Sunday, September 9, 2018

A Medical Error


drawing by Suzanne Dunaway
He’s a dermatology Chief Of Staff, she’s a prominent psychoanalyst, both have offices in their mammoth apartment in a classy Rome neighborhood. One afternoon she greeted a new patient, had him lie down on the analytic couch, and got him talking. For 20 minutes she listened from behind his head, emitting an occasional “um-hmm,” then made a first stab at an interpretation: “You seem very focused on your psoriasis. I wonder what all this concern might come from.” He replied, “Of course I’m focused on my psoriasis, that’s why I took an appointment with the dermatologist.” This is a true story.
Welcome back to Stethoscope On Rome!  As an adoptive Italian I wouldn't dream of posting in August...
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Thursday, July 19, 2018

Warm Water Wizardry


Date: December 24, 1994. Place: Indian Springs Spa, Calistoga, California, two hours north of San Francisco. My second-husband-to-be Alvin Curran and I emerged from our mud packs so blissed out we couldn’t imagine trudging back down to where we were staying in the city, so we asked for a room for the night. “All booked up,” replied the receptionist from under her teased beehive, “And since it’s Christmas Eve so will be everywhere else in town that has a hot pool.” We kept pestering her until she admitted, “Well there is this one place, a good 45 minutes from here, they might have room. But it’s kind of, umm, funky.”
I dialed the number. Yes, they did have hot spring water and yes, they did have a free room. “We have a problem, though,” I said. “We only meant to go to Calistoga for mudpacks, so we didn’t bring any bathing suits along.” “Oh, that’s ok,” said the voice, “We can arrange something.”
The drive took a solid hour through driving rain, over roads that shrank to lanes then to trails, and by the time we handed over our parking fee at the gate of Harbin Hot Springs night had fallen. As we inched forward through the mud, pale figures began to emerge from the darkness, swinging flashlights, and sporting boots but not another stitch of clothing. Both “funky” and “we can arrange something” suddenly made sense: this joint was nudist!
The next morning as we stood soaking to our chins along the edge of the warm pool, exchanging smiles with fellow-hedonists, a burly fellow climbed in as naked as the rest of us, scanned the faces, chose mine, and extended his hand saying, “You look like you could use a watsu.” “A what?” “Close your eyes and I’ll show you…” The WATer shiatSU treatment he gave me, swishes and stretches and massages on the surface of the water, was a blissful pas de deux that must have lasted only ten minutes but felt like forever. In my life I’d had lots of massages and other kinds of body work, but watsu was in its own league.

As I later learned, watsu was invented in the early 1980s by Harold Dull, who moved to Harbin after making his name as a poet in San Francisco. His inventive spirit transported zen shiatsu, which he had studied in Japan with its inventor, Shizuto Masunaga, to the warm spring waters of the hippie spa. The experience is relaxing and energizing at the same time, somewhere between meditating, flying, and dropping mescaline. At least that’s what it felt like to me.
After some years of making runs up to Harbin every time I was in California, in 2000 I decided I’d try seeing what it was like to take on the other role. Giving watsu treatments turned out to be nearly as mind-blowing as receiving them, and three hundred hours of training later I was ready to start practicing bodywork on days I wasn’t seeing patients with colds and cystitis.

