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.

Another visit to the doctor, or an ape in Venice

Yes, there is a hospital in Venice.  It's even possible you may have walked by this building, stopped to take photos and never knew you were snapping a shot of the  Ospedale Civile.  This magnificent marble facade on the front of the Scuola Grande di San Marco is home to some of Venice's grandest lions. And inside the doorway is the home of Venice's medical department, including the Emergency Ward.  This is where I normally go when I have an appointment with my Orthopedic surgeon.  Notice I wrote normally.

Scuola Grande di San Marco, in Campo San Giovanni e Paolo

A few months ago I experienced some unusual pains in my left knee, the one that already has a titanium joint. Sensing something weird was going on, I made an appointment with the Orthopedic doctor. The earliest appointment I could get was not at Ospedale Civile. I'd have to go over to the Lido instead.  

Getting myself to Ospedale al Mare was a whole new experience. Vaporetto to Lido, then the bus to Piazzale Rava (Piazzale what??? Lido is way out of my comfort zone, I had no idea where or what this is).  After asking a few questions at the bus stop, I was assured I was headed in the right direction.  Where should I get off?  I should have known.  Just follow the crowd. Everyone headed to Piazzale Rava is going to Ospedale al Mare.

 Ospedale al Mare, at Piazzale Rava, Lido

The Ospedale complex at Lido is huge, and mostly unusable- old, in ruins.  This far end of it has been  getting some restoration, in fact a brand new radiography department has just opened. Now you can go to Ospedale al Mare for blood work and x-rays, among other things.

I've been out to Ospedale al Mare three times since that first appointment,  including yesterday. I'm a pro by now. And, I have to say, I really like this place. It's fairly easy to get to, and far less crowded than it is at Ospedale Civile. I get in and out of there in way less time than it normally takes to visit the specialist.  And the Orthopedic doctor is one I really like.  I'd been to him several years before when he used to have an office in Dorsoduro.  And, as he recently pointed out, he and I share the same birthday. Not the reason I like him, but it is another factor in the plus column! All things considered, having to go to Ospedale al Mare is a win-win. 

Yesterday I had to return to the dr. for "controllo", which in English is equivalent to a follow up visit. He was going to take a look at the current x-rays and make a diagnosis as to what is causing the pains in my knee.  Thankfully, the verdict was not the dire prediction he had made on my first visit. He was talking a whole new knee replacement then. Fortunately, it is not the joint. Yahoo. Happy Dance time.  He prescribed physical therapy over at FateBeneFratelli. (if you've read some of my earlier posts, you might recall this place).  Ok, thanks, Dr. I'll take that!

Before leaving his office, I mentioned that I need to have another series of Hyaluronic acid injections in my other knee.  He reminded me that he is retiring at the end of this month, that won't be possible.  "Yes, I remember you are retiring, Dr., but can't I make an appointment anyway. Won't there be another doctor here? "  He laughed.   Non so and non mi interessa! "I don't know and I don't care."

I totally get his point. He's counting days to retirement. I wouldn't care either!  Then he adds, "Look, in a while, after a few weeks, just call my house.  You can come after 6pm and I can give you the injections there. You live close to the Lido, that will work fine. But not in July. I'm spending time with my grandson at the beach. "

I'm pretty sure I won't be interrupting his long deserved retirement by popping in for those shots. But...who knows. If I have to go back to Ospedale Civile and can't get an appointment any time soon, I just might. 

Happy retirement, Dr!  I will miss this guy! 

Oh, and there's one more thing I really like about the trip to Ospedale al Mare.  There are these little sidewalk shacks/cafes along the street where the bus drops off and picks up.  Perfect for a coffee (or spritz for all you spritz drinkers) and a cornetto.

Oops. Make that two more things I really like. I get to see an ape or two while I'm out there. Ape. A-P-E. Ah-pey.  The Piaggio Ape is this tiny little truck you see all over Italy, even here on the Lido.  The name ape, which in Italian means bee, refers to the work ethic of this little gem.    I want one.

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? 

Where I've been hiding lately....

I am thankful, and grateful for all of you who read my blog. It never fails to surprise me when I receive an email telling me how much one of you enjoyed reading one of my little adventures. And I must admit, it surprises me even more when I hear from you asking why I haven't been making regular entries.  When I haven't been up to much, I don't think there is a whole lot fun for you to read. And lately, I confess, my life has been less than fun.  The stuff my days have been consumed with are things I have been wishing I could forget, let alone document and reread it some time in my future.

So here's why I have been in hiding recently:

About a month ago, as I headed through Piazzale Roma to the Sant'Andrea vaporetto stop on my way to my morning physical therapy sesson at FateBeneFratelli, I fell down and smacked those Venetian stones on the street hard with my face. It was only after I picked myself up that I realized I had blood streaming out of my mouth and down the side of my face. As I felt my mouth, I discovered I was missing one of my front teeth, which I found lying on the pavement right in front of me. This wasn't good at all.  I made my way to the parking garage closest to where I fell, and asked the attendant to please help me.  He called an ambulance, brought me ice and some towels to wipe myself up with,and stayed with me until help arrived.

