Saturday, September 29, 2018

Misfortunes Trials

 
 
Waiting for the Ouch
Misfortunes Trials
 
Last month’s shenanigans served to remind me once again of the proverb about the nail.
“For want of a nail the shoe was lost.  For want of a shoe the horse was lost. For want of a horse the rider was lost … “
… and on and on until battle and kingdom are lost.  While it has many variations, it serves to show how seemingly unimportant acts can have grave consequences, especially in our day and age when blame appears to have replaced all sense of responsibility.  As the physical laws remind us that every action has a reaction, likewise every act has its consequence.  Thus, with Maria Elena’s caduta (fall) there were consequences and a price to pay.  There would be no way to dodge the responsibility.  Being so personal, affecting especially her, it would be between the two of us to resolve, since the “for better or worse” clause had clearly kicked in.  Ours became a singular purpose – get ourselves through the next 25 days.
By this point she had a cane, a wheelchair, crutches, a broken foot, and a cast she couldn’t walk on.  Because of where we live in the Borgo, Mare wanted to stay inside once she’d made it there.  At issue were the stairs leading to our door.  Because she did not have a walking cast, she could not put weight on her injured leg.  She also was not willing to learn to use the under-arm crutches we’d borrowed because of balance issues and arm strength.  I assured her that if she only tried, in a month, she’d be able to do an iron cross on Olympic still-rings.  It never happened; I apparently had not been persuasive enough.  The wheel chair was just fine, but by myself I could not get her up the seven or so stairs to our door.  To go out, I might have managed, it being downhill, but Marie Elena did not want to try especially absent a seat belt, and come to think of it, a helmet.  Getting her in and out of the house would have to be a two-man operation, and without pre-arrangement wouldn’t happen easily or often.  In any case, she was happy to stay inside.  I doubted she would make it, but she managed to get through the days.  We had WIFI and with her tablet she occupied her days reading or watching just about every movie on Netflix.  I was cook and bottle washer.  I did the shopping and learned not only how to make meals, like Risotto and Pasta a la Vongole, but even learned how to operate the washing machine.  I vacuumed, cleaned the house, made the bed, washed the dishes, and assisted whenever necessary - and to think I’d been able to avoid all that for 49 years.  It had been a long run, but little did I realize how much work was involved.  If convention were different and men were responsible for housework and all it entailed, I’m positive domestic work would be synonymous with sainthood.
Her tumble had upset our vacation plans a great deal.  Many activities during our long stay had already been paid for.  There were also visits by family and friends which were in jeopardy.  We had to cancel activities that would occur in the next 25 days for sure.  One included a stay by the sea with family members at a friend’s home in Santa Maria di Castellabate that we’d looked forward to for so long.  Any delay in Mare’s recovery, as for example not having the cast removed, would continue to ripple through our pre-planned events including trips to Ischia, Rome’s Trastevere district, Santorini, and Salerno.
After a few weeks, I became fixated on the cast.  Not necessarily verbally perseverating about it, though believe me, there was plenty of that, but certainly in my thoughts.  Although my particular intonation didn’t flow well, “Get the cast off” became a sort of personal mantra.  In addition to the fact that we were in another country, we were definitely in an altered state of existence, if not consciousness. 
When we’d departed the Melfi hospital it was our understanding that we could have the cast removed in Calitri.  That is what we thought we were told.  I should have been suspicious right off because the reason we’d gone to Melfi in the first place was because there were no orthopedic doctors in Calitri.  Who then would remove her cast?  I hadn’t thought it through.  I was too anxious to get us out of there after she got her cast and was released.
As the cast’s 25th day anniversary approached, we began to wonder about what was needed in order to return to the hospital.  Did we simply return to the ER?  Nothing had been mentioned in this regard.  When we talked with locals about how to proceed, we got different stories.  We could never get a straight answer or consistently the same answer, which seems to be a common occurrence in Italy.  This only motivated us to keep asking.
