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.