The Upside of Cheap Motels

Cheap motels have many advantages from a hotel doctor’s point of view.

Valets are absent, so I can park inside and safely ignore the threatening signs. Security is absent, so elevators respond to whatever floor I push, and I don’t have to explain myself to the front desk. Americans are absent because they can’t afford the fee. I love America but I also love foreign patients. They’re deferential, and they don’t sue.

On the downside, customer service declines with the price of the room. I often need to call in a prescription or consult with the insurance. When I pick up the hotel phone and punch “9” for an outside line, I may hear a busy signal because many hotels require a deposit before opening the phone. If I identify myself as a doctor, larger hotels open the line, but clerks in cheap hotels refuse unless the guest comes down and pays.

Insurers send me to hotels that don’t call, so I take the opportunity to introduce myself. In mainline hotels, staff remember their manners. They smile, listen intently as I make my pitch, agree that my service sounds wonderful, and thank me effusively for my business card. Then they probably forget about me. It’s rare to pick up business, but I always leave feeling good.  

In cheap motels, clerks don’t disguise their lack of interest. “Nobody gets sick,” they say.   

Lost in Translation Again

“Spik Spanish?”

Not a phrase I like to hear. Ninety percent of Latin American guests speak enough English to get along, and Hispanic hotel staff are usually available. Unfortunately, this visit occurred at a small Super 8, and the single employee on duty was American. Under these circumstances, I shake my head apologetically and proceed in English.

“Tell me what’s going on,” I asked.

As usual when something exotic like an American doctor appears, there was a substantial audience. Usually someone volunteers to interpret. Sure enough, a man stepped forward. He tapped patient’s abdomen and then whirled his finger around his mouth.

“Is she vomiting?” I asked.

Blank looks from everyone, a bad sign. I waited, hoping someone else would contribute, but the man merely repeated his gestures.

I phoned the insurance agency’s 800 number. Its employees are Hispanic and willing to interpret.

“Would you ask what’s bothering her and tell me what she says?” I said after explaining the situation.

I handed over the phone and the lady began a long monologue. When she finally handed back the phone, I listened to the insurance clerk. “She is sick from eating. She give medicine from Argentina, but it does not help. She wants a medicine to help.”

That was too little information. I tried to be specific. “Would you ask what are her symptoms?”

Another long conversation followed by a short, unsatisfactory translation. Eventually I learned enough to thank the clerk, adding that I would examine the patient and then call back for more interpreting.

At the end I gave instructions and medication, and everyone seemed happy. I always leave with the uneasy feeling that the interpreter has left out a great deal. Fortunately the ailments I encounter are usually easy, and the occasional exception is obvious.  

Almost Stiffed

“This is one time the hotel will not be able to charge the bill,” reported the manager one evening when he called about a Middle-Eastern family.

Since I usually collect from the guest, I assured him that that was not a problem.

He connected me to the room where I spoke to someone whose English was not good. The speaker or perhaps someone else had an allergy or maybe a rash that needed a cream. Did I know the proper cream?.... After much to and fro they decided I should come at 11 a.m. the following day.

The guest who answered the door showed me a rash on her neck. It was a simple contact dermatitis. I explained and handed her a tube of cortisone cream. That, of course, was the easy part.

The room was a luxurious suite. The patient was Philippine, so I knew she was a servant. It was disturbing to notice that she was alone. I suspected she did not expect to pay; sure enough, she looked puzzled when I presented my invoice and more puzzled when I explained that the hotel would not pay.

I passed an uncomfortable ten minutes as she noodled with her cell phone, trying to reach her employers. Had they deliberately absented themselves to avoid paying? It might not have been deliberate; sometimes extremely rich people never concern themselves with paying for stuff because it’s always taken care of.

She asked if she could call the hotel. I shrugged, resigned to being stiffed. But it turned out the current manager had no objection to charging the bill.

Worry

A worried mother phoned, asking me to see her two year-old who had a fever of 101.

I’d seen the child two days earlier. He had a 101 fever but was not particularly sick, and my exam was normal. I diagnosed a virus, handed over a bottle of Tylenol, and told the mother he might feel under the weather for two or three or four days.