One story said that we needed an appointment to return to Melfi.  Another said we had to once again go to the local doctor who’d sent us to Melfi in the first place.  The local doctor would give us two “prescriptions”.  One for another X-ray, and if all was healed, another to remove the cast.  It seemed that the local Primary Care Physician (PCP), if that’s what they’re called in Italy, was always involved.  This was unlike our experience with PCPs at home who would hand you over to a specialist who in turn would handle everything until you were healed or dead.  No need to keep checking in.  There is a complex bureaucracy of paperwork in Italy, much like our experience with paying a bill, or better yet, depositing money in an account.  No way to do it on Internet, at least not yet.   
Others counseled that we needed an appointment.  We’d been to the ER and to return there was unnecessary.  To avoid language issues, we had friends call to schedule an appointment for us.  The phone numbers we were given, however, either never answered or didn’t work at all.  One number proved especially bizarre.  It simply rang and rang.  In fact, we later learned that that particular number could only be reached from a hard line, not a cell phone like we were using.  We had never heard of such an arrangement, especially in a wireless age. 
To compound the issue, her 25th day was on a Saturday.  Could we expect that an ortho doctor would be there on a Saturday?  I thought so, but you couldn’t be sure.  What if someone came to the ER with a broken arm or leg on a Saturday?  Would they tell them to come back on Monday because the orthopedic doctor was off for the weekend?  I had my doubts. 
We knew that an appointment was a long lead item and as days passed I feared that to get an appointment on the 25th day was slipping away.  After three plus weeks in the cast, I couldn’t imagine having to keep it on just because we couldn’t get an appointment, or if we got one, our appointment might be off in the future, another week or more away.  In any case, appointment or no appointment, we were going on the appointed day.
A few days before the 25th day, my impatience got the better of me.  I went to see the local doctor to try to explain our predicament, one mostly due to ignorance.  I used the translator on my cellphone to make my case.  He gave me two prescriptions.  One was for an X-ray, the other, if all was well, was for the removal of the cast at the Melfi hospital.  At last, it looked like we had a plan.
One day before the 25th day, D-Day, plans changed when with some much-appreciated help, I got Mare into our little Fiat, “Bianca”, and drove to the local X-ray clinic to see if she had healed.  It was not clear to me whether I was supposed to get the X-ray in Calitri or Melfi.  Why make the trip to Melfi if she’d not healed sufficiently?  If they took the X-ray there and saw insufficient bone mending, we’d just turn around anyway.  We learned that while there had been some “consolidation”, the fractures had not healed.  We were disheartened with depression close behind to say the least.  No need to visit the Melfi Hospital on Saturday after all.  We’d cross our fingers, lite some candles, and planned to wait a few more days.
While I had her in the car, in a knee-jerk reaction we immediately drove the 2.5 hours to the US Navy Hospital north of Naples.  When she had fallen I hadn’t thought about going to the base for help since we were on the other side of Italy at the time.  We didn’t expect much help from the Navy Base but had our fingers crossed, all the while harboring low expectations.  A look at her X-ray results and a second opinion would have been great.  How about a walking cast?  It was late on a Friday afternoon when we finally got there, 3:30pm to be exact.  It wasn’t a bank holiday but some sort of hospital holiday - no ortho doctor available, just a skeleton emergency room crew.  They also hinted that as a sort of professional courtesy, they didn’t want to interfere with treatment already underway by an Italian doctor.  By this point we were batting zero. 
About then, depression was setting in.  I’m not sure but desperation might normally follow depression.  In any case, as we drove through the Apennine mountains to Calitri, we wanted the thing off, even if we did it ourselves.  Since we had never had a broken bone experience, not even with our children, we weren’t sure how a cast was removed.  Did YouTube have a do-it-yourself video covering the procedure?  All I’d need was a hand-held Dremal type tool with a rotating saw blade about the size of a fifty-cent coin, then again I’m reminded that it was due to the lack of a fifty-cent coin that she fell in the first place.  On second thought, if I tried, I’d probably cut her foot, only adding to the problem and her misfortune.
