Diary of a Patient

A week in the hospital, or, how to divest yourself of modesty while not spending money, among other lessons

Sunset from my room at Ospedale di Santa Maria della Misericordia.

About three years ago I was in the hospital here in Perugia, and I kept a diary, partly to pass the time and partly because I thought it’d be interesting for the many people I’ve talked to who are curious about medical care in Italy. So here, for your enlightenment and (hopefully) amusement, is my little saga.

When the medical issue arose, I went to my family doctor, who sent me to a specialist the next day (let’s call him Doc 1), who gave me my first lesson about modesty (or the necessary lack thereof) in Italian medical practice. When he told me to disrobe, I looked around for a privacy curtain. There was none. What was there? An open ground-floor window without a shade. Well, okay then. Honestly, it’s amazing how quickly you can decide some things just don’t matter. I’m happy to report that Doc 1 and his medical student sidekick watched me undress with absolute disinterest—until they got a good look at my rather spectacular rash, at which point their eyes lit up.

After a quick exam, the doc said he wanted to admit me the next morning because it would be easier to figure out what was going on if I were at their disposal and not boomeranging back and forth. I said I had to arrange for dog care, and he said to call in the morning to confirm my admission.

Day 1 (Wednesday)

Kind friends agree to pet sit, so I call to confirm my arrival and am told which unit to go to. That’s right, there’s no central admitting office. A kind gent in white scrubs admits me, all the while discoursing about his likes and dislikes regarding other languages (French = bad, Portuguese and Spanish = good). He’s happy to practice his patchy English, which makes things easier because I discover that most of my sorta-kinda B2-level Italian (on a good day) has fled my brain.

Admission Guy, who turns out to be a nurse, shows me to my room, teaches me the essentials, then leaves with a cheerful “Get in bed!” I snag the window bed and stow my stuff in my locker.

Moments later I’m again lying almost naked, this time in front of Docs 2, 3, and 4. After much discussion over my exposed body (at one point Doc 4 kindly pulls the sheet over me), a plan is made. Doc 4 leaves, and Docs 2 and 3 (attending and resident, as far as I can tell from the scrubs color scheme) spend a long time asking me questions and going through all the medical records, lab work, and so on that I’d brought with me. This is normal in Italy—you need to bring your medical portfolio, or at least all pertinent lab results, x-rays, and so on, to all appointments. I keep mine in an accordion folder, along with a medical history, written in Italian, of course, so that any doc can see my key data at a glance—serious illnesses or medical conditions, surgeries, family history of significant diseases, etc. Trust me, when you’re under stress, it’s much easier to hand someone a written history than to remember how to say “diethylstilbestrol exposure” and “gall bladder surgery” in Italian.

Which leads me to a digression. It can be hard for Italian doctors to understand some of the realities of U.S. medical care delivery. For example, they usually want to know why, according to my little written history, I’d stopped taking a cardiac medication I’d been on for more than a decade, to manage a benign arrhythmia. Deep breath. I explain that the insurance company, who was also the caregiver (i.e., an HMO), wouldn’t let me see a cardiologist (because that would, like, cost them money) and that when I called to renew my prescription, the pharmacy said they were out of that med and, golly gee they were sorry, but they didn’t know when they could get more. I had a very bad feeling about this. Sure enough, a few days later they called to say they couldn’t get the med at all and WAS THERE A REPLACEMENT THEY COULD ORDER FOR ME? I suggested that perhaps, since they were, you know, pharmacists and I was a patient, they could figure that out, or (big leap of imagination here) call a goddamn cardiologist and ask them. At this point, having zero confidence the pharmacy would come up with a solution, I started weaning myself off the medication (it’s dangerous to go off it cold-turkey), and though I still have the arrhythmia, the symptoms controlled by the med didn’t return. Odd, but fortunate. So I stayed off the med and the HMO continued to refuse to let me see a cardiologist.

Back to our hospital scene, day 1. I’ve just explained all of the above to Docs 2 and 3 and they are now staring at me as if I’ve just spoken gibberish—which, given the complexity of the story and my momentarily limited access to Italian, it probably is. I try again, repeating the key points, and they still cannot fathom what/how/why this could happen. Neither can I. We move on.

Admission Guy comes back and starts the fastest, least painful IV I’ve ever had. I praise him and he praises my veins. He draws blood from the IV site, then hands me a test tube to pee in. When I look at him with eyebrows raised, he says, “It’s easier for man than woman,” to which I can only agree. He goes off in search of a cup.

