Wednesday, October 9, 2019

Malasanità: Something Rotten in the State of Italian Health Care?

Newspaper headline: “Malasanità: Wrong Diagnosis, Woman Dies.” One day in the ‘90s a young woman stumbled into an Italian emergency room talking strangely. Seeing her age and her blue jeans, the ER docs took her for a drug addict in withdrawal. Hours later it occurred to someone to take a look at her brain, but the CAT scan machine was on the fritz. It was too much trouble to transfer her to another hospital, so they parked her in a ward bed for the night. She died before dawn, from a ruptured cerebral aneurysm.
For most of my years in Italy malasanità was a regular feature on the front page. The term encompasses malpractice, but it’s used more for something broader: what Italians think of as a chronic sickness of the health care system itself.
Italians tell pollsters they trust and appreciate nurses and physicians. Seeing poor medical outcomes they tend to put all the blame on disorganization, lack of money, and governmental indifference. Of course that argument has a lot going for it, in that public hospitals are sadly short of personnel, equipment, maintenance, and supplies. But I confess as a physician what I find more unnerving is the rôle of professional unevenness, the way Italian doctors here can range, apparently at random, from genius to ignoramus. When one of my patients tragically lost a baby at term you could call it malasanità, since she was shunted from one hospital to another before a Caesarian-section was done, too late. For me, though, the real culprit was the bigwig hospital obstetrician who – I learned later – had seen her regularly throughout the pregnancy without once weighing her, measuring the size of her uterus, or taking her blood pressure.
Lately malasanità has drifted to the back pages. Since the austerity forced by the European Union in the last decade, which cruelly punishes sick Italians for the fiscal sins of their governments, wards are down to half their former staffing, whole hospitals have been shuttered, people are skipping specialist visits and diagnostic tests because of higher co-pays, and waiting lists on the public system (several months for a non-emergency sonogram) make the infamous Veterans Administration look speedy. Medical errors seem relatively trivial when you can’t see a doctor at all.

Tuesday, September 24, 2019

Jeffrey Epstein and Me

No, the voracious child molester Jeffrey Epstein and I never crossed paths - sorry to disappoint! - and we have little in common. I wasn’t one of the hundreds of girls he recruited as masseuses and then abused. Nor have I had skin-to-skin contact with any child older than three. But I confess to sharing one thing with the late Mr. Epstein: I love massage. And the prominence of his squalid story in recent news reports has made me contemplate how often, among my hundreds of bodywork sessions, sex has reared its ugly head.
One time I was visiting Bangkok with my friend Mariateresa in the ‘90s. We told our host, an American acquaintance of my fiancé – I’ll call him Andy – that we wanted to sample the famous Thai massage. He knew just the place, and soon the three of us were marching down a darkened corridor. At its end, behind a full-length glass barrier, sat a dozen glum-looking young women with numbers hung around their necks. Mariateresa and I turned around and marched back toward the entrance. Andy ran after us and cried, “No, no, you’re misunderstanding, it’s really a normal massage parlor, I swear! The numbers are for you to pick your masseuse.” “Why should we pick our masseuse?” we asked, “And on what basis?” “Here in Thailand,” he said, “That’s the way it’s done.” We chose two particularly plain girls, who ushered us down another ill-lit hallway into a room mainly occupied by a giant bed graced with . . . boxes of tissues. We looked at each other and said something like what the hell, it can’t hurt to try. After the numbered women had finished prodding us and twisting us, yanking our arms out of their sockets, and slinging our legs around their necks, all under Andy’s restless and ever-hopeful gaze, we asked how often they gave massages to men and how often to women. They giggled. “Men only.”
Soon thereafter, back in Rome, storefronts boasting “Thai Massage” began springing up like so many toadstools. Given Italian men’s notorious predilection for exotic sex and Thailand’s notorious eagerness to provide, it’s no surprise that many of those outfits seek a clientele less interested in exploring their meridians than in getting off. Exhibit A: the above “No Sex” sign, from one serious center’s home page, where they go on to elaborate, “If you’re looking for sex don’t call, don’t write, and above all don’t show up.”
Sexual massage for Roman males wasn’t a Thai exclusive. When I was studying watsu (a kind of bodywork done in warm water) there was a “Beauty Center” near the university hospital that happened to have a warm pool just barely deep enough and large enough –for me to practice giving treatments. 
Since there was no other option within 20 miles, it was that or nothing. One of my clients was waiting her turn when she heard a young man approach the reception desk and whisper “Can someone give me a special relaxing massage?” (The answer was yes.) A year later the aptly named Extasia got closed down permanently by the vice squad; I hate to think what may have been floating around in that pool.
Another negatively memorable massage involved two self-styled Ayurvedic practitioners in Khajurhao in northern India who laid me and my husband out on bare side-by-side wooden tables, atop the oils and body secretions of all who had lain on it before. Mine couldn’t keep his equally grubby hands from roving – and Alvin told me afterward his couldn’t either. A weird exercise in simultaneity. Maybe they were trying, in their small way, to carry on the erotic tradition embodied in the famed local temple carvings.

