I’m recently back from a weeklong stay in the hospital here in Perugia, which turned out to be fascinating from a “sociological” standpoint (comparing medical care here with that in the U.S.), an impressive example of what good medical care looks like, and (once I felt better) a bit of a writing retreat. Because I know that medical care in Italy seems mysterious to many people (and may be grossly misunderstood by some), here, for your education and amusement, is my little saga.
When the medical issue arose, I saw my doc, who sent me to a specialist the next day (let’s call him Doc #1). He taught me that there’s no place for modesty in Italian medical practice. On this doctor’s orders, and with him and a medical student watching me—and in front of an open ground-floor window—I stripped. It’s amazing how quickly you can decide some things just don’t matter. After a quick exam, he delivered his verdict: hospitalization.
Day 1 (Wednesday):
I call to confirm that I’m being admitted today and am told which unit to go to. That’s right, there’s no central admitting office. A lovely gent in white scrubs admits me, all the while discoursing about his likes and dislikes regarding other languages (French = bad, Portuguese and Spanish = good). He’s happy to practice his patchy English, which makes things easier for me, because I discover that every shred of my sorta-kinda B2 level Italian (true only on an excellent day) has fled my brain. Fortunately, my friend with a heart of gold who drove me to the hospital is there to translate.
Admission Guy, who turns out to be a nurse, shows me to my room, teaches me the essentials, then leaves with a cheerful “Get in bed!” I snag the window bed and stow my stuff in my locker.
My friend leaves, and moments later I’m again lying almost naked, this time in front of Docs #2, #3, and #4. After much discussion over my exposed body (at one point Doc #4 kindly pulls the sheet over me), a plan is made. Doc #4 leaves, and Docs #2 and #3 (attending and resident, as far as I can tell from the scrub color hierarchy) spend a long time asking me questions and going through all the medical records, lab work, and so on that I’d brought with me (organized in an accordion folder for easy retrieval. Recommended!).
Word of advice: I’d written my medical history in Italian, figuring it would make everyone’s lives easier, and it does. Just try to remember how to say “diethylstilbestrol exposure” and “gall bladder surgery” in Italian when you’re under stress, not to mention citing key dates of your medical history on the fly. I’d also written a chronology of the medical incident that brought me to the hospital, which the docs copied for my chart
All that said, and not surprising, there are certain complete disconnects between the realities of U.S. medical care delivery and Italian doctors’ ability to understand such a system. Perusing the history I’d written, they want to know why I’d stopped taking, years ago, a longtime cardiac medication I’d been on for a benign arrhythmia. Deep breath. I explained that the insurance company, who was also the caregiver (i.e., an HMO), wouldn’t let me see a cardiologist. When I called to renew my prescription, the pharmacy said they were out of the med and didn’t know when they could get more. RED FLAG. I had a very bad feeling about this. Sure enough, a few days later they called to say they couldn’t get the med at all and WAS THERE A REPLACEMENT THEY COULD ORDER FOR ME? I suggested that perhaps, since they were, you know, pharmacists and I was a patient, they could figure that out, or (big leap of imagination here) call a goddamn cardiologist. At this point I started weaning myself off the medication; it’s dangerous to cold-turkey it. And, miracle of miracles, though I still had the arrhythmia, I had no symptoms. So I stayed off the med and the HMO still refused to let me see a cardiologist.
Docs #2 and #3 are staring at me as if I’ve just spoken gibberish—which, given the complexity of the story and my limited access to Italian at the moment, it probably is. I try again, repeating the key points, and they still cannot fathom what/how/why this could happen. Me neither. We move on.
Admission Guy comes back and starts the fastest, least painful IV I’ve ever had, and I praise him and he praises my veins. He draws what looks like a quart of blood from the IV site, then caps it off and hands me a narrow tube to pee in. I look at him questioningly and he says, “It’s easier for man than woman,” to which I can only agree. He goes off in search of a cup.
As I settle in, I learn the idiosyncrasies of what will be my “home” for (I think) a few days. The bedside table has two handy water bottle holders—for the water I didn’t know I should bring. Other necessities to bring: all toiletries, towels, nightgown/pajamas, a robe or other cover-up (for traipsing to the lobby to buy water and coffee or cruising around), and a decent pillow—unless, that is, you enjoy nesting your head on a sack of concrete. The bathroom has no lock, just a “libero/occupato” sign to flip over. Hope people read around here.