There was only one hitch: finding the right pool. A watsu pool has to be large enough to swing a client around, calm and quiet enough to permit complete relaxation, just the right depth, and just the right temperature (34º-35º Centigrade, 93º-97º Fahrenheit). Jacuzzis are too small, heated swimming pools not heated enough. Italy’s many famous hot springs can be great for watsu, but the closest to me is an hour and a half drive.
After an exhaustive hunt I found a place inside Rome that qualified, barely: an off-kilter urban spa provocatively named Extasia. The water was so shallow I had to work literally on my knees, and the risk that my client might get skewered on a sharp corner that stuck out into the tiny pool kept me figuratively on my toes. Plus we all couldn’t help but notice one tall white-coated employee who was always popping in and out of the reception area, sporting a short skirt and a strangely prominent Adam’s apple. I did manage give a couple of dozen sessions…
…until one day I heard the place had been closed down – by the vice squad. When eventually they did re-open, they thought it more prudent to bar outside therapists.
I moved on to the lovely swimming pool in the basement of the Grand Palace Hotel on Via Veneto, which they were willing, for a reasonable sum, to heat to watsu temperatures on special request. But around 2010 it too closed down, voluntarily, and when it reopened two years later the new management couldn’t be talked into hosting such a suspicious-sounding activity as water-based massage. Alas, I don’t yet have a decent substitute yet anywhere in Rome – the only appropriate pool I’ve found prices itself out of the running. All suggestions are welcome.
Saddest of all, my beloved Harbin Hot Springs was destroyed in the northern California fires of 2015. It is still struggling to rebuild.
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Monday, July 9, 2018

Daredevil Dentistry


drawing by Suzanne Dunaway
If I had felt like it, when I opened my medical office for business on Rome’s Via Scialoja in 1980 I could have set up a double-duty exam table that tilted thisaway for me to take your Pap smear and thataway for me to fill your cavities. True, most dental drills in Italy even back then were wielded by guys who had gone through all the paces: first a regular medical degree, then a book-based specialization in teeth, finally a practical apprenticeship with a dentist father or family friend to actually learn the job. But a good chunk of the Dentista offices were run by . . . General Practitioners, who rounded out their income with improvised odontoiatric skills. Until 1984 anyone who had graduated from medical school could legally set up shop as a dentist in Italy, without having done a specialization and without any hand-in-mouth training whatsoever. It must have taken nerves of steel. By now, thankfully, that cohort of medical moonlighters are almost all retired.
In Italy the default for doctors and hospitals is public, but the default for dentists is private. For one thing the waiting list for dental work on the public health system can be two years long, and for another NHS dentists are notoriously "cavadenti" who yank teeth instead of fixing them. So whereas private medicine in Italy is largely for the well-to-do, private dentists cater to the masses. But – paradox – they charge twice what they do in the States. The circle is squared by a semi-clandestine horde of cut-rate imposters – as per one of my first blog posts.
(There are phony physicians too, of course. One Roman pseudo-doctor, unmasked after 15 years of practice, rode off into the sunset on his bicycle. Two months later a clochard died of exposure on the steps of a noble Palazzo: it was him. But, then, in 2003 Florida alone convicted 101 fake physicians, so we can confidently guess that right this moment thousands of charlatans are practicing medicine without a license in the US.)
Nino Campanelli, my own dentist for my first 30 years in Rome, had a delicate touch and was a whiz with the Xylocaine. Once, though, I had an emergency while Nino was out of town, and when his substitute leaned on my shoulder for leverage it came close to dislocating. The day they gave a lesson on how to handle flesh gently he must have played hooky. I told my beloved Nino he’d handed me over to a backup who was oblivious to patient comfort. He answered with a sigh: “Yes, I know, he’s a little rough. He knows his stuff, but until now he’s been working in the National Health Service. He still needs to learn how to behave with private patients.” That’s all I know from personal experience about public dentistry, and all I need to know.
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Saturday, June 23, 2018

The Great Adrenalin Sweepstakes


drawing by Suzanne Dunaway


Allergy emergency take one: Charles was on vacation in Tuscany when he got stung by a bee, felt his throat start to close, and headed for the nearest Emergency Room. They recognized impending anaphylactic shock and knew there’s only one way to be sure it won’t be lethal: a shot of adrenalin, which starts working in seconds. The docs gave him the injection, Charles felt better, he stayed under observation the rest of the afternoon, he went home with a prescription for a few days of pills. Ordinary modern medical care.

Allergy emergency take two: Margherita knew she was horribly allergic to nuts. The scoop for her coffee and coconut gelato must have been dipped first in hazelnut or walnut flavor, because she felt her chest begin tightening up. Off to her local hospital, where things started going sideways. The head of the Emergency Room didn’t believe in adrenalin. So his staff gave her only a shot of cortisone, which doesn’t start to have an effect for hours. By the time the medication did kick in Margherita was struggling to breathe. She was lucky, and survived to tell me the tale.