Another time, at a medical conference in Barcelona, I was receiving a quite decent massage in a booth inside the hotel’s fitness center, marred only by a distracting soundtrack of worker-outers’ grunts and pants. At a certain point I noticed the guy’s hands had skimmed my breasts a couple of times and were starting to head elsewhere. 
The offer was plain. I said a polite “No gracias,” and his touch reverted to its previous neutral quality. Everyone was happy. Except maybe him, for missing out on a major-league tip. And for the masseuse wife of a fellow conference attendee, who was infuriated hearing the story over dinner, because of the implied slur on her profession.
Women’s day at Turkish hammams usually culminates in a brief massage by a mountainous female clad only in a loincloth. In my experience these have been hasty and humdrum, but friends have reported having the same experience in Edirne that I had in Barcelona. None will own up to having accepted the sexual offer.
I’ve had many massages in Rome, but almost none from Italian men – for a reason. In my early years of practice I met a fellow who presented himself as a potential resource for my patients. Following my policy regarding body treatments, I took an appointment for a test session. He had an elegant setup on Via Veneto, and his matter-of-fact request for full-body nudity wasn’t particularly unusual. But the significance of his ever more insistent focus on my abdomen and inner thighs was just beginning to sink in when he suddenly lifted his hands and announced he would go out to shoo away everybody in the waiting room… 
I scrambled into my clothes and fled, noticing along the way, as I hadn’t before, that the diploma on his wall featured the word “tantric.” What truly astonished me was not the attempt at seduction per se, but the chutzpah of thinking that masturbating a physician was the royal road to new referrals.
In addition to being transporting and energizing, my beloved watsu is one of the most sensual of bodyworks. Learning to practice it includes learning to pay close, constant attention to avoiding any hint of sexual charge. I pride myself on being good at that. When my mother was 82 and I was barely out of my training, I took her to Extasia for a session. After concentrating for an hour on keeping her nose out of the water, and hoping my hands hadn’t communicated the anxiety I felt at daring to give a watsu to my own mother, I ended the session in the standard way: brought her to the side of the pool, set her back against the wall and her feet on the floor, touched her third-eye and heart chakras, and gently slid my fingers off hers so we reverted to being two people instead of one. 
Then I backed off a few feet, as one does, to wait for her to come back to the normal world. I was eager to hear her first reaction. Would she be ecstatic? Merely appreciative? Maternally supportive? Maternally critical? What actually happened when she opened her eyes was that she looked straight at me and said, “Well I guess that’s probably an excellent means of lesbian seduction.”

Friday, June 14, 2019

Social Complications: The Dark Underbelly of American Medicine

Nowadays I tend to avoid reading illness narratives – by this time in my life they all start to sound alike. On April 28th, though, I was blown away by college professor Anne Boyer’s description of her experience with breast cancer, “What Cancer Takes Away,” in the April 15th issue of the New Yorker that had arrived that day in the mail. I thought it was the best of its kind, ever, and very disturbing for reasons beyond the medical story per se. Boyer kept teaching throughout her treatment, fighting debilitation and mental fog, and despite her earnings she ran through both her savings and her medical leave. “My friends carry my books into the classroom, because I can’t use my arms,” she writes. “Delirious from pain, I give a three-hour lecture on Walt Whitman’s poem ‘The Sleepers’—'wandering and confused, lost to myself, ill-assorted, contradictory’—with the drainage bags stitched to my tightly compressed chest.” 
I fired off an heartfelt letter to the editor, but due to the transatlantic snail mail time lag before I’d seen the magazine issue, my letter arrived too late to be considered for publication. So I’m posting the letter here as a consolation prize to myself: 
To the Editor,
I found Anne Boyer’s description of her experience with breast cancer (“What cancer takes away,” April 15th issue) profoundly moving. She evokes vividly, astutely, with excruciating poetry, the pain, mental haze, degradation, despair, and hope that I have seen so many patients and friends endure in the course of pitiless cancer treatments that end, according to the throw of the dice, in cure or death. Hopefully Boyer has by now left her old “patient” skin far behind and is enjoying a gleaming new one.
But after forty years practicing medicine in Italy I find the social complications she encountered so foreign as to be nearly incomprensible. Suffering is inherent in cancer and its treatment. Premature return to work, and financial strain, are on the contrary utterly unnecessary sources of further misery and humiliation. Due to their union contracts, all Italian workers have at least three months’ sick leave, and most have six or more. The jobs of university professors are held for at least 18 months of illness, the first twelve paid at full salary. And because of their National Health Service, surgery, radiotherapy, chemotherapy, doctors’ visits, hospital stays, and medications involve no out-of-pocket expense.
May the United States one day be so civilized.
Susan Levenstein, MD
Rome, Italy

addendum on June 15th: A sharp-eyed reader has pointed out that my letter failed to mention the expanding gig economy and other such developments, which have deprived many Italian workers, especially young people, of paid sick leave. But - I looked it up - about 83% of the Italian workforce still have those permanent, super-good contracts, and a good portion of the others do at least have the right to have their jobs held for them up to a month if they’re sick. Of course, with all care for serious medical conditions being totally free at the point of care the economic impact of illness is in any case much less than it is for Americans.

