Archive | October, 2012

Happy Halloween

31 Oct

Today is a red-letter day: my bandages came off! Don’t worry, I won’t scare you with the dopo-intervento (after surgery) photos. My doctor says it looks good despite heavy bruising. It was only 6 days ago I had the procedure — and 6 very long days in bandages taking sponge baths. Now I feel free-as-bird without all that added bulk, and I can go back to walking 7km per day.

I cannot adequately describe the positive experience this has been and how pleased I am at the outcome. My legs are a mess now, but already the pain I was experiencing is non-existent. I credit my doctor for making the whole process easy. I had confidence in him from the minute I met him. As you know from my previous post, the hospital was excellent. While there were “moments” for me traversing this landscape with my limited Italian, I am glad I put myself out there and got the problem addressed. And I am oh-so-glad that many of you had a belly laugh at my expense. A few people have approached me and said “I need to get that done.” Ladies, do it! Wear the doggone compression stockings and get the problem addressed. Maybe you can do a medical vacation and have it done in Rome. 🙂  I can make a referral.

Today is Halloween, which is not really celebrated here. There were a couple of parties last weekend, but this time of year is really about the religious holiday of All Saints’ Day. So tomorrow, we have the day off. We get the Italian and the American holidays off, which means November is truly blessed: 1 Italian and 2 American holidays.  I believe the count is 6 extra holidays for us in 2013. Just to make my American colleagues feel better, if an Italian holiday falls on a Saturday or a Sunday, we do not get the corresponding Friday or Monday off.

We have no Butterfingers or Snickers tonight, and no cute kids in costume, but there is a nice primativo open and some dark chocolate around here somewhere. My friends also know I used to decorate the yard for Halloween, and my office was decked out the past few years as well. In celebration of getting my bandages off, and in honoring the day, here is my decoration for tonight.

Happy Halloween! The mummy bandages from last week have been replaced by my Halloween pumpkin socks. 

Bonus photo: Scene at Campo dei Fiori last weekend.

Just like the Portland Farmers’ Market, but with better espresso. I do miss the Santa Rosa Burritos, though. Can someone ship one here?

 

 

Piccolo intervento chirurgico

26 Oct

The hospital is quite far from our home, but a wonderful private driver, Maurizio, who first took us from FCO airport to our new apartment last May, agreed to do the honors and drive us to the clinic — and home again at night. It’s about 18 miles (28.8km) one way. That is not far by American standards, but it is quite far by Roman standards, nearly to the beach at Ostia. In late morning traffic it took us an hour.  It’s possible to go by public transportation, but as this was not to be a day at the beach, a private driver (autista private) it was.

In the U.S. we’d arrive before dawn, having fasted the night before, which I did. My doctor said I could arrive at the luxuriously late hour of 11:00AM because my blood panel had been done prior. And I goaded him into letting me have my caffè (or two) as the anesthetic would be only local with an optional sedative. I was opting out of the sedative (I hate that out of control feeling), so caffè va bene.

This is a private clinic, 100% devoted to cardiology and vascular medicine. Private clinic, private patients (read: private insurance), scheduled elective and non-emergency procedures. Molto tranquillo. No chaos, overhead speakers, elevator music, or rushing about, and very few patients from what we could see. After stumbling through admissions with our limited Italian language, where there seemed to be some challenges in entering information from the insurance company’s letter of guarantee, we were sent to another floor where a nurse greeted us with a hearty “Good morning!” Great, I thought, I have an English-speaking nurse. This will be easier. That, however, seemed to be the end of her English skills because in the room I got a stream of Italian. Here’s a partial  clip:

Nurse in Italian: Change into pajamas and wait here. Rest.

Me in Italian : What pajamas?

Nurse in Italian:  Your pajamas.

Me in English: Good thing I packed a set. (Nurse shrugs.)

Me in Italian: Then what?

Nurse in Italian:  Wait here; Surgery is in the afternoon. (It was now about 11:30.)

