Dreaming In Italian

Hip update and bureaucracy rant

Tuesday, November 16th, 2021

Things are going pretty well with the hip so this post will have an update but will not be the central theme. The central theme will all of the bureaucratic stuff that I need to do by the end of the year including the two least favorite things: renewing my permesso di soggiorno (residence permit) and renewing my annual contribution to the SSN (servizio sanitaria nationale – National Health Service). Plus I need to see my dentist for one of the last steps for a dental implant.

A quick update on the hip. I returned to the hospital for a checkup last week. This included an x-ray and examination by an orthopedist. I had been a little worried about the relatively slow recovery but I was reassured that everything was in great shape and he said that from that day on I should only use one crutch. I was incredulous but when I got home I gave it a try and found that I could do it without any real problems. So it was more my mind that was holding me back. So now I’ve made the appointments for the next two weeks for all of the things that I mentioned above. Also I’ve been reassured that after two more months the hip will be totally healed. Of course there is still the other one (the left) but I hope to get that one done maybe in May if I can get it scheduled that soon. It should heal faster than the right one.

The forms for a permesso di soggiorno are long and complicated (and only in Italian bureaucratize) and I have gone 3 times to an organization that helps foreigners to navigate the process. The first for the initial document and twice to renew it. They are very helpful and are used to having people that speak imperfect Italian and have a lot of patience with us. So I’ve gathered the necessary documents: my passport, the existing permesso that expires at the end of the year, a copy of the apartment lease, a statement of pension income (social security 1099 for 2020) and I always have my carte d’identita (ID card) and tessera sanitaria (medical card) with me when I go out. After I have the forms then I need to buy a tax stamp (marca da bolla) for 16 euros and then go to the post office to send the document package to the wherever it goes (immigration department – I think it goes to Rome) and receive a date and time to go to the local immigration office to finish the process (fingerprints), etc. But before I go to the local immigration office I need to go the bureaucratic office of the SSN and pay for the next year – usually about 1600 euros. Considering that that’s about $180 a month it’s a real bargain. The folks at that department are not very friendly so it’s always a pain in the ass. Next year I can apply for citizenship after 9th of October because at that point Laura and I will have been married for two years. I’ll also apply for a permesso di soggiorno because I’ve read that the citizenship application can take a LONG time. Considering the the permesso di soggiorno usually takes 3 or 4 months that’s really saying something. There’s a reason that Italy if notorious for it’s bureaucracy. When I do get citizenship then that eliminates the two most annoying contacts with the bureaucracy, the permesso and the SSN renewal. I’ll feel a little guilty about having free health service since I’ve not paid into the system (like social security in the U.S.) during my working life. I plan to give a similar amount to some health related charity here to bureaucracy assuage my guilt.

New Adventure with the Italian health care system – Part 3

Monday, October 25th, 2021

I have now been home for a week and a half. I left out one interesting detail of the trip from my hospital room to my bedroom here. As in the U.S. I was given a wheelchair to go from the room to the exit from the hospital. Unlike the U.S. there was no nurse or orderly to push the wheelchair. Staffing is light so Laura had to push the wheelchair and since there was no staff person she had to also return it before she could get the documents to leave the hospital and bring the little suitcase with my stuff while I sat in an uncomfortable chair near the exit. We took a taxi to the house which was not very expensive and I had to cross the street, go up 5 stairs, cross the sidewalk, up 3 more stairs and finally be inside and take the elevator. The longest trek that I had made to that point.

Returning to the positive side, the physical therapy continues at our apartment every two or three days as well as a nurse comes twice a week to change the dressing and this week will take out the stitches. I will also have someone come to draw blood for blood tests at least twice. The removal of stitches and the drawing of blood are not automatic like the visits by the nurse and physical therapist. I had to get a “prescription” for those things and that has it’s own complications. First my primary care physician has to write them and then Laura needs to take them to where appointments are made, usually at a pharmacy but for the blood tests she had to go to a particular center for making appointments. If the doctor doesn’t mark the prescription as being required in a brief time the appointment can be a month of more away – part of the downside to the SSN (national health system). It’s really a pain in the ass and Laura of course had to do all of the footwork as well as talk to the doctor who speaks no English and is very impatient with my Italian. It has been a challenge but we both have learned a lot and the next time it should go more smoothly.