In the first decades I worked here the anti-adrenalin school held sway in Italian Emergency Rooms, at least those within range of Rome. By now things have improved considerably, and most patients who need it do get that magic injection of adrenalin in the Emergency Room.

But though we’re well into the 21st century, I’d estimate that the bad old policy still holds sway at about one ER out of six – which means Russian Roulette for anyone who might be going into anaphylactic shock. One of those eternal Italian mysteries, like why secretaries always tell you to call back instead of taking a message.

Last month a patient provided a scary new twist on the allergy theme: when her throat started closing up at 3 am she rushed to an ER, walked up to the glass barrier with her head tipped backward (the only way any air could get in), and told the triage nurse she couldn’t breathe. The nurse told her to go sit in the waiting room. Three hours later she and all the 15 other supplicants hadn’t seen the shadow of a doctor. Since her throat still hadn’t closed altogether my patient figured she’d live, and went home.

Moral of the story: if you’re visiting Italy and know you have a potentially life-threatening allergy, be sure you bring along an up-to-date Epipen. Locals can obtain the equivalent free at public hospitals, but it can be very difficult to find one being sold in regular pharmacies.

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Monday, June 18, 2018

Drive Me To The Moon


drawing by Suzanne Dunaway
In the days before there were fixed airport rates and before all New York cabs were driven by foreigners who can’t tell Brooklynese from a southern drawl, I used to ratchet up my native Noo Yawk accent when climbing into a cab at JFK, to let the driver know I was a local and thus avoid being chiseled. Not good enough: once I was so sleepy heading to midtown Manhattan at 3 AM I didn’t notice I was being driven all along the Brooklyn seashore, doubling both the mileage and the tab.
But when it comes to fleecing passengers, Rome cabbies take the prize. A team of investigative reporters in the 1990s found that half the foreigners who take a taxi from the Da Vinci airport in Fiumicino got cheated. Nobody wasted gas on extra mileage like my New York cabbie – they’d just tell a packed cab that the meter rate was per person. Legit cabbies can’t pull that trick now that they have to post their rates in four languages, but tourists emerging from International Arrivals still run a gauntlet of unlicensed swindlers muttering “Taxi? Taxi?”
One taxi driver confided to me on the long drive to the airport that before taking off for a vacation elsewhere in Italy he always checked out ahead of time what the cab fares were supposed to be at his destination, assuming that his colleagues there would try to rip him off.
I once went to the American Embassy to plead an employee’s compensation case in front of a State Department lawyer who had been flown in from the States for the occasion. The lawyer had obediently followed the Department’s penny-pinching guidelines and taken a bus to town from the airport instead of spending 25,000 lire on a cab. When he got out at the bus station, he told me, he took a taxi straight to the Embassy half a mile away – had the 30,000 lire he’d paid been the right price? I had to break the news that on the meter it would have been about 3,000. His round pink innocent face had “Take me for a ride” written all over it.
But this is Italy, so you never know – another time the meter reads €10.50 and the cabbie says just give me ten.
Visitors take note: Italian cabbies don’t expect tips! And the fixed rates from Rome’s airports into town include your luggage!
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Wednesday, June 6, 2018

Big News For Me


The book I’ve been working on for more than 30 years, about my adventures practicing medicine in Rome, has been accepted for publication!!! Paul Dry Books in Philadelphia, is planning to bring it out in spring 2019 under the title Dottoressa: An American Woman Doctor In Rome, and hopes to get it published in Italian some time thereafter. Paul Dry is a wonderful small independent publishing house, with focus on the intellectual and the quirky, and I’m proud to be in the company of its authors. The book is entirely independent of the blog – even assiduous blog fans will find it all new material.

