Health care in Italy: Part 5...

Archive post November 11, 2019…

I have a new left hip.

The worst is behind me. I was thoroughly tested. The pre-op anxiety, the post-op pain & discomfort and authoritarianism of rehab were difficult to bear. They were all constant reminders of why I had ardently avoided the operation for 5 years. However, that stance is short-sighted. I have much to gain, like walking upright without pain or, lower back wobble. Let’s hope, OK?

I am now happily installed in the Apt. Azzurro at il Poggiolo with a lovely fireplace blazing away, several good books, my laptop and two very crazed Weimaraners. No w-a-l-k-s drives them to annoyance. The constant rains for the last 10 days have not helped either but, gives me a ready-made excuse for an afternoon nap. Dogs permitting. If allowed, what a treat. I am living off home-made soups, quick pasta’s, chef’s salads and scrambled eggs. My appetite has returned. Cannot shake the desire for pancakes with maple syrup or a MacDonald’s Double Cheeseburger. Calories are saved since I cannot drive yet. I will not starve or die of thirst. Certainly not thirst. You loaded up on wine.

Crutches furnished by my dear English friends here in Codiponte are paar for the course. Unfortunately, the Apt. Azzurro is an obstacle course of furniture, the Dog’s mattress, carpets, short hallways, tight corners. I can often forego the crutches and just crawl along holding onto counters, chair-backs and walls but…. shhh!!! Don’t tell anyone… I’m not suppose to that. Must be upright.

I have to wear stockings to avoid unwanted trombosis. They stink. I cannot take them off. Too hard to get back on. And they make washing beyond a sponge bath impossible. So, I stink somewhat too. The first thing I would like to do, when permitted, will be a long hot shower. Not until the staples are out.

I have to give myself a shot every evening at 5PM. An anti-coagulant. The idea is far worse than actually doing it. How lovely, two options… pick a shoulder or, tummy. Luckily, I still have an abundant tummy. Dott. You taught me a trick… lightly dab the selected area with disinfectant, quickly slap the spot, then poke the syringe pushing the plunger of medicine into your flesh… yeah, a bit disconcerting to say… and you will hardly notice even a pin-prick of pain or, discomfort. More fun when You does it. Makes me laugh. He’s not around.

My immediate post-hip op situation briefly updated.

Previously, I was not much in the mood to post and certainly not during my two week’s stay in hospital & rehab. All too fresh, too raw… a nightmare… to write in Real Time of struggles with severe pain & discomfort, the insistent Rules & Regulations… Signore! Before you even think to touch the floor YOU MUST HAVE your slippers on… the absolute dominion of the nurses, and I can tell you, they rule for better or, for worse. A kind of boot camp… and the tasteless & dull food. Food may not be the appropriate term for what was served, in my opinion. Always a relentless potato puree and a baked apple served with UFO’s posing as chicken, beef or, fish. A couple of times a delightful roast chicken breast or, the 1950’s American feel-good of fish-sticks would be found hiding under a plastic plate’s cover, a happy spoiler to the typically unappetizing bill-of-fair. Lost 7 lbs.

Before I ever got to the hospital…

the pre-op anxiety built its momentum in the days after the call from the Capo Sala. Dealing with fantoms of worry and logistics. Errands to provide enough water, food, clean clothes, toilet articles for my return to the Apt. Azzurro… importantly, a residence all on one level… at il Poggiolo from rehab. Bed made? Dogs set up? Had to drive to Sarzana to buy dog food since, the store in Aulla was, typically, out of Nina’s & Croesus’ dog food. That chewed up an entire morning. Stress. Apt. Azzurro cleaned & organized? Water heater checked so You could have a secure h-e-a-t during his Tour-of-duty as Florenz Nightengale, while I’d be flat on my back in a hospital bed. La Casa Grande cleaned & sorted for its Winter hibernation? Bills were paid, cash pulled for You’s travel & food expenses plus mine to cover my three week convalescence at il Poggiolo. Bag packed for the hospital with slippers, athletic pants and T-s’, etc.? Most done yet, the anxiety persisted weighted by the fantasm of the anticipated hip op, a heavy ball & chain around my delicate consciousness.