A wine embargo went into effect.  Mare drank whole milk for the next four days!  Our thinking, it just might help.  On the 29th day, come what may, we decided to take our chances and drive to Melfi.  We’d take the risk of being rejected at the emergency room rather than continue to play phone tag trying to get through for an appointment.  At least if we were there, we could hopefully make an appointment.  We were off. 
As we were standing in the ER line, the male nurse from Calitri, the one we’d met on our earlier visit, told us to go directly to the orthopedic doctor’s office and wait.  Events were definitely moving faster.  We were used to the drill by then.  Even the bricks I’d sat on before were still there.  We took a number from the wall dispenser as if we were waiting at a supermarket deli.  When our turn to see the doctor arrived, we entered the office to discover a different doctor on duty.  We started anew, beginning with our latest X-ray disk, which as the previous doctor had discovered, he couldn’t open on his computer.  He too went off to read it somewhere else.  When he returned, he directed a nurse to remove the cast.  Heaven be praised!  I nevertheless wondered how this could be.  Based on the same data he’d seen, we’d been told in Calitri that it hadn’t completely healed.  Maybe 25 days was all that was allowed, and casts were habitually removed on the appointed day.  Had he even looked at the disk?  I’d hoped another X-ray, for an updated look at the situation inside the cast, would have been taken when we arrived.  This prompted me to present the prescription for the X-ray that I’d brought along.  His response, regardless of the language differences, was a universal snub.  He immediately dismissed the idea mumbling something that, much like his writing, was hard to understand.  It turned out to be a gibber of criticism.  It seems it was written on the wrong colored paper!  Oh, what do those rural doctors know?  We learned it should have been on reddish prescription paper, possibly some sort of fraternal collusion known only among orthopedic doctors not unlike some secret technique plumbers might only share among themselves.  Not a problem, in true snub for snub roguish fashion, I crumpled it up when he returned it to me and threw it in the basket.  In any case, we were off to the cutting room. 
On that familiar table once again, Maria Elena winced far more this time than when the cast had been applied.   There was no pain, just the anticipation of pain as the spinning saw blade cut through the plaster impregnated tape.  It took some time to remove her artfully decorated boot which over the weeks had become the repository of many a budding artist’s work and flamboyant “John Hancock” style signatures.  Back in the office, the doctor manipulated her ankle.  He tilted it up, then down, then rotated it left and right followed by turns first left then to the right.  With each movement he’d ask her if there was any pain to which she replied, heaven be praised again, “no”.  
We literally “got the boot” two hours after we arrived.  With Maria Elena back in her wheelchair, we rolled across the parking lot to a conveniently located orthopedic store.  It was there where we purchased the walking boot recommended by the doctor.  It extended to her knee and had enough dangling Velcro straps to compete with Medusa’s head teaming with snakes.  Rigid and walkable, it proved to be a big improvement over the cast.
But there was further beatific light ahead, a small garnish of therapeutic hope.  She would shortly experience the soothing recuperative powers from soaking in Greek waters.  It was not what the doctor ordered.  We’d never have been able to get him to write such a prescription, no matter the color of the paper.  Even if he had, it would have been as effective with the airline and hotel as that earlier directive to the Melfi hospital had been for the X-ray.  But that was where we were headed, sore foot, boot, wheelchair, and crutch notwithstanding.  We’d planned a get-away to Greece during our stay in Italy.  As if by some law of rare events, the springs beside the uninhabited island of Nea Kameni, located within Santorini’s ancient volcanic caldera, have warm pools thought to have medicinal powers that help alleviate skin problems and of all things, wait for it … “bone conditions!”  Could the gods be more merciful?  The reputed mythical nail now retrieved, the shoe back in place, I’d be the first to note when she got her foot back and the renewed giddy-up in her gait.