Patients often call after a few days to tell me the illness hasn’t gone away. Sometimes they report a new symptom that gives me pause, but mostly nothing has changed. That was the case this time, so I reassured the mother. Another housecall wasn’t necessary.

People rarely argue with a doctor, so the mother did not disagree with my reassurance. But worry is contagious. No one is perfect, and there was a tiny chance that something terrible was brewing up.

I could have relieved my mind by sending them to a clinic. The doctor would find nothing and reassure the mother. If something terrible happened later, he was the last doctor she had seen, and I would be off the hook. But I didn’t do that, so I worried.

Unsafe

A young man stood blocking the door.

“I want to see your license,” he said.

I showed him. He examined it suspiciously and didn’t move.

“Get out of the way!” said a voice inside. 

Reluctantly, he let me pass. I approached the patient, apparently the man’s girl friend, who had phoned me because of an earache. As she described her problem, he glowered from the doorway.

“I don’t think you’re a doctor,” he said, interrupting. “Where’s your white coat?”

“Shut up, asshole!” she shouted before turning back to me. “He’s being a jerk. He’s probably a little high. Don’t worry.”  

“You should leave,” he said a few minutes later. Approaching, he delivered a gentle shove to my shoulder. The girl friend cursed and pushed him violently.

“Sorry, but I’m not feeling safe here,” I said. I walked out and went down to the lobby. The woman appeared a minute later, full of apologies, and we finished the consultation.

Insect Bites

A caller was suffering an itchy rash, present for a week. Three companions were also affected. That sounded good. When more than one person has a medical problem, it’s the same problem and not serious.

In the room, all four gathered to show me their skin which revealed the scattered, small pink pustules left by ectoparasites. I use that term to be accurate because not every bug that bites is an “insect.” Spiders, ticks, mites, scorpions, and centipedes aren’t.

Bedbugs (an insect) have become fashionable, but these travelers had been moving frequently from place to place. Where hygiene is reasonable, lice (an insect) limit themselves to hairy areas; I didn’t see any. My diagnosis was scabies, a mite (not an insect) that burrows under the skin. Scabies is hard to catch from clothes or bedding; mostly it requires rubbing against someone else with scabies, and it looked like these young people did a lot of that. 

Deception

A tour leader explained that one of his group wanted a doctor to look at her hand. She had fallen.

Minor injuries are easy, but I don’t want to collect money from someone who needs an x-ray and then send them off to pay more money somewhere else. 

I quizzed him. What happened? Where was the pain? Was there much swelling? He assured me that it was not a big deal. The lady just wanted a doctor to check it.

He was lying. When a member of a tour goes to an emergency room, the leader must go along. Anxious to avoid such a tedious job, tour leaders often hope a doctor will make the problem go away.

The lady had a swollen, painful left wrist. If you fall and instinctively catch yourself on your outstretched hand, you’re likely to break a specific spot at the end of your radius. It’s so common it has a name: the Colles fracture.

I was certain she had a Colles fracture, so off they went.

Gushing Blood

Someone at a Beverly Hills hotel had struck his head on the edge of a table. Blood was gushing, and he wanted a doctor.

Scalp lacerations bleed heavily, but my long experience with bumped heads reveals that the wound is rarely impressive. If victims are willing to apply pressure and wait, they usually agree.

He didn’t want to wait.

This was an upscale hotel, but I am not its doctor who was undoubtedly, this being midnight, fast asleep. Someone had searched the internet and found a housecall service which called me. That meant that I had to give the service forty percent of the fee. My wee-hour charge is not skimpy, but none of this mattered. He wanted a doctor.

I told him I would arrive in half an hour, and the manager expressed surprise when I turned up on time. He led me down a hall, through the kitchen to a large room where the patient was resting on a chair, a wet rag over his forehead. Half a dozen employees stood around.  

Removing the rag revealed that the bleeding had stopped. The wound was a shallow 1½ inch scratch. I delivered the good news and applied a band-aid. Everyone was relieved, and the guest peeled off my fee from a wad of bills.

When an Antibiotic Helps

If you receive an antibiotic for a respiratory infection, it’s probably a placebo because almost all respiratory infections are viruses.