The docs come back for more exams, more conferring. Vitals and labs and daily reports are entered into a laptop, and there’s also a paper chart—a little notebook about my stay.
Lunch arrives, sans cutlery and a napkin. I think they’ve forgotten it, so I bum plastic cutlery from the nurse. Turns out we need to bring our own, plus a coffee cup. If you’re wondering whether hospital food in Italy is a cut above that in the U.S., the answer is sometimes. But you do get to choose a primo and a secondo, so you know you’re in Italy.
A roomie arrives. It’s a man—surprise! He’s not here long, though, so the room is all mine for the evening. (Later I decide that they’d just parked him here temporarily.) I doze with a nice breeze on my face, then decide to figure out the TV (a maybe-20-inch hung high on the wall—but hey, it’s a Samsung!), for which there’s no remote. My kindhearted nurse drums one up and I tune into a show about the writer Andrea Camilleri, the author of the Inspector Montalbano books, who died today at age 93. Sadness.
It’s pretty quiet on the ward. I sleep until they wake me for meds and several scans of my hospital ID band (about every 4 hours, I think). Then at 6am the lights come on, the curtain flies open, and a housekeeper bustles in and dusts for (I kid you not) all of 15 seconds. If someone is going to wake me up at 6am, she should make it worth my while. Apparently housekeeping is a task-based system, because later someone else appears with a mop, and later another someone else cleans the bathroom and empties trashcans.
Day 2 (Thursday):
Another day, another blood draw. These people are good. Vitals are taken; my breakfast of two slices of dry, packaged, salt-free toast (no, I’m not on a restricted diet) and plum jam arrives; and then the docs breeze in en mass for more conferring and exams au natural. Doc #3 (the resident) speaks decent English, as does Doc #2 (the attending), to a lesser extent, so we discuss my case, along with how much Doc #3 misses Roma; the fact that Doc #4, whom I saw the day before, is from Latina, which is the province of my maternal grandfather’s hometown; and how my dog care arrangements turned out—because, I now discover, I’ll be here at least through Monday.
A new roomie, a young woman, arrives with her mother. She introduces herself and shakes my hand, which I accept reluctantly, because who knows why she’s here and what she’s got? But social propriety is important, even in the hospital.
I sign consents for a biopsy and to have photos taken (for possible medical journal use, though it turns out the lab also wants them), and then Doc #3 preps me for the biopsy. (Everything is done in the room.) She gives me four injections of a local anesthesia around the biopsy site, warns me that I’ll have stitches and a small scar, then gets to work. She’s excellent.
I am really impressed with these docs—they are smart and super-thorough, ask a ton of questions and listen carefully to the answers, and consider all the data in a big-picture way. They’re friendly, warm, reassuring, calm, and efficient—and very concerned about my dog care arrangements.
More friends of the hearts-of-gold variety arrive, laden with all the stuff I need. Hooray! I have my laptop and WebPocket wi-fi gizmo now, which I hadn’t brought because I thought I’d be here only a couple of days and I didn’t know if there’d be anywhere to lock things up. (There’s unsecured wi-fi here, which I avoid.) One friend brings me a jar of peanut butter, an excellent emergency provision. We chat for a while, and then Admission Guy/Nurse comes in and—in the craziest small-world scenario—remembers Peanut-Butter Friend from some group hikes in the 1990s. They reminisce and we chat about languages again before my friends leave.
Dinnertime. I learn that minestrone and roasted chicken are good bets. Boiled potatoes come with no salt or anything else, so I dunk them in my minestrone. Not bad!
One unfortunate aspect of the timing of my hospital stay is that I’m missing all of Umbria Jazz. I’m bummed, and I’m even more bummed when a friend tells me that Funk Off, a brass-and-drums group that parades along the main corso every day during the festival, came to the hospital to perform. BUT NOT ON MY UNIT! Boh!
Roomie has visitors, and then her mother stays over, sleeping in a chair the hospital provides. In the hall outside our room it’s party central until about 10pm, complete with a shrieking toddler, lots of deafening chatter, and a nurse whose voice could shatter glass (and not with a high C). People like that should be barred from working the night shift, in my opinion. The noise continues until about midnight, my roomie’s mother snores, and I’m having more discomfort than usual, so it’s a miserable night.
