Saturday, March 8, 2014

Going to the Doctor in Italy – Pathos, Schadenfreude and TMI

You all know I’m a fan of Italy’s healthcare system, and am no less so as of this writing. But going to the doctor in Italy, at least in Umbria, or at least in my village in Umbria, is a little like watching a Greek tragedy (the Romans copied that from the Greeks too, after all). And that’s just in the waiting room.

We live in a town of about 400 people, but I don’t know when the last reliable census was taken. Most of our residents are well past middle age. And in a small town like ours, everyone knows everyone else. They’re probably related by marriage or some distant cousin. Hell, we’ve only got like seven surnames in the whole town. Sometimes, just when I think I’ve got the Allerona family tree sorted out, I find out that two octogenarians are siblings, or that they shared a grandparent. And then I have to take out my mental eraser and redraw the family tree.

But back to the doctor. The way the system works here is that Dr. Marco keeps certain hours. Everyone knows what those hours are and if they need to see the doctor, they show up at his office during those hours. There are no appointments—it’s not even possible to make one if you wanted to. So beginning at 8:30, or 11, or whenever Dr. Marco is scheduled to show up, people start to file in the waiting room. They’re seen on a first come, first served basis and everyone respects the system. You walk in, ask, “Who’s last?” and in that way, you can keep track of when it’s your turn should more people show up after you. 

The waiting room can be quite crowded, or it can be deserted. Everyone prays that the nasty woman who has a “precedente,” a card that says she can cut the line, doesn’t show up and butt in front of everyone. She hobbles in on a cane, overweight and reeking of cigarette smoke (seriously lady, you might feel better if you stopped smoking and lost 50 lbs.), waves her card around the room and says “I go first!” as if anyone didn’t know. She’s the reason my husband doesn’t eat cheese, but that’s another story.

As one person exits the doctor’s office, another enters. If a person has been in with the doctor a long time, we all start to sigh heavily and exchange raised-eyebrow glances. If you’re seated in the right place, you can see a shadow move under the door when the person gets up to leave, and you can nod to the others.

The waiting room is where residents seem to come to share their general laments on life, the state of Italy, the condition of our town, etc. Seriously, I’ve never heard a positive word spoken within those four walls. Witness a conversation I listened to yesterday:

The town is dying. Every house is empty. God help us.
Of course it is. We’ve had seven funerals in two months. God protect us.
Have you been to mass lately? Three people there the last time, including the priest! Good God.
The town is dying. When the bar is closed on Monday, it’s quiet as a tomb up there. My God.
All the young people have gone. Why would they stay? Jesus Mary.
And the taxes. Good God.
And all these young people doing drugs. God protect us.
And that man in Rome who threw his baby in the Tiber. God help us.

I don’t participate in these conversations for a couple of reasons. One, I don’t have much to contribute to the pathos and two, they’re speaking mostly in dialect and it’s hard for me to follow along. I occasionally look up and smile and nod, then go back to playing some game on my phone while trying to look like I’m doing something important. (I’d check Facebook or send emails if I could, but there’s no phone signal in the waiting room.) Yesterday I said, “It’s cold in here,” as it seemed like I should somehow join in the complaining. “Un freddo della Madonna,” (a cold of the Madonna—a common expression but seriously, I don’t really know what that means) someone added.

Once in a while, someone will look at me and ask, “La bimba?” (the girl?), inquiring about Naomi’s wellbeing. Yesterday, I felt like I’d really crossed an important hurdle when I was able to share that she’s been very sick, and rattled off a colorfully-described list of her maladies, but that she’s doing much better now. God protect her. God bless her, sang the Greek chorus.

Most importantly, the doctor’s waiting room becomes the place to share one’s latest health woes, or those of a relative. And let me tell you, Italians do not hold back when they talk about their health problems, even—or especially?—when they’re gastrointestinal in nature, or, for women, related to their reproductive systems. I’ve heard of tales of tumors and phlegm and oozing sores, of faulty hearts and soaring blood sugar. I’ve heard vivid, vivid descriptions of shit—too much shit, shit of the wrong color or consistency, lack of shit, and hard-won shit. I once teased one of my family members about talking about shit (as opposed to talking shit, I guess) too much, and she was actually offended. “I’ll talk about shit if I want to!”

