The Impegnativa, one very important Italian document

Perhaps a better title for this post is The Italian Medical system, part XXX .  Seems I could write on this topic endlessly!  It's a subject I get asked about frequently in emails and in conversations with tourists from almost every country imaginable, but mostly from Americans wanting to hear first hand what I think about the differences between medical services here and back home.

I spent a bit of time this rainy morning over at Ospedale Civile while waiting for an appointment with an ear specialist, and that got me to remembering a previous visit to an ear specialist back about 6 years ago.  It was my famous visit to ex-Ospedale Giustinian, over in Dorsoduro, the afternoon I got lost and locked in the bowels of that huge, dark, scary Venetian building and ran into the worker wearing only his underwear. An afternoon I would like to be able to forget, but unfortunately that image is forever etched in my brain.

Last week when I was making this appointment, I flatly refused any and all possible appointment times offered at Giustinian. No, never again. Trust me. Never again. I'll go anywhere else, even to Mestre on the mainland, but not Giustinian. Thankfully this morning finds me at Ospedale Civile in Campo San Giovanni e Paolo.

I couldn't help but do a re-play of that horrifying afternoon in my head while passing time in the waiting room this morning. When my turn was called, I took my place at the sportello (counter) where the intake nurse processed my paperwork. Finished with all that, I asked if she could help me with one other matter.  I've been having a real run around trying to get appointments for injections in my knee for months now, and since Orthopedics share the same office space here I thought I'd just try my luck one more time. I already had an impegnativa (see photo above) for the injections, but for unknown reasons every time I tried to make the appointments, I was given another reason why they could not make an appointment on this doctor's calendar. It has been months, and still nothing. 

I'd discussed this problem with my regular doctor the week before, and she gave me yet another impegnativa for the injections with the advise to try again at the hospital appointment desk. I did try, but was told only my Orthopedic dr. could give this prescription, and I must wait on him.  Yes, I've been waiting. Months. And now the knee has decided this isn't fun any more.  So today, I explain that I now have 2 impegnativas and still no appointments. My regular doctor had also advised me that if I still didn't get an appointment to go take the matter up with the woman who runs the Office of Public Relations. That woman was my next stop this morning, after the ear dr. finished up with me.

The second secretary in the office, who was listening to my explanation of the multi-impegnativas,  turned from her computer screen to face me and told me to come see her when I had finished up with the ear doctor.

Back in the waiting area, I waited for my turn for the doctor. When my number was called, I was
introduced to a fairly young Ear, Nose and Throat specialist. Instead of asking me what brought me to him this morning, he asks what brought me to Italy. I should have been prepared, as this is a very common question, especially in any medical office. I proceed to give him the brief history of Karen becoming an Italian. Why is this so curious?

Next question from the dr. , " Is it true American doctors are all rich? My friend told me this. "
My response: "Doctors in the US do make more than most doctors in Italy, I am sure of this." He turns to his nurse and begins a fairly lengthy discourse on how medical services here in Italy are free or so inexpensive compared to in the US. He seemed quite unhappy with the whole scenario.

As he is examining me, he relays his family story of how his nonno (grandfather) immigrated after the war, how one uncle ended up in the US, another eventually in Germany. The examination conversation took a few more turns, ending with the doctor writing another impegnativa for yet a different examination. As you may have deduced by now, the impegnativa (see photo above)  is like the Willy Wonka Golden Ticket.  This gets you appointments with specialists; blood tests, x-rays and ekg's etc.; and prescriptions. It's a crucial document.

I remembered to stop by that secretary's desk on my way out. She took both of the impegnativa's for the knee injections, looked them over, hit a few keys on her computer and asked me if next Thursday at noon worked for me.  Absolutely yes. No matter what I might have planned for next Thursday, I will be cancelling. There was no way I'd miss an opportunity to get these shots. I asked her about the other 2 dates. She responded, "Don't worry. Get here on Thursday and we'll work all the rest of that out."  I thanked her profusely. She adds, "I remembered you from when you had your knee operated on. The American woman. "

Yes, the American woman. I must seem like a freak show to these Venetians.

A sunny day

Ever have a day when things just didn't go as you planned?  Well, today was one of those for me.  From the minute I left the apartment, nothing went right. I probably should have stayed in bed. 

