Wednesday, January 17, 2018

Hamming It Up

I once had a heart disease patient named Edoardo, the father of a friend, who had angina pectoris so severe he couldn’t cross the room without pain. Back then, in 1989, angioplasty and stenting hadn’t yet been invented, but surgeons did know how to unplug coronary arteries using open heart surgery and he definitely needed it. There was only one problem: in Italy at the time bypass surgery meant at least a one in four chance of dying on the table.

Those were not odds I felt I could recommend. I turned for help to my trusted cardiologist, the late Alberto De Feo, who came up with a solution in the form of brand-new European Union regulations. My patient followed Dr. De Feo’s instructions to the letter. He drove to Monte Carlo on the French Riviera, stayed three days in a hotel hanging around the roulette tables, then went to the Emergency Room of a specific hospital clutching his chest and claiming the pain had just started. He could – and did – get bypass surgery in France and charge the bill to the Italian National Health Service, but only if it was a real emergency. 

Even now, after thirty years of European Union rules easing the obstacles to medical country-hopping, such picturesque Emergency Room theatrics are still not entirely obsolete…
P.S. It was lucky this particular heart patient was Italian; I think most Americans wouldn’t have managed to carry off the trick (and might have been more squeamish about its ethics). Pay attention on any Rome bus and you’ll find at least one native casually improvising melodrama. The ancient theatricality of Italian culture gets an extra boost from a school system based on gaming oral examinations in front of an audience…


  1. Why was it so much safer just over the border in Monte Carlo? All that money that lives there?

  2. Certainly the money doesn't hurt, but I don't think it's the only factor; heart surgery and its aftercare require an extreme degree of precision that has taken many years to overcome the local tendency to pressapochismo. By the way, thanks to your question I went online and learned that the Monaco Cardio-Thoracic Center, which I'm pretty sure was the hospital in question, now accepts direct payment from the Italian National Health Service on equal terms with the French system, so at that particular location there's no longer need for playacting (though there still is elsewhere).

  3. una storia incredibile. Mica la conoscevo! ;-)

  4. Thanks, Susan. This is really valuable information. If need be, I now know where to go for vascular surgery.

  5. A great vignette, Susan. It captures something about Italian pragmatism & your empathy,too.