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Things are different here

30 Mar

Banking, shopping, mammograms: there are many differences here in bella Italia.

Banking was invented in Italy. In fact, the oldest bank in the world is Monte dei Paschi di Siena, which is in deep doo doo over some questionable transactions…but I digress.  We needed to open an Italian bank account so we could pay some local doctors’ bills. The process of opening the account was akin to closing on a house, only more difficult. It took several days and 3 visits to the bank, but no money was deposited until the account was open and we had a fistful of documents in hand to prove it. Only then were we allowed to deposit money.

And about depositing money: We get reimbursement checks from various sources that we deposit here rather than send back to the U.S. for deposit. One day I popped into the bank with four checks, totaling about $150. No deposit slip is necessary; you just tell the teller your account number. For a deposit of four checks, 10 pieces of A4 paper are generated. Each check requires two (one for me, one for the bank), and the deposit itself requires two (same drill). I signed five times to deposit four checks. They are very nice people, very accommodating, and the experience is very personal, as opposed to the no-human-touch-required ATM deposit.  As long as our balance is correct…but many trees sacrificed their lives.

On the other hand, no trees are harmed in creation of bank statements: everything is electronic and self-service. When we opened our account, we received a random-code-generator token for secure access. It’s quite efficient and more advanced than the 3 online banking systems we access in the U.S.

Paying bills is a matter of making a wire transfer. If you want to pay a doctor’s bill, unless you are paying in cash which is quite common, you need the doctor’s International Banking Number as well as bank name. Simple and not too costly. I marched into the bank armed with this information only to be asked by the teller “what is this payment for?”  Hmmm, seems a bit intrusive and personal to ask what I am paying a doctor for. How detailed to get? I mean what if you had something rather, um, sensitive and personal done? Do you blurt out “pap smear” or “wart removal?” (Neither of which were involved I might add.)  I opted for a rather vanilla “medical consultation,” then hours later realized that without an invoice number, perhaps the recipient of the payment might find information beyond the patient name useful in matching payment to service.  Still, a potentially awkward moment; No HIPAA rules here. I’m sticking with “medical consultation.”

Campo dei Fiori

Campo dei Fiori market. Let the vendor select your produce or risk a scolding.

Shopping has oh-so-many differences from the U.S.  First, it can be rather disjointed. Megastores are few, and out in the suburbs. One may need to go to many stores to accomplish what a stop at Target would do. I like small businesses and wandering around Rome, so it’s an opportunity to poke my head into various establishments. But sometimes it is hard to know where to go to get what. Light bulbs, for example, are most likely in an electrical shop, although there are some in the larger grocery stores. Need a curling iron? Don’t try a beauty supply store; go to an appliance and electronics shop.  Cosmetics? A profumeria of course.  If all else fails, try a ferramenta, which is a household goods store with everything from toilet paper to wine glasses, but in the tiniest stores!

Store hours also need to be considered. The larger grocery stores are usually open continually, but a ferramenta or an electrical shop might close from 13:30-16:00. A large wine shop near us does this, even on a busy Saturday, as does Ric’s favorite men’s clothier. They re-open from 16:00-20:00. Since one does not eat before 21:00, these are prime shopping hours.  Even the electronics giant Euronics takes la pausa on Saturday and they close on Sunday, limiting recreational shopping. Quality of life versus consumerism: interesting concept.

At the outdoor markets, like Campo dei Fiori (think large Farmers’ Market in the U.S.) one never touches the produce. Let the nice vendor help you. Be prepared for questions like “What are you going to use them for” when you ask for tomatoes: “For sauce or to eat?” You’ll get different tomatoes based on the answer.  Or the fish monger might ask “How many people is this for,” then argue with you about whether you are buying enough. (He’ll also want to know your method of preparation.)

Rabbit babyfood

Pat the Bunny? No eat the bunny, Babyfood in flavors attuned to Italian tastes. I have not seen equine….

