CATAPULTATED INTO THE ITALIAN HEALTHCARE SYSTEM

Tuesday had been a normal day. It had been fairly hot and we hadn’t done much all day. We’d had pasta for lunch so we just had paninis for dinner…red onions, tomatoes, smoked provolone and fresh basil on bread brushed with olive oil then grilled. After dinner we watered the vegetable garden. I knew I’d need to pick basil the next day and make some pesto. We harvested a few more tomatoes…they’re coming slowly because the nights are so cool.

I needed to take a shower but the breeze had picked up and the air was much cooler so we decided to sit in the garden and just enjoy the evening for a few minutes. I fixed a glass of tea and we relaxed. As we sat talking, all of a sudden Art said “Oooww!” He’d had a quick stabbing pain in his chest similar to ones he’s had in the past.

These pains never occur when he’s working or under any kind of stress, and they’re never accompanied by any of the symptoms of a heart attack like shortness of breath or pain in the left arm. When we were in the states Art saw a cardiologist, had a stress test and everything checked out normal. No explanation for the pains. He’d been taking a low dosage aspirin every day and decided to continue to do so.

As we sat in the garden discussing why he has these occasional pains I thought that he seemed preoccupied. I wasn’t facing him directly so it was hard to for me to tell. At first I thought he was just distracted….maybe he saw a lizard climbing up the wall but somehow something just didn’t seem right. I called his name several times, and he didn’t respond. I got up and stood in front of him, calling his name, asking what was wrong.

He started to answer me, then he just spaced out again. Then his head jerked back….his right fist was clenched and his arm was jerking back and forth. His head continued to jerk backwards, and I was torn….what should I do? What could I do? You know how you have about a zillion thoughts that race through your mind in a millisecond? Should I stay here with him? What could I do? What if it was a heart attack? I had aspirin in the house, but then I’d have to leave him alone….what if he fell out of the chair and cracked open his head? But what if I just stayed there and just watched him possibly die?

With reluctance and fear I raced up the stairs into the house…down the stairs to the kitchen….rooted through the cabinet looking for the bottle of regular strength aspirin we had brought with us. Of course I was all thumbs, and the cabinet that holds the medicine is too high for me to see into easily. Eventually I came up with a bottle of aspirin and I raced back up the stairs to the backyard.

Art was still unconscious and his head was still jerked back. As I approached him, blood started pouring out of his mouth. Oh my god, this couldn’t be a heart attack…what could this be? This must be really bad….I started screaming “Aiuto! Aiutomi!” (“Help! Help me!”) over and over. As I got closer I saw that it wasn’t blood after all….he was throwing up the sandwich…the red was from the tomatoes.

I ripped open the bottle of aspirin and dumped out the pills. It was then that I realized that I’d grabbed the low dosage aspirin and not the regular….Shit!!! I tried to open his mouth figuring that something was better than nothing, but his jaws were clenched. I yelled his name over and over, telling him to open his mouth, trying to get him to respond. I shoved a pill into his mouth, not knowing whether he would swallow it or not.

By this time the neighbors had arrived. Armando was at the gate, Giulda and her son were at the window. I’m not even sure what was said, but it was obvious to everyone that something was really wrong with Art. Giulda went to call the doctor and Armando came into the garden.

And then Art came to. Just like that he was awake and alert. He seemed perfectly normal and lucid and said “I feel fine”. I had to tell him, “no….you’re not alright….you were unconscious….your threw up all over yourself….your teeth were clenched …..“ And of course Armando agreed; whatever had just happened was definitely NOT nothing.

After a few minutes Armando asked Art if he thought he could walk to the bench we have near the front door. Armando thought that this would be a more convenient location to wait for the doctor’s arrival. Art said yes…although he was a little weak, he really felt pretty good.

I guess the doctor arrived after what….10 minutes? Fifteen? Or was it really two hours? Although it felt like forever, when we later thought about it we realized that it must have been only ten or fifteen minutes. We don’t know whether the doctor was in San Venanzo or if he had to drive up from Marsciano, which would have made a difference.

