Sunday, August 17, 2014

A Tropical Disease

They had just flown in explained a father at 1 a.m. While in Hawaii, their two year-old had suffered mosquito bites followed after a few days by fever, restlessness, and refusal to eat. Checking the internet (my heart sank….) he learned about dengue fever.

I explained that dengue is a viral infection that produces the usual symptoms of a viral infection (fever, body aches, general misery) and has no cure. He agreed but pointed out that deadly complications, although uncommon, did occur, and he wanted the child examined.

Before leaving, I consulted a medical book to refresh my knowledge of dengue fever. I’ve never seen a case. The child did not seem terribly ill. Certainly there was no sign of shock or internal bleeding, the typical complication.

I reassured the parents.

Wednesday, August 13, 2014

A Difficult Hotel

The J.W. Marriott is not a regular, but its doctor is not a friend, so I don’t turn down its calls which arrive now and then.

Driving downtown, I had no worries about the patient, a toddler with a cough, but recalled that visiting the J.W. Marriott could be a frustrating experience.

Sure enough, the parking valet ignored a request to hold my car, gave me a parking slip, and drove the car deep into the bowels of the hotel.

The elevator required a room key. I waited for a guest, but apparently new technology makes it impossible to piggy-back on another’s key. I walked to the front desk and asked to use the elevator. This struck the clerk as an odd request.

An elderly man in a suit, carrying a doctor’s bag, and claiming to be a doctor might or might not be telling the truth. She politely quizzed me on my motives, phoned the room to confirm, and then asked me to wait while she summoned a security officer.

The officer remained at my side until the guest opened the door. After the visit, I returned to the lobby and handed over the parking slip to be validated. The desk clerk stared at it as if she had never seen one and then excused herself to consult the manager.

I waited several minutes until she returned to hand back the slip and explain that the hotel “was unable” to validate parking.

Downtown hotel parking is brutally expensive, and I remembered the same difficulty during earlier visits. Everyone hates hotel parking; cashiers are immune to arguments, so I simply scribbled “hotel doctor” on the slip, shoved it through the window, and hurried away to stand at the curb. No one ran after me, and after five minutes my car appeared. 

Saturday, August 9, 2014

It's Summer

A blast of hot air greeted me when the guest opened the door. As I complain regularly, foreigners believe air conditioning spreads disease, so when someone falls ill, they turn it off. They dress for the heat, but I wear a suit and tie. Asking them to turn on the air conditioner is like asking a Moslem to eat a hot dog, so I pretend nothing is amiss and go about my business ignoring the sweat soaking my shirt. It’s summer.

Most of the year, I have no objection to leaving my car a few blocks away to avoid the hassle of hotel parking. I don’t do this when it rains, but rain is rare in Los Angeles. Summer is guaranteed; I dislike making the walk in warm weather and regret it even more if the guest has turned off the air conditioning.

Beaches exist in Northern Europe, but they’re chilly with the sun not much in evidence. Southern California beaches seem more inviting, so Britons, Germans, et al relax, doze off, and acquire gruesome sunburns.

Summer is my busiest season. The phone wakes me three or four times per week, but I don’t mind wee-hour visits. Parking is easy, guests are grateful, and with no office waiting I can take a nap whenever I want.

Tuesday, August 5, 2014

A Bilingual Doctor at Midnight

A guest wanted a doctor who spoke French.

“I don’t speak French, and it’s midnight,” I pointed out. “You won’t find a bilingual doctor to make a housecall at this hour.”

The operator promised to inform the guest and call back. Waiting for people to call back is one of my least favorite activities especially if I have been aroused from sleep. Fifteen minutes passed before the phone rang. The operator apologized for the delay, explaining that the guest wasn’t answering, and she didn’t want to keep me up. When she reached him, she would suggest a housecall for the following morning.

I agreed, adding that I could arrive around ten. The hotel was in Norwalk, thirty miles away, and I prefer to avoid the rush hour.

I went back to bed. Half an hour later the phone rang. It was the operator announcing that the housecall was on for 10 a.m.

Freeway traffic was in the category of “could have been worse,” but I arrived on time. No one answered my knock. According to the desk clerk, the guest was part of a tour group that had checked out earlier.