Wednesday, May 30, 2018

Pre-Pre-Pre Med


When I was maybe five a doctor friend of my parents, Arthur Shapiro, gave me a stethoscope he was finished with. I was thrilled – not about putting the plugs in my ears and listening, but by having a real object, a fetish from the grownup world. Next to that my toy doctor's kit with its little bottle of pink sugar pills paled by comparison.  
Drawing by Suzanne Dunaway
For checkups my brother and I would get driven all the way from Flushing across the 59th Street Bridge to the pediatrics department in the white towers of New York Hospital. All I remember about Dr. Fraad is he once reassured my mother about my baby toenail that she thought was growing in funny. Sixty years later I showed her the same toenail and she was still unconvinced.

Most of the time I kind of liked being sick. Sickness turned on my mother’s Fair Illness Code. You got to eat apple sauce with pills crushed up inside, if you had a fever of 100° you got to stay home from school, and after the fever was gone you had a right to one extra day at home. Once during a high fever I hallucinated climbing a huge mountain without ever getting to the top, like Sisyphus with his stone, and I remember I considered it great fun – delirium as a natural psychedelic.
But once when I had an earache I remember my mother weeping helplessly at my bedside. I must have been howling in pain myself, but the sight of her in tears was so astonishing that it’s all that’s stuck in my memory. The torment of another earache stuck in memory as an engulfing red ball that expanded bigger and bigger. The doctor came to the house, I can still see him looming over my bed, but the pain only stopped when my eardrum burst the next day. I found it wonderful to have no hearing from my right ear, and kept rubbing the outside to test it.
Medicine didn’t have much of a presence in my young universe, but expatriation did. Many of our family friends had fled the Nazis, and as Jews by origin if not religion my parents always kept their mental bags half-packed for a quick exit. Which is why my father once suggested that I should become a doctor, advice I scorned for decades. His reasoning was that – in the worst case scenario – I could instantly set up shop as a physician anywhere in the world. He didn’t, needless to say, know Italian bureaucracy!
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Saturday, May 12, 2018

Germ Warfare


Drawings by Suzanne Dunaway
One day late in 1969, in a back office of Creedmoor psychiatric hospital in Queens, I hiked up my skirt and pulled down my tights. My boss Dr. Gideon Seaman, knowing I would soon be taking off for eight months in Europe, had brought along a huge syringe of gamma globulin and shot that horse dose of protective antibodies into the front of my thigh as I stood in front of him. I fell back onto a chair, passed out from the pain.

What country was he protecting me against? Italy. Why? Because, he said, it’s crawling with hepatitis. The locals would pick up the “infectious” A variety from eating their beloved mussels and clams – they were harvested from polluted waters and cooked, if at all, too briefly to kill any lurking viruses. The “serum” B kind they picked up from mothers as mere tots, preparing them to pass it on as adults through needles and sex; any guy I might pick up would likely have been infected since he was four. (If medical science had known about the C kind of hepatitis at the time – it didn’t – it would have also known that too was big in Italy.)

Today the shoe is on the other foot. Americans are much likelier than Italians to die of infections, mostly because of poor access to health care – not to speak of Italy’s conversion to farmed rather than wild shellfish. Former sins have left their mark on Italy, though, in that several key vaccines reached here decades after they became standard in the States. More cases of measles and congenital German measles are reported in Italy than in any other Western European country, with the number skyrocketing between 2016 and 2017 thanks to a know-nothing “No Vax” movement. And things may get worse: the measles vaccination rate for Italian toddlers fell steadily between 2010 and 2016.

My world-hopping clients often need to attend public travel clinics, which have a monopoly on vaccines against yellow fever and Japanese encephalitis. For decades this was a piece of cake: I wrote a prescription and an address, the patient showed up at the clinic any weekday between 9 and 12, and walked out a half hour later ten dollars poorer, with wisps of cotton taped to their arms. It was a poster child for public medicine. Now the party’s over – in 2013 my beloved vaccinators simultaneously started requiring appointments and stopped answering the phone.