Once he was there the doctor asked Art if he could walk into the house, and of course Art said yes. The doctor asked what had happened, took his blood pressure, gave him a tab of nitroglycerine and looked at the various prescriptions Art takes daily. After some discussion the doctor decided that Art really should go to the hospital. He called the ambulance and we waited.

Armando told me to go upstairs and get some things for Art…his pajamas, toothbrush, etc. Art asked me to bring him a clean shirt and some clean shorts for the trip to the hospital. I ran around like a chicken with my head chopped off trying to collect everything he’d need.

I decided to give Wendy a call just to see if she was available. I thought that once we arrived at the hospital I could call her and she could make sure that the doctors understood clearly what had happened and that we understood what they planned to do about it. As soon as I told her what had happened, and that we were waiting for the ambulance to take us to the hospital, she said, “I’ll meet you there!” Although I hadn’t meant for her to come to the hospital, by that time all I wanted to do was get off the phone and make sure Art was still okay downstairs. I told her “fine” and hung up.

The doctor left shortly after that, but we knew he had communicated all the information to the hospital. The ambulance arrived and the three medics came in to get Art. They insisted that he could NOT walk to the ambulance….even though he had walked INTO the house from the back yard. They strapped him into a small wheelchair and struggled to get him up the stairs.

About this time I discovered that we were NOT going to the hospital in Marsciano. We were going to a hospital in Perugia, San Silvestrini. We were told that this is where the heart specialists were, that the hospital in Marsciano was just not equipped to handle this sort of emergency. I quickly called Wendy to tell her about the change in plans, and luckily I did so as they were loading Art into the ambulance.

We were all outside now, and the doctor had returned for some unknown reason. Of course a group of neighbors had gathered, and there was a lot of confusion. Wendy asked how I was going to get to the hospital and I told here I was going to ride in the ambulance with Art. She asked me if that was possible, and I said I didn’t know. Wendy then asked to speak with Armando, and he then asked the medics if it would be possible for me to ride with them. We were told “no, it’s not possible!” Now what would I do?

I had no idea where the hospital in Perugia was, but if that wasn’t bad enough, I don’t drive a stick! Armando had only been to that hospital once, and at ten o’clock at night he certainly didn’t want to drive that far and then have to drive back. I didn’t blame him for that, and after seeing the way he drives, I’m sure it would have taken us at LEAST an hour to make what would normally be a thirty minute trip.

As Armando continued to talk with the medics, I’m not sure what happened, but apparently Armando knew the driver. Maybe he knew his parents, or maybe they were related. Anyway, the bottom line was that because Armando knew the driver, I would be allowed to ride to the hospital with Art! Once again, you have to know somebody who knows somebody! As the driver told me on the ride to the hospital “SOMETIMES it's possible”!

We drove down to Marsciano at a fairly moderate speed, but for Art, in the back, the curves were just too much. He threw up again in the back of the ambulance, but luckily the attendant was able to catch everything and to clean him off.

Once we hit the E45 the driver picked up his speed, usually driving right down the middle of the road, only moving to the left when some insane person doing a million miles and hour zoomed up behind us. The driver spoke a little English so we were able to talk a little, but for most of the ride I kept my head turned so that I could make sure that Art was still okay. As long as I could see him moving I was okay.

Finally we made it to the hospital, and I realized that I DID know where it was….it was in San Sisto, not too far from the Perugina factory! I saw Wendy and Giuseppe standing by the door waiting for us, and I jumped out to begin explaining to Wendy exactly what had happened so that she could relay it to the doctors.

Art was rolled in and back to an examination room, and the doctor who attended him spoke English…what a lucky break! After a few minutes she came out to tell us that he was going to be admitted, and that we’d need to go around the building to go in through another door.

Once we were on the seventh floor, in what appeared to be the cardiac ICU, we saw Art being rolled by and into a room. We were told to wait in the outer waiting area. By this time it was about 11:30, and I just wanted to get settled so that Wendy and Giuseppe could go home. Thank God for the support of good friends in a time like this.

