Friday, August 31, 2018

The 50 Cent Foul-up

The 50 Cent Foul-up
It was only last month that I happened to write, “… we bolted beyond the scenery of our front door to where else but Italy, this time for three months of whatever may happen”.  Little did I anticipate the come what may intuition buried in those highlighted, open-ended words.
There is a high-altitude wind that blows northeast from Africa with hurricane force.  Known as the Sirocco Wind it is generated when a low-pressure system along the shores of the Mediterranean pulls warm, dry air from the nearby Sahara Desert.  This action causes dust to be sucked-up to high altitudes for easy transport across the Med to Europe.  It is a common occurrence especially in summer months.  Situated as we are in southern Italy, east of Naples (but then just about all of Italy is) we see evidence of this phenomenon whenever we venture out, regardless of the season.  It’s no wonder that a Tuscan friend, years back, once told us we lived in Africa!  Africa it is not, yet as I was making my way to Josephine’s Market for some daily staples recently, I couldn’t help but notice grasses and weeds sprouting from roof-edge gutters, and here and there along the edges of terracotta roof tiles.  It is amazing to me that over time, the fallout from the Sirocco, which is what it basically is, has deposited enough organic material along its path to support the growth of this vegetation.  When the Sirocco is in action, the dust doesn’t care where it settles.  Leave a door or window open, and it stealthily makes its way inside on a cooling breeze to the despair of many a housewife who’s just mopped her marble floors.  There are days when I’ve seen it accumulate overnight on Bianco’s windshield like a fine pink cosmetic blush.  Ever so slowly, unexpectedly, and without notice it just happens.  Life is like that, unexpectedly things just happen.
We arrived at the Ospedale San Giovanni di Dio (Melfi Regional Hospital) emergency room at 10:30 am.  It had been a 45-minute journey over hill and dale from Calitri.  I’d been driving, and by this point it wasn’t an emergency, maybe it never had been.  Along with us was our friend, Titti (T-T), who would serve as our translator.  That, at least, we had anticipated and luckily, she was available.  When we entered the Pronto Soccorso (Emergency Room) there were about 25-30 people already waiting.  It was not immediately clear what the process might be.  Everyone was seated in a hall-like room overlooked by a large glass window.  While there wasn’t any blood visible anywhere, there were prominent signs explaining their color-coded levels of triage ranging from rosso (critical), giallo (urgent situation), verde (situation not grave), and bianco (nothing urgent), based as it said on the gravity of the case.  This was the closest orthopedic hospital in our region but first let me explain how we got to be there. 
We’d been in Italy for a few weeks by the time we headed off to Polignano a Mare on Puglia’s Adriatic coast for a change of scenery.  By then, there had been a changeout in our visitors.  Leslie and Lilly had returned to the States and our daughter’s husband, Michael, had arrived to add to the number of men in Calitri named “Michaele”.  We’d visited Puglia many times before and wanted our family to also experience its intriguing cliffside cities along the sea, so one day off we ventured into the morning sun.  We were staying at lovely B&B Dimora delle Rondini in Polignano who’s only drawback was that it was on the top floor of a three-story building, without an elevator of course.  Here I advise caution to all those who travel adventurously with multiple suitcases and every pair of shoes they own.  Try it and discover that less equals happier.  I doubt I’ve ever meet a traveler claiming they’re sorry they hadn’t brought more along.
The region of Puglia, south of Bari, offers a picturesque coastline of sabbia (sand) wedged between rocky outcroppings enough to generate 800 kms of the finest beaches in all of Italy.  Here and there, white limestone pillars dot the shore like watery signposts announcing you’ve arrived.  Moving down the coast, blockhouse style watchtowers, that once warned of pirate attacks, add man- made monoliths to nature’s majesty.   Rocky rustic or saltshaker sandy, these beaches feature the cleanest, see-through water sprinkled every shade of blue imaginable.  Now and again, strikingly regional trabucco fishing machines, thought to be Phoenician in origin, jut from their rocky perches.  Poles like giant lobster antennas, swathed with nets, extend out over the water from a platform.  A winch mechanism dips the nets below the surface of the water, hopefully, to later be hoisted with a rewarding catch.  Ancient Puglian towns like Polignano a Mare sit atop these limestone cliffs all along the coast.  Beneath them, the Adriatic sea’s incessant actions have gouged caves big enough to explore by boat.  We looked forward to sharing all these irresistible sights: the caves, the towns, and of course the soft golden sandy beaches with our visiting family members. 
