Aftershocks in Umbria

A tale of earthquakes, the ER, and the oculista

Photo by v2osk on Unsplash

Cari amici,

Medical care in Italy seems to be of great interest to many people, from what I’ve heard and judging by one of my most popular posts. Given that, I thought I’d regale you with my eye-problem adventures of the last couple of weeks.

It all started with a 4.6 earthquake that struck near the northern Umbria city of Umbertide, about 20 kilometers north of Perugia, followed four hours later by another 4.4 quake and then a third one, magnitude 3.8. Hardest hit was the tiny frazione of Pierantonio (officially a part of Umbertide), whose historic center was severely damaged. Hundreds of people have been left homeless, and many fear that Pierantonio will become a ghost town.

Here in Perugia, the terrifying jolts and tremors sent me diving under a table. After 32 years in the San Francisco Bay Area, during which time I lived through the 6.9 magnitude Loma Prieta earthquake (which killed 63 people and injured more than 3,700) and many, many others (less lethal but frightening), I was cavalier about the quakes here in seismically active Italy. I’d felt only one, a small one, in my almost-five years here before the Umbertide quake. Perugia perches on a hilltop west of the more earthquake-prone areas of eastern Umbria, Le Marche, and Abruzzo. It’s also west of the Tevere (Tiber), which supposedly (so I’ve been told) acts as a sort of interrupter of seismic activity that happens farther east. (A quick search turns up zero proof of that claim, though I’d love to believe it.) As of March 9, however, I am cavalier no more.

Anyway, from my vantage point under the dining table, I noticed that half the couch stood directly underneath a chandelier—a ceramic one with a suddenly-lethal-looking point primed to land on my head. The next day I rearranged the furniture to give my chandelier fewer chances to kill me, and one thing led to another, and soon it wasn’t just the living room getting a new look. Not all of my ideas panned out, which meant shoving furniture down a long hallway and back again. You get the idea. Late in the day I noticed flashes of light on the outskirts of my left field of vision—not a few here and there, but a Capodanno-esque barrage of mini arcobaleni (rainbows). Alarming, yes, but not panic-worthy.

The next morning, a Saturday—because these things always happen on a weekend—off I went to the emergency department (pronto soccorso), fearing damage to my retina. Of course I’d googled my symptoms, though I already knew that flashes of light and little floating mosche (flies), as they’re called here (which I was now seeing along with the little lightning bolts), can signal an impending detached retina. But it turns out dehydration and physical effort can cause or exacerbate the flashes and flies, and I realized with dismay that my water intake the day before, while I’d shoved and hoisted furniture around, had been way below normal. Plus, myopia—mine is pretty extreme—makes the retina more fragile. Fortunately I had no loss of vision, no shadowy “curtain” sliding in from offstage to totally freak me out.

At this point I’d like to propose the radical idea that signage, especially when the intended targets are likely stressed-out or panicked potential patients and families, is a good thing. At Perugia’s Ospedale Santa Maria della Misericordia, a sprawling complex designed by someone with an airport fetish, it’s pretty easy to get where you’re going and/or have some idea what to do when you get there. Not so at the adjacent pronto soccorso. True, the pedestrian entrance, a single, lonely-looking door off to the left of the ambulance bay, is marked, albeit unenthusiastically. But once you enter, are there signs shouting “Register here!” or “Take a number!” or “Triage; please wait here”? No.

I enter, pause to get my bearings. Large double doors open into what I’m sure is a treatment area; the window next to them, shade drawn, looks less than inviting. Then, yes, okay, I see it, a sign that says “triage,” but rather quietly, on a door to what looks like an examining room. Should I knock? Wait until someone comes out? Oh wait, there’s a little window, like at the cassa at a bar, and oh, there’s someone in there! “Scusi signore—”

But the signore (a nurse, I assume) tells me to wait because he’s with a patient. After another look around for a number dispenser, I hover near the door, staking my claim in case the new arrivals, two in the last five minutes, try to jump the line. And those people sitting in the waiting area, are they family members or are they too waiting to be seen? I don’t know if I’m next in line, or nineteenth.

Five minutes later it turns out I’m next. I’m quizzed about what brought me there, my tessera sanitaria (healthcare system card) data is entered, and I’m told to go to an ambulatorio (clinic/office) in the hospital and wait there. Through the double doors I go, following orange lines into the heart of the hospital, where signage (imagine that!) leads me the rest of the way.