If you have been reading my blog for awhile, you might remember that I had knee replacement surgery a few years back. For the last few months my other knee has been giving me all the signs that it too is ready for some modern technology. I knew I couldn't put off seeing my orthopedic surgeon any longer, so the other day I visited my regular doctor to request a referral.  At the same time she wrote a prescription for an x-ray, as I will need to take a current x-ray with me to the surgeon.  

This morning I got up early in order to be one of the first at the office for the x-rays.  I intended to have this done at Giustinian,  the medical facility over in Dorsoduro.  However, when I got to the vaporetto stop I had just missed the 5.2 boat going to the Zattere, the closest stop to Giustinian.  If they weren't doing construction on the Sant'Elena vaporetto stop, I would have been there in time. Instead, I had to walk up the fondamenta a bit farther, which took me a few more minutes. End result =missed boat. Knowing I'd have to wait another 30 minutes for the next boat  (thanks to the newly reduced winter boat schedule effective September 15), I switched gears, ran over to the other boat dock and waited for the 4.1 boat headed towards Fondamenta Nove, planning instead to get the x-ray done at Ospedale Civile. 

Once at Ospedale, I had to navigate the giant maze called our hospital to find the Radiology department.  Inside  that building, I waited my turn at the in-take clerk, only to be told I needed to make an appointment to have the x-ray.  I racked my brain, but for the life of me I did not recall ever having to make an appointment for  x-rays. I thought for sure I just took the prescription in with me.  I'd only had x-rays at either Giustinian or Fatebenefratelli, and the last time was 3 years ago, so perhaps they'd changed procedures since then.  This is Italy, and I'm learning I need to just go with the flow. I'll never understand how anything operates in this country. 

Nothing is ever easy. I then had to get myself back into the maze, wander around a bit, and luckily located the right office for appointments.They have been doing a lot of renovation at Ospedale ( a good thing) which means it will be even more confusing that it normally would be.   On one hand, this was good because I needed to make an appointment for the surgeon anyway. Good, I'll kill two birds. But on the other hand... not so good. When it was my turn, the girl behind the desk making appointments laughed in my face when I asked if it was possible to get the x-ray done today. No, three months from now, she tells me. I should have expected nothing less, seeing how my morning was going. 

With some magic, she managed to find an appointment for me with an orthopedic surgeon on October 7. That's promising. The appointment is somewhere on the Lido, and I have no clue where that hospital building is, but who cares. I'll deal with that fiasco on October 7.  I tell her to book it.  With that done, she managed to find an appointment for an x-ray on September 29, at Giustinian.  Wonderful. Thank you. At least I'll be able to have the x-ray to take with me when I go to the surgeon, otherwise his visit would be for naught. 

Not happy that I wasn't successful getting the x-ray as I had planned, but thankful that I at least had made some sort of  progress, I exited the Ospedale building into one of Venice's most beautiful campos,  San Giovanni e Paolo.  The campo is empty, the caffe's are just getting awnings out, and it's sunny. I decided I've earned myself a little treat, so I stopped for tea in the campo. 

There was only one other table occupied at Bar Colleoni when I sat down. Wouldn't you know it? It's a gorgeous day and I don't have my camera.  The photo above is mine, from some previous day of wandering.  Sitting with this marvelous statue in front of me, relaxing with a cup of tea is a pretty good way to spend my morning. I took out my notebook and started to write. I wrote the blog I intended to post today. A blog about yesterday's adventures.

I dragged my tea break out for well over an hour, just enjoying the sun and my surroundings.  Instead of heading to the closest vaporetto stop, I chose to walk most of the way home. I meandered my way from Campo San Giovanni e Paolo back to San Zaccaria. Along the way I popped into New Zealand's Architectural Biennale exhibition, where I had the best time meeting and chatting with  the two women running the exhibition. We've made plans to meet again in a few days.

Sunshine. Tea. New friends. Not such a bad day after all.

And that blog I worked on?  Saving that for tomorrow.

How did your day turn out? 

My first Italian eye exam

Yesterday I experienced yet another "first"... an eye exam.  I have no idea why I believed this would be routine and ordinary. I should know better by now!

My first clue should have been that the appointment was in the same old hospital building where I got hopelessly lost in the basement.  I clearly remember that thrilling adventure!!!

