|
MEETING #1643
4:00 P.M.
January 4, 2001
House Calls
by James A. Fallows M.D.
Assembly Room, A. K. Smiley Public
Library
Summary
House calls in Redlands were more frequent in past years. Some were
life-saving, some were unusual, some were by automobile and some by horse, Many were
enjoyable because of the fine patients who became friends. This paper documents a
selection of house calls from thirty-five years of medical practice in Redlands..
Biography Of The Author
James A. Fallows M.D. is a retired
physician, having practiced Internal Medicine at the Beaver Medical Clinic for 35 years
until retirement in 1990.
He was born in Abington, Pennsylvania, in
1925. After graduation from Harvard Medical School, he trained at hospitals in
Philadelphia, and served in the U.S. Navy at Bethesda National Naval Medical Center, and
first came to California to be on the staff of the U.S. Naval Hospital in Corona,
California. He is a Fellow of the American College of Physicians and the American College
of Cardiology.
In Redlands he has served on the School
Board. He headed the Intensive Care Unit for its first fifteen years. At times he has been
active with The Redlands Racquet Club, Redlands Mounted Police, Rim-of-the-World Riders,
Redlands Symphony Orchestra, Trinity Episcopal Church, the Fortnightly Club, Friends of
the Library, the Kimberly Shirk Association, the Beaver Medical Clinic Foundation, the
YMCA, Medical Explorers of BSA, and others. In his medical practice and subsequently he
has been interested in and aided by computers.
His wife, Jean, his four children and their families have always been
a joy to him.
House Calls
by James A. Fallows M.D.
Introduction
Yucaipa – with computer bag
These days I make volunteer computer house calls to help friends who
are starting to use computers. However a few weeks ago a previous patient (I have been
retired for ten years) called for help for his wife, who had been ill for two days and her
next appointment would be four days away. Taking a medical bag I drove to see her in
Yucaipa. After examining her and advising her, I said, “Let’s check your blood
pressure.” I have two medical bags that
look alike. What a surprise to open my bag and find a maze of computer cables and
attachments! Fortunately she had a good sense of humor when I could only reassure her that
electrically she was fine. I thought later that she might have said, “I didn’t
ask for a digital exam!”
Coverage by internists
In our early years, except for taking turns on weekends,. we five
internists were on call every evening. That allowed for recognition of our patients’
problems.
There was no Urgent Care Center. There was no physician in the
hospital’s Emergency Room. Every hospital physician was assigned a day and night to
respond to calls from the Emergency Room.
Documentation
House calls were frequent and helpful in the years when I practiced
Internal Medicine with the Beaver Medical Clinic in Redlands from 1955 to 1990. Although
house calls are still made, circumstances have made them infrequent. If I consider at
least two house calls per week for 35 years, a wealth of recollections from more than 3500
house calls exists. I plan to document some of the highlights. I’ll group them as
Lifesavers, Unusual, Automobile, Horseback,
and Local.
LIFESAVERS
Millie Darrah – subdural hematoma
We were having dinner at a restaurant when my daughter, Katie, called
to say that Millie Darrah had phoned but Millie could only give her name before fading and
hanging up. I called Millie. There was no answer. I left dinner and went to her home in
Braemar Apartments. Looking in the window, I could see her slumped unconscious on the
sofa. I couldn’t rouse her and I couldn’t open the windows or doors. The fire
department responded with their “jaws of life” to break open the door. Millie,
who was on anticoagulants, had fallen onto her head and sustained a subdural hematoma, a
collection of blood compressing her brain. Soon after T Loma Linda Hospital neurosurgeons
with burr holes were able to evacuate the clot. Millie did well for some years after that.
Harold Baker – pacemaker
I had known Harold Baker from horse rides, where he rode a mule. I
knew he was pacemaker dependent. Harold’s wife called when I was seeing office
patients to say that, because of episodes of faintness, he had phoned Saint
Bernardine’s Hospital to check the pacemaker’s function. The report was
favorable, but he continued to have episodes. A few minutes after I arrived at his home in
Kimberly Apartments, he fell to the floor, unconscious. In attempting to revive him I
found that he recovered consciousness when I raised his left arm next to his head, and
slumped when I lowered it. It was obvious that his electrode was separating when he
lowered his arm and that he looked good on the phone call while his arm was up holding the
phone. I held his arm up while we rode in the ambulance to Saint Bernardine’s where a
replacement electrode was inserted. He did well for some years after that.
Earl Nicks – aortic aneurysm
Another office hours phone call was from Earl Nicks, a longtime
patient and friend, who was having abdominal pain and faintness. On the house call soon
after I found he was pale, was in a cold sweat with low blood pressure, and he had an
enlarged and tender abdominal aorta. Those symptoms meant that he was bleeding from an
aneurysm of the abdominal aorta, a medical emergency. I called the hospital and then put
Earl into the Porsche I was driving then. Surgeons Ralph Weaver and Craig Wesson
interrupted the elective operation they were planning and immediately operated on Earl
Nicks, saving his life.