I take a seat and am promptly told by the nurse who whizzes out that I’m supposed to wait down the hall. They’ll call me. I wait, chatting with the other patients and families there, and after a while, since no one’s name has been called, we decide we can’t possibly hear any such summons. I grumble that I see no reason why we can’t wait outside the ambulatorio, and the others urge me to go back. I do, and am promptly ousted again, with the scolding explanation that these chairs (many of which are empty) are reserved for people who’ve had their eyes dilated. I slink back to the second-class waiting area, and we all agree that the nurse is on a power trip.

I’m thirsty (hydrate, hydrate, hydrate!). A woman in our non-dilated group directs me to a machine, then, in a typically Italian gesture of kindness, gives me money when I find I have none. I dash off and return to find the nurse yelling my name. Soon I take a seat in the coveted dilated-eyes chairs, and soon after that, upon examining my retina, the doc pronounces it intact. As we age, he explains, the vitreous gel dries out (hydrate, hydrate, hydrate!) and shrinks a bit, at times tugging on the retina, at times tearing it. I should avoid fast movements of my head and forceful actions and seek help if the problem gets worse.

The next day, the problem persists. Is it worse? Hard to say, but there’s no letup to the flashes and flies and I’m not inclined to take any chances with my vision. First thing Monday morning I call my oculista (ophthalmologist), only to be told he has no appointments until July (what?) and I should go to the pronto soccorso. “I was just there,” I say, not terribly politely, “and I’d like another opinion. Surely you can see someone with an urgent problem.” Not gonna happen. “Mi dispiace signora,” says the woman on the phone, “non posso aiutarLa.”

Because I think going back to the pronto soccorso would yield the same result it did the first time, and because I’m not keen to spend another three hours (at least) reliving history, I nose around for a doctor who might see me on short notice, find one with a promising number of stars and positive reviews, and call him. He answers the phone himself. “I work in Tuscany today, but if you can come at 9:45 I can see you.” Ci sto! I’m in!

Given the oculista’s need to get to wherever in Tuscany, I expect to be hustled in and out; instead, he wants to chat about America and italiano (“most of my foreign patients can’t speak a word!”), where I live in Perugia, where he lives in Perugia, his medical practice and training, my career, and what kind of work my husband does. (“What!” he exclaims when I say I’m not married. Uh, thanks, I guess?) Then the doc examines my eye with the same equipment used at the pronto soccorso. He too says my retina looks good, and I’m relieved—but not for long.

Apparently, with that machine, it’s possible to see only the central portion of the retina. To see the periphery, the doc presses something called a Goldmann lens against my eyeball while shooting daggers of brilliant light into my eye. And lo and behold, that fun exam reveals a vitreous detachment, causing a hemorrhage inside my eye. He gives me a prescription to help reabsorb the blood, heparin drops to eliminate any clotting in there, and a follow-up appointment.

Five minutes later I’m standing in the parking lot, googling pharmacies and straining to see the screen, when the doc, on his way to Tuscany, materializes at my side. Taking my hand, he walks me across the street to a nearby pharmacy, then leaves with a warning to be careful getting home. Talk about full-service treatment!

Epilogue: the second visit reveals that most of the blood has been reabsorbed. After (or before) my third and hopefully final torture session appointment, I’m to call him if I have any problems, even on weekends. My regular oculista, he explains (the medical world is small and close-knit here), only sees patients for routine exams anymore, whereas he (this doc) only deals with problems, and so he always leaves room in his schedule for urgent matters.

In case you were wondering, I’m receiving this care outside of the national health system (“going private,” as we say here). There’s no way I could get a same-day (or maybe same week or same month) appointment by going through the system; my only recourse would be the pronto soccorso. I doubt such short-notice appointments would have been possible even pre-Covid, and things are much worse now. Some people say there’s a push from the right to move to a privatized system (I really don’t want that to happen; what I want is for things to work as well as they did four years ago), and in fact shiny new clinics loaded with the latest high-tech equipment are popping up all over Umbria. Who’s paying for them? But that’s (maybe) a topic for another day.

This period of fright and damage and questions of health ended—fittingly, I guess, in a sad way—with a funeral on Saturday, for a friend’s brother. All told, it makes you realize, all over again (because of course you know it), how valuable our health is, how fleeting life can be, and how important it is to tell, and show, our loved ones that we treasure them.

Alla prossima (unless I see you in the comments first),

Cheryl

© 2023 Cheryl A. Ossola

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Book of the week:

• Blindness by José Saramago

Poem of the week:

• “Leaning into the Afternoons” by Pablo Neruda