If you are really badly ill (terrible pain, blood all over the place, broken bones), go to pronto soccorso (the emergency room) and be surprised at how good it is. When my Florentine wife was unconscious after a fall, the ambulance came in minutes and when I sliced through my thumb with a chainsaw, I was seen by a senior surgeon almost at once. But if you are feeling just a little ill, why bother with a doctor? Try being Italian and call a friend. Most are amateur doctors and these days real doctors don’t look at you anymore. They just look at their screens. Your friend will know all about your problem and tell you what to do.
Attitudes + culture
In the north of Europe, bodies are private, but here they are the property of just about everyone: friends, relations, supermarket checkout workers, people on the bus. In Britain, ask about someone’s health and the reply will usually be “not bad, mustn’t grumble”. Have you ever heard a Scot volunteering details about his prostate? I remember the confusion I caused when greeting a line of Italian guests at my wedding with a cheery “how are you?” The otherwise joyful event suddenly changed into a list of symptoms and medications. Later, the priest, whose concern should have been my newly married soul, asked me to join him in the vestry so he could show off his rash.
On coming to live in Florence pre-internet, I learned to scan the bookcase for the medical dictionary in people’s homes. Once found, I took a discreet look to see which pages had been heavily thumbed. Like a wine expert who sneaks a glance at the bottle before tasting, it is wise to know the main family illnesses in advance. I once got this wrong when the medical dictionary fell open at the page where all the illnesses began with “Em” and, as a lung specialist, I helpfully steered the lunchtime conversation round to emphysema. My questions were strictly above the belt, but my hostess kept pulling the conversation further down. Light eventually dawned that the signora really wanted to talk about her emorroidi (piles).
Italians are astonishingly well informed about biology, perhaps because their education favours science or perhaps it is all these illness conversations. Well-educated Brits may be strong on interest rates, gardening and Shakespeare, but feeble when it comes to digestion and kidney stones. In contrast, my plumber could get a diploma in magnetic resonance imaging, testosterone or hormone replacement therapy. Plumbers know about tubes, of course, and your body has lots of them but it’s not only plumbers. My chimney sweep, whose passion is Greek philosophy, is an expert on pancreatic cancer because of his father, about dementia because of his mother, and the side effects of vaccination because of his children.
Everyone in Italy keeps their own medical records, reads and understands them, and often challenging their doctors about the details. There is no presumption that “the doctor knows best”. Locals are pros about nutrition and are very free with advice. Never eat fruit at the end of a meal as it ferments into unwanted alcohol. Beware of aluminium cooking pots that are “scientifically proven” to damage the brain. Avoid air-conditioning after a large lunch as it delays digestion. These opinions are so strongly held that it is foolish to take issue with them, so instead I just nod and say, “Yes, so I have heard”.
Diagnosis
While working in a cardiology unit in Rome, I encountered countless large men who arrived in the early afternoon sweating and clutching their chest. I knew a heart attack when I saw one and admitted them swiftly to the coronary care unit. After a week, the professor took me aside and told me to stop filling up the ward with people suffering from “congestione”. This diagnosis is unknown in England where lunches are smaller; it is probably just acute indigestion. Once I had got the hang of it, I advised them to eat less for lunch, chew slowly and put up with the “congestion” as, like traffic, it always moves on eventually. I sent the patients home, happy and reassured. I will never know how often my new carefree approach missed a heart attack. Then there is the menace of a colpo d’aria, literally a “blast of air”, an illness that especially affects small children. You will see them in the park on warm winter days wearing jackets so thick and padded that they can hardly move, arms sticking out horizontally like scarecrows. Un colpo d’aria is the same as catching a chill due, of course, not to the temperature, but to huddling together when the winter winds are cold. Adults combat it by wearing extra protection around their liver to keep the organ warm. Livers are vulnerable to crises in Italy, although the French crise du foie is even worse.
A second opinion
Every week, one of my nine grandchildren has a cold, a sore throat, mumps or injuries. A phone call ensues: “xxx fell off his bike and his arm looks a bit wonky. Should he have an x-ray?” (Both forearms were fractured and so, no school for two weeks: yippee!) It’s not just my family, however; it’s everyone I know. “Would you mind having a look at my scan report?” For centuries, medical language, usually Ancient Greek or Latin, was useful to conceal ignorance and impress the patient. This still works and radiology reports are full of tremendous descriptions of lesions, opacities, parenchyma, stenosis and much, much more. You don’t need to read these words. Just look at the conclusion, a single sentence towards the end.
“Should I see a specialist?” or “Is my specialist the right one and have you heard of him?” The specialist has to be a “top specialist” and there is a disturbing habit of believing in specialists who are a long way away, usually Milan or, better still, Switzerland. The flip side is that, however good the specialist and however correct his treatment, someone else might be better, and so second opinions are part of the system. Slightly different opinions undermine confidence, and so a third opinion is wanted. A very fit golfing friend has an international collection of opinions about his shoulder. At present, the need for surgery is finely balanced between Italy and France. The score is 3-all, so rigori…
Phone call: “My scar, it’s huge”. Yes, I concurred, and a minute later a photo of a recently operated abdomen appeared on my phone.
I used to be flattered and thought my opinion was important. Not so, I was just one of many friends who were being informed. The medical event was being shared and the concern of the family reduced by being widely distributed. I am simply joining the healing ritual of “a problem shared is a problem halved”.
Treatment
People often decide about their own treatment before negotiating with a pharmacist, quietly at first, then louder. Fellow citizens in the queue begin to mumble, exchanging opinions, joining in and advising. Pharmacists can be persuaded to give antibiotics without prescription. This flexibility with rules, dangerous while driving, can be lifesaving. When my friend Alex was stung by a bee, he swelled up and couldn’t breathe. I was too worried to leave him and sent my teenage son to the pharmacy for a needle, syringe, cortisone and adrenaline. He rushed off on his motorbike and ten minutes later was back with syringes and drugs. No pharmacist in England would supply such equipment to an unwashed biker in leathers without a prescription. The moral of the story? Alex survived.
Closing thoughts
Phone call: “Could you please give me my injection to save me going to the hospital? I would do it myself, but have trouble reaching my buttocks.” Three cheers for Italian cooking. What is the ideal medical culture? The protestant north of Europe favours the lonely “grin and bear it / don’t make a fuss / it will get better by itself / why trouble the doctor” approach: often right, but heartless. In the Catholic south, an illness is a shared event supported by family and friends and treatment is more chaotic. The mortality statistics favour Italy and Spain, oil over butter. Perhaps we should all be happy in our own cultures. I, from the north, will go on being interested in your Mediterranean body, so please keep telling me about it. I will, however, keep quiet about my own.