I arrived at Giustinian, the old hospital building in Dorsoduro, on time, and found my way to the right location for my appointment, miraculously. This old place is enormous, and generally empty. Trying to find someone to ask directions is not even an option.  I searched all the signs for "Occulista", made my way to the second floor, and continued looking.  Relieved I appeared to be in the right location, I took a seat in a small waiting area along with 2 other Italians.

About 10 minutes later, a woman appeared in the waiting room and called my name, preceeded by "Signora".  I still have trouble responding to that, it always takes me a second or two, then I figure out .. Hey, they mean me!  I followed this nurse or whatever she was down the hall, and entered a dark room. Why does this always have to be so spooky in this building??  Also in the room was a woman in a white lab coat-it became apparent she is the eye doctor.  The doctoressa invited me to sit down behind one of those eye examination machines.  Before things got started, I apologized that I had forgotten to bring along my glasses.  The doctoressa proceeds to lash into me in rapid Italian which I roughly translated to be something along these lines " HOW CAN I CHECK YOUR GLASSES IF YOU DON'T BRING THEM!!!!!!  "  She is not happy with me one bit.

Ok, I apologized again, then asked if she could please just do an eye exam, as it's been 2 years since I've had them checked and I think I need the prescription adjusted. Yes, she can do that.  Whew.. I have made it through the first hurdle, all the while praying to God that there aren't any more to come.

The doctoressa uses this machine, into which I peer while she adjusts a few dials.  What I see on the other end is a hot air balloon out in a field. The whole thing starts out kind of fuzzy, but clears up as she adjusts a few dials.  Ok, she is finished, and motions for me to follow her.  We move to another office near by.

I sit in a chair, and she puts a pair of funny glass frames on my face. They were huge, with thick rims around the eyes, and thick armpieces. This was not  anything like the equipment I was used to my American eye doctor using. (Sidenote:  I love Dr. Blandina, my American eye doctor. And at this moment in time, I was really really missing her!)  Into the front of these "glasses" she slides some different lenses, and asks me to read the eye chart on the opposite wall.  I read with the right eye, then the left. She makes an adjustment on the left side lense, we try again, then she says "OK".

The doctoressa sits at a desk across from me and begins asking a few questions - what medications do I take , when did I come to Italy, where did I live in the United States , and why am I here.  These weren't needed for her forms, she was just curious. I'm used to this by now, so I humor her and answer her questions.  Every doctor and nurse I've seen so far has had the same curiosity.

Next, the doctoressa explains she is going to put drops in my eyes. I'm not sure I understood her correctly, she was speaking at warp speed, even though I had explained to her I need her to speak slowly. What I think I understood was she was going to dilate my eyes, so she could look or measure the retina. I wasn't going to argue her, I was along for the ride.  Yes, sure , whatever, give me the drops.  She puts the drops in my eyes, then tells me to go wait outside in the waiting area for 10-15 minutes.

When recalled into the examination room, I was told to sit at a different machine this time. The doctoressa started with the right eye. This intensely bright light beamed into my eye, so bright that it hurt, I could barely keep my eye open. Once again, the lovely doctoressa is screaming at me "KEEP YOUR EYE OPEN".  "LOOK LEFT" ,... "LOOK RIGHT"..."LOOK UP"... "LOOK DOWN".  She switched over to the left eye. I had even more trouble keeping the left eye open. She grew tired of trying to deal with me., turned off the machine, threw up her hands and said "It's too difficult".  She is clearly not happy with me once again. Yes, I got that. I prayed that she would not bring out a ruler and smack me, because I was feeling just like I had been a naughty child who was summoned to the principle's office. Why is it Italians make me feel this way whenever I make the slightest little goof????

She wrote out a prescription for my lenses, handed it to me, and told me to come back for another visit next year.  I mumbled a "Thank you" and left quietly.  I figured out how to get myself out of the maze of this building and out onto the street. My eyeballs hurt so much from whatever that last machine was!  I was thinking I probably would find some excuse not to return the following year, and I was saddened that I had not found a friendly eye doctor here to take the place of Dr. Blandina back in Baltimore.

Thankful that I had managed to maneuver yet another Italian first, I treated myself to a cup of tea in Campo Santa Margherita.  Yes, one more experience under my belt. But this was only part 1. Next I am going to have to deal with shopping for new glasses.  I can only imagine what kind of nightmare (lol, adventure) that will be.   Make that two cups of tea. I needed it.

Life in Venice - Another unbelieveable day in Venice.. this one may take the cake!