Tuesday, May 21, 2019

Happy Book Launch Day: Dottoressa is Out!!!

As of today Paul Dry Books have officially published my memoir, Dottoressa: An American Doctor in Rome, which you have heard so much about at Stethoscope On Rome! 
In the US you can order the paperback directly from the publisher:
or from Amazon:
where you can check it out using the Look Inside feature
…or you can get a Kindle version:
In the rest of the world, you can find it at any Amazon online store or order from Book Depository:
If you do order the book, and enjoy it, consider leaving a review at or Goodreads.

Wednesday, May 15, 2019

The Dottoressa Story, part 2: A Marathon Gestation

People ask me, “How long did it take you to write Dottoressa: An American Doctor in Rome?” I answer “half my lifetime.” 
Three years after I opened an office in Rome, Christopher Winner approached me to write a weekly health column. Yes, the same Chris Winner who created and edits The American In Italia Magazine. Back then in the ‘80s there were enough expats in Rome to support a Rome Daily American, and Chris was its editor-in-chief. I liked the idea, though I was terrified at appearing in print. My friend the writer Mike Mewshaw gave the column its title, Medical Muse – years later, he also came up with Dottoressa.
I decided on a phony Q & A format where I made up both the questions and the answers. Grinding out those 1200 words took hours of scribbling, typing, red-pencilling, and retyping draft after draft on my Selectric typewriter – this was long before word processors and computers made revising a breeze.
My main terror was of getting medical facts wrong. For my father, always ready to pounce, factual inaccuracy was up there with murder, a sin punishable whenever possible by public mockery. But how naïve I was! It turned out that whatever nonsense I might write, if it was printed black on white, would be taken by readers as holy writ. I had the disconcerting experience of having to argue with patients who were spouting misremembered lines from my own columns.
I stuck to topics I knew cold: obesity, the Italian diet, booze, checkups, allergies, migraine… But during the year it ran, before the paper folded in 1984, I was also seeing patients in my office. What I was learning from that full-immersion adventure in Italian medical life and culture was the stuff that really interested me. What they thought was healthy, how patients acted when they were sick, how doctors acted with patients, how the two interacted. As Frederika Randall said decades later in her blurb for Dottoressa, “So far as medicine is concerned, Italy really is a foreign country.” I took endless notes, ripped articles out of newspapers and magazines, and threw the lot into outsized manila envelopes. It started as a journal cum curiosity cabinet, and – encouraged by Mike Mewshaw – inched its way toward breeding a fantasy of bookdom.
November 1988, my marital interregnum. Andrea was barely gone and Alvin just a glimmer on the horizon. So I was glad to accompany my friend Caroline Leaf for a three-week retreat in a stone cottage a mile from a tiny village on Ireland’s farthest-flung coast. I pulled out the envelopes of notes and clippings and hauled them up to Baltimore, County Cork, along with my beige Apple Macintosh 128K system 1.0 computer, for transcription to floppy disc. Never have fingers so frozen plied a keyboard.
The road from Baltimore
In the early ‘90s I actually wrote something for the first time – a piece I called “Eternal City, Eternal Wait,” describing my epic pursuit of an Italian medical license. It went off in futile succession to The New YorkerHarper’sThe Atlantic Monthlythe International Herald Tribune, and the New York Times travel section. The New Yorker’s rejection note was the kindest, praising “Some funny bits.” (Twenty-five years later the article features, mostly intact and still under its original name, as Chapter 1 of Dottoressa: An American Doctor in Rome.) After a second article, of tourist narratives, met a similar fate, I more or less scotched the book idea.
Until 2000, when a patient invited me to dinner in Trastevere. At the opposite end of the giant table sat a raven-haired fellow named Lenny, obsessed with mad cow disease, who shot challenges down the room at everything I said, about psychotic bovines or otherwise. I thought he was off his rocker. Then he looked across at me and said, for no discernable reason, “You’re a writer, aren’t you?” An amazing hint that the Strong Inventory’s oracle (see Part 1) might have known something I didn’t.
A year earlier I had loved a short story about a mathematician in the New Yorker, “The Penultimate Conjecture,” so much I remembered every detail. Turned out Lenny was the Leonard Michaels who had written it. He was a prince of style, considered by some the best living short story writer. I was incredibly lucky to have run into him, and to have had the chance to savor his friendship and his mentoring for a few years before his premature death in 2003.