Let me close with the strange case of tetanus. There are 400,000 horses in Italy and they are often healthy carriers of tetanus spores, including the ones you see roving the streets of Rome or Florence with police on their backs. Many of these healthy-looking animals gaily deposit manure laced with tetanus spores on the pavement, manure that then patiently waits for a passer-by to get injured so the spores can enter the body, wake up, and multiply. Italians now over fifty weren’t vaccinated as children, nor were most immigrants, so plenty of the people who show up in Italian Emergency Rooms with contaminated wounds should by rights receive not just a tetanus booster but also a shot of antiserum – a type of immune globulin hyper-packed with tetanus antibodies.

But as far as I know that antiserum has never once been administered, in any Rome hospital, to a single patient of mine. Emergency Room physicians go to great lengths to avoid giving it. They’ll tell patients that antiserum is no good two days after the injury (nope – it works even after three weeks). They’ll branish consent forms that claim it can transmit AIDS (possible in theory but nonexistent in practice). They’ll say tetanus was eradicated long ago (would that it were). Why those docs put up so much resistance is a mystery but it may be merely that the hospitals don’t keep the perishable antiserum in stock. An Italian team that studied tetanus prophylaxis in Naples’s public hospitals just a few years ago concluded, “Only 1.5% of the physicians correctly adhere to guidelines.” The upshot? More than a third of the cases of tetanus in the European Union occur in Italy, with 60 fatalities a year. So be forewarned: odd though it may sound for an otherwise proudly developed nation, Italy is one of those countries where you’ll want to make sure your tetanus vaccinations are up to date.
(This post is being published simultaneously as a Bedside Manners column in The American In Italia.)

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Wednesday, May 2, 2018

Scorecard: Booze


United States          Italy
Drank any alcohol during the past year          67%                 84%
Drink alcohol almost every day                      6%                   50%
Liters of pure alcohol per person per year     8.82                 7.56
Alcohol abuse
            Men                                                    10.7%              1.3%
            Women                                                4.2%                0.8%
Binge drinking in past month                          16.9%              4.2%
Yearly deaths from alcohol per 100,000         2.91                 0.37
What’s Their Secret?
By tradition Italians consider wine and beer to be foods, not drugs, knocked back to enhance a meal rather than to get soused. When I was first getting invited to dinner in Italian homes, in 1970, the children would be served acquavino, water laced with a few drops of wine. I’m convinced this non-medical homeopathy innoculated them against later dipsomania. Those old habits have by and large held up nicely, but very recently some young Italians have started to imitate the tourists in their midst by converting to the northern European cult of Saturday night drunkenness. Let’s hope it’s just a fad.
As with many American phenomena that favor the all-or-nothing (think Tesla vs. SUV), the United States is overloaded with problem drinkers on the one hand and teetotalers on the other. I sip my way through two glasses of wine every evening with supper, more alcohol than 95% of American women.
Alcoholic beverages are sold in every Rome supermarket and at every corner store, at all hours. The exception is before a soccer match if the Rome or Lazio team is playing against an adversary with notoriously hard-drinking fans, such as Manchester United, in which case City Hall has been known to institute temporary bans in the attempt to keep hordes of drunken Englishmen from taking over the streets.
(Curiously, a horde of drunken Italians is something of a contradiction in terms. Liquored up Romans get cheerful and friendly, not raucous and rowdy. Turns out the way people act when they’ve been imbibing is due at least as much to cultural expectation as to the pharmacological effect of alcohol.)
You’re supposed to be 18 to buy, but this being Italy nobody at the checkout counter is checking IDs. When American “abroad” college students catch on, they tend to go off the deep end and can land in deep trouble – since I’ve lived here a half dozen are known to have fallen to their deaths out of windows, from bridges, or off walls, and that’s not counting the cases that have been hushed up.
A small glass of wine every day throughout pregnancy doesn’t cause fetal alcohol syndrome or anthing else, by the way, contrary to the prohibitionist terror campaign in the United States. Every adult Italian you see on the street was exposed to it and survived.
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Monday, April 16, 2018

