Under the Knife in Italy and the U.S.

One surgery, two countries, vastly different experiences

Photo by National Cancer Institute on Unsplash

Cari amici,

About a year and a half ago I wrote what turned out to be one of my most popular letters, called “Diary of a Patient.” Having just had surgery, I’ve got another medical story for you.

Twenty years ago I had a benign tumor, of a type called a schwannoma, removed from my left leg. Last week I had a cluster of what, by all indications (pending biopsy results) appear to be more schwannomas, removed from essentially the same place. So, same tumor (we hope, because they’re almost always benign), same operation, but there the resemblances end.

Let me qualify this comparison of my experience by saying that in the U.S. my healthcare was delivered via an HMO. That’s a Health Maintenance Organization for any of you non-Americans, whose business model is providing healthcare coverage limited to their own network and prioritizing profits. In a word, it sucked. Yeah, yeah, many people say they’ve had great care from them. I did not. A few examples: 1) telling the pharmacy, well in advance, that I was running out of an important medication and having them whine about supply problems and ultimately fail to get the med, at which point they asked me, the patient, if there was a different one they could substitute, at which point I suggested, not politely at all, that they should ASK MY DAMN DOCTOR. 2) Refusing, because my symptoms weren’t typical, to consider the possibility that my severe, ongoing abdominal pain could be a gallbladder problem, resulting in me circumventing my regular doc and seeing another one, a young, eager fellow who didn’t have a problem ordering a gallbladder ultrasound, at which point everyone started yelling that I needed surgery. Then they made me wait three months despite having excruciating pain that no narcotic could touch.

In giving me a post-op report, the surgeon stopped himself after “I’ve never seen such a—” No doubt he realized he was setting himself up for a potential lawsuit, because the remainder of the sentence was clear: he’d never seen such a diseased gallbladder. Yeah, and you fuckers made me wait three months.

I could go on, but let’s get to the surgery in question. We’ll start with the U.S.; it won’t take long to describe what happened. My memories are supplemented by medical records, so don’t take this with too many grains of salt.

Surgery no. 1, U.S., huge medical facility, 2003

I presented with a lump on my leg and was told it should be removed (yeah, duh). No pre-op tests were done, not an ultrasound, not bloodwork, nothing. Oh wait! On the day of surgery I did have to fill out a Latex/Rubber Patient Questionnaire!

When I showed up at the hospital for the operation, I swear to you (while freely admitting that this was 20 years ago and my memory could be sketchy), it was me and two doctors in what amounted to an empty room. There was no operating suite, no sterile everything. The docs wore lab coats with their ties tucked inside, and, if I remember correctly, they didn’t wear masks. (I really hope I’m remembering that wrong. I must be, right?) But hey, at least they gloved up!

I hopped on a table, they prepped the site and gave me a local anesthetic, then sliced away while chatting. At one point—and I know this is true because I can see it like it was yesterday—the surgeon, without asking me if it was okay, held up this HIDEOUS THING he’d excised as if he expected me to say, “Oh wow man, copacetic!” I said nothing because I was too busy trying not to vomit. Then they sewed up the wound, sent me to the pharmacy for some Vicodin, and I went home. I think I drove myself.

End of U.S. experience. Oh yes, I did have a post-op checkup 10 days later and confirmation, via biopsy, of the diagnosis of a benign schwannoma. I don’t recall how much I paid for the surgery, but I did pay.

Surgery no. 2, Italy, 77-bed small-town hospital, 2023

My medico di base (family doctor) agreed that the new lump perched on my tibia was probably another schwannoma. She ordered an ecografia (ultrasound) and a surgical consult, both of which were done about a month later. The ecografia confirmed, in high likelihood, our suspicions (and the presence of two smaller tumors I didn’t know were there), and I was put on a waiting list for the operation, which the surgeon said would be within two months. It was—almost exactly two months from the consult date.

A week before surgery I went in for a pre-op consultation, which included meeting with an anesthesiologist (even though the anesthetic, again, would be local), an ECG, bloodwork, and a medical history. I was given detailed pre-op instructions to fast from midnight, wash with an antibiotic soap the morning of the surgery, cut my nails and remove any polish, and remove all jewelry and piercings. As is normal here in Italy, along with my carta d’identità (ID) and tessera sanitaria (health insurance card) I needed to bring a coffee/tea cup, a water glass, silverware, napkins, pajamas, non-skid slippers, change of undies, and a bathrobe.

The day of the surgery, I arrived as instructed at 7am for a Covid test. Next, after a wait of about an hour, came the administrative intake—preparation of my cartelle, or medical record, filling out consent forms, discussion of prior surgeries (for the second time), allergies if any, etc. The surgeon arrived and minutes later I was taken to my room (shared). After changing into PJs, I went to another room to be prepped. Let’s just say I’m all set for swimsuit season for the next year or two.

Minutes later my transport gurney arrived and off we went to the sparkling, seemingly brand-new OR suite, where four or five staffers were waiting. In an holding area, a nurse asked my name, then started an IV (expertly and painlessly). I was hatted and masked, my IV arm strapped down, and my other arm bundled alongside my body. The anesthesiologist introduced himself and confirmed that he’d do a local. He gave me an IV antibiotic and asked if I wanted something to help me relax, which I declined. Then we did the gurney-to-operating-table switcheroo.

Before the surgeon arrived, another ecografia was done to visualize the smaller masses, which the surgeon had said she’d remove if she could see them well enough. When it was showtime the anesthesiologist said he was going to give me the relaxing med after all, va bene? and the next thing I remember was waking up in my room hours later. I wasn’t allowed out of bed for a few hours, and when I finally did get up it was with a nurse hovering beside me.

At around 3pm the surgeon and her team came by to check the site (she got all the tumors—technically neoplasms until we have a diagnosis) and give me discharge instructions. For post-op pain (which was minimal) I was told to take up to 1 gram of paracetamolo (acetaminophen) three times a day as needed.

At around 4:30 my friends arrived to take me home, and I left with printed instructions and two scheduled follow-up appointments for a checkup and stitches removal. Since I’d gone through the national healthcare plan, for which I pay annual dues, there was no bill.

End of Italy experience, minus the follow-up visits.

I’ll let you draw your own conclusions about the care I received at these two times and in these two places, and I’ll acknowledge that the 20-year gap means the comparisons might not be totally fair. After all, that shit HMO could have decided to prioritize patient care in that amount of time. Yeah, right.

However. Does this tip the scales? The day after the surgery I developed a scratchy throat that turned out to be—ta da!—Covid. It seems unlikely that I picked up the virus in the hospital because the incubation period isn’t typically 24-36 hours, according to my online sleuthing. But I was negative on Wednesday and Thursday, so who knows. Really, though, wtf? I evade the damn virus for three years and then get sick the day after an operation? Thank goodness I didn’t have major and/or abdominal surgery! In any case, I’m filing a complaint against the Virus Gods.

Tante belle cose. Alla prossima—

Cheryl

© 2023 Cheryl A. Ossola

P.S. My book! Which you can buy here or on the usual sites, or, better yet, order if from you local bookstore. Another fab option is to ask your library to stock it. If you read it and like it, please tell your friends and/or leave a few lines of praise on any bookish site. You’d be surprised how much a rating or review helps authors. Baci!