After my battery was recharged by Lenny, the book project made progress, though at a snail’s pace. In 2009, goaded by the ever-loyal Mr. Mewshaw, I drew up a hypothetical 15-chapter Table of Contents and shot it off, along with “Eternal City Eternal Wait,” to a publisher of Mike’s whom he thought might be interested. She wasn’t. “Right now publishing needs to be pressing and relevant and this memoir is a little off the beaten path. I really wish you luck with it.” 
Scribble scribble, clip clip clip. For many years I barely wrote an sentence, jotting down only enough words to nudge my memory. After my culture shock had worn off, Dottoressa wasn’t so much a writing project as a form of psychotherapy, much as my poetry had been in high school. Every time I encountered an infuriating medical episode – a patient whose doctor told him his gonorrhea was due to a metabolic imbalance, a heart attack victim turned away from an Emergency Room – I’d channel my fury into a scrawled note. More polite than sounding off to colleagues, or heaven forbid to patients – and an explanation of why the book gives Italian medicine so much more diss than praise. 
In August 2014 I brought the box of clippings and loose pages along on a Sardinian vacation, typed up the as yet untyped, and, after 30 years of accumulating raw material, finally got down to turning it into a book. My notes swelled into paragraphs, the paragraphs assembled into chapters, the chapters reshuffled into a first draft that was . . . 196,915 words long. Normal is more like 80,000. 
And there was another problem: my prose had lost its old punch. In 15 years of writing only scientific papers and academic books (I completed the second edition of my mother’s Messages From Home: The Parent-Child Home Program after she died), I’d shoehorned my natural slanginess into the obligatory plodding expositive style. 
It took two and a half years to cajole some perk back into my writing, cutting the manuscript down along the way, and on February 13, 2017, I declared the book FINISHED. And only 130,000 words long! Champagne! The hard part was done. The easy part, as with my mother’s book, would be handing it over to a publishing house . . . 
Not. It turned out Lesson 1 in Authoring 101 was publishers don’t deal with writers, they deal with literary agents. Academic presses, like Temple University Press which had published Messages From Home, were an exception. So I started to hunt for an agent. First I burned my way through the agents of all my writer friends. Then the agents of acquaintances. Eventually I was reduced to writing cold to agents who I found at Publishers Marketplace or were thanked in the Prefaces of random books about Italy or medicine. 
Over 12 months my “queries,” blow-your-own-horn descriptions plus a Table of Contents and a sample chapter, were rejected by 40 agents and five publishers. Most of them never replied, agentspeak for get lost. Ten asked for the whole manuscript before turning thumbs down. Several wrote back that the book was insufficiently novelistic, badly organized, or peculiarly written. Others claimed they liked it but the potential audience was too small – apparently only likely best-sellers were publishable. I could never decide which kind of rejection was worse.
I enlisted a few friends as readers, including the long-suffering Mike M., and tried to follow all their conflicting suggestions at once. I pruned ruthlessly to get the manuscript down to a more saleable 102,000 words. Those outtakes have been put to good use since I started a blog, “Stethoscope On Rome,” in September 2017. Most of my posts are based on material cut from the book, thus blending the principle of “Waste not, want not” with the hope that blog readers would be kinder than agents.” They are, which provided great consolation in those dark months.
By March 2018 I was on the verge of throwing in the sponge and falling back on the ignominious self-publishing route. Then Don Thomases, a high school friend who lives in Philadelphia, happened to attend a talk by a local independent publisher. He liked what he heard, thought of me, and tracked down an email address. The publisher asked for the complete MS and had the courtesy to reply. The chapters were engaging vignettes but didn’t tell a proper story, he wrote, the manuscript was far too long... I’d heard this song before, and skipped to the end of the email: “I would like to publish either finished version of this prospective book.” I read this sentence over a few more times, carried my computer over to Alvin so he could read it too, checked our eyes weren’t having some kind of short-circuit, and finally grasped that those 12 words had turned my life rightside up.
The rest of the story is blissfully boring. Paul Dry Books provided the best editor in the world, a graphic designer who offered me 13 potential covers, the works... My home phone would ring and there would be Dry himself, calling just for the heck of it. He did make me trim the manuscript still further, from 102,000 to 88,000 words, but the cuts just provided more fodder for Stethoscope On Rome. And now, miraculously, the book has been printed, with copies winging their way around the world to stores from Brazil to Australia!
If you want to buy Dottoressa:
In the United States: the physical book is available from my publisher or Amazon: paperbackKindle
In the United Kingdom: paperbackKindle 
In Italy: paperbackKindle