Day 3 (Friday):
Another morning, another blood draw. The nurse and I chat about Leonardo da Vinci (sparked by the book I’m reading, Walter Isaacson’s fascinating biography of Leonardo), his Benois Madonna that’s on loan at the National Gallery of Umbria in Perugia, various museums in Paris, and where I’m from.
Doc #2 appears with Doc #5, who will be covering on the weekend. More exams, more questions, more discussions. Doc #2 calls Doc #1 (preadmission) and asks him to come by to take a look at me. A very tall, very bubbly guy, he shows up in the late afternoon to examine me—and of course inquires about my dog. I’m tempted to whip out a photo, but this doc moves as fast as he looks exuberant, and in a flash he’s gone.
The dressing on my biopsy site is coming loose, so I survey what’s underneath. Looking good, and there’s zero pain—how is that possible? It wasn’t a scraping, they dug a hole!
Dinnertime. My roomie picks up her tray and says, “Buona cena.” I’m tickled by the courtesy.
In the evening Doc #2 comes by and discusses the day’s lab results and a possible plan for the weekend. She’s on call and says not to hesitate to call her during the night if needed.
Admission Guy/Nurse comes by to check on me in the evening, even though he’s not my nurse. What a sweetie!
Day 4 (Saturday):
Buongiorno! My day begins at 6am with a blood draw. I’m groggy, so we don’t chat.
While I have my biscottate, jam, and tea, a nurse changes the bed. Today I get clean bottom and draw sheets only; maybe pillowcases and top sheets are an every-other-day thing. I make a mental note to find out, because, I mean, who doesn’t want to know this stuff?
Food mystery #1: one package of biscottate (which should contain two slices) has one intact piece and some fragments, which, when combined, do not equal a whole piece. Maybe the person who packaged it also packaged the "pair" of calzini I bought recently, which contained only one sock.
Docs #5, #6, and #7 (a suspected med student) arrive (Docs #2 and #3 are off for the weekend). This time we speak Italian only, but because I’m feeling more alert it’s okay. More exams, more questions. As the docs leave, I nab #5 and ask what the plan is, and he says they’ll wait for today’s lab results and maybe start a new treatment tomorrow.
I get my IV med while the docs are here. Once I’m untethered, it’s time for coffee, so I wander down the hall to the machine in the waiting room. The coffee at the hospital’s bar is excellent, but I’m not ready to face that much of the public. I’ve been there quite a few time times as a visitor/outpatient, and aside from good coffee, pastries, and sandwiches, as well as decent pizza, it’s a fascinating place, a hub for hospital employees of all stripes, EMTs, visitors, outpatients, and inpatients brave enough to stand in line in a bathrobe and slippers. In other words, people who are less vain than I am. (I always get a kick out of seeing the sign for the bar, because my kneejerk American interpretation of the word is so not-hospital-appropriate.)
The bar here is far more interesting than the American cafeterias I’ve been in. It’s vibrant, filled with caffè-fueled chatter and greetings and comings-and-goings. U.S. cafeterias, in my experience, are drab and dull and depressed-looking, with isolated people pushing inedible food around their plates, worried-looking visitors, and an air of enervation. Maybe it’s the good coffee and cornetti here that make the difference.
I get my cappuccino, then wander off to another waiting area. Beyond the parking lot, there are open fields and a farmhouse. I can imagine what the owners thought when they found out a hospital would be built here, and I hope they got a decent price for their land. Ospedale Santa Maria della Misericordia was founded in 1303; this modern facility—which reminds me of an airport, with spokes leading to various “blocks,” complete with street names, emanating from the main entrance—was built in the 1980s, I believe, with additions and updates since then.
On my way back to my room I peek into a room marked “Cucina,” and smile when I see a large Moka caffettiera. That’s for the staff, though; we patients get caffè d’orzo, a barley coffee that (trust me) you don’t want to drink. There are three giant teakettles for making the twice-daily tea I’m offered.
Food mystery #2: how does “polpetta in brodo” (meatball in broth) translate into one sad, dry meatball on a plate? Advice: avoid the pasta. Cooked greens are a win.
