The life of a hotel doctor: how many tablets in the bottle…?

If you Google the appropriate terms, including the year 2003, you'll find a story about a Los Angeles doctor who had trouble with the California Medical Board over his generosity in prescribing drugs to famous actresses. It's probably safe to name him, but two months ago I named another doctor, someone I liked and who often asked me to cover his very nice hotels. The column mentioned a few quirks but in friendly tone, a foolish mistake. Every writer knows that, aside from public figures, people who see their names in print are always outraged unless the contents are entirely flattering. He was outraged. He hasn't spoken to me since.

A hotel guest who wants a Demerol injection or Oxycontin pills must behave more or less like someone in pain. If he becomes too demanding, reckless, or reluctant to pay, even a generous doctor might wash his hand of him. Referring a disagreeable patient to another doctor is considered bad manners, but it happens.

"Incredible! You answered the phone! I never called a doctor who answered the phone himself!"

"I'm one of the few."

"The concierge gave me your number. Janice. It's a weird situation, but I swear it's the truth, and I need your help. Desperately."

Another drug abuser. Not all called after midnight but a fair number did. While this is an invented scenario, you have my word that I've engaged in identical dialogues dozens of times.

"I came back to the room, and my medication was gone. The maid threw it out when she cleaned. Can you help me?"

"What was your medication?" Guests often called for missing prescriptions, but there was no chance this gentleman needed penicillin or heart pills.

"Vicodin. I've had four back operations."

"And how many tablets in the bottle?"

"Almost two hundred. That's how many my doctor gives."

My wife disliked being awakened, but she kept quiet if it sounded like the caller was in distress. Long experience hearing ‘and how many tablets...' persuaded her this was not one of those cases, and she began suggesting I get off the phone.

"I swear it's true. I've had four back operations, and I'm in constant pain. I have meetings all week, and I can't function without medication."

"That's a lot of Vicodin."

"Check me out. I'll show you the scars. I need your help. Please."

A combination of hydrocodone and Tylenol (Vicodin, Lortab) may be the most popular prescription drug in the US. Ironically, narcotics (the class that includes Vicodin, Percodan, heroin, Oxycontin, and morphine) are safer than the other class of pain remedies, the nonsteroidal anti-inflammatories (Advil, Motrin, Naproxen, aspirin) because they don't cause GI bleeding. But they are addictive in people inclined to addiction.

The world is not divided into addicts and normal people. Plenty of individuals take more drugs than they should and for the wrong reasons but continue to lead productive lives. It depends on the drug. You can't do this with speed. Speed drugs like amphetamines and cocaine poison tissues, the brain most of all, so the lives of heavy users eventually fall apart. Alcohol is also a toxin; alcoholics ruin their health. This doesn't seem true for narcotics. One can consume high doses for a lifetime with no noticeable harm except chronic constipation. Street addicts die from overdoses, contaminated drugs, disease spread from dirty needles, and violence. In countries that provide clean narcotics, addicts enjoy a normal life expectancy.

No one objects to giving narcotics for a fatal illness like cancer. Experts once frowned on narcotics to treat chronic pain such as arthritis; nowadays they're sometimes prescribed. They are probably useful for selected patients who have a doctor who pays attention, but there's no denying too many people are taking more narcotics than they need. Good doctors object because there are better methods of treating chronic pain, although these methods take more time. Moralists object on the grounds that doctors should make patients feel normal but never happier than normal (Peter Kramer, a psychiatrist, delivers a delightful discussion of that subject in Listening to Prozac).

"As a hotel doctor, I encounter this problem now and then..."

"I swear I'm not a junkie, Doctor Oppenheim. I have chronic spinal pain, and I'm under a doctor's care."

"I'm glad to hear that, because before I prescribe narcotics I have to speak to your doctor."

"He's in New York. It's five a.m. in New York."

"I know. So I'm going to phone three piroxicam to the all-night Walgreen's at Santa Monica and Lincoln. Tell your doctor to call me tomorrow." Piroxicam is a good pain remedy but not a narcotic.

"He's on vacation. A hundred Vicodin. I'm begging you!"

"Three piroxicam is my limit until I talk to your doctor."

"The damn hotel threw out two hundred pills! They said you'd replace them!"

"I don't work for the hotel."

"Where is Doctor (censored) when I need him? He never gave me this hassle. Do you have his number?"

"It sounds this is unacceptable to you. So..."

"I'll take the piroxicam."

This would satisfy him till morning; the odds were one hundred percent his doctor wouldn't call, but he would, and I'd refuse more pills. There was a small chance he'd move to another hotel and pester another doctor. There was a large chance he'd behave in a sufficiently obnoxious manner that, after a few days, the exasperated hotel staff would take any complaint about me with a grain of salt.

Doctor Oppenheim has been a hotel doctor in Los Angeles for thirty years. He has made about 15,000 visits.

Authors contact:
Mike Oppenheim
Email: michaeloppen@yahoo.com.

Related articles

* Advice from a Hotel Doctor
* Freebies and dodging bullets
* How I became America’s only fulltime hotel doctor
* Saving a hotel's Bacon
* The life of a hotel doctor
* The life of a hotel doctor: Competitors
* The life of a hotel doctor: Getting help
* The life of a hotel doctor: I receive an official reprimand
* The life of a hotel doctor: Referral fees
* The life of a hotel doctor: Stepping on toes



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Medical Director: Board-Certified by American Board of Anesthesiology 1994, former chief of cardiac anesthesia, University of Nevada School of Medicine.

Board-Certified by American Board of Pain Medicine 1997, Clinical Assistant Professor University Nevada School of Medicine