In the rest of the world: paperback

Sunday, May 5, 2019

The Dottoressa Story, part 1: Making Things

from the Thematic Apperception Test
With the publication date for Dottoressa looming, I thought I might tell Stethoscope On Rome readers how the book came into existence. When I began reconstructing the history of that project I found myself wandering back farther and farther, meditating more generally on creativity in my life, following side paths, exhuming long-forgotten relics in dusty boxes. So I’m going to have to split the genesis of Dottoressa into two blog posts. This one goes back all the way to my childhood . . . hope you’ll forgive the self-indulgence.
In theory Creativity was my parents’ highest value, and they constantly complained at the dearth of Creations from their offspring. But in practice there wasn’t much happening on their side either. Mostly a few animal shapes my mother twisted out of clothes hangers and hung as decoration. My parents were were too poor for original artwork, and too devoted to Less is More modernism to stick cheap prints on the walls, so it was wire elephants or nothing. 
We did own a hand-crafted marionette, Susie Goosey, but it was my artist aunt Cyril who had done the crafting. Family dinner table conversations were at the antipodes from Creative. Every word came straight from the dictionary – no ambiguity, no banter – and nonverbal communication was not on the menu. Once many years later my mother watched me and my ex agree wordlessly that he’d start cooking dinner, and she was mystified.
One thing I did do a lot of as a child was take tests. I parroted strings of numbers, came up with endings to half-finished sentences, heard “black” and said “white,” arranged little colored cubes to copy patterns, saw butterflies in inkblots, made up stories to match pictures (like the one above). My psychologist mother was taking courses in testing, and I was her guinea pig.
My parents hoped summer camp might make me more Creative. Camp Lakeside, which I attended when I was 12 and 13, was entirely populated by red-diaper kids sent there to learn both the breaststroke and Which Side Are You On. Camp Hurley, at 14 and 15, added an admixture of black kids with street creds. Two girls were kicked out after being caught in one of their bunks, in flagrante. My best friend, Ronnie, asked me if I was still a virgin. We were convinced saltpeter was being dusted into our food, to channel our hormones away from sex and toward – you guessed it – Creativity (lopsided bowls, drawings embossed on copper…). My Creations all sucked, but I didn't care. I was more into learning to dance the mashed potatoes and joining forays off-site to score Rocky Road ice cream.
My mother found the best test ever the year between my two summers at Hurley, the Strong Interest Inventory. Hundreds of questions, to be answered fast without thinking: Do you like watching sporting events? Stamp collecting? Hanging out with friends? Would you rather work in import-export or a research lab? Do you prefer playing it safe or taking chances? The Strong chewed up your answers and spat out your destiny. Mine was “Author.” The idea was that I had answered those apparently random questions the same way as real-life authors. I shrugged and ignored this prophecy – at that point I knew for a fact I’d be a mathematician.
OK, yeah, I did write poetry. My high school poems ranged from mocking political doggerel about “duck-and-cover”
It’s time to have a shelter drill,
So come on, everyone!
Let’s leave our books and write our wills
And then we’ll have some fun…
to in-your-face imitation Ferlinghetti
and carolbethdorispamela necked furiously backstage with joejeffharrybillpete the guywhoworksthelights and ripped her dress
and (heaven help us) erotic sonnets 
I almost wish you wouldn’t touch my hand
with yours; your fingers violate the secrets 
of my palm, deflower the softest tips
of all my fingers…
The political poems went into Swirl, the Wantagh High School writing magazine, but the sex-drenched stuff got nixed by the faculty advisor. I guess I was lucky – they could have censored out the political ones as well.
Poetry didn’t count as writing, it was just stuff that happened, that emerged unbidden when I was feeling angry, hurt, indignant, or unrequited as I often did. In my eye what real authors did was write fiction, which was and still is beyond me.
In college I never wrote anything besides term papers, my spare time consumed by sex drugs and rock ‘n’ roll. Even afterward, as one friend unkindly pointed out, I didn't make things. In the ‘70s everybody else, including her, was creating something: sweaters, pillows, paintings, macrame wall hangings, earrings, belts, mugs, songs... The closest I came was Mozart piano sonatas, but those were mere ephemeral sounds, and they were based on slavish obedience to black spots on paper. 
I did make one stab at making things, on a trip in 1972 to Turkey, where I boldly purchased a sketchbook and some pencils. I’d never been able to draw anything. But in Istanbul I happily sat for hours across from mosques and pavillions, copying the façades with my thumb as a measuring stick. I always left out trees, people, and any other hard parts. My efforts were more successful at attracting curious children than at producing recognizeable much less artistic images. 
In 1973 when Kevin Moore, the love of my life, was killed by a truck riding his bike across the Brooklyn Bridge, I found myself writing poetry again. Every day a new metaphor for anguish would come to me and pour out onto the page. For many years thereafter my losses inevitably, and my joys occasionally, would transmute into free verse. 
But never, until well after I moved to Italy years later, did it occur to me that anything I wrote might be of interest to anyone except myself.
…stay tuned for part 2 of the Dottoressa Story next week.
…and if you’d like to preorder the book:
In the United States:paperbackKindle
In Italy: paperbackKindle
In the United Kingdom: paperback,Kindle
In the rest of the world, paperback