So Ric & I pass the time reading, talking, with occasional interruptions from nursing staff for minimal health history and information. (I still have not filled out a form, but I signed a couple that said if anything goes wrong it is all my fault.)

This experience certainly stretched my Italian skills. There is a game called: Is-My-English-Worse-Than-Your-Italian-Then-Let’s-Use-Italian-and-You-Can-Struggle. Often the Italians I encounter understand more than they speak, just as I understand more Italian than I speak. (A variation of the game is If-The -Other-Person-Doesn’t-Know-I-Speak-insert language-I Won’t-Have-To.  First person to speak in the other person’s language loses. I usually lose.) Fortunately my doctor speaks English perfectly and I adore him. He lived in Houston for 3 years and taught at UT Medical School. He’s fabulous! But he was not there for all the pre-op  procedures, so there were some “Moments In Communication.” A cardiologist came in to interview me and we had some amusing misunderstandings. There were some funny questions. Why on earth would a cardio need to know when I started il ciclo mestruale? I am frickin’ almost 60 years old! What happened at 12 or 13 seems irrelevant at least to me. Also, what do I eat? Did she mean today? Yesterday? No always, every day, what do you eat? Should have brought my weekly menu plan. Ric managed to mention vino and caffè. She spoke about 3 words of English, one of which was “pee pee.” However, la dotteressa cardiologa redeemed herself when she asked my current age, was surprised, and told me I carried my years well. God bless her!

So the procedure – removal of congenital varicose veins (Grazie Mamma) that had become quite painful – was to be under local anesthetic and mild sedative. After all the waiting it would take only about an hour. During a pre-op Dopplar-Ultrasound I reiterated to my doctor that I didn’t need nor want the sedative. I was perfectly tranquillo; my blood pressure was great. However, my tranquility, hanging around in my own cute jammies, was spoiled when the nurse came in and gave me the “gown” for surgery. It was a paper, diaphanous dark green that provided “coverage” of a sort yet  exposed everything. It was woven, soft, and sort of mesh-like. I told Ric: “That sedative is sounding better.” Oh, and after I climbed into this hideous excuse for coverage, they took my blood pressure again and wondered why it had spiked. Hello!! I am mezza nuda here on the gurney! Tranquillo is out the window!  During surgery they simply ripped holes in the paper to accommodate leads to various devices. Charming. There was a lot of “exposure.”  (Mind you my last “surgery” was eye surgery in 1988, and for that I only had to remove my eyeglasses.)

The procedure was fine if extensive. Under considerable pressure from the surgeon and the anesthesiologist, I did accept un po’ del sedativo, but remained awake the whole time, listening to the banter of the 30 or so people in the operating room. (OK, not really 30, but Lord, there were a lot of people about for my “minor” intervento!)  I was able to respond, comment, and even laugh a little.  The team was very attentive and efficient. But when they took me back to my room, the two male nurses kicked Ric out and simply ripped the flimsy paper gown off me, slapping ECG leads on my naked self, which was made all the more amusing by the fact that my legs are bandaged from my feet to 3 inches below my groin. When one of them tried to help me back into my pajamas like one would with a two-year-old, my Type-A-self kicked in. “Faccio io!” (I’ll do it myself!) They backed off.

Two hours after the procedure, I was cleared for take-off, and the charming Maurizio was there to whisk us home through evening traffic. Yup, another hour. I’ll close by saying, it’s a damn good thing I brought pajamas with me.

This is my view the morning after while laying in the recliner. At least I have pretty toes.  The bandages go all the way up. All the way. They come off Wednesday and I will have new legs and be able to roam in Rome once again.

Medico

24 Oct

Thanks to our overseas move, I’ve spent more time in medical offices in 2012 than I did in the ten years prior.  Dental, optical, general medical: you name it I had it checked. None of it because I was ill, mind you. I had hoped the appointments would end when we arrived, but a minor problem had me heading to a specialist in August. Luckily the Embassy refers us to English-speaking physicians so language is not a barrier. But there are surprising differences in our systems.

