Italian Healthcare

"You know you are over the hill when the mind makes a promise that the body can't fill."

Little Feat, Waiting for Columbus-1977

I know you haven't heard from me in more than a week but I think you'll excuse my tardiness. Last week I started feeling off; I didn't have the spring in my step and I fought constant queasiness. I thought perhaps it was the familiar malaise I reluctantly welcome during the autumnal season change. I have seen this movie many times; I soldier on until the mild depression lifts. I also have had the standard gastro-intestinal issues that face most aging Jewish men. I also have not adjusted to the European custom of eating dinner at lunchtime my big meal of the day is still supper. Because restaurants close at 6.00PM I usually make myself a nice dinner in my flat, not extravagant or fancy, but I don't eat of boxes. I did not touch my suppers two nights in a row...I just wasn’t hungry.

Then Friday night it hit.

Imagine a riot breaks out between ANTIFA and Proud Boys whilst be speckled, middle-aged election volunteers recount the Georgia presidential ballots. Folks are blinded by flash bombs, deafened by the report of gunfire and terrified by the insufferably laughable and pathetic Tiki-torches brandished by the even more pathetic, white supremeists, Nazis, and skinheads. And no self respecting political fracas would dare call itself a "riot" unless there were at least one or two Molotov cocktails.

Welcome to my belly.

The next morning, Saturday, the riot thankfully had been quelled by the calvary. Unfortunately they neglected to remove the Extra Terrestrial germinating in my gut…man where is Sigourney Weaver when I need her?!?!? The pain got so severe that I had to see a doctor. I phoned one of my friends and before you could say “gastro intestinal,” Stefan was standing in my flat. He called an ambulance and while we were waiting I was doing "Price is Right" in my head on how much this would cost. Thankfully I have a short term International policy.

The ambulance arrived and my first question was “How much is this going to cost?”. My Italian is admittedly worse than bad, but I definitely know that I know how to say “How much does this cost?” Nonetheless, the ambulance drivers looked at me like I was speaking a different language. They responded with “Cosi intnendi?”..what do you mean”… Another Italian phrase I know quite well. I repeated in my best singsongy voice trying to sound like Ida Lupino when she was on I Love Lucy, “Quanto costa questo?” And I saw the “aha-phenomenon” exploding in their eyes and they sort of chuckled and said “E gratis”..it’s free. Stefan said that all health care in Italy is free…no charge for anything. I immediately hobbled into the ambulance, a retro-fitted Citroen mini-van and off we went.

When we arrived at the hospital I was immediately wheeled directly into triage. There was no filling out of forms, no waivers, no indemnifications, and definitely no wristband that looks like I am a VIP at the I Need an Appendectomy Rockfest 2020. As they wheeled me in I noticed that they had those old fashioned light fixtures like we had in elementary school when I was a little boy; they look like the old fashion upside down ice trays with the annoyingly buzzing fluorescent light tubes. “OK”, I thought, “Not state of the art, but this thing is about to burrow out of my navel anyway” or they’ll make me feel better." Other than the ambulance asking a few a questions and looking at my passport, there was no admittance process. Nonetheless, 30 minutes after calling for the ambulance, I was in a bed with an IV for fluids and pain. Forget that I was still in wearing the same clothes in which I’d arrived, including my shoes, I was feeling better. A few minutes later, a nurse came into to take me for a CT scan. Again she spoke very little English but we communicated and helped each other understand. Getting the CT was much like the states except the equipment looked like it came from a hospital-going-out-of-business auction, though I assume it was in perfect working order. At this point, I was rather impressed. The place was depressingly dated and they clearly had a resource gap, but it was enough; I felt like I was in reasonable care and the orderly wheeled back to my area in ER triage.

Awhile later, a different nurse came in and told me I had pancreatic cancer. I immediately panicked knowing what that meant and began to ask her rapid-fire questions; she started chuckling and said "non un cancro, INFEZIONE!". OK, I understood now; I have an infected pancreas. “Quando posse vedare un dottore? When can I see a doctor?" And she says ‘presto” soon. I know in doctorspeak that basically means “when we feel like it”. It went downhill from there. Because of Covid, the rooms were as sparse as the language barrier was insurmountable. My bed was in a corridor with several other patients because they needed the triage for other ER patients. The doctors wanted me to stay indefinitely for observation, but 26 hours in, I knew I could convalesce better at my flat. I also learned that there were private hospitals that accepted my insurance. My discharge papers indicated that I needed to see a specialist and get an MRI. I asked around and my friend Leone said to go the “Hospital Gemilli; it’s where the Pope goes”. That seemed like a pretty good endorsement. We tapped into the Jewish Mafia and within 5 minutes I had appointment with one of the pope’s GI doctors.

My other friend Gianluca picked me up this morning and we drove up to the northwest side of Roma. Gemelli is the university hospital for the best medical school in Italy; it is a huge campus, with four or five 7 story buildings. When we entered the hospital complex, I had the weirdest sensation of needing to play Scabble. Really weird.

On the way, I shared with Gianluca that I was more than a little concerned that when I stepped through the door, I would trigger the Circumcision Detector and a big Star of David would turn red and blare out the distinctively European siren sound of OOO-AH, OOO-AH, OOO-AH and I’d be whisked away for a private consult with “Dr. Torquemada”. I breathed a sigh of relief when I safely crossed the threshold. This was a much more western experience and one that was more familiar. It was an easy and efficient process and I was in and out in an hour. Doctor Rispielli was really nice, he examined the notes from the ER, examined me and indicated though I was recovering nicely, he wanted to see an MRI without haste. What happened next would never happen in the US, ever. Doctor Rispielli picked up the phone on his desk, made a quick call and jotted down some notes. I figured he was making a tee time or calling his bookie because I knew he was asking about availability, he needed it soon and he talked about money. Sure enough, he slid over the chit with the notes and said “Tomorrow you have an MRI. Here is the information and it costs 550 euro.” I was shocked; jaw open, eyebrows raised. There was none of this calling of the number to make an appointment and bringing in a 3rd party testing company and we don’t know how much it costs and all of the shuffling of the paper. The head space of the physician more patient focussed; the patient. Not the hospital administration, not some cubical sitting actuarial at some insurance company in Kansas, but the patient. Me.

I learned that I had basically broken my pancreas by not taking care of myself. Eating and drinking like I was on holiday for a solid month had caught up with me and my body is revolting; not like the sight of me makes others gag, but my body got all Roberto Duran on me and said “no mas”. Pardon the Little Feat riff, but as I age there is a widening gap between what I crave and what my body won’t accept. I fasted for two days and a liquid diet for another day and a half. I feel fine now, I really do but I know that I am not healed. I will radically change my diet for at least the next month and stay away from alcohol for the foreseeable future. I also learned how other countries do healthcare. During a period of 72 hours I saw a completely free system that is strained, needs resources but provides adequate care for the vast majority of Italians. Had a global pandemic not been raging, I suspect it would have sufficed for me. At the other end I went to arguably the best hospital in Italy and saw one of the Nation’s most qualified doctors who trains the next generation of Italian GI specialists. He made an appointment for an MRI on my behalf….that costs 1/10 of what it costs in the US. Bear in mind, I am choosing to pay for the MRI and taking the expensive route, yet the cost is still about the same as my co-pay in the US. The contrast between the two were glaring yet the similarities are staggering; we could learn a lot.

Be well and I look forward to sharing the rest of my birthday adventure soon!