Following our arrival and check-in, we had lunch at “Neuro”, a restaurant in the old town’s main square, Piazza Vittorio Emanuele, followed afterword by a quick tour of the town.  There had been a storm at sea and high surf put off the chance of any cave exploring by boat from nearby Fear Cove.  It remained that way our entire stay.  There would not be a boat tour of the caves or the opportunity to jump overboard and swim in the caves as we’d envisioned.  We needed a Plan B. 
Plan B materialized in the form of a next day excursion to Castellana Grotte, a cave system formed about 90 million years ago beneath a nearby town of the same name.  In an amazing scenario of stalactites, stalagmites, concretions, canyons, lofty domes, in addition to incredibly shaped fictitious inhabitants, colors, and precious crystals, nature has molded the caverns into one of the most important attractions in Puglia.  The cave network went on for miles, but ours would be an abbreviated tour.  Our excursion would cover a distance of 1 km, 70 meters below the surface, all at a refreshing temperature of 65 deg F verses the 80 plus degree temperature we were experiencing on the surface.  Not knowing we’d be grouped into tours with scheduled departure times, we’d arrived out of sync and had to kill almost two hours waiting for our 50-minute English guided tour to begin.  We accommodated the time breach in a shaded garden-like cafĂ© before joining the growing line of anxious spelunkers.
It was right about then that I learned a new Italian word, caduta.  Maria Elena thought it wise to go to the bathroom before heading off on the tour.  There’d be no chance for a stop once the tour got underway.  As we waited in line she noticed a restroom in the piazza and walked over to investigate.  Apparently to use it, she’d need 50 centesimi, or just over 50 cents.  As she was walking back toward us, all the while looking in her purse in hope that she might have the necessary exact change, she walked off the edge of the piazza.  When I was a kid, I’d wear Weejun loafers.  Back then, sneakers were worn for gym class and blue jeans were what farmers wore.  As I recall, they were called “penny-loafers”.  Mare went with the conventional penny slid into the convenient tab on top of each shoe, which wasn’t really useful for anything beyond aesthetics.  Without a clue what “aesthetics” even meant (it sounded like athletics to me), I inserted dimes in mine just in case I might need to make a phone call.  Yes, absent cellphones, a telephone call from a little shelter called a phone booth was only a dime back then, and yes, we went to high school together.  In this instance, a shoe with bigger slots for 50 cent EU coins would certainly have helped Maria Elena, possibly saving the day.  While the terrace continued, she had not noticed that it changed levels, not by much, only about 5 inches, but enough of a step down that unexpected as it was, she fell (caduta).  Thankfully, she didn’t hit her head and overall did a pretty good roll if you were into grading it, but still enough of a caduta to apparently twist her ankle, or so we suspected.  Sure enough, it began to swell.  While an attendant got a chemical ice pack, we got her comfortably situated in the shade.  Smiling and downplaying the incident, while repeatedly announcing she’d be alright which she routinely does whenever she is injured, Mare insisted we continue with the tour while she’d wait for us.  She couldn’t have gotten far in 50 minutes anyway!
Over the next few days the swelling seemed to go down.  The ankle looked better.  Along with elevating it above the level of her heart, as everyone would advise, taping it with a sort of ace bandage, and applying ice-packs, she invented a new use for our room’s bidet and would soak her ankle there in cool water while sipping wine. She could walk on it, but it was tender.  We were encouraged when she told us how painful it had been once when she’d broken a toe, and this was nothing like that.  We couldn’t find a place that would rent a wheelchair or borrow one from one of the old women who would sit in the street late on afternoons, but we were able to get her a cane with an arm cup for added support.  It was made of aluminum, was adjustable in length, and even came with a red reflector in the handle for added visibility at night, although we knew she wouldn’t be out on the streets sauntering along in the evening any time soon.  The three story hike up and down the stairs to our apartment, meant for people with two good feet, didn’t help.  Slow and easy does it, a step at a time, she’d make it.
