatal diarrhea. 

Diagnosing Clostridium requires more than suspicion, and there were other possibilities. She needed a thorough evaluation.

Fortunately, Coris USA is a good travel insurer: meaning that it (a) pays promptly and (b) takes my advice. These sound unrelated, but I’ve found that good insurers do both, bad ones do neither.

I phoned Coris’s Miami office with the news and the name of the doctor I recommended. The dispatcher contacted the main office in Buenos Aires for authorization; it appeared within the hour, and the patient went off. If I were dealing with a bad insurer, authorization would be denied or remain pending indefinitely. I often send patients off, warning that they will have to pay up front and try for reimbursement later.

Tests were positive, and she began improving after a few days of treatment: an antibiotic but one different from the one that caused the problem.

Free Enterprise in Action

Visiting Disneyland, a couple’s two year-old twins fell ill. The parents consulted the concierge, and a doctor who wasn’t me duly arrived.

A week later, the family traveled to Hollywood to spend a few days before flying home. That’s where I came on the scene.

The children had recovered, and I wrote my clearance-to-travel. From the parents’ description, they had suffered viral upper respiratory infections with cough, congestion, and general miseries. The hotel doctor had diagnosed: “otitis, tonsillitis, bronchitis, and mild pneumonia.” He had given injections, handed over medication, and written prescriptions for antibiotics, cough medicine, and eardrops.

The parents showed me his invoices. The fee for one child totaled $495, for the other $390. The prescriptions and injections came to over $100, so they paid about a thousand dollars for a single visit.

Nothing I do in a hotel room costs much, so I quote a flat fee and never charge extra for anything. That doctor billed $30 for an injection; those I carry for common problems (vomiting, pain, allergy) cost less than a dollar a dose. A syringe costs a dime. He handed over small packets of pills, charging $20 apiece. I carry similar packets containing from three to eight pills. Each pill costs between a nickel and a quarter. A bottle of cough medicine costs $1.50. A week’s supply of antibiotics is usually less than $5.00. I pay about $3.00 for a bottle of antibiotic eye drops. Perhaps my most expensive drug is antibiotic ear drops at $8.00. Doctors may charge $30 for a urinalysis, but the dipsticks they dunk in your urine come in bottles of 100 at $40.00. That’s 40 cents a dipstick.

Medicine is a noble profession, but while I’m in favor of doctors earning a large income, it’s beneath their dignity to pay obsessive attention to it. This might not be a majority opinion. Doctors regularly claim that they are businessmen operating in a free market. As such, it’s reasonable to charge for every service. Sensible patients understand, they insist.

Another Second Opinion

“I need a second opinion about something personal,” said an elderly man at a West Hollywood hotel.

It’s always pleasure to visit a patient who isn’t sick, although this seemed an odd situation. But first, since he was American and over 65, I explained that I wasn’t a Medicare doctor, so Medicare wouldn’t pay for this visit.

“That’s OK. I need to see you.”

I drove to the hotel and listened as he explained that his scrotum hung too low. His family doctor hadn’t taken it seriously, so he wanted my advice.

On examination, his scrotum appeared normal although perhaps lengthy. I asked how this caused a problem.

“When I sit on the toilet, it dips into the water,” he said.

I scratched my head.

“A urologist could probably do surgery to shorten it, but I’m not sure Medicare would pay.... Why don’t you lower the water in the toilet bowl?”

Breaking My Rule

I was awake at 7 a.m. writing this blog when a guest called with symptoms of a bladder infection.

Being American, her first question was: do I accept her insurance. I explained that I didn’t, adding that there was an urgent care clinic a mile away that would.

“I’d probably have to wait forever,” she said. “I have meetings.”

“I’m definitely convenient,” I said.

“Do you bring the medicine?”

“I do.”

I wanted to finish writing and eat breakfast, so I told her I’d arrive at 9 a.m., thereby demonstrating that, despite my wisdom and vast experience, I do stupid things.

It’s a rule of hotel doctoring to go as soon as possible. Guests who wait often reconsider, so I knew what to expect when the hotel’s number popped up on my caller ID at 8:00.

“I’m feeling better,” she lied. “I won’t need to see a doctor after all.”

“You won’t save much at the clinic,” I pointed out. “They’ll charge extra for the urine test and extra for the culture, and you’ll have to find a pharmacy and pay for the prescription.”

“Oh, no! I’m feeling fine,” she insisted. “Thank you for your help.” She hung up.