Kuddo’s for Florenz Nightengale. You redeemed himself marvelously. The threat of not coming down from Genoa for my op was another fantasm. Of course he was going to come. He arrived at il Poggiolo the Saturday before. We drove and deposited the Dogs with their sitters Sunday morning, continuing on to a birthday party for You’s brother, who had knocked upon 60 years. A distraction. Mountain trattoria specializing in funghi. It’s been a grand season for funghi in Italy this year. Ordered a lasagna packed full of funghi porcini. Could not eat another thing afterwards. Maybe a salad. Drove back to il Poggiolo only to head out for a pizza at You’s preferred pizzeria in Pieve San Lorenzo above our village of Codiponte. Our favourite lady pizzaiolo was manning the palette at the hot brick oven. She did good. A golden calzone for You, pizza bianca con un’uova for me. Eating seemed to assuage anxiety somewhat and until I took a pill to sleep.

You drove me to the hospital Monday morning. The appointment was for 8:30. Neither of us, and one is an Italian doctor working within the Italian national health scheme, could figure out why I had to lay in a hospital bed for a entire day. You patiently sat while I was interrogated by the Admitting Nurse on who I was, my medical history… previous operations, allergies, transfusions… and what was supposed to happen to me in the hospital. What? You don’t know? My left hip! Just checking, Signore. A test? Then, You stayed to accompany me through a saltless lunch before excusing himself to drive back to il Poggiolo for an afternoon nap. He deserved it. I couldn’t nap and instead, tried to distract myself with an afternoon of reading. You returned to watch me not eat a saltless dinner. The tray retrieved and You gave me a quick kiss and a Buona Notte to head for home to rest up for tomorrow’s ordeal. Sleep? Got a pill without the asking. Thank the Good Lord.

I was awakened at 6:30AM. Temp, blood pressure and a last minute check on my heart-beat. All OK. Two nurses arrived with brisk instructions on how & where to shave myself and the intricacies of slipping on a transparent coat?… and covers for my feet and head… in a bright green synthetic material. Rather chic, leaving aside their requirement. Like a beach cover-up with no interest to cover-up. Once done, into the bed for the trip to the operating theatre. A long voyage once past the automatic double doors protecting the inner sanctum.

Darn if it wasn’t nearly the same crew I had five years ago for the op on my right hip. An intermediate stop for one last interrogation… a test?… before submitting unconsciously to the saw. Lo’ & behold, there was my surgeon chatting with a colleague in an adjoining room. We smile, waved and exchanged in bocca lupo separated by a glass partition. Felt a bit superstitious. Like not seeing the bride before the wedding. The surgeon came out to introduce me to a few members of his staff. Beside himself, there was another orthopedic surgeon, a general surgeon… to stitch me up, I discovered later… a technical consultant from the manufacturer of the prosthesis… defects have arisen for prosthesis installed between 2000 and 2011. Whew!… the capo sala operatoria, 2 anesthesiologists… a guy and a girl… and 6 nurses. 13 people in all!!! A convention of health care professionals assembled on my behalf. WOW!

The operating theatre was rife with nervous energy to get-going. The get-going got stopped when neither of the 2 anaesthesiologists could find the sweet-spot between the vertebrae of my spinal column to slide the needle in with its drug to deeply numb all below my belly-button. This wrecked everyone’s nerves.

Other nerves were wrecked when a blackened mole was seen at the base of my back. Staff was concerned and affirmed… to me in my semi-drugged state… that I would be visited post-op by an in-house dermatologist to have a look. Back to the needle. Doubled over myself and crunched down by two attending nurses, the spot was eventually found and off into la-la-land went any sensation from my tummy down. I was gently rolled over onto my right side to expose my left hip, a mask was put over my face. The next thing I knew was the gentle pat on my shoulder from the gal anaesthesiologist to tell me the final stitches were being sutured and all would be done. It all went splendidly. I did good. Gosh. Thank you, dottoressa. Occasionally, blood would rush down a tube close to my face. Reminded me of the ads for products to unclog drains. Sani-flush? I was wheeled out and could manage a regal wave to Staff, liberally dispensing my thank you’s for those who tagged along… everyone is fascinated that I am an American, thus, the groupies… my surgeon included and I was promptly given his benediction with a thumb’s up… and a nice, big smile.

Once sensation had returned and I could talk and be understood in my American accented Italian, a nurse… I remembered her, Daniela, from the last op five years ago. A garrulous force of nature with a sense of humour and a heart too… came to me to ask if I had made arrangements to laterally move to rehab after a few days in hospital. Don Gnocchi? No. I thought it was automatic. No, signore. Ci vuole una richiesta. La seguo io. Non preoccuparti. Grazie, Daniela. She ran into a brick wall of bureaucracy, poor thing.