(Note :This turned out a bit long, but the background stuff is necessary today! The ending makes the read worth it, I think.)

I’ve been slowly learning the ropes of the Italian medical system in the last month. I had no idea my education was still so lacking!!! I’ve managed to get through most of the hoops in obtaining our National Health Insurance, finally, and regret I have been negligent in blogging that tale. I promise I will get on it as soon as I finish this blog episode, as yesterday was by far the most fun I’ve had in a long time.

There’s been a strange faint ringing in my left ear for several weeks now. It’s nothing I’ve ever experienced before, has not gone away, and frankly is bugging me, so when I made my first visit to my new Italian doctor a couple of weeks ago, I mentioned this as well. He referred me to an Ear specialist for tests. Making this new appointment required finding a different building in Dorsoduro, the old hospital at Giustinian. I knew exactly where that was, it shouldn’t be an issue getting there. I just would have to figure out the procedure once I got in the building.

Immediately upon leaving my doctor, I trotted off to Giustinian. No point putting it off, I would have to deal with it soon anyway-- this would be one more little adventure. Once inside the building, there is a reception area where you have to check in. I handed the man behind the window at the reception booth my referral from Dr. Viannello, and also my Tessera Sanitaria card (I’ll explain this one in my blog on the National Health Insurance system ). In short, without presenting this card, you don’t get very far. This man told me to go around the corner to the right, then another left, then the second Sportello on the right. Sportello, btw, could be either a counter or booth or an office, depending on what government office or bank you may be at.

At this Appointment Office, you take a number and wait outside with the rest of the herd. Some days it’s a long line. One by one when your number appears on the Neon sign, you go in and take your turn. When my number came up, I went in, explained to the girl behind the window that I don’t speak Italian very well, and handed over both my referral form and my Tessera card. With no problems whatsoever, she was able to schedule an appointment for me on January 9th, handed me a form with all the information on it, and explained that the doctor’s office is in this same building.

Yesterday being January 9th, I ventured off to Giustinian to meet my new Ear doctor and see what fun would be awaiting me! First stop, the man behind the reception desk. Once he checked out my appointment form and my Tessera card, he instructed me to go to the Primo Piano. I was also able to pick up the results of some recent blood tests from the same window, so I tackled two birds with one stone while there. I was feeling quite confident, I must say. I still had to make my co-payment for this visit, but I had figured out the mechanics of that on my first visit. You make your payment by deposting money into a machine, exactly like the ones you use in parking garages in the USA. The machine prints out a receipt for you, and away you go.

I followed signs to the Primo Piano (first floor, what we in America would call the 2nd floor), but once I got past the next doorway, I was faced with two stairways, an elevator, and no way to know where to go next. Fortunately for me there was a nice nurse in the doorway at the same time who I was able to ask for more directions. I’ve pretty much now made it my routine to first explain that I only speak halting Italian--- my attempt to pre-empt what could be an ugly scene when we get to the point I can’t understand anymore. She was delightful, indicating to follow her. We set off for the next floor via the elevator. This place is HUGE. Thank god for her, I would never have found my way. I need to do some research on what this building was originally. It has to have been one amazing Palazzo or something important to be the size it is. We made some pleasant conversation as we walked, talking about where I was from originally, where I live now, where my mother was born. She dropped me off right at the Ear specialists office, a very long way from the elevator via a windy path of corridors. I remember thinking to myself I would be having a devil of a time finding my way back out without her.

While seated in the waiting area (a few old chairs in the hallway outside the door), a nurse came to retrieve my appointment form, my receipt from the machine downstairs , and my Tessera card. When it was finally my turn, I went in, just a little hesitant. You never know what to expect behind the doors, you know? There was a little man in a lab coat with sort of wild grey hair and glasses. For some reason, I liked him instantly. He smiled when I told him I can’t speak well. “No problema”, he responded, and directed me to sit down in an examination chair, alongside which was a table with an assortment of instruments. He took about 1 minute to look in my ears, then my nose, and asked me what kind of work I do and if I smoke ( I don’t). He already knew what ailed me, but I mentioned that I have been sick with a cold this week. Ok. He took a different instrument, a tiny flashlight gizmo and peered into both nostrils again. Next thing I know he is tilting back my head, and inserting this bent- in- the- middle tweezer- like apparatus into my left nostril. I just wasn’t prepared for that! He was twisting and turning it--gently, mind you-- but honestly, I was afraid something was going to get ruptured in there. God help me, for an instant there I was afraid for my brain . Clearly I don’t know enough about this part of my anatomy!! This went on for more than a few minutes. I had to close my eyes, grip the armrests of the chair and just breathe slowly to relax. Finally he was done. He showed me a huge pile of mucousy-glop he had extracted from my left nostril cavity. This must be the stuff of sinus infections!!! I had no idea! Then my little old dottore smiles and says “Bene” ( Good).

