Freebies And Dodging Bullets | The Life Of A Hotel Doctor

I heard muffled sounds, and then a female voice came on the line. Elderly men invariably handed the phone to their wives. “We just flew in from Chicago, and we leave for Tahiti in three hours. I feel so stupid... We went off without our medicine. Is there any way you could see us and write some prescriptions?”

Tourists regularly forgot their pills or lost them or packed them in luggage that disappeared. Authorities discourage doctors from prescribing without a thorough evaluation. Housecall agencies virtuously explained this, then sent a doctor who wrote prescriptions for heart pills, cholesterol pills, diabetes pills et al, then collected the usual fee. I could not bring myself to charge for writing prescriptions.

“I don’t have to see you. If they’re medications you take regularly, I’ll phone a pharmacy, and tell them to give you some more.”

“That’s so nice. My husband takes Lanoxin.” “And what dose?” “What dose, Frank…? He says the usual.” “Point two five milligrams?” “Point two five milligrams, Frank…? He says that’s probably right.” “How many do you want?” “Just enough till we get back.” The woman paused either to calculate or simply because she felt I was psychic. I repeated the question. “Say fifteen. He also needs Glyburide for his diabetes.” “What’s the milligrams?” “What milligrams, Frank…? He’s not sure, but it’s a little green pill.”

The man required three prescriptions, his wife four. Their recollections of dose and dosing schedule were vague. I determined several by consulting the Physician’s Desk Reference, but details of the wife’s “for my stomach” pill remained a puzzle, so I chose one that seemed harmless. I compromised on two other uncertainties by prescribing the lowest dose. The elderly take so many medicines there’s a good chance many are unnecessary. The call took fifteen minutes.

“We’re so grateful for your help, doctor. How can we pay?”

“No charge. But I’d like you to tell the manager how nice I was. This is a competitive business.”

The woman laughed. “I’ll do it first thing.”

Asked about payment after providing phone help, I always refused, then suggested the guest praise me to the hotel staff, and the guest always treated it as a joke. It was a joke, mostly, and I doubted many obeyed, but I hoped a few would.

Fifty-two guests were too sick to remain in the room but not sick enough for paramedics, so I loaded them into my car and drove to wherever they needed to go, almost always an emergency room. Calling a commercial ambulance service meant at least an hour’s wait, and leaving was not an option because I would have worried intensely. Patients do not always follow instructions even when consequences could be disastrous, and I dreaded having a guest die in a room after I’d left. Transporting a patient in a doctor’s private car is a legal nightmare. All authorities warn against it; no insurance covers it; colleagues roll their eyes on learning I did this routinely. Yet it solved everyone’s problem. Driving is the quickest way to reach a hospital – quicker than paramedics. Guests appreciated it. Finally, when the guest disappeared through the hospital doors, I felt a burden lift from my shoulders. His or her fate became another doctor’s responsibility.

The Third Factor

An army officer, his wife, and three children were spending the night in a Los Angeles airport hotel in 1992, preparing to ship out to an overseas base, when the wife fell ill.

The army does not hand out generous transportation allowances, so it housed everyone in a single room of a Days Inn. Furthermore, the family had apparently brought all its worldly possessions. Arriving, I squeezed my way past dozens of boxes stacked along the walls and between three rollaway beds where the children slept. The wife had a cough and fever. I suspected pneumonia, rarely a serious disease in a young patient. A course of antibiotics takes care of it. But this woman looked sicker than usual. I noticed a touch of shortness of breath. While not alarming, it required that I think things over (95 percent of a doctor’s patients demand no deep thought, but it’s a bad idea to miss that five percent).

Doctors constantly weigh the pros and cons of a situation. Mostly they make a decision based on facts or gut feeling, but now and then a third factor intervenes: whether the decision causes inconvenience. Thus, if you’re a patient, it’s never good to be the final appointment before lunch or last at the end of the day. Thinking about, say, ordering a chest X-ray for which you’ll go to the X-ray department and return with the film half an hour later, the doctor will order the test if he’s certain you need it. But if he’s not certain, the desire to get out of the office might tip the balance. Very rarely, including this third factor leads to a decision that comes back to bite the doctor in the ass. I’ve been around long enough to follow a rule: if I’m about to chose an option that saves aggravation, I do the opposite.

That rule definitely applied here. Getting that family to an emergency room would involve a tedious effort. Why not simply give medicine and call back in a few hours to check? If she were sicker, I’d send the paramedics. Remembering my rule, I reluctantly announced that the wife needed to go to an emergency room now.

The father did not normally care for the children, so I sat patiently for half an hour as he woke the children, struggled to dress them, made several phone calls to reschedule his flight, then shifted a dozen boxes between his wife’s bed and the door. After this was well under way, I left to bring my car, parked two blocks away. Fitting six people into a tiny Toyota took additional effort.

It was a relief to usher them into the waiting room, explain the situation to the clerk, and say my goodbyes. It was a greater relief to learn, when I called later, that the wife lay in the ICU and on a respirator. According to the doctor, she was not the traditional army wife but a drug addict now suffering a catastrophic pulmonary infection.

Dodging a Bullet – Again

The phone rang as I was pouring out my breakfast cereal. A young woman at the Airport Marriott told me her stomach was hurting, and she had vomited once. It sounded like the usual gastroenteritis. People with upset stomachs don’t like to wait, and I could have arrived at the Marriott in half an hour, skipping breakfast, if she hadn’t added that she was feeling better. Hearing this, I told her I’d come in my usual “within the hour.”

Breakfast took thirty minutes, so I knocked on her door in exactly an hour. I knocked again when no one answered, then knocked several more times. The door was locked. I was considering calling Security when I heard the lock click. The door remained shut, so I pushed it open. The room seemed empty until I looked down to see a naked woman, prone and motionless. She had apparently crawled across the floor to unlock the door.

Dragging her back to bed, I phoned the paramedics who whisked her off. She turned out to have a ruptured ectopic pregnancy. Symptoms of even disastrous problems wax and wane; she had called during a period of waning. Had I eaten a more leisurely breakfast, she might have bled to death internally before reaching the operating room.

I can usually tell during the initial phone call if a guest is sick enough to require paramedics, but at least a dozen times I arrived in the room before it was clear the guest needed urgent attention. Once I decide to call the paramedics, I kiss my fee goodbye. No one has ever paid me. The guest is too sick to think about money. His or her companion is so upset, and I’m reluctant to bring up the subject. Once firemen and paramedics fill the room, clumping about with their tools and gurney, it’s too late. Invariably, however, as the guest is wheeled out and everyone follows, the spouse turns and thanks me warmly for my attention.