The ambulance that arrived had wheels. I was expecting a boat.  Clearly I would not be going to the Pronto Soccorso at the Ospedale here in Venice. I was examined briefly, then put in the van and taken to the new hospital on the outskirts of Mestre, where I sat waiting my turn for the next 4 hours. After being seen by the ER doctor and getting a series of x rays, the dentist on call extracted a second tooth that was lodged in my upper lip and stitched me up.  I had no idea there was a second tooth knocked out! Here is where we get to the only comical portion of this saga. This happened on Friday morning. The dentist gave me instructions to return to the same hospital on Monday morning to begin the work needed to restore my two teeth. Upon learning I lived in Venice, he changed his mind, and told me to instead go to the hospital in Venice on Saturday morning as there would be an oral surgeon on call and this would save me the trip out to Mestre. Turns out the oral surgeon on call was none other than my landlord.  Is this a small world or what??

So- over the course of the last month I have made 14 trips to the my landlord's dental office just off St. Mark's square. He and I have gotten to know each other much better thanks to my accident. The swelling on my cheek and under my eye finally returned to normal. The swelling on my upper lip has gone down, but there is still a little bit of puffiness  even today that won't go away. My landlord tells me it might be permanent scar tissue where the stitches internally were. Great. I was sans 2 teeth for about a week- my mouth was too swollen for the dentist to complete all that needed to be done until the swelling went down. Then I had temporary teeth for about a week and half, and finally two new permanent crowns.

The good news- my knee wasn't injured in the fall. That was my big concern.
The bad news- looks like I will be visiting yet a second dentist out in Spinea, about 30 minutes out of Venice, who specializes in veneers, which would be a closer match to the color of the rest of the teeth in my mouth than these two new crowns are.

And there you have it. You know the saying "When it rains, it pours" ???   I've had my own monsoon.

Back home, catching up

It's been over a month, the worst is behind me and I am home recuperating. I had no access to my computer the entire time or I would have been blogging religiously, as this was some experience! Unfortunately, no computers allowed where I was, so I wrote on paper.

What I will attempt to do over the next several blogs is record my last month. These are times I never want to forget. Not sure how I'll blog in reverse, but I'll give it a shot.

First, though, HUGE THANKS, to all of you who keep up with my little adventures for emailing me during this ordeal. It was amazing to hear from everyone, and the little notes and emails kept me going on some tough days!

When I posted last, I described the days of going to give blood in preparation for surgery. A week later I was to check into the hospital, so that's a good place to pick up.

I was scheduled to check into Ospedale Civile here in Venice at 8:00 am on November 15, have tests during the day, with surgery set for the morning of November 16. I had been told ahead of time to bring a suitcase of personal items like pajamas, underwear, and toothpaste, and also two important items: stampelle and monocollante. Stampelle are crutches. Monocollante are these very thick stocking/sock- like things which you must wear to reduce the possibility of blood clots after surgeries like this.

For both of these items we visited our local farmacia. Our farmacista has been fabulous, so we knew she'd be able to tell us where to go for these things. Fortunately, she handled it for us. She had stampelle, Mike purchased a pair for 30 Euro. She told him she needed to make measurements of my legs, so I had to return laster that afternoon. I showed up at the farmacia, she took me behind the counter and proceeded to measure around ankle, thigh, calf, and whole leg measurement. She got on the phone, made an order and told me to return the next day, with 42 Euros for each of the socks (you must have one for each leg). Done. Little did I know then that these sock like things were going to have an important role during the next month! More on that later.

With my bag packed, stampelle and monocollante included, on the morning of Nov 15 Mike and I left the house at 6:30 am to catch the #52 boat to Ospedale. Wouldn't you know it that morning, because of fog, the 52 wasn't running! So, we caught a 42 for Fondementa Nove and walked the remaining distance to Ospedale, which caused us to be about 15 min late.

Being late didn't seem to matter, even after we ran around several floors trying to find the right place. We eventually located the waiting area for Orthopedia and rang the bell. No one came.
A few nurses went in and out, I spoke to each one explaining I was here to be checked in and no one seemed to know what was going on. We continued to wait. After about 2 hours, a nurse finally came and told me that there were no beds for me available that day, I would have to return tomorrow, but first had to go have x-rays taken. A nurse came, took me off to x-ray, and left. When the x-rays were completed, I walked myself back to Orthopedics, told the nurse I was finished, and she said "go home, be back here at 7:30 am tomorrow". I had expected to meet the dr. who would perform the surgery that day, and told the nurse this. She said, "ok, talk to the dr, he is right there. " OK. In my halting Italian, I asked the dr a few questions. He opened my file and handed me a 3 page document I had signed earlier which described all the complications possible with a surgery like mine. What I had wanted was a little explanation of what would happen during the surgery, not what could happen as a result of it. The nurse handed me a form to sign, which essentially was giving my permission to be released overnite, and off we went home.

To be honest, I was relieved to be sleeping at home that night. It took alot of the nervousness away for me.

The next day, we repeated the trip to Ospedale Civile and arrived in plenty of time. I rang the bell at Orthopedics. This time, a nurse came right out for me, and ushered us inside. She explained that I was first in line for surgery that day, there still was no bed for me, but there would be one by the time I came out of recovery. They had me change into a hospital gown, and the nurse put a few drops of something into a little plastic cup for me. She said this would relax me some. She was right. Whatever was in that cup was perfect. My fear and nervousness were miraculously gone, and I was on that gurney ready to go! Mike had my bag and stampelle, he was going off to wait in the waiting room, and I was wheeled off to surgery- feeling quite happy. There were alot of days after that I wished for more of whatever those magic drops were.