I love the fact that the fruit I get with every meal arrives rolling around on my tray as if bent on escape. So I’ve developed a new game, which I call The Fruit Rolling Index. Retroactively, I give yesterday’s three small apricots a 10. I can’t think of a fruit that would be more unstable, except maybe some loose grapes or an entire cantaloupe. Okay, that could actually happen, so the apricots get a 9.
My roomie offers to get water for me, then refuses to let me pay, so the generosity baton is now in my hand. Later I hear her tell someone on the phone that I speak some Italian, so maybe she’s warning them that she can’t gossip about me. She and the medical staff are very curious about where I’m from, what I think of Italy, etc.—as l’americana, I’m the novelty in the unit.
Day 5 (Sunday):
A quiet day—no vampire poking my veins at 6am, no bed linen change. It’s Sunday, after all, and work is limited to the essentials.
I write all morning. Turns out a hospital stay, when you’re feeling pretty good, makes a fine writing retreat. I churn out 2,000 words before lunch.
Doc #5 comes by and is very pleased with my progress. Now there’s a chance I’ll get sprung on Tuesday. Fingers crossed.
My biopsy site is clean, no swelling or redness. Brava, Doc #3!
Lunch arrives. I remember to wish my roomie a buon pranzo. She hasn’t let me buy her water or coffee, so I’m still one down in courtesy points.
Food surprise! The roasted potatoes have rosemary on them! Rolling Index game: a large peach, pretty stable. I give it a 3.
The afternoon whizzes by with reading and more writing. I get up to stretch and look out the window. Across the way, someone has hung a towel and some clothing out the window to dry. Just like home!
A post-op patient with head and leg dressings rattles by with his walker and IV pole. I wish I’d started counting the number of times he’s traversed the hall; he’s very motivated. Earlier his wife or girlfriend walked with him, now it’s a tall young man. Warms my heart.
Dinner arrives. Roomie beats me to the buona cena. I’m down two courtesy points again. Food Rolling Index: apricots again. Damn, where’s the challenge? But they’re riper and less inclined to roll, so I gleefully downgrade them from a 9 to an 8.
Another food surprise, minus the glee: prosciutto cotto isn’t a nice warm slab of cooked ham I'd hoped for, it’s the packaged stuff you buy at the grocery store. I try making a sandwich with yesterday’s slice-of-bread-in-a-bag, but the bread is stale. (I can safely say that “fresh” isn’t a word that ever described this bread.) I plop the ham on my plate and slice it up. The pasta in my soup is about four minutes past al dente, but I forgive the cooks. I imagine the ritual: boil water, cook pasta, drain, repeat. And repeat and repeat and repeat and repeat. A little grated pecorino would go a long way, though.
Day 6 (Monday):
My IV med gets interrupted for a trip to radiology. The orderly hums and scats along the way, and I ask him if he sings in a chorus. He says something about all the orderlies singing, but I don’t quite get it, so, to cover, I joke that he’s my singing gondoliere, which he likes. We whiz through what seems like a mile of corridors and take two separate elevators down to the radiology department. As an inpatient, I get to jump the line of people who are waiting, numbers in hand. On the way back Singing Orderly tells me we’ll fare un giro to another department and escort a patient to the breast unit.
Docs #2 and #3 come by with Docs #8 and #9. Another exam, much discussion. They agree on a probable diagnosis (pending some tests that will take a while) and a new treatment. We resume the IV med, but it’s leaking, so they pull it. A student nurse comes by to draw blood and puts a gel, topped by some gauze, on a giant hematoma left by a previous draw (I bruise easily). I’ve never heard of such a treatment, but when I take off the gauze, the hematoma is much improved. Very cool!
Lunch arrives, along with a major disappointment—I forgot to order fruit. So much for my game.
When my first oral med arrives it seems ceremonial, presented to me on a square of gauze like an offering. I take it. Now we wait.
Dinner: no fruit again. Major fail.
Day 7 (Tuesday):
The cleaning crew wakes me at 6am, as usual. I think the guy who changes the linens has it in for me; once again I get no clean top sheet or pillowcase. Unfortunately, when I go down the hall to get coffee and get locked out of my unit, Linens Guy is the one who lets me in. Tomorrow I probably will get no clean sheets.
A nurse comes by to ask if I have any pain. Belatedly, I realize the nurses do this every morning and evening; it’s as much a ritual as the barcode scan of my hospital ID bracelet. Quite civilized!