I get better every day but still am reluctant to go out of the house but perhaps after another week or 10 days I’ll be walking well enough with the crutches to venture out for a coffee at a bar nearby with friends once or twice a week. Inside the house I’m pretty active to improve my walking ability. We have a mezzanine below the main floor so I also have a stairway for practice and exercise. I’m also helping out in the kitchen which is something that I enjoy and makes me feel useful during this period.

I’m expecting that in 6 to 8 weeks I can resume reasonably normal outings and have full recovery after 3 months.

Oh, by the way, I don’t know if I mentioned that the other hip needs to be replaced. I’m hoping to have that one done in the spring giving me 3 months of relatively normal life before reliving this experience.

And so far the the price has been zero although I think that I’m going to have to pay something like 14 euros (about $16) for the blood tests.

New Adventure with the Italian health care system – Part 2

Monday, October 18th, 2021

The Italian national health care system (SSN) works pretty well in many ways but like any such system it has it’s flaws. I of course couldn’t help but comparing it with the system in the US. On the positive side, everyone is covered and there are few and low priced co-pays. None for your primary care physician and low ones for specialist visits. In my case since I’m over 70 I have rarely had any co-pay. In general the medical costs are much lower in Italy than the US. The prescriptions are either very inexpensive or free – imagine that. On the other side of that coin the non prescription drugs (ibruprofen, aspirin) cost much more. The pharmacies need to make money somehow. The medical care is probably about equal to that in the U.S. Some doctors are better than others and a couple times I changed the primary care physician or specialist. In general I would say that the system is less responsive since it has less money and the patient has more responsibility for his/her medical care. Add to this some quirks of Italian bureaucracy and it can lead to frustration. For instance they requested a bunch of documents that I had to obtain from the health care system itself and from my primary care physician plus prior test results, ecc. prior to check-in at the hospital. Having duly gathered everything I was never asked for several of them during the check-in process.

I was notified of the date to arrive at the hospital for the hip surgery on 5 October in a fasting state at 7:00 AM. Fasting would indicate that the plan was for surgery that day. So being punctual I arrived at that hour and went to a waiting room where there were probably 6 or 7 other people waiting by a few minutes after 7. I waited for over an hour before being called. So why can’t they space out the arrival times? The interview for all of the information during check-in was rather brusque. I had asked via email for a list of personal things that I should bring with me to the hospital that was never answered. So I brought a bunch of stuff including the few prescription medications that I take regularly. It made sense. Maybe all hospitals are this way but they would not accept mine since they were not in the bubble packs as they always come from the pharmacies here. This kind of leads into my complaint of the general lack of information during the entire process. So anyway I was in bed in a room by about 9 AM and was told that the surgery was to be sometime in the afternoon. I can’t really fault the hospital that I couldn’t have it that day since there had been some sort of operating room emergency, however it would have been nice to have that information before 5:30 PM. By that time it was pretty obvious that I wouldn’t have it that day.

The room was really pretty nice with two beds spaced relatively far apart, a bathroom, individual TVs, etc. One thing different from hospital stays that I’ve had in the U.S. is the almost complete lack of privacy. At least in the U.S. there was always a curtain that could be drawn around the bed but here there was nothing and since after the operation I was pretty much always in bed that meant also that all personal bodily functions were done without privacy other than a sheet over me.

So now getting back to the positive side of the stay. I was in the hospital for a total of 9 day. It would have been 8 if not for the one day delay in the surgery. By American standards I think that pretty long but during this time I had physical therapy twice a day for which I’m really grateful. If I had left after only 2 or 3 days it would have been much more difficult because I would have been weaker, had more pain and little experience with the crutches to walk and go up and down stairs. There was kind of a rotating cast of therapists but they all seemed pretty competent and caring except for the one who thankfully I saw for only one afternoon session. The nurses were generally caring and likeable (again with one exception who I mentally thought of as Nurse Ratched – “One Flew Over the Cuckoo’s Nest” reference).