Tuesday, April 23, 2019

The Pill And I: Tales From Both Ends of the Speculum

drawing by Suzanne Dunaway
Not long after the first-ever birth control pill came on the market, I lost my virginity. Grateful it hadn’t been the other way around, I headed off to the Harvard Student Health Service to score a prescription. Its chief, Dr. Curtis Prout, was willing to oblige, bucking Massachusetts law. That was in November 1964. To my dismay, when I came back in six months for a refill I was turned down. Only decades later did I learn that Dr. Prout was not deliberately humiliating me, but bowing to a change in school policy after some parentsprotested. Fortunately the good doctor was among the few who eventually resumed quietly writing those prescriptions (“Once you’ve started I guess you’re not going to stop,” he’d told me on our first encounter).
Back then the Pill, the only Pill, was named Enovid. It packed a hypercharge of estrogen, ten times stronger than is used nowadays. That hormonal overdrive made me mock-pregnant all through college: nauseated, jumpy, and – especially – perpetually hungry. I remember driving to the supermarket, buying a cake, and wolfing the whole thing down in my car before I reached home. I went from 116 pounds (53 kg) to 150 (68 kg), and from a barely B cup bra to a zaftig D. 
In 1964 the Pill had been already around for half a decade, but who knew? During my time in high school it wasn’t easy to obtain even if you were legit married grownups, and I doubt any of the girls in those Buick back seats had even heard the news. For us sex and pregnancy still went together like a horse and carriage. Girls who “went all the way” were likely to “get in trouble,” and every year a few were shipped “upstate,” to sit out their pregnancies in homes for wayward females where they’d whisk the baby away for adoption straight from the delivery room. 
As the first near-failsafe means of contraception, Enovid changed everything. Virginity was doomed, since there was no longer any serious reason for girls to hold out – gonorrhea could be cured with a shot in the butt, and herpes and HIV hadn’t yet hit. American weddings had never demanded the hanging of bloody sheets out the window, so with the threat of pregnancy no longer a deterrent the intactness of your hymen could remainea secret between you and your groom. 
My own Pill-popping ended in 1969 at the urging of my boss, psychiatrist Gideon Seaman, whose wife Barbara had just written a best-seller called The Doctor’s Case Against the Pill, warning about blood clots and strokes. But my relationship with the Pill remains intimate, in the form of the thousands of prescriptions I’ve written since graduating from medical school (by which time the dosage of the hormones had shrunk to safer levels).
In Italy, those scripts count as something of a one-woman crusade. The Vatican managed to keep the Pill out of the country for many years, and even now many Italian women are convinced it’s both unnatural and dangerous. In 2010, 17.4% of American women ages 15-49 were taking the Pill, but only 2.8% of Italians of the same age. Medically speaking the Pill is so innocuous that in several American states you can buy it without a prescription, but in Italy you’d think it were as risky as setting off to climb Mount Everest. Gynecologists play a major role in discouraging its use by refusing to write a prescription without first demanding a frighteningly long list of blood tests, supposedly to check whether you’re healthy enough to resist its presumed dangers. 
Even more barriers lurk. Sometimes a Catholic pharmacist claiming to be a Conscientious Objector will refuse point-blank to fill a prescription. This is, of course, illegal. Others like to play doctor; one patient who brought my prescription to renew her birth control pill was told, "The Pill you were taking is too strong – I'll give you a better one." And 3-weeks-out-of-4 oral contraceptives, the commonest kind, are sold without the week of sugar pills that are included in American packets. I’ve always suspected this invitation to messing up your timing of being a morsel of ecclesiastic sabotage.
But the proof of the pudding is in the eating. Italians’ approach to contraception, like their approach to so much else, may be muddled but it works: they have among the lowest birth rates in the world. How do they do it? Condoms, rhythm, and – mainly – pulling out. Yup. Time-honored, tech-free coitus interruptus may be a drag, but it turns out to be a lot more effective than most of us think – including my medical school teachers. 
P.S. Bonus factoid for you from Stethoscope On Rome: A wild plant named silphium was apparently such an effective oral contraceptive that it was over-harvested to extinction by the 4thcentury ce.
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Friday, April 19, 2019

The article about me in Sette, now online

Couldn't find last week’s Sette magazine at your local newsstand? You can see a trimmed-down version of the interview with me at 

Google Translate can actually give you an amazingly good idea of the content, with few real bloopers (for fourth grade read fourth year of specialization, for miss so tutto io miss know-it-all, for evaluate her you judge…). Try going to
and pasting in the article’s url.