Docs #2 and #3 come by, with a med student. Lab work validates Doc #2’s diagnosis, but they’re puzzled by some persistent symptoms, so they want me to stay until Thursday. This is becoming quite the productive writing retreat. It’s also become clear that thoroughness and patient well-being are what drive the docs’ decision-making, not money. THIS IS AMAZING. No one is rushing to get me out of here because of crappy insurance coverage and massive copays/deductibles. In the U.S., this stay would have cost me at least $6,500 (aside from monthly premiums), the amount of my annual deductible. For a weeklong stay, I imagine it would have been much, much more.
Roomie goes home. She, her mother, and I exchange “auguri”s, and then I wash out some clothing and hang it to dry. With my laundry flapping in the breeze, I’m beginning to feel like I live here. My friends who are taking care of my dog probably feel like it too.
Rolling Index game: a very purple but very hard peach for lunch—a 10. Dinner brings two ripe yellow plums with somewhat flattened ends. Very stable. I give them a 4.
Day 8 (Wednesday):
Housekeeping comes to mop the floor and I lie in bed listening to morning chatter accompanied by the banging of metallic objects. Then there’s a big crash, followed by some sort of alarm. I’m curious but don’t want to risk skiing across the wet floor to find out what happened.
My new roomie arrives while I’m having breakfast (I’ve really gotten to like the biscottate, btw). She’s elderly and seems quite ill; her husband and daughter look worried. They barely get her settled before the nursing staff wheels her away again.
Linen change. Just the draw sheet again. But it’s a different guy, so I guess this is normal—unless my nemesis left him instructions.
Docs #2 and #3 come by and we all agree I’m much better. Home tomorrow! Doc #2 impresses me again by anticipating every question I was poised to ask her. I feel very lucky.
Rolling Index game: very stable peach, virtually immobile. I give it a 1. I think we have a winner!
Docs #2 and #3 redux, plus Doc #4: quick exam, confirmation of tomorrow’s discharge and action plan. Since Doc #4 seemed to have some doubts about the diagnosis yesterday, I ask his opinion. He’s on board with it, but the tests we’ll do later will be proof.
Roomie has been back for a while. She’s got an NG tube now, but she and her family got good news; things aren’t as serious as the docs first thought. Hooray for Roomie!
Oh, Admission Guy. Really? REALLY? I have been mobile the entire time I’ve been here, and I’m sitting here fully clothed, typing, and I’m going home tomorrow. Did you really need to caution me not to use Roomie’s bedpan?
It’s gonna be a rough night. Roomie needs attention, so the lights are on half the time and there’s a fair amount of noise and activity.
Day 9 (Thursday):
I’m going home! Docs #2 and #3 have given me the all clear and answered my questions. Doc #2 inspects the language workbook at my bedside and asks if I like Italian. I say yes, and she says it isn’t necessary and I say it is if you’re living here. She concedes the point.
Roomie is better! She’s mobile now, and sitting up in bed. And Post-Op Guy is zipping down the hall with his walker. I give him a thumbs-up and praise his speed, and he shoots back a big smile.
Doc #3 reviews the discharge instructions with me. They’ve set up several follow-ups for suture removal, some tests, and a consult with another specialty. I’ll have to get the prescriptions from my GP because they can’t prescribe them here, but when I say my GP doesn’t have office hours until the next day, Doc #3 gives me a one-day supply. Then I’m off to order copies of my hospital files (12 euros) for pickup here later, and then I head out into the blazing heat with Peanut-Butter Friend, who’s driving me home.
Total bill for 8 days of hospitalization, who knows how many exams and consults, IV and oral meds, a ton of lab work, X-rays, and the pending appointments and tests:
Yeah, that's a zero. To put that in perspective, for a year of care here under the national health service (which encompasses all GP visits, routine screenings like mammograms, emergency care, and hospitalizations), I pay roughly the equivalent of 2 months of my 2018 insurance premiums in the U.S. (For visits to specialists or access to private doctors/facilities, I’ve paid anywhere from 17 to 100 euro. Pocket change compared to many thousands of dollars in annual U.S. insurance premiums.) I had excellent care, which I can say with some authority since I used to be, eons ago, an RN.