The meds/procedures cart. “Treatment in progress, don’t touch.”

With the docs gone, I settle in. The bedside table has two handy water bottle holders—for the water I didn’t know I should have brought. Other necessities you’re expected to provide: all toiletries, towels, nightgown/pajamas, a robe or other cover-up (for traipsing off to buy water and coffee or for cruising around, if you enjoy such freedoms), and a decent pillow—unless, that is, you prefer sleeping on a sack of concrete. The bathroom has no lock, just a “libero/occupato” sign to flip over. Hopefully people read around here.

The docs come back for more exams, more conferring. Vitals and labs and daily reports are entered into a laptop, and there’s also a paper chart—a little notebook about my stay.

Lunch arrives, sans cutlery and a napkin. I think they’ve forgotten it, so I bum plastic cutlery from the nurse. Turns out that’s another thing we’re supposed to bring from home, plus a coffee cup. But to heck with that; you’re wondering about the food, aren’t you? I’d say most of it is better than U.S. hospital fare, and since you get to choose a primo and a secondo, you know you’re in Italy.

A roomie arrives. Surprise, it’s a man! He’s not here long, though, so I get to solo for the evening. (Later I decide that they’d just parked the guy here temporarily.) I doze for a while with a nice breeze on my face, then decide to figure out the TV (a maybe-20-inch hung high on the wall—but hey, it’s a Samsung!), for which there’s no remote. My kindhearted nurse drums one up and I tune into a show about the writer Andrea Camilleri, author of the Inspector Montalbano books, who died today at age 93. Sadness.

My room’s TV. Blank wall provided for scale.

It’s pretty quiet on the ward. I sleep, with interruptions only for meds and several scans of my hospital ID band. Then at 6am the lights come on, the curtain flies open, and a housekeeper bustles in and dusts for (I kid you not) all of 15 seconds. Apparently housekeeping is a task-based system, because later someone else appears with a mop, and later another someone else cleans the bathroom and empties trashcans.

Day 2 (Thursday)

Another day, another blood draw. These people are good. Vitals are taken; my breakfast of caffè d’orzo (a coffee substitute made from barley), two slices of dry, packaged, salt-free toast, and plum jam arrives; and then the docs breeze in for more conferring and exams au naturel. My brain is still busy forgetting all the Italian I ever knew, but Doc 3 (the resident) speaks decent English, as does Doc 2 (the attending) to a lesser extent, so we discuss my case, along with how much Doc 3 misses Rome; the fact that Doc 4 is from the province of Latina, which is where my maternal grandfather’s hometown is; and how my dog care arrangements turned out—because, I now discover, I’ll be here at least through Monday.

Yum. No, really, they’re tasty!

A new roomie, a young woman barely in her 20s, arrives with her mother. She introduces herself and shakes my hand (this is pre-Covid, remember), which I accept reluctantly, because who knows why she’s here and what she’s got. But social norms are important, even in the hospital.

I sign consents for a biopsy and to have photos taken for possible medical journal use, and then Doc 3 preps me for the biopsy. (Everything is done in the room.) She injects a local anesthesia, explains that I’ll have stitches and a small scar, then gets to work. She’s excellent.

I am really impressed with these doctors—they are smart and super-thorough, ask a ton of questions and listen carefully to the answers, and consider all the data in a big-picture way. They’re friendly, warm, reassuring, calm, and efficient—and very concerned about my dog-care arrangements.

Friends arrive, laden with all the stuff I should have brought, plus my laptop. We chat for a while, and then Admission Guy/Nurse comes in and—in the craziest small-world scenario—recognizes one of my friends from some group hikes they did in the 1990s.

Dinnertime. I learn that minestrone and roasted chicken are good bets. Boiled potatoes come absolutely naked, so I dunk them in my minestrone. Not bad!

Roomie has visitors, and then her mother stays over, sleeping (and snoring) in a chair. The hall outside our room is party central, complete with a shrieking toddler, constant chatter, and a woman whose voice could shatter glass. It’s a miserable night.

Day 3 (Friday)

Another morning, another blood draw. The nurse and I chat about Leonardo da Vinci (sparked by the book I’m reading, Walter Isaacson’s fascinating biography of the artist), his Benois Madonna that’s on loan at the National Gallery of Umbria in Perugia, various museums in Paris, and where I’m from.