In Italy, staff is limited. The doctor met with me alone. Completely alone. There was no one else present, primarily I assumed because it was the end of the Ferragosto holiday period, but the experiences of friends – and one appointment Ric had – point to a trend: There is not a lot of support staff. One American doctor who is familiar with the situation here told me “they can’t afford a lot of extra people in the practice.” Still, there are not many American physicians who would treat a woman alone in his office, no one else even in shouting distance. There would be fear of allegations of inappropriate behavior. Maybe that happens here, too, but it doesn’t seem to paralyze. It certainly did not bother me.

It’s all about conversation. There were no forms to fill out or extraneous medical history. Just info pertinent to the problem at hand. Maybe that was because I was referred in and a foreigner.  (As an aside, I can’t even buy coffee at the Nespresso Store without having given my codice fiscale — sort of like a social security number or Tax ID — and it is not uncommon to be asked your date of birth as a form of ID, almost as nonchalantly as asking for a cell phone number.) The doctor simply engaged me in conversation: What is your problem and why are you here? What’s the family history? OK, let’s take a look.

Doctors do their own billing. Again confirmed by an Italian friend: yup, it’s routine if they want to get paid. I suppose this pertains only to private patients that are not on national healthcare, but imagine my surprise when I received an email from the doctor, at 8:00PM that same night, with a full report and bill.  (In a future post I’ll tell you about bill payment and banking. Another cultural shift.)  As if to prove it is not an anomaly, when Ric had a medical visit the doctor hand wrote an invoice and gave it to him. We were surrounded by fascinating and state-of-the-art healthcare and diagnostic technology, but the bill is written out long hand. It probably took less time to do it by hand than to submit the details to a billing department that would spew out an invoice. And neither Ric’s appointment nor mine cost nearly what one might expect from a specialist. Low-overhead = Sensible bills? Could be.

Doctors spend time with you.  Kaiser Permanente docs seem to have 15-minute increments for patient care. My doctor must have spent 75 minutes with me, not only on the medical issue at hand, but just talking: His vacation, my vacation, summer in Rome, working in an embassy, his time in Texas. It was nice. And he personally answered several emails.  The guy is a world-class vascular surgeon and he’s answering emails about my minor issue. No advice nurse, no middleperson, no gatekeeper receptionist. He even made my surgical appointment personally. (Although I did have a challenging moment in language use when I spoke to the hospital billing office. I always love it when they say my Italian is better than their English. That means their English is really limited. )

Doctors answer their own phones. Ric was given a phone number – turned out to be a cell phone – by the Embassy doc and called for an appointment. The specialist answered his own phone, made his own appointment, and when we arrived we found this excellent specialist in a one-man office. Very simple, very hands on, and (we think) very effective. There is no diluting the doctor-patient conversation. Need an ECG or an Echocardiogram? The doctor will do it.  No technician, no nurse, no waiting.

Patients have a greater degree of personal responsibility. Need lab tests? There’s a lab up the street. Send the doctor the results when you get them.  This means in all likelihood you will go for the lab test then have to go back in two days to get the results, scan them and email them to the doctor.

So no charming pictures of quaint villages this post. Just an observation of unique – not bad – cultural differences. Interestingly Italy is known for having the 2nd best health care system in the world (France is first). The U.S. is #37, but we spend more.  I’m sure some of the reason for the high-ranking is due to access to national healthcare, but they spend less than we do in the U.S., and rank higher. There’s no lack of knowledge or technology; these are good doctors with all the resources and expertise one would expect. But the story is not over. On Thursday I will have un piccolo intervento chirurgico (minor surgery). I’m sure I will have more stories.

OK you made it through an all text post. Here’s a beauty shot bonus. I can walk by this every weekend. SIGH.

Nobody does it better: Bernini’s Fountain of the Four Rivers, Piazza Navona.

