Saving A Hotel’s Bacon | The Life Of A Hotel Doctor | By Mike Oppenheim, M.d.

The consultation took place in a small room off the hotel’s main ballroom. I could hear the crowd murmur. Inside gathered half a dozen worried employees including the general manager who had called another hotel to get my name. Failure in this situation would be depressing. The sales manager vehemently denied feeling upset, and I had no reason to doubt her. She also denied doing anything to injure her neck.

“Did you do anything recently you don’t ordinarily do?” I asked, grasping at straws.

She considered then admitted she had felt queasy an hour earlier and taken a pill a colleague had offered. It was Compazine, a common nausea treatment. That meant nothing. Then it did. I could barely contain my exhilaration. Phenothiazine drugs - Compazine, Thorazine - occasionally cause a weird dystonic muscle spasm. It’s so rare most doctors never see one, but I remember a case that arrived when I was visiting the Bellevue emergency room as a first year medical student. In that incident, the patient’s tongue stuck out, and she insisted she couldn’t retract it. The residents on duty confidently diagnosed hysteria, and it took a while before they figured it out. Treatment is the familiar antihistamine, Benadryl. I carried Benadryl. Within minutes of receiving the injection, her head came unstuck. Everyone was delighted.

In 1985, Marina Marriott security summoned me at one a.m. Arriving, I encountered an odd scene. Earlier, a guest at the bar had asked a waiter to light her cigarette. When he complied, her forefinger burst into flame. She had recently put on acrylic nails, and the fresh cement is very flammable. Drunk and enraged, the guest had refused to go to an emergency room. By the time I appeared, she had grown tired of hurling abuse. Head resting on the table, she was sobbing. Spilled drinks and broken glass littered the area.

Security officers had cleared out the bar. Near the entrance, a crowd of security personnel, clerks, patrons, and the night manager parted to allow my passage. Although not a master at handling drunks or psychotics, I understood the soothing effect of an older man with a grey beard, wearing a suit and carrying a doctor’s bag. Standing quietly until she looked up, I introduced myself and suggested we go to her room. After dressing the burn, I stayed long enough for her pain to give way to the effects of alcohol, and I could assure everyone she would cause no more trouble.

In 1989, a guest at the Ramada in Beverly Hills had showered and shaved and was nearly finished dressing when he stretched to reach a hairbrush, striking his nose against a clothes hook with enough force to bring tears of pain to his eyes and blood to his nose. After pulling himself together, he noticed the hook had been installed precisely at nose level. This was clearly, in his judgment, a poor design decision and certainly dangerous. A hotel that tolerated such an unsafe condition was irresponsible and perhaps legally liable. The guest was, of course, a lawyer.

Fortunately, I lived barely three miles from the Ramada, so I arrived at the general manager’s office only fifteen minutes after his call. The guest interrupted his harangue as we exchanged introductions. I could see a small abrasion on his nose. From an ethical point of view, this was awkward. A doctor’s sole obligation is to his patient, but it was obvious the manager wanted help in fending off the furious guest. Getting the patient out of the office might defuse matters, but when I suggested privacy for our consultation the lawyer told me to take care of things on the spot. So I examined his nose. This took a few seconds, the amount of time I needed to look at the abrasion. A few seconds was far too little. Young doctors love to blurt out a diagnosis as soon as the patient walks through the door (which is possible more often than you think). Not only do patients find this offensive, they don’t believe it, so doctors learn to give the impression they are thinking deeply before announcing an opinion. I stared thoughtfully at the nose from several angles. I carefully palpated it. I pulled out my otoscope and peered up his nostrils. Having performed a thorough exam, I scratched my beard and mused thoughtfully. Finally, I turned to the guest and announced he had suffered a superficial nasal contusion that, fortunately, had done no harm. He needed no X-ray, no treatment. He was fine. He could go about his business.

