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.

How I learned Italian medical terms...or .. More fun and games with the Italian medical system AGAIN!

One of my favorite lions in Venice, on  the Scuola Grande di San Marco, has nothing to do with the contents of my blog today, but since he graces the front of our wonderful hospital, I thought I ought to use it. I am writing about something medically related, after all.

In a recent blog, I wrote about having to make several trips to the hospital on the Lido, and that my orthopedic surgeon there was retiring at the end of June.  Since then, I've had to have a series of injections in my other knee. As there is no one replacing my dear Dott. F at Lido, I had to see a different doctor at the Giustinian building in Dorsoduro.  If you are a long-time follower of my blog, you may recall one of my wonderful adventures being lost in the basement of the Giustinian building. I have avoided this particular building ever since!  Unfortunately, I had no choice this time, so back to Giustinian I went.

The first injection went off without a hitch. I felt a little better about having to go to Giustinian.  The second visit was a complete bust. I went at my appointed time, sat in the waiting room, and waited, and waited, and waited. Finally I tracked down a nurse. She looked at my appointment papers, motioned for me to sit, and ran off. When she returned, she asked me to follow her. Down a maze of halls we went, I had no idea what was going on. We finally got to an office where another woman was behind the desk. She looked up at me and said " We called you but you never answered. The doctor (Dott. D.) isn't here today."  We went back and forth, it turns out she called but never left a message. She wanted to know why I didn't pick up the phone. I was busy at the time, I told her. I wanted to know why she didn't leave a message.  Her response?  "No one here in Venice ever listens to voice mail, so we don't bother doing it."  Seriously.  Bottom line, we had to reschedule the visit.

The second injection- when it actually happened- also went smoothly. While I was there, I asked the doctor to take a look at my hand, which had a lump at one of the joints on my fingers.  I asked him if there was something I could do for the arthritis in my hand, which seemed to be getting worse lately.  Dott. D. took one look and said, "Signora, this isn't arthritis. You have a tumor. " Next he asked, "You are American, yes? "  Yes.  He instructed  me to stay on the examining  table. He went  to his desk, did something on the computer and  told me to come have a look.  I thought he was going to show me information about this tumor, maybe some photos so I could have a better understanding of what it was.  Instead, he had a document displayed on his screen, written in English and asked me to translate it for him.

I wanted to laugh out loud.  He's asked me to translate a Letter of Recognition, sent to him by the US Army in recognition of his service in Afghanistan assisting an American medical team. It was filled with medical terms. I study Italian,  I'm  at  upper Intermediate level but  I'm certainly no translator. Oh, what the heck, I  took a crack at it.  As I translated line by line from English to Italian, he typed my words on the computer. Every once in awhile he'd look up and say "Hmmm.. I don't like this word here. Do you have another instead of that ?"  I got out my phone which has a dictionary on it and looked up the word.  I'd give him a choice of one or two synonyms and he'd choose the one he liked, and off we'd go again until we got to the end of the letter.  Dott D.  was happy with the result, and I'd had one more weird medical experience to write about.

But we're not done yet. I asked him about Afghanistan. He said it was the worst 3 months he'd ever spent in his life. He was doing surgery on casualties there along with an American team of doctors.  Next, he got on the phone and scheduled an appointment for me to have this tumor removed. He said he had connections at Mestre and could get me in right away, but he couldn't do that at the hospital in Venice, so I should go to Mestre.  I said, "I hate going to Mestre. " He said, "Go to Mestre, we'll do it there." I think my translating got me a little connection.  He wrote out the appointment and off I went. Thanks, Dott. D.

Today was my apppointment at Mestre.  Honestly, I hate to go to Mestre. I had to take a boat to Piazzale Roma, then the 24 H bus to the new hospital out there. I was thankful to actually have arrived at the right place. Anything else that might happen would be gravy. The only other time I'd been to that hospital was in an ambulance through the emergency entrance, so I was totally unfamiliar with what the rest of the place looks like. This hospital is enormous!  After much hunting and pecking my way through the place, I located a secretary who took a look at the letter Dott. D. had given me and pointed me to an office.

Trying my hardest to remain optimistic, I just had a sinking feeling that the day was going to turn south. I waited my turn in the waiting room.   When my name was called, I was surprised to discover that my doctor was NOT the doctor in the room with me.  I fully expected Dott.D. had scheduled the appointment on a day he was working at that hospital. Surprise, surprise.  This new doctor took a look at my letter, looked up at me and said, "Dott D.  Of course."  That should have tipped me off right there.  He asked for the x-rays.  I told him Dott D. hadn't send me for any x-rays.  He reached for my hand, took a closer look, then looked up and said, "No, I'm not cutting without x-rays".  Then he asks, "Why are you here? Why didn't you just go to the hospital in Venice? "  Hmmm. "Well, Dott. D sent me here."
He responds, " Mestrini come here. Venetians stay in Venice.  Doesn't make sense for you to come here.  You can come back here if you want, but I think you should just go to Venice for the x-rays and see the surgeon there."

Coming out of the hospital I discovered there is a train that goes  right to the Venice Santa Lucia station. You could call that the fun part of my day. I bought a ticket for 1.25 Euro ( had to use my credit card since the ticket machine wouldn't take cash), hopped on the train, and got back to Santa Lucia in under 20 minutes. Sweet.  Since I'm not going back to the Mestre hospital I won't be using this handy route, but it seemed like something I ought to know about.

The train ride gave me a little time to ponder my situation. Makes a lot of sense to have x-rays. But my Dottore D. didn't need them. No, he'd been to Afghanistan. He can probably do heart surgery without x-rays.

Tomorrow I am making the x-ray appointment. In Venice. Even if I get sent back to Dott. D for the actual surgery, I'll feel a little more at ease I have them.  You never know,  someone might even look at them.

And why is it some of my best adventures involve the Italian medical system?  I'd like an answer to that.