Eventually I was allowed back to see Art for a few minutes. Of course he was hooked up to a heart monitor and an IV, but otherwise he looked fine and said he felt fine. He was in a room with another man, who of course had been abruptly awakened by Art’s arrival, so I didn’t stay too long. I wanted Art to relax and get some rest and I said goodnight.

I walked to the nurse’s station to ask if it was possible for me to stay there, and they said that yes I could stay, but not in the room. I could stay in the waiting area though. Although the waiting area was a large room, there were only a few sets of molded plastic chairs for visitors.

Wendy and Giuseppe offered to drive me back to San Venanzo, but that just wasn’t even thinkable. Additionally, how would I get back to the hospital the next morning? No, it was better if I just stayed there. Of course I still needed a shower, and I was wearing shorts, a t-shirt and sandals, but the way I looked then, or even the way I might look in the morning just wasn’t important. Because what had happened to Art was so sudden and so unexpected, I just couldn’t risk leaving him.

After Wendy and Giuseppe said goodbye it was just me. The lobby was huge, with windows on two sides. A wonderful cool breeze was blowing through the room, but the only seating was on plastic molded chairs, fastened together in groups of three or four. I tried to lay down across them, but each seat was raised on each side, creating a sort of bucket seat effect. There was just no way to get comfortable. Eventually I just put my head back against the wall and closed my eyes.

When some other people arrived in the waiting area, I decided to move over into the dark corner by the telephones. The light was subdued and I hoped that by sitting back into the corner my head would be supported. Of course this didn’t work either. Next I tried simply laying flat on the floor, and I discovered that the thick back seam on blue jean shorts is REALLY uncomfortable when lying on a hard tile floor. The only way I was ever going to sleep was to drop from exhaustion. Time for a walk.

The floor Art was on, the seventh, consisted of two large wings, both restricted and closed off by doors. A separate smaller wing contained a few offices, but of course no one was there.  I walked down the stairs to the sixth floor which appeared to be under renovation. All the rooms had been gutted and the waiting area was filled with doors that had been taken off the rooms. I did find a bathroom that worked, so at least I wouldn’t have to go all the way back down to the main floor. Thank goodness I carry a pack of tissues in my purse.

A survey of the fifth floor proved no more interesting than either of the two previous floors, until I spied an open room….an open SUPPLY room. Maybe I would find some towels or something to make into a pillow. There was one cleaning cart in the room, but it was empty. And then I saw it….a chair! It was like the lounge chairs used at the pool except that instead of webbing or plastic straps it had curvy metal supports, sort of like a mattress frame might have. This was covered with a cotton cushion…not as thick as I would have liked, but at this point it didn’t matter. I folded my lawn chair and headed back upstairs.

I set up camp in the dark corner by the pay phones and drifted in and out of sleep. Every time I did fall asleep I think I subconsciously jerked myself awake again, maybe just because I was still so tense and scared. Eventually six a.m. arrived and I walked down to the main floor to see what the bar had to offer for breakfast.

I ordered a cup of hot chocolate and a small panino, then bought a large bottle of water to take with me. I would later find out that the only water Art would have during his stay would be provided by me….even when the nurse brought him a pill!

Once I went back upstairs, I asked a passing doctor when I could see Art and I was told not until seven thirty…or maybe later. People had started to arrive and the waiting area filled up rather quickly. I stood near the doors, hoping to see something; I’m not even sure what. At some point the door was left ajar and I stepped inside and waited. After standing there for five, maybe ten minutes I decided to push my luck and walk down to Art’s room.

As I stuck my head inside the door, Art was awake and alert. He told me that he hadn’t slept at all due to the noise….you know how it is in hospitals. After a few minutes a woman popped her head into the room and asked Art if he would like breakfast. His response was an enthusiastic “YES!” and she asked what he would like and he told her “everything!”