Tuesday, April 9, 2019

Read About Me in an Italian Magazine This Week!

Day after tomorrow, on Thursday April 11th, Corriere della Sera's glossy weekly magazine, 7 - Sette, will publish an interview with me (in Italian, of course) by Vittorio Zincone as part of his Doppio Binario series. Complete with pictures! If you live in Italy, go out and buy it!!! The issue will stay at your local edicola for a week.

(as a distant second best, you ought to eventually be able to read the article online by looking at at

Wednesday, April 3, 2019

Yet another review of my book…

 Here's the finale of a new pre-publication review of Dottoressa: An American Doctor in Rome: "A funny and endearing but also deadly serious memoir of the Italian health care system by an astute and caring outsider." This one comes from Booklist - one of those publications, like Publishers Weekly and Kirkus, that exist mainly for booksellers and libraries to pick their titles.
you can read the whole thing online
Only a month and a half until the official publication date!

Friday, March 29, 2019

What Can Italy Teach the Rest of the World About Health?

A version of the Epilogue of my upcoming book, Dottoressa: An American Doctor in Rome, has been published by The Local, an excellent online magazine that describes itself as "the largest English-language news network in Europe."  
Non-subscribers are supposed to be able to access my article free, hassle-free – if anyone has any trouble doing so, please let me know right away and I will post the entire text here at Stethoscope!!!
In its book review, Publishers Weekly happened to single out the Epilogue – which in the book is titled "A Moral, Or Three" – for praise: "A timely epilogue discusses the Affordable Care Act from her unique position as an American expat and an Italian physician, with Levenstein reflecting on how Italians, despite widespread dissatisfaction with their own health system, manage to live more healthily than Americans.”—Publishers Weekly

Wednesday, March 27, 2019

Warmth, depth and intellectual curiosity

Another nice pre-publication review for Dottoressa: An American Doctor in Rome, this time from Madeleine Johnson, a writer and neuroscientist who knows Italy super-well, having spent three decades here. Here's some of what she says in The American In Italia

"Levenstein’s anecdotal memoir — set for release in May — steers clear of the colonialist trope in which life among “friendly Italian natives” brings emotional and sensual liberation to the hidebound foreigner. Levenstein pulls back from that stereotypical brink by infusing her odyssey with warmth, depth and intellectual curiosity . . . as non-judgmental as it is intellectually acute. She also extracts deeper lessons and delivers insights into how societies and individuals heal and live. These come with laugh-aloud examples that deftly trace 50 years of changes . . .
"These days, hundreds of policy papers and newspaper editorials regularly debate competing claims of medical efficiency, patient care, cost-containment, and expanding reach. But none do so with Levenstein’s humor and sensitivity to the human condition. And they certainly don’t make it fun — never mind being able to set the story in the Eternal City." 

Saturday, March 23, 2019


drawing by Suzanne Dunaway
Italy’s fashion and restaurants belong in the First World, its bureaucracy in what was once called the Second World, its garbage collection—at least in Rome—squarely in the Third. In healthcare the dominant model is mixed: free but slightly shabby health care for all, and a private sector providing a luxury dusting of sugar on top.
A private doc is expected to hear you out, sift through your records, lay on hands, assign a diagnostic label, and prescribe a pageful of remedies. In short, enhance not just your health but your self-worth. At your National Health Service GP’s office you may stand in the hall two hours marking time; in a private waiting room you’ll be leafing through art books in a Le Corbusier chair.
I’ve had feet in both tracks of the system: the underfunded public side for doing research, and the flush private world for seeing patients. I caught on fast that being a leftist wouldn’t save me from the siren call of private medicine’s petty corruptions. When business is slow, economic self-interest can nudge you to bring the patient back in two weeks rather than four and to do an ECG that in a busier moment you might have skipped. When the schedule is packed you can be tempted to start cutting corners in your thoroughness, vigilance, and attention to detail. And however much you despise yourself for it, you treat Very Important Patients with kid gloves.
Private medicine has always been bigger in southern Italy than in the North, where the public system works. Back in the 1980s, the golden days of free spending, people would check into Rome’s private hospitals or cliniche for week-long tune-ups. Those posh wards were packed with healthy, wealthy Romans enjoying prods, needle sticks, and x-rays. Italian private medicine began to suffer in the 1990s, when the Clean Hands political corruption investigation shriveled the supply of illicit cash. Since then, the cliniche have struggled to fill their beds. Even if there weren’t a perennial economic crisis, there’s Europe and a steadily improving Italian National Health Service: why should you pay to stay in a private hospital when you can have world-class surgery at a public one, here or elsewhere in the European Union, for free?
Some private hospitals have fought back by making deals with the National Health Service, so public funds will cover the room and the operating suite while the patient pays the surgeon and the anesthesiologist.
Others keep afloat by stiffing their medical staff. Squeezed by an economic climate that leaves half their beds empty but eager to improve their competitive edge, some of Rome’s cliniche have plunged ahead with expensive renovation schemes despite a shortfall in ready cash, making up the difference by pocketing the money sent by insurance companies to cover doctors’ fees. At this moment I’ve been waiting a year and a half to get €550 for one patient’s brief hospitalization; a surgeon friend claims he’s owed €150,000.
But then nearly everybody scrambles to cobble together a living here, though watching the elegant figures parade down Rome streets you’d never know it. While I was building up my practice, funding my office rent by doing medical translations, I used to wait eight or ten months to be paid; my tax refund for 1987 came through in 1992. My musician husband may get his concert fee the same night, a year later, or never. Even a permanent full-time civil service job can’t be counted on for a steady income if, as I write, one of the public hospital docs in my office hasn’t been paid for six months. Thank heavens for the long-suffering Italian family, a surefire backup system guaranteed to ward off starvation.
(a version of this post has been published in my Bedside Manners column, at The American: In Italia)
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Tuesday, March 19, 2019