We still had a day to go before returning to Calitri.  With the surf still “unboatworthy”, we decided to go to the beach.  Mirella, our B&B hostess, recommended a private beach in Locale Capitolo to our south called “Sabbiadoro” (Golden Sand).  Here was a classic example of one of those ultra-organized Italian beaches with uniformed attendants, a colorful umbrella tree-farm, easy access bars and cabanas, everything you’d expect.  We thought Maria Elena could relax on a sunbed in the shade of an umbrella and occasionally venture into the water for refreshing breaks, even soak her foot.  That turned out not to work well.  Waves and the soft sand beneath her one good foot, that would erode with each arriving wave, didn’t allow her to stand in the water.  Sitting down wasn’t any better either because she’d get battered like a piece of driftwood by those after-storm waves.  One try was enough, especially after the lifeguards arrived to investigate.  That’s how bad it must have looked.  She didn’t mind a bit.  Some lotion, a chilled bottle of prosecco and bowl of fries proved just what the doctor would have ordered.  How times have changed, we used to refer to it as “suntan lotion”, now it’s “sunblock”! All in all, aside from a little tanning, we made a good day of it.
It was late on Friday, three days after Mare had rolled her ankle, when we returned to Calitri.  We decided then that we’d visit a doctor on Monday.  Titti met us at the doctor’s office that morning about 9 am.  There are no appointments, you simply sit in the waiting area and on a first-come, first-served basis, which everyone tracks like a hawk, you get to see the doctor.  We were in his office all of two minutes max.  After Titti explained what had happened, he just glanced at her ankle and immediately proclaimed that she needed an X-ray.  So much for that, but like a Primary Care Physician back home, you needed to touch base with a doctor to authorize further treatment.  They referred to getting the X-ray as a prescription.  Ten minutes later we entered the Centro Diagnostico alta Irpinia.  When it was her turn, she was taken to an X-ray room and asked to stand on a metal flange on the floor and hold onto a handle at her side.  Soon in position, she was quite surprised when the support behind her began to tilt backwards away from her.  After all these years, I can honestly say Mare is not mechanically inclined and hadn’t figured it out, although in her defense nothing had been said, there had been no forewarning.  Seems the machine, like a utility dolly, was beginning to lean her back into a prone position with her as the cargo.  Once horizontal, the head of the X-ray unit was positioned over her foot.  It was a rather dated unit.  As the technician made final adjustments, Maria Elena later told us how she’d asked for a lead shielded apron, which was her expectation whenever radiation was involved.  He apparently hadn’t planned to provide one but kindly accommodated her.  The results were not encouraging.  He reported that Maria Elena had two fractures and a small break … I recall the “5th metatarsal” being mentioned.  The next day, back at the doctor’s office, we were quickly informed that we next needed to visit the orthopedic department at the Melfi Hospital since there were no orthopedic doctors in Calitri.    
The long and short of it faithfully summarized, my story now unspooled, those were the events and “missteps” that got us to the Melfi Emergency Room.  It soon became clear that the glass window and what lay behind it was the ER operations center.  Inside we could see what appeared to be a curly haired, blond nurse in a maroon uniform taking the vital signs of an earlier arrival.  A crowd of limping and assisted newcomers soon appeared and cued-up.  Fortunately, we were next.  Inside the office we provided the necessary information which was dutifully entered into a computer and then we rejoined the crowd of patients who’d apparently already been processed, waiting with a submissive resignation so typical of the Italian temperament.  How long they’d been waiting, I was afraid to ask. 
We were called 30 minutes later.  Halleluiah, we thought we were on our way to getting Maria Elena’s foot issue addressed.  Our hopes were dashed, however, when an attendant rolled Mare inside swinging doors, past a Jesus and Mary corner shrine, and down a corridor to another room where a rather gruff, middle-aged man, whom at first, I took to be a doctor, reviewed our information and asked for more.  When another attendant arrived whom Titti knew and who just happened to be from Calitri, it took no time before Titti got to talking about Calitri, the local pasta dish, “cannazze”, and the Tre Rose Ristorante.  It was so typically Italian.  She’d apparently struck a nerve or else he was hungry, for it cropped the mood which seemed to instantly change, laughter erupted, invitations were exchanged, and now 100% approved, Mare was rolled back to the waiting room where the faces, now familiar, remained the same.  Thank God for Titti.