I had to say, “ Dr., I still have this problem with the ringing in my left ear”. Yes. He takes my hand and leads me to an adjoining room, which contains an isolation booth. Yup. An isolation booth. Just like the ones you used to see on game shows where they don’t want you to overhear anything. And this booth was that old,too! I am seated inside it, with earphones on, and have been given instructions to signal with my hand when I hear a tone in my right ear. I do that. Next, I am to repeat that for the left ear. I want to laugh, because there is a window between the doctor and me, and he is looking up at me whenever there is a new tone to hear. The devil in me wanted to just wave my hand at him whenever he looked up at me. I behaved. For the right ear, I had passed with flying colors. On the left side, obviously there was one tone that I was missing, I could tell by the look on his face.

Finished with that portion of the exam, we go back to the other room. He writes me two prescriptions, tells me the dosage information, and sends me on my way. I’ve survived another Italian doctor visit! Not so bad, I’m thinking, feeling pretty proud of myself. If I had only known there was one more twist yet to come. I had to find my way OUT of this building. I walked down several corridors, trying to remember which way we had come on the way in. Every hallway looked the same. I was doomed. It’s late in the afternoon on a Friday, not much going on in Giustinian. There is no one around. I will have to file that tidbit of information for the next time I have to make an appointment here. I decide instead of trying to hunt down the elevator, I would take one of the exit stairwells, as they were clearly marked.

I opened an exit door. Immediately upon entering, I knew something bad was about to smack me in the face. The door shuts behind me, and is locked from this side. The stairwell is completely dark. I bang on the door for a few moments, but I already know no one is on the other side to help me. Only one thing to do, I go down the dark stairs, and am let out in the dark bowels of the hospital basement. And I do mean dark bowels. There is no one down here either. I wandered a bit and found an open exit door into an old courtyard. Ah ha!! There is a gate to the outside. I walk there, only to find it with a large chain and padlock on it. I’m now locked inside here. A woman leans out a third story window of a next door building and asks what I need. “An exit”, I say, in recognizable Italian even. She points me back inside. Not good. Ok. Back inside I go.

I start trying each of the doorknobs on every door going down the corridor in this scary, dark ,deserted basement. Just to remind you, this is a building built in the 1500 or 1600’s probably. (For anyone familiar with Venice, you know that there are no basements here, it is actually the first floor.) Just the same, it’s dark, deserted, old and starting to cause me some anxiety. Each door is locked. Some doors have hazardous waste signs on them, I see a few really old wheelchairs sort of tossed around, and a lot of construction-like cordoned off areas. I keep trying doors, -- one of them opens!!! I push it open wider. Inside is one man, in his drawers and a plaid shirt, standing near an open locker. He looks up and sees me at the door. What have I walked into??? I mumble “Mi Scusi” and back out quickly. Back to trying door handles, but nothing. I am so doomed. I thought I should probably go back into that locker room and have a chat with this guy, but abandoned that idea very quickly.

All I could think was I would be locked in here for the weekend, ‘cause it’s approaching 5pm on a Friday. I have THAT kind of luck. This place would be tighter than a high security lockdown facility. I’m trying a few more door handles a good 5 minutes later when this man steps out of his room and sees me in the hallway--- still . I had no choice but to explain that I had come out of the stairwell lost and now couldn’t find an exit, would he please help me--- in some half English-half Italian mumbo jumbo. He pointed and we walked together, down the hallway I had just come from. Eventually we got to an open doorway. I recognized the reception area where I had started out earlier in this adventure. This dawning on me, I said “Mama Mia!!” . We both laughed. I said “Grazie mille” about a mille times, and we went our separate ways.

The really funny thing is, my new city is quite small. I know it won’t be too long before I’ll pass this man on the street, and recognition will occur. We’ll both know that I have seen him with his drawers on!!! I think I will just have to invite him for a caffe and make a new friend!!

And so goes another day in Venice!!