When patients cancel, I console myself if the illness seems likely to produce an unsatisfying encounter. For example, guests are often disappointed when I can’t cure their respiratory infection. But urine infections are easy to treat and treatment produces dramatic improvement. I hate to miss one.  

A Hotel Doctor's Database, Part 2

Men travel more than women but are less likely to call a doctor so I’ve seen more women (9833) than men (8483). My database contains 124 patients under age one and seventeen over 90, the oldest 97. The smallest of the small hours are not silent. I’ve made 858 housecalls between midnight and 5 a.m.

My leading diagnosis is the same as that of any family doctor: respiratory infections, 4700 visits. In second place are upset stomachs with vomiting and diarrhea: 2672.

I’ve been around long enough to see 77 patients with chicken pox, another 83 with gout, 12 with mumps, 61 with herpes, 29 with poison ivy, and 149 suffering a kidney stone. Victims of kidney stones rarely delay calling a doctor, and since they are rarely emergencies I visit a fair number.  I’ve seen 82 guests with chest pain and sent fifteen to the hospital. Far more of my 30,000 callers complained of chest pain, but I work hard weed out emergencies over the phone. Those fifteen were mistakes.

My most numerous foreign patients are from Argentina, 1854, barely surpassing Britons at 1821. That’s because South American travel insurers mostly began there and are still mostly based in Buenos Aires. But they are expanding, and since 2000 I’ve seen more Latin American guests from Brazil. 

I’ve cared for guests from Andorra, Tonga, Malta, New Caledonia, and Curacao but not from Latvia, Estonia, Yemen, and half a dozen African nations. Russians didn’t travel until the fall of the Soviet Union. I saw my first in 1991. The Chinese don’t appear until 1998. So far Cuba has sent one.

Six guests died – fortunately none in the room after my visit. One was dead when I arrived. Four died soon after I sent them to the hospital and one after the ER doctor (mistakenly) sent her back. I called the paramedics after examining sixteen guests. To my great distress (because that means no payment) paramedics were there when I arrived six times. Many more guests needed attention but weren’t urgent. Leaving after obtaining their promise to go to an emergency room is a bad idea. If the guest decides to wait, and something dreadful happens, I’m the last doctor he or she saw, a situation that focuses the attention of malpractice lawyers. When a guest needs an emergency room, I offer to drive them. I’ve done this 48 times.

28 guests cancelled while I was still driving. 47 weren’t in the room when I arrived. 60 refused to pay. 21 paid with a bad check, but not all were deliberate. I eventually collected on 8. Four times, when I arrived, another doctor was there.  I don’t record guests who get a discount but 173 paid between $5 and $50. 110, mostly hotel employees paid nothing. I will not deny that I have a category for “celebrity.” It has 95 entries although that includes their wives and children. I try to head off drug abusers, but 78 slipped through. The diagnosis on four was “drunk,” but that’s certainly too few.

A Hotel Doctor's Database, Part 1

Few things besides wine and cheese improve with time, but a personal database is among them.   

It didn’t seem significant when I began in 1983, but now I can look over 18,316 visits. So when I claim to have made more housecalls than any doctor now alive, I have the evidence . It’s a fascinating trove of information. I saw 967 patients from Brazil, for example; 42 of them suffered skin problems. Of those calls from Brazilians, 70 arrived between 11pm and 6am, getting me out of bed.

Of the 18,316 nearly 12,000 (11,849) were of calls directly from a hotel. The remainder came from four other sources. 

The second source is agencies that insure travelers visiting America: 3490 visits. Few come from Europe or Australia whose insurers follow the American strategy of insisting that clients pay up front and apply for reimbursement later. Asian and Latin American carriers do better. Their clients phone the 800 number of the agency’s US office; the agency phones me; I make the housecall and send my invoice to the agency which pays exactly what I bill (American carriers undoubtedly roll their eyes at this archaic behavior).

Inevitably some insurers are less easy to deal with than others. Some have adopted the American system of requiring elaborate forms, itemization, and codes for every procedure. Others pay slowly and only after many pestering phone calls. When my patience runs out, I stop accepting their calls.

This doesn’t mean I stop seeing their clients, because they transfer their business to my third source of calls: competitors with 1760 visits. That includes other Los Angeles hotel doctors who ask my help or cover for me when I’m busy as well as one of the national housecall services. They have names like Expressdoc, AMPM Housecalls, Hoteldoc, Global Med. If you live in a large city, they may be available, but be warned that some are reasonable but others charge fees that will take your breath away.