And then there’s the uteruses.

In a past life, I wrote medical coding newsletters for the billing departments of ObGyn practices. As a result, I have more than a layperson’s knowledge of problems and conditions of the female reproductive system, including uterine prolapse. For the uninitiated, uterine prolapse is basically when the muscles in the pelvic area no longer support the reproductive organs and things start to fall…out. It’s very common in women who have had multiple and/or difficult childbirths. One option for correcting uterine and other types of prolapse is a surgery that puts in a mesh-like sling to hold things in place. But these surgeries can fail over time, particularly if the woman engages in a lot of strenuous activity, say like picking olives or lifting sick and infirm husbands or fathers in an out of bed, shower, toilet, etc.

Suffice to say that several women in town, including a family member who shall remain nameless, have either opted not to have their uterine prolapse surgically corrected, or their sling surgery has failed, as my relative’s has. I sat in Dr. Marco’s waiting room one morning, recoiling in horror, as a trio of these women started comparing notes as to just how much of their uteruses had fallen out of their vaginas. One woman held out her hands, fingers and thumbs touching in a downward-pointing diamond, and said, “I’ve got a piece like this sticking out.” My family member said, “Oh shut up, some days I can barely walk.” “Oh my God,” said another, “don’t get me started.” (Please, please, don’t get her started…)

When she’s not complaining at the doctor’s office, my family member complains to me from time to time about her uterine prolapse, as it seems to come and go, or at least, wax and wane, depending on her activity levels. Every time she mentions it, I mumble something about how maybe she should see a doctor about getting that sling surgery redone. And then I excuse myself, race home and do some Kegel exercises. I’m hoping this ensures that in the future, when I sit in the doctor’s waiting room and watch for the shadow under the door, I’ll have neither a starring role nor a spot on the chorus line of our little Umbrian tragedy.

Friday, January 10, 2014

My Italian Driver’s License Part 2: A Scofflaw No More

So it’s been more than a month since I posted Part 1 of my Italian driver’s license saga. And it took me more than a year to get my license, three years after the deadline had expired for me to do so. Do you sense a theme here? Procrastination, thy name is Liz. Well that, and I’ve been busy driving.

You also have to memorize all these road signs,and all the rules that go with them.
Still, when I finally decided to get serious about getting my Italian driver’s license, it’s not as though I had smooth open road before me. Italian driver’s licenses are notoriously difficult to obtain, even for Italians. The reason for this is an extremely difficult written test, which consists of 40 true/false questions. That might not sound so bad, but consider that you can only miss up to 4 questions and still pass the test, and that there is a pool of more than 3,000 questions from which your 40 are randomly selected. So the only way to guarantee passing is to memorize each question. Each and every one.

Consider too that the questions are intentionally tricky. For every softball question like, “A helmet is not required for motorcycle passengers” (umm, false) or “If you see an old man with a white cane attempting to cross the road, but he’s not in a designated crosswalk, you must stop anyway” (umm, true), there are 10 convoluted ones, with excessive wording, double negatives and hyperbolic scenarios. There are hairsplitting questions that could easily go either way. A few examples:

- “The maximum speed limit for a vehicle up to 3.5 tons on secondary roads it is 90 km/h.” Umm, no idea. How much does my car weigh, anyway? - “In one second, a vehicle moving at 150 km/h travels 20 meters.” Seriously, this test requires math?
- “On motorways and main roads it is prohibited to drive bicycles, mopeds, motorcycles with a cylinder capacity less than 150 cc.” I need 150 ccs of prosecco, stat.
- “In case of accident or breakdown, the mobile triangular danger signal should be placed on the roadway so that it is visible at a distance of at least 50 yards from approaching vehicles.” Sure, I guess? But unless I was in one of those approaching vehicles, how would I know it was visible at least 50 yards? 

Did I mention that the test is in Italian? And that it’s timed? And that foreigners can’t bring with them an English/Italian dictionary or any kind of translating device. And that it’s in Italian? 