In the grocery store produce department, one dons a plastic glove, then bags, weighs, and prices one’s own produce. You won’t forget to do that more than once,because if in a moment of American-ness you get distracted and head for the checkout, the cassa will send you trotting back through the store to price the goods, holding up the entire line while you do so. Che imbarazzante! (I’ve only done it once.)

Milk is sold in shelf-stable cartons that do not have to be refrigerated until after opening, and eggs are always on the shelf at room temp.  There is a staggering variety of pasta of course, and the best tuna ever, packed in olive oil. Who needs mayonnaise? Ethnic foods (Mexican, Thai, Chinese) are impossible to find in a regular store. There are specialty shops, but I have not sought them out yet. However, if your infant likes parmesan cheese, salmon, or rabbit, there’s a baby food for that. 

mammografiaThis picture says almost all you need to know about getting a mammogram here: there is no virtually useless “gown.” Just strip to the waist and belly up to the bar. I was warned by the Embassy Health Unit what to expect, and provided a paper gown to take along, but geez, really, did I want to be la Americana there with the Italian women, the only one shielding her girls with a flimsy gown that was mostly coming off anyway?  So I went along with local custom.  But there’s one more surprise for those of us from a sheltered, HIPAA-indoctrinated, North American, law-suit inspired environment: many of the mammographers are men. 

As I entered the office of the senologist (breasts are their only business), I saw a man in scrubs with long gray hair, a little wild, who resembled an aging 60s rock musician. “Please God, don’t let that be my mammographer,” I pleaded silently.  I waited with the other women and was relieved to be summoned to an exam room by a lovely young woman; Take off everything from the waist up and so we begin. But could this be a straightforward get-it-done process? Of course not! She’d get me arranged in the machine then open the door to the adjoining suite and ask a question. She set me up again, and with my breast pressed inextricably between two plates of glass, open the door to the reception area and talk to another person. At one point she left me hanging (literally and figuratively) for about 2 minutes while she went through yet a third door and talked to someone else! At the end of the session she motioned to the chair where I had left my clothes and said I should make myself comfortable (Si accomodi usually means make yourself comfortable, have a seat;  but I now know it can also be used as for “lay back and relax”) and wait for the doctor. To me comfortable  (and relaxed!) is fully dressed, so I began to suit up. I had just put my bra on and had my arms in the sleeves of my blouse when a man in a white coat opened Door Number 3 and my tech beamed with a cheery Ciao bello! Buongiorno! As they consulted over some technical issue (I don’t know if he was a doctor or a computer technician), I buttoned my blouse and donned my sweater. Standing there awkwardly I asked if I should wait. “Sì” and another wave to the chair.

About 40 seconds later in sweeps another young woman who escorts me into the room where I thought the aging rocker was. Yup; He’s the doctor. I figured he was going to give me the “all clear” and I’d be on my way.  Huge office with a desk on one side, mammograms up on the large computer screens, which the doctor is studying. On the other side of the office is an exam table, which the nurse escorts me to and tells me to undress. I ask: “What are we doing?” “An exam” she says, perplexed. I had heard they do ultrasounds on most everyone…. So I strip to the waist again and lay down (Si accomodi!), only to be left there, half-naked and certainly not comfortable, while the doctor makes a phone call and the nurse comes-and-goes a couple of times. They ask me for my last films (not handy – they are in Oregon), and finally the doctor does the ultrasound.  I give great credit for thoroughness.  My favorite part (tongue firmly in cheek) was when he motioned bare-breasted me 20 feet across the huge office to see my mammogram close up, and then back again to the complete the exam.  My only question is why they even allowed me to dress between the two exams. I suspect an Italian woman would not do so, would know she was moving on through Door Number 1 for the sonogram.

In our own environment we know pretty-much what to expect, and I think in North America medical personnel tend to explain — maybe even over-explain — what you are to do, what is going to happen, what to expect. Here there seems to be a great assumption that one already knows what to expect. And of course in North America we have huge body-consciousness/privacy issues. Not worth having here….

I can hardly wait for a trip to the gynecologist.

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.