Foreign airline crew make up the fourth source: 913 visits. American airlines have no interest in crew who fall ill when laying over. They have medical insurance but with no transportation or knowledge of facilities in a strange city, they are out of luck. Occasionally I deal with their pitiful calls and treat them as charity cases. As with American insurance carriers, it’s hopeless to bill an American airline for a housecall. 

A minor fifth category is what I call “private-parties:” 293 visits. These are people who learn about me from another source. That includes locals as well as former patients who return to the city and call me directly.

Night in a Hotel Room

Patients are often suicidally reluctant to wake a doctor, but I don’t object. Traffic is light, parking is easy, and since I have no office, I can sleep late. I’ve made a thousand housecalls that got me out of bed.

Callers awaken in the dark, certain something terrible is about to happen. I try to handle anxiety attacks over the phone using sympathy and calm reassurance. I never point out that nothing terrible will happen because guests know that; it’s why they’re upset. I explain that no one is perfect; sometimes our brains go haywire, but it never lasts long. If I keep the guest on the line, this almost always works. Making a housecall is risky because guests often feel better and cancel before I arrive or feel worse and insist that the hotel call paramedics.

Some hotel doctors use paramedics as a substitute for getting out of bed, but I reserve them for emergencies. Mostly, these are obvious. Heart attacks can rouse victims from sleep, but they are not subtle. Niggling chest discomfort doesn’t qualify, and chest pain in a young person is probably something else. 

I see a cross-section of ailments, but guests with an upset stomach seem overrepresented. I consider a wee-hour visit for vomiting a good call (i.e. not life-threatening; I can help; patients are especially grateful). The latest antivomiting drug, ondansetron, is superior to the old standby, Compazine. It was once wildly expensive and used only for vomiting after cancer chemotherapy, but its patent expired a few years ago, and the price has plummeted.

Most upset stomachs don’t last long. I assure guests they’ll probably feel better when the sun rises, and (a perk of being a doctor) when that happens, guests believe I’ve cured them.

You Can't Make a Diagnosis Over the Phone

I talk to guests before making a housecall, so I have a good idea of what’s happening before I drive off or decide that a visit isn’t necessary. 

“Of course, you can’t make a diagnosis over the phone,” guests tell me.

But I can. Doctors do it all the time. I’d estimate my accuracy at ninety percent. It may be one hundred for some problems: respiratory infections, urine infections, backaches, most rashes, injuries, anxiety attacks. Driving to the hotel, it’s relaxing to know in advance that the guest has chicken pox, gout, herpes, a bladder infection, or the flu. I can deliver my diagnosis, advice, and medication, collect my money and thanks, and drive home. What an easy job!

Jumping to conclusions is a major reason doctors get into trouble, so I pay attention. If a fifty year-old describes chest pain that doesn’t sound like a heart attack, it’s unlikely I’ll tell him that it’s OK to wait. It’s also unlikely that I’ll make a housecall because an examination rarely helps. On the other hand, chest pain in a twenty year-old is hardly ever a serious matter.

Abdominal pain is tricky at any age. Guests suggest gas, indigestion, and constipation, none of which cause severe pain. I worry about a dozen conditions that require a surgeon. Oddly, it’s reassuring when vomiting or diarrhea accompanies the pain. Provided the guest is in good health, it’s usually a short-lived stomach virus, my second most common reason for a housecall. Without vomiting or diarrhea, I’m likely to suggest a clinic visit where a doctor can get more information than a housecall provides.

“I can walk on it, so it’s not broken…” “I can move it, so it’s not broken….”  These are as accurate as most popular health beliefs. I walked on a painful foot for a week before an X-ray that revealed a fracture. Hotel guests yearn to hear that their injury is not serious, and I sometimes comply. Doctors do little for cracked ribs and broken toes except to relieve pain, so X-rays aren’t essential. All bets are off with the elderly, but it requires a good deal of violence to break a young bone. Lifting a heavy suitcase won’t do it; experts urge doctors (in vain) not to order spinal x-rays unless pain persists for weeks.

My greatest service is not in diagnosing fractures which is usually impossible but saving guests the misery of spending hours in an emergency room. Most injuries are not emergencies, even if a bone is fractured. If the guest is willing to wait, I can send him to the more civilized atmosphere of an orthopedist’s office. 

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.