She needs a license, Godfather.
And she needs it now.
So many Italians have difficulty with the test that there is a huge black market for driver’s licenses, most likely controlled by the Mafia. If you know who to ask and you have the money, you can get a real, valid license, issued to you by a corrupt government official. “Go to Rome and buy one,” Paolo’s aunt told me. “How much is it?” I asked, though I wasn’t seriously considering an illegally obtained license. “Only 1,200 euro!” his cousin chimed in. “Are you fucking kidding me?” I replied. I’ll take my chances going legit.

I began studying for the test by taking online quizzes on one of the many free websites designed as study tools. I started slowly, but intensified my efforts in the Spring of 2013, when the cabin fever was getting to be just. too. much.

By July, I was passing more quizzes than I was failing, so I was starting to feel like I was ready. Paolo helped me get all my required paperwork together. This involved a form completed by my doctor saying I was of sound enough mind and body to drive. It involved an eye test. It involved several francobolli, or tax stamps, attached to various declarations, which were then stamped fervently by persons of authority. Then, it involved me getting to Terni, the seat of our province and about an hour away, to take the test. I’d arranged for a friend to drive me down, and I felt my chances of passing were at 80% or better. Except the night before, Naomi was up sick with a fever all night long, and I got no sleep. I arrived to the test site tired, agitated and with entirely too much caffeine in my system.

For the sake of brevity, let’s just say I failed the first test. Test results are posted in the testing waiting room, for all to see. Once the test proctor tacks the results on the bulletin board, all the nervous test takers gather round to see if they passed. So while a dozen or so teenagers squealed and jumped up and down and hugged and high-fived—fuck all those little ingrates, anyway—my heart sank in disbelief as I saw my name on the list, with the number of errors I’d made right next to it. I’d missed 7. Seven. I could only miss 4. I walked out and got in my friend’s car, and we rode in near silence on the way home. “It’s a dumb test,” he said now and then. “Even Italians fail it.”

After a brief period of mourning, I attacked my studies with renewed vigor. I switched to a different study website ( for those in need) and spent at least an hour a day studying. When I was missing no more than 1 or 2 questions per quiz, I felt I was ready to try again. 

Rather than wake up at 6 am to get to Terni by test time, Paolo and I left Naomi with her nonna and went down the night before and stayed in a hotel. I took an Ambien to make sure I got a good night’s sleep. We had a leisurely breakfast and arrived to the test site about 10 minutes before I was called in.
I was all ready to do this...

Still, on my second attempt, I walked out feeling like I probably hadn’t passed. I counted 7 questions I wasn’t sure of. I changed my answers back and forth on several of them. Paolo, who could watch the test takers on a closed circuit TV in the waiting room, saw me put my head in my hands several times. I walked out and looked at him defeatedly, shaking my head in dismay.

When the proctor came out about 5 minutes later with the results, I elbowed a few skinny teenaged girls wearing too much eye makeup out of my way. There was no number next to my name to tell how many questions I’d gotten wrong. That could only mean one thing—I had passed! I gave Paolo a thumb’s up from across the room, then checked the results again. Then one more time.

But my driving school instructor
was all ready for me to do this.
It took me weeks to actually believe that I’d passed the test. I would be driving somewhere with Paolo—I had my foglio rosso, or leaner’s permit now, and I’d announce, incredulous, “I still can’t believe I passed that test.”

In truth, I still can’t believe I passed that test. I’ve spent a lot of time in college studying for difficult tests, and none of them gave me the anxiety this one did, and none of them did I study so hard for as I did the test for my Italian driver’s license. Yes, I still had to attend driving school and spend a set number of hours behind the wheel with an instructor. I still had to take the physical driving test and pray that I had unlearned enough of my lazy driving habits in order to pass scrutiny. But the worst was over. So over. So completely over.

Valid until 2024, bitches!

Within a month, I had my Italian driver’s license. To say that my outlook on life in the Italian countryside has improved considerably is a bit of an understatement. I am back to being taxi driver for my female relatives who don’t drive. I’m back to running errands and taking Naomi for spins farther afield than Allerona Scalo. I’m back to having lunches and cocktails with friends in Orvieto, because I can drive myself there. In short, I’m back. And freedom is a beautiful thing, indeed.

Now I can do this again with my friends!