There is no lesson here. It’s part of a hotel doctor’s life.

Friday, August 1, 2014

I Save a Life

The phone rang at 5 a.m. but I am an early riser. April Travel Insurance told me of a lady with a cough at the Residence Inn in Manhattan Beach. Vacationers hate to get sick, so even a bad cold produces wee-hour calls.

This sounded easy. It was a fifteen mile drive, but the freeways were clear, and I would return before the rush hour.

Guest often feel obligated to demonstrate how miserable they feel, and this lady coughed loudly from the time I walked in. Listening to her lungs was difficult because she wouldn’t stop, but what I heard was not reassuring. A bad cough doesn’t necessarily mean a bad disease, but this patient had one ominous sign: she was my age.

Long ago, pneumonia was called, perhaps sarcastically, the old man’s friend. Nowadays, we usually treat it as an outpatient but not in the elderly who are, I say with reluctance, too fragile.

I phoned April's office to explain that the lady needed a chest x-ray and possible hospitalization. This is bad news for an insurer. An ordinary emergency room visit costs over a thousand dollars, an admission for pneumonia twenty times that. Some travel services work hard over their fine print to avoid responsibility for expensive incidents, and I occasionally urge guests to go to the hospital after they’ve learned that insurance won’t pay.

April doesn’t do that. The dispatcher quickly agreed to arrange matters. Later that day, the husband informed me that his wife had been admitted for pneumonia. That meant I had saved her life. I don’t save a life often, and it makes me feel good.

Monday, July 28, 2014

The No-Housecall Mode

Half a dozen times per year, a hotel guest suffers a bloody nose. I don’t make housecalls for nosebleeds because there’s nothing I can do. Treatment is to pinch the nose, releasing pressure every five minutes to check if bleeding has stopped. I tell guests to repeat until they get bored. If bleeding persists, the next step is cautery or nasal packing, both of which require expertise.

I regularly hear “I can move it, so I know it’s not broken…” but this is as true as most popular medical theories.  Examining a wrist, finger, ankle, foot, or ribs I can suspect a fracture, but I’m never certain. Most common fractures aren’t urgent, so I often tell guests it’s OK to wait to see if there’s quick improvement. If not, they need an X-ray.

All insect bites look the same, bee stings included. Redness and itching spread, peaking at two days before slowly fading. I explain this over the phone, but guests often want me to take a look.

When a guest suggests he has bronchitis, I immediately go into no-housecall mode because this is a fake diagnosis doctors use when they prescribe an antibiotic as a placebo (other fake diagnoses are “sinus infection” and “strep”). You may be surprised to read that bronchitis is not a disease but a fancy medical term for coughing. 

Not every guest who mentions bronchitis is demanding an antibiotic, but all are seeing me for the first time. They’ve seen their family doctor many times, and if he or she routinely prescribes antibiotics (so common even good doctors do it), my failure to do so requires an explanation. Most guests accept it, but a minority do not conceal their disappointment, and a tiny minority are upset.

I hate it when I do the right thing and patients are unhappy, so I refer these guests to a walk-in clinic where the doctor will probably prescribe an antibiotic for their bronchitis. 

Thursday, July 24, 2014

Lost On Campus

It was after nine when I left for Long Beach, thirty miles away. Freeway traffic moved swiftly; the patient was a sixteen year-old with a sore throat, usually an easy visit.

Google maps guided me to 1250 Bellflower Boulevard which turned out to be the student union of California State University in Long Beach. 1250 Bellflower Boulevard is the address of the university, not any particular building. The student union was deserted. It was the summer break. I left messages on a cell phone that may or may have been the patient’s.

A couple walking nearby pointed me in the direction of distant residence halls which, when I arrived, did not look like residence halls. I phoned the travel insurer who had sent me. The dispatcher managed to contact the patient and then passed on her directions. She was not familiar with the campus, so I couldn't find her. I told the dispatcher that, since the patient was an adolescent, she was undoubtedly part of a group with a group leader.

The patient agreed that such a person existed and went off to find him. After a considerable delay he came on the line, determined my location, and talked me through a complex warren of street to the proper building. As usual, caring for the patient was the easiest part.