Penicillin allergy – anaphylaxis
A phone call from a patient who lived a few blocks from the clinic,
said that she was feeling very faint and unable to drive. On an urgent house call, I found
that she was in shock with cold sweat and low blood pressure. She had a history of severe
penicillin allergy. Her son had taken a penicillin tablet for an infection. The mother had
unthinkingly drunk the rest of the water from the glass. Surprisingly this was sufficient
for her to have an anaphylactoid reaction. Rushing her to the clinic we gave her
intravenous fluids, cortisone, and other medications. We were relieved to see gradual improvement of her condition.
Teenager – insulin reaction
Blood sugar control methods have improved in recent years. Diabetic
teenagers have had a more variable response to insulin so that a severe overdose can cause
confusion, convulsions or unconsciousness. Several times over the years an emergency house
call has been followed by dramatic relief after injection of glucose or glucagon when the
patient was too ill to drink orange juice.
Phil’s - Dr. Jacobsen’s apnea
As I was driving on Redlands Boulevard, I saw Dr. Joe Hayhurst
entering Phil’s Restaurant with his medical bag. I stopped and went in too. A diner
was in severe respiratory distress, blue, unconscious, and barely breathing. It became
obvious that he was choking on a piece of meat that was too far down for us to see or
feel. Dr. Joe used a knife from the kitchen to to do a tracheotomy, which is a cut into
the windpipe below the obstruction. I borrowed from Bob Hatfield a hollow tube from part
of his fountain pen and inserted it to allow breathing and relief. In the hospital I was
able to remove the chunk of meat. Dr. Jacobsen, the patient, was later able to return to
his medical practice in San Bernardino. Dr. Joe told the story on Art Linkletter’s
show. Dr. Jacobsen sent me a gift sweater each Christmas for several years.
Conant Halsey – verbal motor aphasia
A few years ago when I called our Fortnightly Treasurer, Conant
Halsey, he responded with only a few sounds. Knowing that he lived alone, I went to his
house and found that he had a kind of stroke with verbal motor aphasia, meaning that he
could not talk. We had the pleasure of having his company in our house until his speech
returned.
UNUSUAL ONES
Pager beeping at dump
During an on-call
weekend I drove a truckload of bush prunings and garden cuttings to the dump. On return
home I realized my pager was missing. I called the answering service and had them page me
on a continuing basis. At the dump those beeps guided my search for the pager. I have
thought that a similar system would be helpful for a golf ball in the rough.
Bryn Mawr – narcotic fix
Before there was an Urgent Care Unit, I answered a call to Bryn Mawr
late in the evening. In a creepy setting with her boyfriend hovering over me, my
examination of a writhing woman pleading for pain relief led me to believe her pain was
not real and that she wanted a morphine fix. After I had given her a sedative instead, I
felt relieved after I was able to back away from the threatening look of the boyfriend and
drive away.
Washington D.C. flight
The daughter of one of my patients heard that I would be attending a
medical meeting in Washington, D.C. Her father, a wheelchair patient with cardiac disease
needed to fly to Washington, Accompanying him and with the aid of a slender wheelchair, we
made an uneventful trip. And my ticket was paid for.
Oxford – Annie Throop
One of our sons, Jim, married Debbie in Oxford, England. When Annie
Throop, an elderly patient with diabetes and congestive failure, told me she was
determined to attend the wedding, having known Jim from his childhood. I explained the
risks to her health, but she was willing to take that chance. At Oxford before the wedding
I received a message that she was in a London hospital. After locating her, I arranged her
transfer to Radcliffe Infirmary, a famous Oxford Hospital where penicillin was discovered.
On the flight from California Annie Throop had not been given her usual insulin and her
food was too salty. She responded to treatment and was able to attend the wedding in
Queen’s College.
Because I was the volunteer head of the Redlands Community Hospital
ICU for its first fifteen years, I visited ICU’s in many cities in United States as
well as in Rome and Paris and London. Radcliffe Infirmary at that time had outstanding
consultants including Dr. Barnard of South African fame and Dr. Beeson, head of Medicine
at Yale. The Radcliffe Infirmary had opened as Oxford's first hospital in 1770, mainly due
to a bequest made by Dr John Radcliffe who was the Physician to Queen Anne. When I asked
to see the ICU there, I was told they did not have one, but that they did have one monitor
that they moved to the patient who needed it most. I rationalized that, forced to choose,
it was better to have a lack of equipment and excellent physicians, instead of the
opposite.