Doc 2 appears with Doc 5, who will be covering on the weekend. More exams, more questions, more discussions. Doc 2 calls Doc 1 (preadmission) and asks him to stop by. A very tall, very bubbly guy, he shows up in the late afternoon and immediately asks about my dog. I’m tempted to whip out a photo, but Doc 1 moves fast—a quick exam and he’s gone.

The dressing on my biopsy site is coming loose, so I survey what’s underneath. Looking good, and there’s zero pain—how is that possible when they dug a hole and sewed it shut?

Dinnertime. My roomie picks up her tray and says, “Buona cena.” (Have a good dinner.) I’m tickled by the courtesy.

In the evening Doc 2 comes by and discusses the day’s lab results and a possible plan for the weekend. She’s on call and says not to hesitate to call her during the night if needed. Later Admission Guy/Nurse comes by to check on me, even though he’s not my nurse tonight. What a sweetie!

Day 4 (Saturday)

Buongiorno! It’s 6am, time for a blood draw. Later, while I have breakfast, a nurse changes the bottom sheet. Maybe changing the pillowcases and top sheets is an every-other-day thing? Chissà! Who knows!

Docs 5, 6, and (probable med student) 7 arrive. Docs 2 and 3 are off for the weekend. More exams, more questions. To my delight, I find that my Italian has returned to my brain. As the docs leave, I nab Doc 5 and ask what the plan is, and he says they’ll wait for today’s lab results and maybe start a new treatment tomorrow.

Once I’m untethered from my IV med, it’s time for coffee, so I wander off to the machine in the waiting room. I know from prior visits that the hospital bar has excellent coffee, but I’m not ready to face that much of the public. The bar is a fascinating place, a vibrant hub for hospital employees of all stripes, EMTs, visitors, outpatients, and inpatients brave enough to stand in line in a bathrobe and slippers—in other words, who are less vain than I am.

I get a cappuccino, then wander off to another waiting area. Beyond the parking lot are open fields and a farmhouse. I can imagine what the farm’s owners thought when they found out a hospital would be built here, probably on part of their land. I hope they got a decent price for it. Ospedale Santa Maria della Misericordia, founded in 1303, was housed initially in the Borgo Bello neighborhood of Perugia, near the Chiesa di Sant’Ercolano, then in Monteluce for hundreds of years. This modern facility—which reminds me of an airport, with spokes (complete with street names) that emanate from the main entrance and lead to various “blocks”—was built in the 1980s, with additions and updates since then.

The unfortunate farmhouse, just above the yellow field.

Dinner comes, along with a food mystery: how does polpetta in brodo (meatball in broth) translate into a sad, dry meatball on a plate? Advice: avoid the pasta. Cooked greens are a win, though.

I get fruit with lunch and dinner, and it always arrives rolling wildly on my tray as if bent on escape. So I’ve developed a new game, called Fruit Rolling Index (okay, yes, it needs a better name). Retroactively, I give yesterday’s three small apricots a 10 because I can’t think of a fruit that would be more unstable, except maybe some loose grapes or an entire cantaloupe. Then I realize the grapes could show up on my tray, so I change the apricots’ score to a 9.

My roomie offers to get water for me, then refuses to let me pay. She’s now ahead in both the courtesy and generosity departments. Later I hear her tell someone on the phone that I speak some Italian—maybe a warning that she can’t gossip about me? She and the medical staff are very curious about where I’m from, what I think of Italy, etc.—as l’americana, I’m the novelty in the unit.

Day 5 (Sunday)

A quiet day—no vampire poking my veins at 6am, no bed linen change. It’s Sunday, after all, and work is limited to the essentials. Taking advantage of the peace, I write all morning. Turns out a hospital stay, when you’re feeling pretty good, makes a fine writing retreat. I churn out 2,000 words before lunch.

Doc 5 comes by and is very pleased with my progress. And my biopsy site is clean, without any swelling or redness. (Brava, Doc 3!) Now there’s a chance I’ll get sprung on Tuesday. Fingers crossed.

Lunch arrives. I beat my roomie to the buon pranzo, but she’s refused to let me buy her water or coffee, so I’m still down one in courtesy points.

Food surprise! The roasted potatoes have rosemary on them! Fruit Rolling Index game: a large peach, pretty stable. I give it a 3.

