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A healthy lesson, Italian-style

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    A healthy lesson, Italian-style

    http://www.timesonline.co.uk/tol/lif...cle2186859.ece

    When her brother fell ill in Umbria, one woman saw a hospital deal with him in a way that put our NHS to shame

    Rosemary Righter
    On Sunday, we had held the annual “animals’ birthday party”, a two-dog, four-cat excuse for gathering around 40 friends for a long lunch under the huge fig and oak trees that shade just enough of our Umbrian garden to put the fresco into alfresco. It had been quite a party, although not particularly boozy; Italians fall on the food but sip their wine and drink vast quantities of water, and in the heat of summer we foreigners mostly do likewise.

    So when my eldest brother, Sholto, who had come over from London for this landmark event, appeared the next day green of countenance, shaking like a leaf and complaining of heartburn, his heartless sister had no business putting it all down to a touch of the “morning after”, handing him a Zantac and continuing with the last little bits of clearing up.

    By lunchtime, the poor man was complaining of acute pain in the sternum, evidently fighting for breath and picking miserably at the exotic leftovers, and still his sister didn’t quite get it. We did set off for Todi, the medieval jewel that is our nearest town, but I insisted on taking him for a leisurely consultation with Orlando, our wizard optician, before finally heading for the “Pronto Soccorso”, the emergency unit at Todi’s small hospital.

    Subconsciously, I suppose I was foolishly hoping that it would “just clear up”. I’d had some bad moments in Italian hospitals, such as the time when there was only one night nurse for 28 acute beds at the San Giovanni e San Paolo hospital in Venice and I had to learn how to administer drips and medication to my unconscious, desperately ill husband. It’s easier to be ill in your own language, they say. Sholto’s Italian amounted to thank you and goodbye, and he was due to fly home in a couple of days.

    Providentially, prudence prevailed over instinct. Todi Hospital was everything the NHS ought to be, and is not.

    Ten seconds after ringing the Pronto Soccorso bell, my brother was on his back getting an ECG from two fast-moving medics, gentle giants both of them, who gave a running commentary on the results to the emergency doctor, who was simultaneously compiling Sholto’s medical history. (He: “When did he last see a doctor?” Me: “Around 30 years ago.” “Operations?” “None.” “Medication?” “None”. “Smoker?” “Pretty heavy.” At this, a warm and gentle smile, accompanied by undeserved praise for having been so quick to bring him in.)

    Within little more than an hour, my brother had been X-rayed and given an ultrasound test, had more than 30 blood tests processed by the laboratory; had been seen by the radiologist and by the consultant cardiologist, had been diagnosed with acute pericardial inflammation and had been admitted to a cool and immaculately clean two-bedded room, otherwise unoccupied, with a view over the town’s old tiled rooftops. In a London hospital, we’d almost certainly have waited far longer than that to be seen by an intern.

    Not only was there no hanging around, but patient comfort and reassurance extended to giving him an airy day-bed while the lab processed the blood tests, so that he wouldn’t have to sit fretting in a wheelchair. Not a word about documents was said, even to me, until he was comfortably settled and treatment was under way, and no, there was no hurry – tomorrow would be quite time enough to bring in his passport and sort out the NHS paperwork.

    Two doctors then sat down with me and took me slowly and carefully through all the test results, ran through the ultrasound, showed me the X-ray, and explained exactly what happens when the membranes surrounding the heart become infected and inflamed, and the extent of the danger.

    Now, they said, they must determine the cause, which they thought – correctly, as it turned out – was a virus, but could not yet be sure. He must stay in hospital, they said firmly, for at least six days, and stay on for at least a week thereafter for postdischarge monitoring. He must, they insisted, be entirely cured before even thinking of travelling.

    Not content with leaving me to explain to my brother what was wrong, they later found a doctor with some command of English to talk things through with him. (Next day, to Sholto’s mild discomfiture but, eventually, enjoyment, a priest appeared from Perugia, a 40-minute drive away, ambled in and introduced himself in a gentle drawl: he hailed from Miami. Italian hospitals do “body and soul”.)

    Next day I was summoned to see Dottore Biscottini, the primario heading the hospital medical team. (Umbrian surnames are a constant delight. Biscottini means little biscuits, the cardiologist is aptly named Professor Fuoco – fire – and the intern on duty that day was an elegant beanpole called Gambacorta, “Doctor Shortleg”, she said cheerfully, in English.) I told him that London hospitals could not have matched his team’s speed, efficiency, thoroughness and good humour.

    He gave me an incredulous look – Italians almost automatically assume that their public services are vastly inferior to anyone else’s, let alone the famous NHS, and Todi hospital is so low in the Umbria pecking order that (for political more than medical reasons) it is under constant threat of closure.

    Then he cracked a wonderful smile. Rita, my friend who works there as a nurse, told me later that the news was all round the hospital within minutes.

    There are things that Italian hospitals do not do. My brother was astonished to be handed a thermometer and chart and told to take his own temperature every two hours – a perfectly rational saving of nurses’ time. Relatives expect, and are expected, to help out where they can, bringing in not just towels, soap, tissues and loo paper, but glass and mug, plates and cutlery. This frees up staff to keep the place clean – really clean. There is not a speck of grime in rooms, corridors or bathrooms. Hygiene is taken so seriously that when the food trolley is in use, no patient or visitor is allowed to pass it in the corridor. I have yet to hear of a patient catching a “hospital bug” in Todi.

    What is on the food trolley is, well, basic: dry biscuits for breakfast came as a bit of a culture shock to my “big breakfast” brother, and although there is theoretically a choice of menu, if you are last room in the line as he was, it quite often comes down to thin soup or thin soup, cheese or cheese, and a baked apple begging to be put out of its misery. Hunger is a great language instructor. Sholto’s original two words now extend to basic “restaurant Italian”. Families appear in huge, noisy, numbers at mealtimes loaded with extra goodies; tough luck on patients with no family to hand. There seems to be no such thing as television “down time”.

    But, equally, there is no such thing as dozen-bed wards; the largest had four beds. All hospitals are noisy. Besides which, my brother did not have much daylight leisure to contemplate the scene. Appalled that he had not had a medical check-up in decades, the doctors decided on a total MoT: not just repeated heart and blood pressure checks but his lungs, kidneys, liver, even pancreas – you name it. By the time they discharged him six days later, his medical records were as thick as a thumb.

    A comprehensive tour of your insides is not everyone’s idea of holiday sightseeing. But it did him a power of good. The man I collected was not only vastly relieved to have been told that his cardiac muscle had survived the infection undamaged, but reassured on almost every count, but one. That one was lung damage, which they insisted he could and must reverse.

    That got through the language barrier. After I am not going to say how many decades of puffing away, my brother emerged into the Umbrian sun a nonsmoker. Meno male, said the doctors. Literally, could be worse, but like many Italian expressions this is an elastic phrase, and in this case it simply meant “delighted”.
    I've seen much of the rest of the world. It is brutal and cruel and dark, Rome is the light.

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