According to the law, a person has no grounds for a suit unless he has suffered damage, but any competent lawyer can discover damage in any situation. Instinctively, the guest checked his watch and discovered he was late for an important meeting, but I doubt visions of profit had brought him to the manager’s office. He was upset at his pain and wanted sympathy. The manager had expressed regret and offered to comp the guest’s bill but had maintained his dignity. A humble apology would have worked better. Still fuming, the guest asked my professional opinion of the public health hazard in installing clothes hooks at precisely nose level. I agreed the matter deserved attention but pointed out that noses come at many levels.

Medical science has no cure for drunkenness. This doesn’t seem widely known because hotels regularly called for help. I always began by asking if the guest wanted a doctor. The answer was never yes but followed by assurance that the hotel would pay my fee. This was awkward. A doctor is not supposed to care for someone who doesn’t want a doctor, but when a hotel appealed for help I did not like to refuse. No one called for a drunk sitting quietly in a room, and it was rare that security officers hadn’t already tried to defuse the situation, so an inebriated guest for which a hotel yearned for my skills was bad news. Suggesting calling the police never worked because (like calling paramedics) their arrival ruffled the businesslike atmosphere hotels prefer. Also, arrested guests rarely turned into repeat customers.

Confronting drunks, I enjoyed certain advantages. I was older than any employee, conservatively dressed in a suit with white shirt and tie, and obviously a physician. These qualities tended to inhibit anyone inclined to abuse, but they worked best in people who think rationally. Drunks and psychotics are not impervious to my charisma, but they’re unpredictable. Obstreperous drunks nurse a grievance against someone: the staff, a lover, or life in general. Providing an attentive audience helped as long as they didn’t insist on action, so I tried to get them talking. Success gave me a sense of accomplishment after the fact but no pleasure at the time. Drunks are boring. Patients with a functioning brain who recite their troubles hold my attention because they tell a coherent story. I listen for inconsistencies or opportunities to give advice. While these patients don’t accept everything I say, they give it serious consideration. Not so with crazy people, drunks included. Their stories don’t make sense. When they say something they consider insightful, they repeat it again and again. If I question a detail that seems illogical, they wave me off. Crazy people never admit they’re wrong. Long ago, in medical school, psychiatry professors interviewed delusional patients for our education. Invariably, one of the smarter students would address the patient, providing irrefutable evidence that he couldn’t possibly be, say, the son of God. It never worked. My encounters with drunks had a sameness that doesn’t make for entertaining anecdotes. To illustrate, an executive staying at the downtown Omni learned he had been fired. After drinking too much, he phoned his boss to discuss the matter only to learn the boss was also in Los Angeles. Efforts to get a room number from the front desk failed, probably because his boss was in another hotel. But drunks do not discourage easily. His increasingly loud appearances at the front desk made the staff nervous, so they consulted me.

Drunks obsess about their grievances because no one wants to listen, so they cheer up when someone expresses interest. He followed me to a quiet corner of the lobby, and I composed myself to look attentive as he explained that his dismissal was inexplicable and possibly an error because four months earlier his performance review had been entirely positive. Having a copy in his possession, he proceeded to read the two pages. I agreed it was flattering. He reread a passage praising his efforts to improve customer service then asked why a company would dismiss someone it clearly valued. I agreed this sounded unreasonable. Then I made the usual mistake of those speaking to the deranged and asked a logical question: what might have happened since the performance review to upset his superiors.

“Improved customer service,” he repeated. Looking down, he consulted his review and found more evidence of injustice. As he recited a passage praising his imaginative contributions to marketing, I decided my role was to keep quiet and nod from time to time. Suddenly there was silence. A housekeeper was operating a vacuum cleaner at the far end of the lobby; the drunk gentleman lay back in his chair, snoring. I had fallen asleep, too. Feeling pleased at a tedious job well-done, I proceeded to the front desk for gratitude and payment. Unfortunately, at that time the Hyatt was not a regular where everyone knew me. Signing out at the change of shift, the day manager had mentioned summoning a doctor to deal with a drunk but failed to add that the hotel had agreed to pay, so the night manager told me to take up the matter during the day.