A Charming Story Well Told

...that's what Kirkus Reviews calls my book Dottoressa: An American Doctor in Rome, which is rolling off the presses as we speak.😃
Here are some of the specifics that caught the reviewer’s attention:
“. . . One of the first words to learn, she writes, was “pazienza,” or “patience squared,” which is “often invoked as a gentle reprimand for a foreigner’s loss of cool” and “extends beyond the prosaic ‘keep waiting’ to the philosophical.” . . . After finally gaining the official title of Dottoressa, waiting for the sole calligrapher to produce her diploma took nearly two decades. . . . The most interesting part of the book is the author’s descriptions of her alternating admiration and horror at Italian medical practices . . . Doctors almost never touch their patients, but they always listen to every word. Though they write prescriptions, the pharmacist can and will substitute another drug . . . Levenstein also demonstrates how well universal health coverage works. Italians live some of the longest, healthiest lives of anyone on the planet, mostly due to diet, accessible care, and even distribution of wealth. The author gives many illuminating examples of patient encounters . . .”

Saturday, March 16, 2019

Elevator Philosophy (Esprit de l'Ascenseur?)

“Media terrorism”: Winter red alert! It might get cold! –Nicola Bucci
My husband and I took a stroll the other day to the Palazzo Merulana, a new museum housing the Cerasi family’s collection of  Fascist-period Italian art. We entered the elevator along with a well-dressed Italian who pressed “2.” We then pressed “4,” on the chance the museum might have installed a modern elevator, the kind that can keep several destinations in its brain at once. The commoner old-fashioned Italian kind, such as the rickety cage that carries us up the five floors to our own apartment, has to be spoon-fed one stop at a time.
Neither: the elevator flew past the second story, and headed straight for the fourth. An unprecedented variation on the theme of Italian collective transport. All three of us commented with amusement, but our elevatormate took it one step further with a touch of philosophical fantasy, turning the elevator buttons into a microcosm of Italian life: “That’s what life is always like in Italy. He who speaks last wins the argument.”
After viewing a hundred paintings and sculptures, many interesting and some beautiful, I was obliged to hunt down their well-hidden bathroom. On the way in I rubbed shoulders with an Italian lady of a certain age who forewarned: “It’s not very clean” (an understatement). She added, to forestall any suspicions, “I didn’t touch anything.” But, this being Italy, she too felt that wasn’t enough, and added, “We Italians still haven’t reached a level worthy of being called civilization.”
My adoptive countryfolk always rise to one more level of generalization and one more degree of flair. And they never miss a chance to acknowledge – and mock with resigned affection – their own national foibles. Nicola Bucci, a political cartoonist, is a particular genius at putting the brilliant Italian mix of invention and provincialism into captioned images. Now my fellow art-lovers had offered up two strikes in one hour…
Strike three was awaiting me at home, in the form of a friend’s Facebook post about the latest Roman scandal. In 2011 a landowner had paid off a €55,000,000 debt to City Hall by handing over, it was reported at the time, 200 kilometers of precious nickel wire packed into a bundle. This treasure has been sitting in a vault in City Hall ever since, under the watchful 24/7 gaze of armed guards hired for the task. Until a few months ago when city officials, tipped off about a fraud by the same characters in northern Italy, opened the vault and determined that whatever it is that’s rolled up in that stash it’s worth nowhere near what was claimed – maybe €20,000 at the most. Less, I’d guess, than what they’ve been paying every month to those rent-a-cops.
The heights of fantasy in the depths of financial scams. I love Italy.
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