Unfortunately he had temporarily forgotten where he was, and breakfast consisted of only coffee with everything….and when he finished it, there was still a think layer of undissolved sugar on the bottom of the cup. I guess the standard Italian breakfast of coffee and a cigaret had been modified since we were in the cardiac ICU!

I was able to hang around in the room until about 8:30 or so, when the nurse told me that I’d have to wait outside. Art was still hooked up to the monitors, but they had removed the oxygen mask. They ran an EKG on him and waited for the doctor to arrive. I called Wendy to give her an update and she asked me if we knew if Art would be able to come home. I told her I’d have to call her back when we had more information.

She asked if I’d like some magazines and newspapers in English, and I told her that would be great. Giuseppe stopped by later with imported British versions of People and National Enquire-type magazines. He also brought the Herald Tribune and I knew Art would enjoy that a lot more than reading about Brad Pitt/Jennifer Aniston/Angelina Jolie.

At lunch Art told me that they’d done some sort of a test where they strapped him on a board and tilted him. The windows were closed and the room was dark. His heart was monitored while they did this. I’ve never heard of this test and have no idea what it was for.

After a pretty blah lunch of tepid soup, pureed potatoes and veal with tomato sauce, (nothing to drink!) a nurse came in to hook up some sort of monitor. There was a large cassette player that was hung around his neck and it was attached to things stuck all over his chest. We were told that this was a 24 hour heart monitor, so we knew at this point that Art would be staying another day.

At lunchtime the doors again opened….visiting hours were posted and they were for two hours in the morning, two hours at lunch, and two hours in the evening. I did my best to hide whenever I could and usually managed to stretch my time beyond the posted hours.

I called Wendy to tell her that Art would have to stay for at least another 24 hours and she asked if I’d like to go home and take a shower, get some things for Art, etc. In Italy when you go to the hospital it’s standard to bring your own toilet paper, your own coffee cup and your own utensils. Oh, and your own water as mentioned previously.

We didn’t bother with the coffee cup or utensils because the hospital did have plastic cups and utensils and the man sharing the room with Art had offered to share his roll of toilet paper. I did bring a few packs of kleenex, which came in handy when the other man checked out later that day.

Giuseppe picked me up later in the afternoon and we drove back to San Venanzo. Giuseppe settled himself in front of the television and promptly fell asleep during the soccer match he was watching. Good….a quick nap for him meant that I didn’t feel pressure to rush quite as much.

I took a quick shower and changed my clothes, then gathered a few things that Art had requested: his pillow, some lighter weight pajamas, eyeshades and an Italian book to study. I warmed up some pasta (thank God we still believe in the American concept of leftovers!) and ate a quick lunch/dinner combination. I grabbed a few more paperbacks to read and we were ready to head back to the hospital.

Giuseppe stopped in for a quick visit with Art, then we were left alone. I had brought my lawn chair into Art’s room and had put it under his bed so that I’d have it again for tonight. When his roommate had checked out, we wondered if it might be possible for me to stay in his room. That idea was dispelled when another man was wheeled in shortly after that. Oh well.

Art’s new roommate was a diabetic, and we watched as he gave himself his injection of insulin. Can you imagine such a thing happening in the states?! Art had been told not to take any of his prescriptions, even though we had brought everything with us. He was told to take only what they gave him, and I think that was only aspirin.

One of his prescriptions did cause some confusion. Art had been taking Topomax for the nerve pain in his legs. Apparently the most common use of this drug is for epilepsy. Once the doctors saw the Topomax, knowing that Art had had some sort of convulsion, they immediately assumed that he had some sort of history of epilepsy.

Art was able to explain this to the doctors in the hospital but later, when he saw our new family doctor, he got Our friend Ramon, a docotr, emailed us the results of studies showing that it HAD been proven effective, at least in the U.S., but we’d never be able to argue this point with someone who speaks no English.

