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Tag Archives: healthcare

Naked in Italy

27 May
That title should make the read-rate for this blog go through the roof.
The other day I was in the gym. Having finished my workout I went to the very small locker room, where my first act is usually to wash my hands since I’ve been touching all sorts of equipment. Right in front of the sink was a naked Italian woman, chit-chatting with a couple of other women while she donned her black lace panties. I was not going to ask permesso to go to into the very small area by the sink, squeezing past her naked self. As she went to put on her bra, her cell phone rang and – I kid you not – she took a 5 minute call with one boob in the bra and one boob out, still blocking the sink.  I changed my clothes and went on my way, shaking my head.
Venus After the Bath, a stunning nude by Giambologna, on display at the U.S. Embassy in Rome.

Venus After the Bath, a stunning nude by Giambologna, on display at the U.S. Embassy in Rome.

Body image and nakedness in Italy is a culture shock for American women I have spoken to. The attitude towards the body is much more open in Italy than in North America. Whether in the locker room at the gym or at the doctor’s office, unabashed nakedness is taken for granted.
Most North American men – or men from anywhere for that matter and as far as I know – don’t give a rip about taking off their clothes in front of other men. Man boobs or not, they change and shower openly from what I am told. Not so women in North America, right?
I respect the openness with which Italians treat the body. There is little or no modesty or self-consciousness, which is somewhat refreshing, but frankly I don’t know where to put my eyes when confronted with the naked conversation.  
Another time I came into the locker room to get changed before working out and a young woman came out of the toilet stall, naked but for her shower flip-flops. (God- forbid she should get a fungus while walking around the locker room naked.)  I tried to suppress my surprise but I am certain my jaw dropped a bit. As a hung-up Americana I don’t even potty at home completely naked. Naked is for the shower and certain bed-time activities. “Buongiorno! Come vai?” she said.  Where do I put my eyes?  I think I chose a corner high and to the right.
Is this narcissism? “Look at me! I am in your way and I am naked!” She may or may not have a body one wants to see naked…. And regardless, where the heck am I supposed to put my eyes?
I have become somewhat used to doffing my clothes in a medical situation, although luckily I have been able to take care that my mammographer is not a man. (Yup, many of them are in Italy. See Things Are Different Here.) When I expressed a desire to NOT have a male mammographer the nurse said to me “What do you care? They’re only breasts.” Yes, but they are my breasts, and I like to be the one to select who touches them.  After last year’s experience I made a point of selecting a facility where the doctor herself does the mammogram and sonogram. Still, when one gets a mammogram here there are no little pink capes over your shoulders. You enter the x-ray room, strip to the waist and belly-up to the machine. This is followed by a walk to an adjacent room where you get a sonogram, sometimes involving two specialists if consultation is required. And no one explains what’s going happen. In the U.S. one would expect the doctor to say “I’d like to call in Dr. So-and-So to have a look. Do you mind?” and she would buzz someone to come in. Here, a door to a busy hallway will suddenly open and someone you’ve not met while clothed will walk in and start examining your breasts with no introduction.  Thorough, though: No one is taking chances that they will miss anything. After the exam you sit there bare-breasted while having a conversation about what was or was not found.
Perhaps Italy's most famous nude, David.

Perhaps Italy’s most famous nude, David.

Whether for skin cancer checks, a visit to the cardiologist for an ECG, or to the vascular surgeon, one just slips out of the appropriate garments while chatting up the doctor and perhaps while dressing after the exam has a conversation about vacation, or family, or life in an embassy. Very convivial. Actually I like the system a great deal in that one has the full attention of the physician. But it took some adjusting to not having privacy for undressing and dressing and occasionally having a door unexpectedly open and others arrive on the scene unexplained.
The lack of privacy also extends to the pharmacy. Hell, there isn’t even a word for privacy in Italian.  Everyone hears everyone else’s symptoms and problems. You do not walk into a pharmacy and peruse the shelves looking for your own solutions or symptoms. You have to ask the pharmacist for whatever you might need. Everyone in the store will know what you came to buy. Sort of a different form of exposure.
In the U.S. we are so concerned about privacy. God-forbid someone would overhear the pharmacist give instructions on how to take an antibiotic or how to apply that anti-fungal cream! Once I had to sign a privacy statement when they gave me instructions at the people pharmacy on how to administer a medication to my dog. In locker rooms we are shy and at the doctor’s we expect gowns and drapes, introductions and explanations before anything is looked at, probed, or handled.  
It’s certainly not that either approach is wrong. It just takes some getting used to flaunting your “stuff” in public. And I still don’t know where to look when chatting up naked women in the locker room. 
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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.

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