AUTOMOBILE
Yucaipa - Police on way to asthmatic Al Marshall
As I was rushing to Yucaipa because of Al Marshall’s asthma, a
policeman stopped me for speeding. Fortunately for Al the policeman said “follow
me” and we arrived soon after.
Indio – angina
We took care of many patients from Beaumont, Banning, 29 Palms, and
Indio because at that time there were limited medical facilities in those areas.. My
farthest “local” housecall was to see a longtime patient in Indio whose
condition made transport, except by a very long ambulance ride, difficult. I remember
taking equipment with me to do an electrocardiogram.
HORSEBACK
Garden St. and Mariposa
From time to time I made house calls by riding up Garden Street to
visit Howard Marsh, a gracious, talented and generous man. He had established the
Hilltop Foundation that funded hospitalization for needy working families in association
with the physicians of the Beaver Clinic providing free care. Howard Marsh had also
provided the fifth floor of the hospital tower and funded the monitoring equipment that
led to the hospital’s first DOU.
Further on I would visit by horseback Dr. Walter Power on Mariposa.
He had been a founding member of the American College of Surgeons while in New York City.
He moved here in middle age because of tuberculosis and did well pursuing scientific
inquiries almost to his death at 102 years.
San Timoteo Canyon – Search & Rescue
As a member of a rescue exercise by the Redlands Mounted Police, I
came upon a simulated victim. I remember telling him that, if this were real, I would
immediately attend to his injuries, but instead I would take his picture. We even had an
ambulance come to his remote location in the hills south of the San Timoteo Canyon.
San Gorgonio – Exhaustion Hypotension
Four of us were riding horses on a trail halfway to the summit of
Mount San Gorgonio, the highest peak in Southern California. Lying by the trail was a
young man. He felt lightheaded with faint pulse when he tried to stand. Without breakfast
or water he had run to the mountain top and was running down when he became faint. After
he was given some water and a snack, he lay across my saddle as I led my horse down for
rest and relief.
LOCAL
Matt Bromberger – broken arm
Many years ago a phone call led to my going to the woods of Smiley
Heights, undeveloped at that time. Fritz’s son, Matt, had fallen out of a tree and
his arm was hurting. One of his friends asked in a low voice about removing his shirt.
When Matt heard me answer, “We’ll have to cut it off.”, you can imagine his
“oh, no, not my arm!”
San Mateo – Saudi Arabian prince
Prince Khaled, of Saudi Arabia, who was attending the University of
Redlands, became ill. At his house on San Mateo I was met by his veiled wife in flowing
dress. She led me though incense and lilting music to his bedside. He was most pleasant.
After my exam and advice in those days of limited long-distance calls, he phoned the
palace to report. Although he later invited me to Riyadh to join him in falcon hunting. I
have not had that opportunity.
Memorable Redlands people
Redlands is known for the high quality of its residents. I treasure
the memories of house calls to many, including President George Armacost of the University
of Redlands, Bill & Frank Moore of the Daily Facts, Father Keene at Sacred Heart,
Catholic Sisters at the house known as the Burrage Estate, Father Cummings at Trinity
Episcopal Church, , Ambassador Frances Willis. and weekend calls to Stillman Berry of this
club and to Mrs. Shirk at Kimberly Crest..
Bibliography
http://www.ucihealth.com/seniors/v1n1a.htm
http://dept.gatech.edu/vpea/news_releases/cyber.html
Health care providers soon will be able to examine patients in their
homes electronically, thanks to a joint venture of The Medical College of Georgia, the
Georgia Institute of Technology and a group of telecommunications executives.
http://aging.utmb.edu/clinical/housecall.asp
Program cares for adult patients age 65 and older who are homebound
in Galveston County and who would in most cases require an ambulance transfer to get to a
clinic or physician appointment.
The Geriatric House Call team consists of a Geriatric Nurse
Practitioner, a Social Worker and a Faculty Geriatric Physician.
http://www.columbia.edu/cu/news/00/03/telemed.html
Doctors Reinvent The House Call: $28 Million Telemedicine
Demonstration Project Is Largest Ever Funded By Federal Department Of Health & Human
Services
Initially, 1,500 patients from Northern Manhattan (Washington
Heights, Inwood, and North and Central Harlem) and rural areas of Central and Upstate New
York will be enrolled in the project. Computers with devices to read blood sugar, take
pictures of skin and feet, and check blood pressure will be placed in half of these
patients' homes and the other half, the control group, will continue with the care they
usually receive from their providers. The American Diabetes AssociSation also has designed
a special "trusted" website -- no marketing or advertising -- for participants
in the telemedicine project that offers comprehensive and reliable information on diabetes
management in both English and Spanish and at levels that all users can understand.
|