We passed the afternoon reading, and every so often a nurse would come in, but not nearly as often as in the states. Apparently this is a teaching hospital and at one time Art had as many as eleven doctors, or a combination of doctors and doctors-in-training, in his room. This hospital is supposed to be one of the best cardiac care centers in Italy, and we were both very pleased with the care Art received. The nurses were all very nice, all spoke a few words of English, and all seemed willing to help in any way they could.

On Wednesday night when visiting hours were over, I pulled my lawn chair out from under the bed and said good night. At least I was able to leave my purse in the room with Art, but I did take a paperback to the waiting room with me. I knew it would still be a very long night, and that sleep wouldn’t come easily. Eventually I ended up moving my lawn chair to the vacant sixth floor where I knew it would be nice and quiet. I wasn’t quite as concerned that someone would come racing out of the ward telling me that there had been an emergency, and I slept a little better.

Luckily Art got a little sleep that night too, although every time he rolled over he had to reposition the cassette player hanging around his neck. The pillows they had in the hospital were fairly flat and not what he was used to. Having his own pillow definitely helped.

Unfortunately his roommate, whom we nicknamed the plumber because of the way his pajama pants fit, was a snorer, but I guess at that point Art was tired enough to sleep despite the noise. The eyeshades ensured that it was dark, and luckily for everyone the temperature cooled off considerably at night. During the day the windows were normally open to allow a breeze to enter, but it was still hot.

On Thursday morning we were told that today Art would have some neurological tests…an EEG and something else. He was wheeled out for the first test around 10:30 or so, and I waved to him both as he left and when he returned. Lunch was served shortly after that, and just as he was getting ready to eat the nurse came in and told him to wait because they wanted to do the other test right then. She promised that she would re-heat his lunch once he returned so at least he’s have a hot, if not delicious, meal to look forward to.

After lunch the 24 hour monitor was removed and more doctors came in. Apparently all the tests were coming back negative, or normal. It had been assumed fairly early on that the problem was NOT a heart attack, so the question was: what was it? We weren’t’ sure how long they would keep him or how many tests they would run before he was released.

At this point an amazing thing happened: a doctor who spoke very good English came in to talk to us. He was a cardiac doctor, Dr. Angeli, and he told us that as best they could figure, Art had had a TIA, which is a mini-stroke. He told us that we’d need to return to the hospital on Monday to get the results of the last test, but that Art would be released today! Yeah!   (In the end, it wasn't a TIA, but a seizure that was brought on because Art had decided to stop taking one of his medications - yes, the Topomax - which is why you should NEVER just stop taking a prescribed medication without first checking with your doctor.)

We started to gather up his things, and the nurse came to disconnect the shunt that was still in his arm. A few minutes later the nurse brought us in a letter stating what the findings had been and what follow-up care was necessary. And that was it! We were free to go! No papers to sign, no final instructions, just a simple letter. Now the only problem we had was….just exactly how were we going to get home?

Art called Giacomo to see if he was busy, and he said that he could come to pick us up, but not for about an hour or so. We told him that we might be able to get another ride sooner and told him we’d call him back. We then called Corinna who told us what time she’d be leaving Perugina, and of course she said that she’d be glad to pick us up on her way. I then called Wendy to tell her that we had a ride to San Venanzo. I swear she sounded as if here feelings were hurt! She said “Well…..if that’s what you want to do….If you want to make your friend drive you all the way up to ‘San Venanzo….” !

Now it would have taken Corinna ten minutes to drive past her house and up to San Venanzo to drop us off, versus the thirty or forty minutes it would take for her or Giuseppe to drive all the way from the hospital to San Venanzo, but I guess it was something they wanted to do. We arranged to meet her outside the hospital and headed down to the lobby. We called Corinna and Giacomo back to let them know we didn’t need a ride and thanked them for their kindness.

Wendy picked us up and took us to her office where we met Giuseppe who then drove us to San Venanzo. I guess we arrived home around six p.m., exhausted but relieved. It would be good to relax in familiar surroundings and to sleep in our own bed….in the dark, in the silence. As for the follow-ups and the Italian healthcare system….we’d think about that tomorrow. For now it was enough to be together and to be home.