In 1988 I visited a Sunset Strip hotel to see a guest complaining of the flu. When I arrived, I took his temperature, and it was high. The examination was normal, but patients with influenza have a normal exam.
This was one of the rare occasions I realized what a good doctor I was. It had nothing to do with intelligence; all doctors are smart. It was not a matter of diagnostic acumen which is also fairly common. This patient revealed that I possessed an intuition that went beyond the facts. Doctors hardly ever need it, but "hardly ever" is not the same as never.
All flu victims look miserable, but something about this man's misery made me uneasy. He was forty-one and in good health otherwise. Flu is not life-threatening in this age group, but he looked so bad I couldn't bring myself to leave him in the room.
Explaining that he required further attention, I helped him into my car, and drove to an emergency room. The next day I phoned the emergency room doctor and learned he had admitted the man who died a few hours later. The doctor was as mystified as I. We theorized the guest was suffering an overwhelming infection from an unknown source. Perhaps he took drugs. This was early in the AIDS epidemic, and victims sometimes died abruptly when their immunity vanished. We never found out.
The guest had paid before I took him to the hospital, but his check bounced.
* * *
"Thank God! He's over there! I think it's an emergency!"
Such a greeting when I emerge from the elevator means a cardiac arrest. Despite the impression left by television, cardiac arrests outside of a hospital are almost always fatal. The fatality of the few I encountered was 100 percent, and this did not look like an exception. Kneeling clumsily on the bed, an overweight security officer bounced up and down as he pounded an old man's chest. The guest's false teeth had jarred loose and protruded from his mouth; I plucked them out.
Security officers attend a CPR course now and then, but opportunities come rarely, so they forget the details. Cardiac massage on a soft bed doesn't work. The officer should have dragged the guest onto the floor. A colleague should have been giving mouth-to-mouth respiration, but it's impossible to persuade laymen to perform something they consider disgusting. I asked how much time has passed since the arrest.
"I don't know. He was out when I got here." gasped the officer. "Could you take over? I'm beat."
My exam indicated the man had been dead for some time. Hearing this news, an elderly lady in a nightgown hovering nearby burst into tears. At that moment, two paramedics and two firemen stomped noisily into the room accompanied by a man in a suit and a young woman, apparently the manager on duty and the concierge. Arrests always attracted too many people.
Observing the corpse and the weeping woman, the senior paramedic flipped through the pages on his clipboard for the proper form. "Is that your husband, ma'am? Could you give me his name?"
She couldn't. Disobeying my rule about staying out of the way in the presence of paramedics, I crossed the room and threw my arms around her. This is one time physical contact between doctor and patient is OK. Lowering his clipboard, the paramedic waited patiently. This was the single activity paramedics are happy to leave in the hands of a physician. After a few minutes, she became calmer.
Disposing of a dead guest took time. Two police arrived and took down the wife's story a second time. Shortly after retiring, she explained, her husband had awakened with gas pains, so she had called the concierge who called me. A few minutes later, the husband had lost consciousness.
One by one, the staff left, followed by the police and paramedics. The medical examiner's ambulance drove off with the body, and the lady returned to bed. She couldn't find her sleeping pills, so I provided them. I left my phone number and promised to call in the morning.
Doctor Oppenheim has been a hotel doctor in Los Angeles for thirty years. He has made about 15,000 visits.