The afternoon whizzes by with reading and more writing. I get up to stretch and look out the window. Across the way, someone has hung a towel and some clothing out the window to dry. Just like home!

Hanging laundry at the hospital.

A post-op patient with head and leg dressings rattles by with his walker and IV pole. He’s clearly motivated, because he does laps on and off all day. Earlier his wife or girlfriend walked with him; now it’s a tall young man. Warms my heart.

Dinner arrives. Roomie beats me to the buona cena, damn it. Fruit Rolling Index: apricots again. Come on, where’s the challenge? But they’re ripe and thus less inclined to roll, so I downgrade them from a 9 to an 8.

Another food surprise: prosciutto cotto isn’t the nice warm slice of cooked ham I'd hoped for, it’s the packaged stuff. I try making a sandwich with yesterday’s slice-of-bread-in-a-bag, but the bread is stale. (I can safely say that it was never fresh.) The soup isn’t much better, with pasta that’s about four minutes past al dente. But really, those poor cooks, boiling water, cooking pasta, draining pasta, repeat and repeat and repeat and repeat and repeat. I gotta say, though, a little grated pecorino would go a long way.

Day 6 (Monday)

My IV med gets interrupted for a trip to radiology. The orderly hums and scats along the way, and I compliment him on his voice and ask if he sings in a chorus. He says something to the effect that all the orderlies sing, and I joke that he’s my singing gondoliere, which he likes. We whiz through a maze of corridors and take two separate elevators down to the radiology department. As an inpatient, I get to jump the line of outpatients waiting with numbers in hand.

Docs 2 and 3 come by with Docs 8 and 9. Another exam, much discussion. They agree on a probable diagnosis (pending some tests that will take a while) and a new treatment. We resume the IV med, but it’s leaking, so they pull it. A student nurse comes by to draw blood and puts a gauze-topped gel on a hematoma left by a previous draw. I’ve never heard of this treatment, but when I take off the gauze, the hematoma is much improved. Very cool!

Lunch arrives, along with a major disappointment—I forgot to order fruit. Che scema!

My first oral med arrives, presented to me on a square of gauze like an offering; it’s almost ceremonial. I take it with an appropriately somber expression. Now we wait.

Dinner: no fruit again. Major fail.

Day 7 (Tuesday)

The cleaning crew wakes me at 6am, as usual. I think the guy who changes the linens has it in for me because once again I get no clean top sheet or pillowcase. Unfortunately, when I go down the hall for coffee, I get locked out of my unit and Linens Guy is the one who lets me in, which means tomorrow I probably will get no clean sheets at all.

A nurse comes by to ask if I need anything for pain. Belatedly, I realize the nurses do this every morning and evening; it’s as much a ritual as the barcode scan of my hospital ID bracelet. Quite civilized!

Docs 2 and 3 come by, along with a med student. Lab work validates Doc 2’s diagnosis, but they’re puzzled by some persistent symptoms, so they want me to stay until Thursday. This is becoming quite the productive writing retreat.

Roomie goes home. We wish each other well, and then I wash some clothing and hang it to dry. With my laundry flapping in the breeze, I’m beginning to feel like I live here. My friends who are taking care of my dog “for a few days” probably feel like it too.

Lunchtime. Fruit Rolling Index for a very red but very hard peach—a 10. Dinner brings two ripe yellow plums with somewhat flattened ends, very stable. They get a 4.

Day 8 (Wednesday)

In the morning, housekeeping comes to mop the floor and I lie in bed listening to hallway chatter accompanied by the banging of metallic objects. Then there’s a big crash, followed by some sort of alarm. I’m curious but don’t want to risk skiing across the wet floor to find out what happened. If it’s an emergency, they’ll evacuate us, right? Right?

My new roomie arrives while I’m having breakfast. (I’ve really gotten to like the biscottate, btw.) She’s elderly and seems quite ill; her husband and daughter look worried. They barely get her settled before the nursing staff wheels her away again.

Bed linens change, again only the draw sheet. But it’s a different guy, so I guess this is normal—unless my nemesis left him instructions to deprive me.

Docs 2 and 3 come by and we all agree I’m much better. Home tomorrow! Doc 2 impresses me again by anticipating every question I was poised to ask her. I feel very lucky.

Lunch. Fruit Rolling Index for a very stable peach, virtually immobile—clearly a 1. Hooray, I think we have a winner!