Take Some Bling And Call Me In The Morning


Italians have never been much for Calvinist-type frugality. The Catholic hierarchy’s response to Luther’s 16th century revolt was a Counter-Reformation construction boom which aimed to woo back the faithful by dazzling them with ever more lavish churches. Rome’s Gesù is a prime example, with its dazzling colored marbles, swooping angels, and mouth-watering lapis lazuli columns. Same thing for clothes. Where my generation of American girls were taught to underdress – “look in the mirror before you go out, and remove one piece of jewelry” – Italian ragazze would toss on an extra necklace.
Public hospitals in Rome are shabby and General Practitioner offices run to the bare-bone, but in one medical niche the glitz principle holds: the vast private system. A ghostly for-profit shadow hovers alongside the National Health Service, complete with its own doctors (including me), laboratories, and hospitals. A private casa di cura or clinica will have an atrium decked out in Ficus benjamina, oil paintings, and design furniture, and rooms with disposable slippers and a comfy sleep-on couch for your spouse. A Italian patient of mine, exposed to the private system for the first time, cast his eyes around and said in wonder, “My God, this hospital’s so clean.”
Once you get past the glitter, Rome cliniche usually offer a narrow range of medical services. One may concentrate on childbirth, another on cancer, a third on cardiac catheterization, none covering all the bases and most preferring elective rather than emergency procedures – think hotels with operating suites. Here and there you’ll find a small intensive care unit, but they never have a real Emergency Room. A couple claim to cover emergencies 24/7, but the one time a patient of mine tested that boast the hospital flunked: she showed up with an asthma attack, something anyone with a medical degree should be able to handle, and was sent home without being examined much less treated because they “didn’t have the right specialist.” As the locals say with ironic intent, Tanto siamo in Italia, What can you do, we’re in Italy.
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Wednesday, April 4, 2018

Rules Italian Style



After a decade of widowhood my ex-mother-in-law, Mariada, finally made a visit to the Italian telephone company offices to change her account from her late husband’s name to her own. Employee: “If you want to change the name, Mario has to endorse it. You can just sign his name here.” Mother-in-law: “I can’t sign it for him, he’s been dead for ten years.” Employee, helpfully: “Why don’t you step outside with the form and sign it in the corridor? When you come back in I’ll pretend it’s the first time I’ve seen you.”
Glossary: infrazione
A petty violation of the law. A colleague was explaining the route to drive to the University: "You drive down Via del Quirinale to Largo Santa Susanna, and then… no, you're too American, you can't." "Can't what?" "Well, then you have to make a slightly illegal left turn, a small infrazione, it's the only way to get there."
Italian rules often seem made to be broken, but they can turn inflexible when you least desire it. I helped a schizophrenic patient through infinite red tape to get an Italian disability pension, a welcome supplement to his meager wages from a manual job an hour’s drive from home. One week after he received his first pension check he was notified that now that he had been certified as disabled his driver’s license had been automatically revoked.
The casual lawlessness rubs off on you. I shocked a friend by distractedly bypassing a dozen cars waiting at a California tollbooth and sneaking back into the line. I shocked myself by swearing to the State of New York I’d lost my drivers license when I’d actually handed it in to the authorities here in return for an Italian one. I shocked my mother by suggesting over the phone she sign my name to a jury duty summons; once she’d recovered, though, she said what the hell and practiced my signature until she could forge it on the dotted line, savoring the glee of transgression after 65 years of walking the straight and narrow.
Italians’ behavior is governed by the ad hoc and the ad personem. They consider Americans’ reliability to be rigidity, our rules to be unwarranted limits on options, our planfulness a brake on spontaneity, our constant pleases and thank yous a defense, our lofty ethical precepts hypocritical cop-outs geared to avoiding immersion in the complexities of human relations. Romans prefer a “half date,” a mezzo appuntamento, to a definite one, and they don’t hesitate to cancel at the last minute if they’re feeling tired or antisocial. When I told a friend this seemed rude, he said an unwilling dinner guest wouldn’t be fun anyway.
Italians disdain rule-worshippers just as illiterate people disdain those who can’t remember anything if they don’t write it down. My friend Daniela once made a U-turn on an empty small-town street in Switzerland. A woman leaned out her second-floor window and yelled a reprimand. Daniela – who hails from Italy’s relatively law-abiding North – responded by making another U-turn, then another, then another… Italians are great at improvisation and seat-of-your-pants, farm by the phases of the moon when they’re not designing Maseratis, and always feel more secure having a low-tech backup. They wear a condom but pull out anyway. They shine during Third-World travel: when things go wrong, stick with the Italians, who get busy devising a fix while the Americans are sitting around waiting for the authorities to show up. Neapolitans call it l’arte di arrangiarsi, the art of muddling through.
There are traffic lights in Rome deemed unnecessary by popular opinion. You’ll be honked at if you stop.
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Tuesday, March 13, 2018