 
From that Rogue Tourist
Paolo
 


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
Paolo

Tuesday, July 31, 2018

Aren't We There Yet? - A Travel Log




Aren’t We There Yet? – A Travel Log

We can see quite a long way down the road from our home.  Let me qualify that some … not from home in Italy where concrete walls shelter a maze of ancient dwellings, but from our home in the States.  Out the front door to the end of the driveway, then on to the street, and the open road to anywhere in the world awaits.  So, it was on a Sunday in July that we bolted beyond the scenery of our front door to where else but Italy, this time for three months of whatever may happen.  Once again, the unfettered charm of something still undefined beckoned.  They say, “All Roads Lead to Rome” and they just may.  We’d give it another try, well beyond Rome, south to Calitri, beginning with the beckoning strada at our front door. 
There were five of us at this stage of the trip with two more planned to join us when we arrived in Naples.  Exactly how many phases there would be to our journey was only an educated guess at this point.  If all went well, we could anticipate four, with periods of waiting interspersed here and there.  All told, there would be enough to consume about 24 hours.  As a child, in the back seat of the Chevy four-door, I recall how road trips never seemed to end.  Sitting there on the interlaced threads of the plastic seat covers of the back seat, they seemed endless.  Only the fuzzy backs of the front seats, topped by my parent’s heads, were visible.  Absent the distraction of any hand-held electronics to occupy our time, dreams while asleep from the motion of the vehicle were our video games.  This trek eclipsed all that.  The grandchildren with us and adults alike would at least wonder, if not voice aloud that reprise expectant of some form of relief, “Aren’t we there yet?”  
As expected, the road petered-out about four hours later when we reached the bustling JFK Airport on Long Island.  Months earlier I’d jumped at a 30% discount offer from an Italian airline operating from JFK.  The savings would hopefully more than offset the cost of the one-way rental and it did.  In the meantime, ticket prices apparently dropped with Boston area carriers.  Truth be told, when you got right down to it, in addition to adding to the length of the trip, I could have saved the expense and the bother of driving all that way and flown from Boston for about the same price.  So much for the overthinking brought on by the chain of decisions called advanced planning.
From the four wheels of Phase I, we soon transitioned to the 10 wheels of Phase II as our Airbus 330 lifted off for an eight-hour flight to Milan.  To that point it had been a hurry-up and wait affair.  We’d set out early enough to insure we arrived with time to spare.  The downside being that if all went well, we’d arrive early at JFK.  Light Sunday traffic, great weather, and a reliable vehicle saw us get there without difficulty.  The hurry-up concluded, our waiting began as we lingered until the sign over what had once read Air France to Riyadh (just a little too far east for our liking) flipped to Air Italy. 
The direct JFK to Naples flight, on the once-upon-a-time Meridiana Air route we’d looked forward to for months, was now an indirect flight to Naples via Milan, on the newly christened Air Italy.  While much had changed, certainly the length of the trip, I was powerless to change a thing.  With king for a day empowerment, I’d certainly tell Mr. Aga Khan, who owns the airlines but doubtfully has never sat in economy for eight or so hours, how to improve boarding.  I still do not understand, but certainly appreciate, the confusion of boarding.  Instead of calling rows, let’s say in the normal manner, beginning at the back of the aircraft and working forward or how about by passengers sitting by windows followed next by those with center seats (a computer could certainly figure this out), theirs featured a free-for-all melee.  We’ve been to Italian wedding receptions like that, where as soon as the bride and groom are seated, the scuffle begins as the hoard of guests dash for the buffet appetizers en masse.  The idea of calling people to come forward by assigned table number was as foreign as we were.  Plain and simple, it is a survival of the fittest affair or at least the dominance of the hungriest with the sharpest elbows.  Frequent flyers can appreciate the similarity as you quickly find yourself in a queue somewhere along those 100 foot, nose-to-tail aisles, while 17G, 20A, 23B, ad infinitum, first search for their ticket stubs to confirm their seat assignments, then wait while earlier arrivals get up and move out into the aisle to allow them to enter, while others shuffle back into the aisle to unload every conceivable device they may need during the flight before jamming their carry-on into the overhead.  All the while they’d hold-up the uncoordinated line now easily extending through the shi-shi, prosecco sipping, first class glitterati, to the cockpit, and out the hatch.  Do I exaggerate or am I preaching to the choir here?