Docs 2 and 3 redux, plus Doc 4: quick exam, confirmation of tomorrow’s discharge and action plan. Since Doc 4 seemed to have some doubts about the diagnosis yesterday, I ask his opinion. He’s on board with it, but the tests we’ll do later will be proof.

Roomie has been back for a while. She has an NG tube now, but she and her family got good news and it seems things aren’t as serious as the docs first thought. Hooray for Roomie!

Oh, Admission Guy. Really? REALLY? I have been mobile the entire time I’ve been here, and I’m sitting here fully clothed, typing, and I’m going home tomorrow. Did you really need to warn me not to use Roomie’s bedpan?

Day 9 (Thursday)

I’m going home! As Docs 2 and 3 give me the all-clear and answer my questions, Doc 2 notices the language workbook I’ve been using this morning and asks if I like Italian. I say yes, and she says speaking it isn’t necessary, and I say it is if you live here. She concedes the point.

Roomie is better! She’s mobile now. And so is Post-Op Guy, more so than ever, zipping down the hall with his walker, solo this time. I give him a thumbs-up and praise his speed, and he shoots back a big smile.

Doc 3 reviews the discharge instructions with me. They’ve set up several follow-ups for suture removal, some tests, and a consult with another specialty. I’ll have to get the prescriptions from my family doc because they can’t prescribe them here, but when I say she doesn’t have office hours until the next day, Doc 3 gives me a one-day supply. Then I’m off to order copies of my hospital files (€12) for pickup here in a few weeks, after which I head off with the friend who’s driving me home.

Ciao, home sweet hospital room!

That €12 I paid for a copy of my medical records (optional but recommended) was all I spent. The total bill for eight days of hospitalization, dozens of exams and consults, IV and oral meds, daily lab work, X-rays, and the pending appointments and tests was: €0.

Yeah, that’s a zero. And I had excellent care, which I can say with some authority because I used to be, eons ago in another life, an RN.

Now, I want to emphasize something, because there’s a misconception out there that healthcare in Italy is free. It’s not. It is, however, a fantastic bargain. People with an Italian paycheck have a percentage taken out to cover their annual premium, and those of us who haven’t paid into the system via Italian wages pay an annual amount based on income (which they trust us to declare honestly). That means, for an equivalent hospital to mine (for which I paid nothing), someone else with a higher annual income might have to pay something above and beyond their annual fee.

So what does healthcare cost in Italy? Well, for a year of care here under the national health service—which encompasses all family doc (aka GP) visits, routine screenings like mammograms, vaccines, many prescription drugs, emergency care, and, in some cases, hospitalizations—I pay roughly the equivalent of two months of my 2018 U.S. health insurance premiums. (Note I say premiums and not all healthcare costs, because my expensive U.S. “coverage” covered very little, not even a trip to the ER. Yeah, my bad for being a single person without employer-provided health insurance.) Here,  for visits to specialists or private doctors or clinics, I pay anywhere from €17 to €150—pocket change compared to U.S. healthcare costs.

But here’s the real takeaway from my hospital experience: what drove my docs’ decision making was their own thoroughness and their concern for my well-being. NOT MONEY. THIS IS AMAZING. No one was rushing to get me out of the hospital because of crappy insurance coverage or concerns about massive copays or deductibles. I didn’t have to worry that the radiologist or some random specialist wasn’t “on my plan” and thus would bill me later for untold hundreds or thousands of euros. In the U.S., my eight-day hospital stay would have cost at least $6,500, the amount of my 2018 annual deductible, and probably much, much more. (Try to explain a deductible to an Italian. I dare you.)

Socialized medicine kicks ass, baby. Ask any European (or former European, aka a Brit—who, if they’re non-Brexiters, still consider themselves European). Another little example: I have a friend here who’s on a medication that would cost $148,000 per year in the U.S. My friend pays nothing. For many Americans with subpar or no insurance, that outrageous cost would likely mean they wouldn’t take the drug, which could well mean a death sentence. And don’t get me started on the hundreds of dollars per month people with diabetes have to pay for insulin.

Sorry for getting political here, but it’s hard not to draw comparisons. The U.S. is so hung up on the idea that socialism is bad that it would never—oh wait. What about Social Security, which is, needless to say, hugely popular with Americans? What about Medicare? Hmmm.

---

Poem of the week:

• “Hospital” by Marianne Boruch

Comments? Questions? I’d love to hear from you.