Mario and Nikolas


Recently I’ve been thinking a lot about a patient I’ll call Mario. He was a ministerial employee, happily married, and totally nuts. Under his façade of normality lay a vast web of paranoid delusions that linked his family, the Church, and both Cold War antagonists in a delicate equilibrium. All through the 1980s I prescribed antipsychotic medication under supervision, and he did just fine. But when the Berlin Wall fell in 1989 the web no longer held, the balance wobbled, the web fell apart, and Mario snapped. He first confessed vague violent fantasies, then disappeared from treatment, only to resurface in prison, after stabbing his cousin.
What reminded me of Mario in these last weeks was the rather similar story of Nikolas Cruz, the Parkland, Florida mass murderer. Both were deeply disturbed, both were armed, both were obsessed with fantasies of violence, and in both cases outside events – in Cruz’s case the death of his mother, in Mario’s the end of the Soviet empire – cut whatever inner restraints had prevented acting on those fantasies. What made the difference between one man wounded and 17 teenagers dead was the weapon: Cruz carried an AR-15, Mario a kitchen knife.
Nikolas walked into a Florida gun store, passed the laughable instant background checks, and walked out with his gun. In Italy you can’t buy a pistol, or carry any firearm on the street, without a license (porto d’armi) issued by the police.What you need to get that license:
1) A specifically authorized specialist physician (not me, and not your own General Practitioner) must certify your mental health. So much for Mario or Nikolas.
2) A specifically authorized physician must certify that you have no visual, hearing, or other physical problems that would interfere with proper use of a firearm.
3) You must have a clean criminal record, with no history of violent crimes or restraining orders.
4) You must not be an army deserter or a conscientious objector.
5) You must have had proper training in gun use and safety, either in the army or a certified two-month civilian course.
6) You must provide a list of all the people you live with.
7) You must demonstrate a specific reason for being at high risk of violent attacks – owning a jewelry shop or working as a security guard will do. Few people meet the test, and certainly not Mario or Nikolas.
You have to reapply for your carry license every year, and you can only own 200 bullets at a time.
If you only want a weapon firearm for sport* or hunting the process is easier – you can buy a few shotguns on the basis of just criteria one through six, with a license good for six years. But by law you have to report every acquisition of a weapon or ammunition to the police within three days. You must also store your guns in such a way that children, thieves, and household members who are mentally ill, alcoholics, or drug addicts can’t get hold of them; and transport them to and from the shooting range or game reserve unloaded and locked away. If a family member goes to the police about fights at home, the cops will come take away your guns.
Moral of the story: there are one tenth as many guns in Italy per capita as in the US. And one tenth as many gun deaths, even if you include suicides, accidents, and the Mafia.
*A reader has pointed out that air guns used for target practice can be purchased without a license.
entrance of my conference hotel in Louisville last week

Sunday, March 4, 2018

Can’t Stop Talking About Italy…


The same Expatclic website that kindly featured Stethoscope On Rome as their Blog of the Month at the beginning of February has now published a nice interview with me about my life in Italy. The questions from an Italian woman living in Indonesia were very thoughtful, so it was fun to think about them and come up with answers. If you’re interested, you can read the whole interview here.