If you receive an antibiotic for a skin infection, there’s a chance you have a bacterial infection that an antibiotic won’t help. A boil or other collection of pus will heal if the pus is drained. If the doctor gives an antibiotic but doesn’t drain the pus, it will also heal. That’s because most infections, boils included, eventually heal.

You’ll get an antibiotic if your doctor diagnoses an ear or sinus infection. It’s a bad idea to ask if this will help because (if he’s honest), he’ll admit that no one knows. In experiment after experiment, when researchers compare patients given and not given antibiotics for ear or sinus infections, the results are never dramatic. Often there’s no difference. Sometimes they help a little. Doctors in some nations don’t treat these with antibiotics.

That’s why urine infections are my favorites. It’s not controversial that antibiotics help. For infections in young women, help comes quickly, usually within a day. These are satisfying encounters for everyone concerned.

Delivering Medical Care is the Easy Part

Park La-Brea Towers is a huge apartment complex in West Hollywood. I’ve been there a dozen times. Inside, the buildings have numbers which follow a cryptic system that I have yet to decipher, and finding them is a chore. Since it’s an old complex with inadequate off-street lots, street parking is permitted.

You don’t want to visit Park La-Brea Towers during the wee-hours. Many streets are gated, and the gates are closed. Everyone is home, and so are their cars.

I went at 2 a.m. last week. I was in luck because someone was leaving as I arrived, so I could slip through the gate before it closed. Since the streets were empty, I was able to drive slowly and peer at the buildings to find the number. Then I searched and searched, but all street parking spots were occupied. I found spaces in the reserved lots, but signs warned of terrible consequences for wrongful parkers. I noticed a car parked directly in front of my building and decided to do the same.

Drawing near, I saw a ticket on its window. I wasn’t willing to take the chance. I couldn’t phone the apartment because the family didn’t have an American cell phone. I phoned the agency and woke up the person who sent me (it’s a boutique agency, so the owner sometimes takes calls). I told her to call the family and tell them to send someone down to watch my car and plead my case if parking enforcement arrived.

Someone duly appeared, and I went upstairs. As usual, delivering medical care was the easy part.

Overdressed for Summer

It’s August. Wearing a suit and tie, I’m reminded of how much I resent hotels that refuse to let me park free. I only learned that the Casa Del Mar didn’t when the clerk declined to validate, and I was stuck for $20. But the Casa Del Mar is on the beach where it’s cool enough to walk a few blocks without suffering.

The Sheraton in Pasadena is in Pasadena where it’s ten degrees warmer than Los Angeles. The average summer day in Los Angeles is tolerable but opening the car door in Pasadena is always a shock. Worse, I travel to the Pasadena Sheraton to see Virgin-Atlantic crew who are British. Foreigners, Arabs excepted, believe that air conditioning is bad for the health. When anyone gets sick, they turn it off, so not only do I arrive at the hotel in a sweat but go about my business in a hot room.

Another Free Service

A caller in Huntington Beach was having a panic attack. He had had them before, and he needed a doctor to come and make sure he wasn’t dying.

This was a bad call in many ways. Waking me at midnight was not one, because I don’t consider that a big deal. Making a housecall for a panic attack is risky because victims often improve while I’m driving and cancel, and Huntington Beach is 45 miles away. There’s not much a doctor on the spot can do with medicine for a panic attack  (“a shot” doesn’t exist).

Finally, the caller didn’t know the fee; I would have to tell him.

In his distress, he had searched the internet and found a national housecall agency. Most such agencies tell callers the fee, so by the time I hear from them, they’ve agreed to pay. But this particular agency specializes in foreign airline crew and tourists with travel insurance where the fee is already arranged. On the rare occasion when an American contacts the agency’s answering service directly, it simply passes the call onto me.

I knew that my fee to Huntington Beach at midnight including a 40 percent cut for the service would never pass. Worse, once I mentioned it the horrified patient would quickly get off the phone.  

That wouldn’t bother an operator, but once someone asks a doctor for help, he or she is obligated to help (ethically obligated; in reality maybe not). So I held off delivering the bad news and kept the conversation going. 

After forty minutes of soothing and reassurance he began running out of gas and admitted that maybe this wasn’t an emergency. He agreed to keep my number and call if he changed his mind.