It all originates at check-in where you deposit your luggage and get your boarding pass.  For years orderliness was not part of this experience in Italy.  I’d say it was far more like the wedding appetizer buffet stampede I described.  At the airport, in a similar fashion, we’d be greeted by an inverted triangle of travelers.  Its long base ran along the counter while that poor last patron, tapering off the peak of the pile, stood farthest from the counter.  For those lost souls out there on the fringes in la-la land, there needed to be a modification to the beatitude “Blessed are the meek, for they shall inherit the earth”.  Something along the lines, “for they shall get there someday”, would have been more appropriate.  Those days are gone, but it took years before the civilizing effect of the roped line was introduced. 
Like cruising, it used to be fun to fly.  We even got dressed-up as if we were going to church.  Not anymore.  At least not these days, where like that inverted triangle example, an inverse rule seems to apply, for as aircraft get larger, seats get narrower and more densely packed even for the ergonomically-correct, 32 inch waisted, five foot eight, 160 pound, stereotypical male passenger.  Like the movie Titanic, the reverse also applies as we found ourselves retracing the steps of an endless flow of ancestry, although in reverse, where instead we were headed for Italy, not America, yet with steerage accommodations in the form of “Economy” class still very much in vogue.
I did find that the much-maligned airline food had improved over Meridiana Air’s previous fare, although Maria Elena would counter here if she had access to these keys and point out I’d eat just about anything.  Much to the delight of the bovine population, chicken was still offered.  The other choice was ever inventive pasta in one of its many guises.  I chose the lasagna bolognaise which was just great, while my granddaughter, Gabriella, got to enjoy four dessert rejections including one from a neighboring passenger destined for Sicily over concern for her sugar count.  She also made a sign of the cross on take-off.  With God as our co-pilot and still more pilots up-front, I felt reassured we were in good hands.  Surprisingly, we were attended to by an all-male staff.  I hesitate to call them stewards, but why not, when for years we referred to their opposites as stewardesses.  How they broke into that female dominated profession, I’m not sure, though it must be a similar kinship I’m seeing nowadays with male cashiers in supermarkets.  
After dinner, we settled in for the long flight, almost eight hours we were informed, eventually into a rising sun.  I was seated across the aisle from my daughter and granddaughter while in front of me sat my other granddaughter and Maria Elena.  How I’d settled for that last-minute arrangement remains a mystery.  I think someone wanted to sit with Nana.  I hadn’t thought the consequences through when I’d agreed, for when the cabin lights dimmed, I had no one to lean into and fall asleep against.  Sitting on the aisle, there was only one way to go for I didn’t think the fidgety young woman beside me would appreciate me tilted her way to the accompaniment of an occasional cacophonous snore.  I have a problem sleeping while sitting upright.  I attribute it to years in the cockpit where falling asleep was for good reason, prohibited.  Putting my head down on my tray was also out of the question.  I must somehow get sideways, which is impossible in today’s seats no matter what the airline commercials feed us about the luxuries of flying.  Jennifer Aniston and that inflight shower she advertised on TV, along with a stand-up bar, were nowhere to be found.  In fact, amenities were rather limited.  With a compliment of 236 economy class seats, there were only four toilets available.  Four additional toilets were just beyond the curtain two rows in front of us, but unfortunately access to them was like crossing into the Korean Demilitarized Zone, also known as Business Class.  Luckily, we were not seated in the tail where the restrooms we had access to were located.  The aisles there were continually filled with what might be called anxious though straining flyers, who like Jack in the Boxes would pop-up whenever the seat belt light was extinguished and head back to join the rapidly growing queue.  I was thankful I was not seated back there for it would have been impossible to sleep in one of those aisle seats flanked by inconvenienced travelers whose discomfort grew by the moment. 