Finally, I think 2 days before being released from the hospital I was given the date and a suggested time of my release from the hospital. In retrospect I should have asked more questions at that point which I will further explain in the third and final chapter.

One great thing is that Laura came to visit me every day. The visiting hours were from 6 to 7 PM which makes sense because the physical therapy appointments and generally other activities in the hospital shouldn’t be disrupted by visitors and frankly while it was always great to see Laura we generally ran out of things to talk about before the hour was up.

The third chapter will come soon.

New Adventure with the Italian health care system – Part 1

Saturday, October 16th, 2021

I haven’t done a new post since July. Time flies when you’re having fun. With the continuing pandemic not so much fun. In any case I don’t think that I ever mentioned that I have been having problems with a hip. This started a year and a half ago when I moved to the new house in Bologna. There wasn’t a lot of stuff to move at that point but I believe that lifting the TV (probably the heaviest thing that I had) provoked a problem with my left hip. By the time that could go to Torino to join Laura a couple of weeks later (there were pandemic restrictions on travel) it was pretty bad. I bought a cane that I’ve been using ever since. I thought at first it was a pulled muscle problem but since it persisted I finally went to an orthopedist after Laura and I moved to Bologna in July of 2020. After an x-ray he said that I would need a hip replacement and put me on a waiting list in October of that year. With a cane I’ve been able to manage well enough although having it is certainly a limitation. I changed orthopedist May of this year (2021) since the existing one had given me clearly bad advice a couple of times and I no longer trusted him. The new one is at the Rizzoli institute which is well known as a center of excellence for orthopedics. In early July I got a call to go to the Institute to have pre-surgery tests, blood, x-ray and a bunch of other things that I don’t clearly remember. The anesthesiologist has a big say about surgeries and while I was still there and all of test results came back we had a discussion of the results. She told me that there was one sticking point – I have a low platelet count. I have known this for years and when I had a knee replacement in San Francisco in 2008 they noted it and said that they would would just give me a platelet transfusion prior to the operation. They did, and everything went OK. The anesthesiologist at Rizzoli rejected that option and sent me to an hematologist. They don’t have one at Rizzoli so I went to a hospital not too far from home which seems to be the best place around here for hematology. There they said that with a platelet count of 60 (thousand per micro liter) it should be no problem but wanted to try to get to the root of the problem and gave me a list of exams to do and to return in October. I was able to get the 4 or 5 tests done within about 2 -3 weeks and corresponded with a hematologist and he then gave me an August date (instead of October) to return with the results. The tests ruled out everything other than perhaps my genetic makeup, i.e. my body was just that way or there was some kind of auto-immune condition that was limiting the platelets. He wrote a report that reiterated that anything about 50k shouldn’t be a problem for the surgery and again the anesthesiologist ignored that and said that it needed to be above 80. So I continued to correspond with the hematologist and there were only two options the more palatable one was to take a pretty heavy dose of a drug called prednisone for 10 days just before the surgery. I did research on the drug and found that while it was clearly very useful for a lot of conditions it also had a long list of undesirable side effects. Fortunately the hematologist was very available for email conversations and even a telephone call (this seems pretty rare here) and in the end I decide to take the prednisone. I started immediately after I return from a short trip to California and already had an appointment to return to the hematologist after 8 days with the drug. So on the 8th day I returned and the platelet count was 109 – yippee. I already had an appointment at Rizzoli (given that I was going to take prednisone) for 5 October. So that was pretty good. As for the side effects that I experienced there were two obvious ones: insomnia and irritability. I warned Laura about the irritability and since I was aware of it I could repress the urge to be outwardly cranky.

Oh yes, I forgot one important detail. In July I started having a problem with my RIGHT hip. In fact it quickly became worse than my left so I made an appointment with the orthopedist and when I saw him he showed my the x-ray from when I went there in early July and said “THAT is an ugly hip” so he agreed to do the right one first.

I don’t know how interesting this stuff will be to the few readers that I have but I’m going to continue anyway about this more serious encounter with the SSN – national health service and how it contrasts with my surgery experiences in the U.S.

Let me know what you think.