By this point, I was having a hard time understanding how Italy was medically ranked so high.  Could it be accounted for by their rate of taxation, among the heaviest in all of Europe, where citizens and corporations pay around 50%, not counting a VAT tax as high as 22%?  We understood that medically they were up there in the top ten.  So far, I wasn’t impressed but then we really hadn’t seen a doctor or the system in motion.  In 2000, the World Health Organization (WHO) ranked the performance of 191-member states toward achieving health care system goals.  Reading through the report, the author’s rating criteria are complicated.  The results are hard to swallow when it is common to hear reports of people from all over the world coming to the USA for medical treatment.  The subject, however, was reform, or to the laymen, improvement.  “Reform”, that helped explain why Italy was ranked #2 just behind France while the good old USA was listed behind Morocco (29th) and just after 37th placed Costa Rica.  Typically American, throwing money at the problem seemed to help, for the US placed first in “Per Capita Expenditure”.  The USA spends a whopping 17% of GDP, outstripping all its peers, on a patchwork of medical services and insurance programs with little to show for it.  It ranked 11th in a more recent Commonwealth Fund report.  Returning to an Italian focus, my suspicion is that as you move northward, away from the “Africa” of the south, services and facilities greatly improve.  Suspicions yes, but we’re not willing to volunteer to find out for sure.
At 12:30 pm she was called again.  She was rolled down a different hallway and told to wait in the corridor outside an office door.  While Mare sat in a wheel chair, neither Titti or myself could find chairs.  There were no chairs available anywhere and I finally sat on some bricks apparently intended to eventually wall-up a nearby doorway because, as an example of my brilliant observation skills, one course had already been laid.  Titti chose to stand.  I watched over the door like I’d intently watch the tip of my fishing pole.  While the WHO improvement study was new to me, I was familiar with the Six Sigma process improvement technique.  As an engineer once upon a time, I had to identify defects in processes, then systematically work to eliminate them and report on progress weekly.  I could think of one metric, customer emergency room satisfaction.  It would be on the level of what we used to refer to as “bedside manner” for hospitalized patients.  It had to do with the availability of plain old chairs and the number of wheelchairs with inflated tires.  The one we were using had flat tires and made pushing Mare around just a little tougher.  Though I doubt we’ll ever see one, satisfaction surveys might also help.  This one would have been an easy fix, but I never got the sense anyone cared.  I’d only been there a few hours and maybe I’m all wrong, but the staff seemed garnished in lethargy, burned out by the tedium of daily routine, fallen victim to the malaise of the unenthused, victims to blank impassiveness.
At 1:00 pm we were surprised when the office door opened.  We hadn’t thought it was occupied.  A man dressed in scrubs, his head covered in a tight bandanna-like cap, exited.  He could have been a doctor, but looked awfully young, but then nowadays, everyone seems to look young to me.  He passed by without looking or acknowledging us and said nothing in the process as he walked off.  This only added to our feeling of isolation and insignificance.  We continued to wait.  I’d just about gotten that brick to hatch when over an hour later he returned.  He was the orthopedic doctor on duty.
We’d been provided a copy of Maria Elena’s X-ray results hosted on a disk from our Calitri radiological clinic.  When it would not open on the doctor’s computer, he got up and left the office to try somewhere else.  He evidently was successful because he soon returned and told us that she would not need surgery, only a cast.  We were relieved to hear this and followed him down the hall into another room.  This room was clearly where casts were custom formed.  I’d never been in a “cast-a-torium” before, but rolls of plaster impregnated tape, water baths, various type hoists, and tables to recline on provided static evidence of the obvious.  My belief was buttressed by debris, towels, and paper thrown about along with spills of plaster in evidence that it had already been used that day.  Maria Elena got on a table, laid down with her foot propped up on a U-shaped support, and then the doctor and an assistant went to work.  They’d obviously done this many times and did a masterful job of it.  It would take about 12 hours to harden.  It was not a walking cast so for 25 days she was not to put any weight on it.  It was a tall order.  I wasn’t sure how good she was at hopscotch and would have to wait and see how that went. 