At some point, I must have fallen asleep for some of my hours aboard are unaccounted for, as if I’d been abducted by aliens (the UFO kind).  At intervals, I was jostled awake by some passing night aisle-walker when I’d list too far into the aisle or when my daughter would do the jostling herself from across the aisle after I’d discharged an especially vociferous snort.  After all, she had my reputation to uphold among all these strangers while I slept.  Conscious once again when the cabin lights came up, I was pleased to learn that there were just over two hours remaining before landing.  There are benefits from sitting up front.  One being that they haven’t run out of the wake-up breakfast omelets just yet.  When we actually did touch down, passengers applauded, while across the aisle, the lady from Sicily made a sign of the cross again.  For our part, we joined in the applause but any enthusiasm for having arrived in bella Italia was tempered by the realization that we could have been in Naples by then if the route structure hadn’t been changed.  Gathering our belongings from the overhead we quickly began to shuffle toward the exit, just another up-front seating perk that allows you to get off quicker and queue to the passport line before those hundreds of fellow passengers farther back.  It’s a perk, however, that can only be fully exploited by the business and first-class passengers, the very first off and already at passport control when we arrived.  
Milan Airport, properly referred to as Malpensa, is big and expansive.  We’d parked at the “B” side of town and had to make our way to the “A” side for our next flight.  This was deceptive.  Only a letter away, in reality an entire sprawling terminal separated us from our next flight.  Luckily, we had two hours between flights with no luggage involved, only customs to attend to since this was our first point of entry into the European Union (EU).  Thankfully, we‘d landed early and had that time-pad in our favor for our entire planeload of fellow passengers had to be seen by a rather bored immigration officer ensconced in a glass vault.  In addition to his normal duties of guarding the exit from Terminal B to anywhere else in the EU, he oversaw a red line on the floor that he’d shoo over-eager travelers back across whenever they’d stray too close to his realm, uninvited.  
The coveted stamp of approval eventually in hand, we next made our way to our departure terminal.  To do that, we had to navigate through corridors of consumerism.  With a captured crowd on hand, many with hours to kill and vacation Euros to mete out, airports have embraced the lucrative idea of a mini-mall on the way to the gates.  In some airports there is no way to proceed without zig-zagging through retail shops loaded with kiosks brandishing typical regional products in hope that you may have missed something earlier.  They serve their purpose, especially when we must endure a long wait.  It’s nice to be able to get up and browse the shops or enjoy some refreshments while waiting.  Who knows, you might even find something you like.  Myself, I’m usually a sucker for that last minute, duty-free, oversized bottle of Aperol at a considerable discount from Stateside prices.
Our flight to Naples boarded on time.  Another phase of our journey, thankfully a rather short one, was underway.  We were scattered in our seat assignments but after takeoff we were able to move closer together because the aircraft wasn’t full.  Our daughter was eager to meet her friend and her daughter who’d arrived in Naples ahead of us.  Following landing, we exited the aircraft to an awaiting bus that brought us to the terminal.  The Naples terminal has seen many improvements over the years.  For instance, nowadays when we exit the ramp shuttle into the terminal, we are greeted with an audio-visual welcome to Naples.  It highlights the many archeological wonders and sights of the area, from Pompeii to the Amalfitano peninsula, that make this part of Italy so unique.  Arriving at the baggage carousel, we found Leslie and Lily waiting for us.  Surprisingly they had remained in the baggage claim area since they’ed retrieved their luggage hours earlier.  Never having been to Europe before, they were hesitant to leave the baggage area for fear of what lay behind the swinging exit doors.  They also knew that eventually we would pass through this area and it would be a sure way to meet us.  They were right.  We were glad they’d made it on their own, and that neither group had had any problems.  Hugs and kisses duly administered, we waited for our luggage.