On the sanctuary trail in the Cinque Terre

14 Oct

GIOVEDI

We arrived home Friday, and I am finally getting around to the last part of our trip report.

Our last full day, Thursday, we went back to the high trails, this time from Riomaggiore to the Santuario della Madonna di Montenero, one of five religious sanctuaries linked to the five villages. It is possible to hike between all five, although it is a very long hike.  We chose a hike to a magnificent vista that stretched from Monterosso al Mare to the north to Portovenere in the south. Breathtaking!

Also breathtaking was the  1,110 foot climb. Some people apparently had no idea what they were in for. On what planet is it OK for a woman of 60+ to open her shirt to cool off while hiking? Thank God she was wearing a bra. (That was a rhetorical question. The answer to “on what planet” is Germany.)

While the day was partly cloudy and rain threatened, it did not start to rain until we were done hiking for the day. Torrential rains in the afternoon must have made the locals fear a repeat of last October’s flood. Luckily, by nightfall it was  dry and we enjoyed another fabulous Ligurian meal overlooking the harbor at Manarola. We might have to come back next year….

The way up is far steeper than this looks. Many many stairs created and maintained by volunteers.

All along the trail, the “Via Grande,” were shrines to the Madonna, donated by various families. The “Via Grande” is described as “an ancient road.” These footpaths were essential transportation routes for centuries.

At the top, a church more than 119 years old. And few people.

View from the top looking south, all the way to Portovenere. Worth the climb!

The path is “paved” in many places, especially where it might wash out. But it is very rough and footing is tricky on the downhill portion. Sturdy hiking boots are in order.

As you can tell, we had a wonderful time in the Cinque Terre.  Walking and eating: What’s not to love?

There are so many daytrippers who do not have time to explore the  National Park. They merely get off the train, spend 37 minutes looking at the souvenir ships in a town, then move on and do the same thing in the next village. I actually overheard a woman telling her husband “We have 37 minutes here. That should be plenty of time.” Seriously?

More postcards from the Cinque Terre

11 Oct

MERCOLEDI

Monday was a city walk (Lerici/San Terenzo) and Tuesday was a trail hike high above Manarola and Corniglia (see previous post), but our walks are always followed by lunch: sometimes substantial, sometimes a quick panino, and if possible there is wine. (Surprise! That’s how we know we are on vacation.)

Wednesday we took a journey to the north of the Cinque Terre – off the map according to Ric – to Portofino. But instead of arriving via yacht, as the glitterati would, we walked.   Well we took a train to Santa Margherita Ligure, then walked, about 1 ½ hours from the SML station, to lunch on the piazza in Portofino. Portofino is not far from Genoa, but it is a world away from the ruggedness of the Cinque Terre. It’s also crazily expensive.  Here are a few shots from our path and of our lunch.

Santa Margherita Ligure, as seen from across the bay, on our walk to Portofino. (Photo by Laurel Barton)

There are several small inlets along the path to Portofino, with beautiful houses, hotels, and beaches. (Photo by Laurel Barton)

The distinctive colors of Liguria are found here, too, along our path to lunch. Love the light! (Photo by Laurel Barton)

Wildlife in the bay enjoying the October sun. Oregon Zoo friends, please keep me honest: Are these cormorants? (Photo by Laurel Barton)

Almost there! Ric on the final leg of our walk, a paved path through the woods into Portofino. Very upscale! (Photo by Laurel Barton)

At last, 90 minutes later, we reached our objective and treated ourselves to a fine lunch in a fabulous location.

Mussels

Ah, lunch! Beautiful mussels and cold Vermentino wine. On the harbor in Portofino. Una bella vista! (Photo by Laurel Barton)

Ric’s choice: a seafood salad, served warm. (Photo by Ric Barton)

Portofino harbor and piazza, on a sunny, warm, and quiet midweek day in October. I shudder to think of the crowds in summer. (Photo by Laurel Barton)

We took the easy way back: a ferry across the bay from Portifino to SML and a train back to Manarola.