We were surprised when next they wanted to take an X-ray.  I’d have thought an X-ray, as a sort of baseline, would have been taken before the cast was crafted but it might have had to do with positioning after the cast was in place.  In any case, we again waited for someone to come for her.  I crouched again outside in the hallway on my brick perch until eventually someone did come along.  I’d describe her as a clone of Nurse Ratched (remember “One Flew Over the CucKoo’s Nest”?) and Brunhilda (by the way the name means “Ready for Battle”).  As opposed to the earlier Calitri X-ray unit, this devise did not have a patient reclining feature.  There was no way Mare was going to be able to get up on the X-ray table herself, especially with the soft cast, yet that was what she’d been ordered to do.  Brunhilda Ratched did not offer to help, so Titti and I hoisted Mare out of her wheelchair into position.  What would have been done it we weren’t there will forever remain speculation, but I estimate both Mare and the soft cast would have suffered.  Oh, and as for a protective lead blanket, none was provided.  Later Mare related that when she asked for one, Brun’s response was a waving of hands and a flurry of “nah”, “nah”, “nah”.  OK then, how bad can a little extra radiation be?
We then re-entered waiting mode for another hour.  We were in the hall for a while when a cleaning woman tiding up the “cast-a-torium” brought us across the hallway into a waiting room, with to our surprise, chairs.  Minutes later, we were joined by 5-10 other patients also waiting for the doctor.  I thought it was a tour group at first.  We apparently needed his sign-off to be released.  I soon gave up waiting and found my stack of bricks once again, closer to his office, and squatted there.  About 45 minutes later he appeared.  I quickly got Mare and flat tire rolled her to his doorway.  The others noticed and quickly joined the line.  He waved us in.  He was obliging, maybe he just wanted to be rid of the aggressive Americans with their many questions.  Papers soon signed, stamped, and stapled, we headed for the emergency room once again.  I’d done some reconnoitering earlier ... from the ER it was a straight shot out the back door to where the ambulances were parked.  Passing through the ER, the rogue got the better of me and in a breach in civility I said aloud to all the those waiting, “Buona fortuna a tutti, ci sono voluti solo sei ore!” (Good luck everyone, it only took us six hours!)  Can’t you see my grin through the spaces in these words?
Soon to be absent the wheelchair, we’d need help getting Maria Elena into our car.  What better place then where the ambulance teams, trained to properly move people, were sitting.  When I brought the car around and wheeled Mare into position, they joined in and masterfully slid her across the back seat.  What we’d do when we reached Calitri, we still needed to figure out.  It was late enough in the afternoon that stores would have reopened by the time we’d arrive.  There was an orthopedic supply store there that Titti was pretty sure rented wheelchairs.  It would be out first stop.  I was tired of sitting on bricks and in 25 days Mare would certainly feel the same about her wheelchair.  On our way home, we relived the experience of our first-ever, total immersion in the Italian medical system, a totally new species of encounters.  It had been an eye-opener many times over.  I’d still get to see how their improvement program, if one existed, was coming along because in about a month we’d return to hopefully have the cast removed.  While I could possibly have been appointed “chair tsar”, for both fixed and rolling stock, like wheelchairs, I’ll pass.  Hopefully, everything would go all right from getting there on to the removal of Mare’s cast and the return of her mobility.  But that stuff, you know the stuff I mean, well it just happens doesn’t it.  And it happens so unexpectedly, bang, right out of the blue.  They say things happen in threes, and since we’d arrived in Italy, it’s already been three strikes for Maria Elena - she’s lost a filling, sat on her glasses and demolished the hinge, and fractured her foot.  I think she’s done, while I’m wide-open vulnerable.  I’ll need to be careful, for having seen the emergency room side of the operation, I wouldn’t want to experience the inpatient side of things anytime soon, then again, not ever. 

From that Rogue Tourist