Arrival’s epicenter of activity, baggage claim, is another prayerful place where fervent entreaties are offered by petitioners even before the conveyer belt begins to move.  Prayers become more fervent with each cycle of the belt as it disappeared into the wall in hopes that a new load, bearing your suitcase, personally decorated to get your attention, would emerge.  I watched the lady from Sicily with interest.  She finished another supplication and low and behold, her appeal was answered, a miracle for certain, as her suitcases emerged through those mechanized portals of pure chance.  We hadn’t seen ours since JFK, one suitcase each.  I always check when the attendant slips the coded destination tag under the handle.  In New York it read MXP (Milan) followed by NAP, for Naples of course.  Much depends on these codes being correct.  That’s half the battle.  From then on, seeing your luggage again depends on a system of baggage scanners, enough time between flights to transfer bags, the absence of the occasional baggage handler slowdown or strike, your luggage being pulled for a contents inspection, finding its way aboard the correct trolley, and a heavy dose of baggage luck.  A second miracle occurred that night, only minutes after the first, when Maria Elena’s four-wheeled shell of a suitcase suddenly appeared, followed less than half a belt later by my duffle-bag, each embellished with a bright yellow cord as a personal compliment to the MXP/NAP codes.
One final phase remained, getting to Calitri from Naples.  Here we had options, though limited.  Hiring a Uber was not one of them.  There were none.  There was, however, a bus to the main train station in the bowels of Naples and from there another bus to Calitri, if a sufficient number of seats were available.  Our group, now grown to seven, would be asking a lot, especially when due to the hour, it would be the last bus available that day.  Could we take the chance?  To add to this stew, it had already been a long day of travel, actually more than a day.  Everyone was tired.  With many stops along the route, it would be hours before we’d arrive.  Then there would be a bag-drag from the bus stop through town to the Borgo where we lived … just a little much.   By this point only one option made sense.  Dropping the idea of this stew, we went for the filet mignon.  I’d arranged for a driver with a van to collect us and drive us to Calitri, non-stop.  With roller bags in tow we exited, single file, through the baggage claim swinging doors into a waiting crowd of anxious family members, resort services, and shuttle drivers, many brandishing signs.  Just beyond the barricade we met our driver, Salvatore, who with a broad sign inscribed with my name and an even broader smile, greeted us.  We had never met Salvatore.  Our ride had been arranged by Emma, our Calitri house manager.  Grateful for his presence, we followed Salvatore outside in single file, across the hectic street of arriving and departing travelers to his van.  Minutes later, we were on the A16 autostrada headed east, away from the coast and across the Apennine mountains deep into the valleys of Campania.  After that treat, Maria Elena now expects this kind of special handling on future arrivals.  As they say in that card game, “Go fish”!
We were delivered to the piazza by the Calitri town hall.  Not quite there yet, all that remained was one brief trek, the final phase, along cobbled streets to our door.  The clicking of our many suitcase wheels as we lurched along across the cobbles trumpeted our arrival.  There was no hiding it.  We were used to the drill, but not our guests.  I could only imagine their private thoughts reflected in their expressions and weary body language.  There was enquiry in their looks, I’d seen it before.  It was a mix of “when will this trip end” and “not another step”.  They were undoubtedly thoughts which when stripped of their crassest modifiers, absent a few dangling expletives, and distilled to its politest residue, there only remained “Aren’t We There Yet?”  Effectively we were.  The final impediments before the onset of traveler’s relief, were a few broad stone steps and a short passage through a
salmon colored tunnel to our door.  After the drive, our guests could appreciate Campania’s geography of stone, mountains, scattered hilltop villages, and broad vistas speaking to them across thousands of years.  They had an inkling by then that this wasn’t Kansas.  Instead, this was undiscovered southern Italy.  They’d made it.  For a few weeks, theirs would be a multisensory experience.  The wonderment of it truly incomparable - the very old alongside shiny new, faces with a thousand wrinkles, the communion of picturesque vineyards carpeting heaving hillsides, the aroma of grana padano stuffed zucchini blossoms, the recurring melody of “buona sera” and “buon giorno” from everyone you pass - enough to incubate a thousand memories.  Up those last steps and through the tunnel a different new awaited, new moments in time that have lasted forever.

 
From that Rogue Tourist
Paolo