One of the absolute elements of living in Italy is residency. It’s essential. You can’t move without it. Residency defines you, corrals you, attaches you to the Italian State and all of its many branches, like the ASL, the Italian national health scheme. Big ASL health stuff, like an op, can happen anywhere in Italy since, you are given the right to choose your attending dottore, chiurugo, expert, wherever in the country. The small ASL health stuff… rehab, therapies, post-op checks & controls… has to be done where you have your residency. Mine is in Genoa. No way man. I’d get lost, overlooked, forgotten there… and wait a life-time for an appointment. No problem for me to have been operated upon in a hospital in the town of Fivizzano by a Tuscan surgeon. Fantastic. Humane dimensions, good people, superb surgeon. But, I got a…Eeets not possibile la riabilitazione qui, signore. Lei deve andare a Genova. The Bureaucratic Wall.

The local rehab is housed in a newly built palazzo next door to the Fivizzano hospital. The facility is actually a sub-contractor to ASL, partially funded by the Catholic Church. Don Gnocchi. A real person, a priest, who did lots of Good, was made a Saint, then, financing quickly followed after Beatificazione to create a foundation. There are Don Gnocchi’s all over Italy. Think the cookie-cutter reliability of a Holiday Inn, only there are bunches of nurses, doctors and therapists bustling about at all hours of the day & night and each in their own color-coordinated uniforms. Blu per i dottori, verde per gli infermieri, azzurro per gli assistenti and bianco per quelli adatti alla pulizia. A big, modern, professional health care business. However, Don Gnocchi has to obey the Rules & Regulations, ie residency or no residency. The B-wall.

The nurse, Daniela came back with the Bad News… no Don Gnocchi. Oh? Well, that’s crummy. What next, Daniela? Let me see what I can do. Non preoccuparti. OK. Molto grazie.

She took pity on me. She had help. I know on Earth and, I suspect, from on High too. There was no way the hospital could send me home, barely able to move on crutches or, with a walker, and dependent on pain-killers & anti- biotics… I had a recurring and often high temperature… plus constant anti-inflammation drugs 24/7. I appreciated the concern, the responsibility of the hospital and its staff towards its patients. Daniela went to speak with Dott. Vaselli. A bald, smiling gentleman and the hospital’s il capo for orthopedics and its care & treatments. He took pity on me too.

Daniela came back with a proposal from il Dott. Vaselli with the idea of moving me to an extended stay ward where I could stay, receive physical-therapy visits, until I was able to go home and care for myself properly. Sounded like a fine proposal. I enthusiastically gave my approval and thanks.

An hour later in walked Daniela with a dottore I had never seen before. Tall, thin, smiling, gentile. 10 years in the Lunigiana utilising its health care facilities, I have come to know most of i dottori. He was introduced to me as Dott. Barilli, like the pasta but, sadly for him, no relation, and is the head of Don Gnocchi-Fivizzano. He had a new proposal to….yes, move me on over to rehab. Apparently, Daniela, Dott. Vaselli and Barilli were in cahoots to make something necessary happen for my better health. They had ingeniously gotten around ASL’s residency requirement. I asked no questions. Anonymity serves in certain happenstances. Hip-hip-hurrah!!!

Four days after me op, I was transported next door to Don Gnocchi. I gave my heartfelt thanks and gratitude to all the nurses present and, lo & behold, to Dott. Vaselli who appeared as I was pushed to rehab. Nurses & doctors are a wonderful species, don’t you think?

Rehab was rehab. Work in another word. 2 hours in the morning of being manipulated, exercised, bicycled till I cried… Mother!!!… and in time to be seated in my room for yet another tasteless lunch followed by a nap, if lucky, only to return for another 2 hour stint of the same in the afternoon. Day in and day out. I thought I was destined for massages, hot medicinal baths to soothe the pain & discomfort and torment of a hip op, alternating with laps around the facility on crutches. Nope. No pain, no gain. Gym work. On my off hours, I read all my books and watched The Crown for the umpteenth time, took photos of the juniper trees outside my window, felt bored and pined for my Dogs and Roberto too. I wanted to run-away from rehab. I got my chance on the following Saturday. Roberto went to retrieve our canines after two weeks with the sitters. Their time was up and thus, mine too. Rehab did not want me to leave. The nurses seemed bit miffed that after a week I was ready to hit the road. Begging their pardon, I road off in You’s old AUDI into the rain to be happily installed in the Apt. Azzurro, You, the Dogs, refrig, and fireplace ready for me. Hallelujah!!!

How about a photo-medley?…

P.S. I have spend out of pocket on my hip op Euro 272,21 or, $300.72.