Friday, November 29, 2019

The Accidental Scientist

drawing by Suzanne Dunaway
For all of 1980, when my Roman medical practice was just getting under way, the lire barely trickled in and my ex and I were living hand to mouth. It was a godsend when I landed a half-year paid internship on Professor Cosimo Prantera’s gastroenterology ward – $190 a month may have been slim pickings, but it helped keep our plates full of pasta. 
Professor Prantera’s specialty was Crohn’s disease, a serious and potentially fatal inflammatory condition of the intestine, and part of his standard treatment was a strict no-residue diet. Fruit-and-veg loving Italians were forced to buy centrifugal juicers so they could consume their peaches and their spinach in liquid form. 
This amazed me. My medical school alma mater Mount Sinai, in New York, happened to have been where Dr. Burrill B. Crohn had first described the disease in 1932, and it was still the world’s foremost treatment center. At Mt. Sinai, Crohn’s patients were allowed to eat anything they wanted. 
When I pointed this out Prantera replied, “In my opinion, fiber puts strain on the sick bowel. Prove me wrong.” I searched the medical journals (not an easy task, back in those pre-Google days), and found to my surprise that nobody had ever studied the issue. So a month later there I was, randomizing patients to normal versus low-residue diets to test it scientifically. I had been launched on a research career by sheer pigheadedness. 
With Cosimo backing me up, it was easy. Between medical staffers with time on their hands and young volunteer doctors eager for brownie points, I succeeded in assembling a terrific research team with zero funding, spent three years slaving over it gratis, and managed to get our results – which proved the Mount Sinai docs basically right – published in a prestigious journal with a wonderful title: Gut.
My interest in research then evaporated until six years later, when my first marriage broke up and I needed to find ways to fill up my time and my brain if I was to keep my sanity. Dr. Prantera was happy to support me, saying that this time I could choose any topic I wanted as long as the gastroenterology ward patients would be appropriate guinea pigs. As an ex-wannabe-psychiatrist I decided to go for the psychosomatic angle, figuring it would be a cinch. After all, we had plenty of ulcer patients on the ward, and “everybody knew” ulcers were due to stress. 
Who could have guessed that the Helicobacter pylori bomb was about to explode? By a year after I started my first ulcer study, “everybody knew” ulcers were due to Helicobacter infection, and the whole stress concept had been tossed in the trash because doctors couldn’t keep two causative factors in their minds at once. It seemed to me at the time that this was probably simpleminded, and by now I think I've proved it so.
Doing research kept my mind alive and my toe in public medicine, so I had no problem working pro bono. The research assistants contributed free legwork to further their game plan of worming their way into a real job. A statistician I’d met at a party volunteered his time out of friendship, the staff docs helped because they were told to, and the ward psychologist, whose usual gig was as a counselor, was more than glad to come on board. Everyone’s generosity was fortified by the promise of publications to fatten their CV’s. In the States I'd have never wriggled my way into medical research that way; there if your grant funding falls through you pack up your marbles and go home. If a study does get accomplished on the cheap, its results may even be considered a bit suspect. 
For all but three of my 18 research years at the Nuovo Regina Margherita no money changed hands, and when we did have a brief flurry of funding it came not from Italy but from the US. I found out that the American National Institutes of Health would finance foreign research, filed an application, got turned down, applied again, and kept reapplying until I managed to win a grant. It started small and was reduced to peanuts by the Italian 20% inflation rate, but for us it was manna from heaven. 
After my NIH grant had been approved and needed only a rubber stamp from the local health council, the whole project nearly got squelched: the councilors couldn’t believe we had gotten the grant without paying somebody off, and were petrified that if they gave the project their imprimatur they’d wind up in handcuffs. In a period where a Supreme Court justice was notoriously in the pay of the Mafia, they could hardly be blamed for seeing corruption behind every tree. 
In the end Professor’s Prantera’s powers of persuasion succeeded in saving the day, but I’ll never know exactly how. During the health council meeting where he made his winning pitch, he avoided any undesirable American outbursts by prudently shutting me out of the room.

Friday, November 1, 2019

"Highly recommended": A Tidbit From Dottoressa

The shirt says "Totti is my uncle." Drawing by Suzanne Dunaway.

An excerpt from the "Wet Paint On My Shingle" chapter of Dottoressa: An American Doctor In Rome:

Back in my greenhorn days in Italy, when I was practically fresh off the boat, a hospital colleague asked me how they selected among applicants for medical school in the States. “College grades, mostly,” I answered, “But also scores on a Medical College Admission Test, a personal interview, recommendations . . .” He chortled and said, “Allora tutto il mondo รจ paeseSo the world is just a small village—even in the great America you have to know somebody.” I was mystified, not realizing that when I had translated recommendations as raccomandazioni I had produced the Italian word for having someone powerful pull strings in your favor. Case in point: a breast cancer patient called Milan’s famous Tumor Institute and was given an appointment a month later. Then she discovered she knew someone who knew someone who knew its Chief, Professor Veronesi, and was squeezed in the next day. 
Glossary: raccomandazione
A nudge from friends in high places that helps you land a job, a telephone line, a boot camp close to mamma. Traditionally offered by a politician in return for votes or support. La Repubblica editorial: “Italy is based on the raccomandazione, you need one even to get what’s yours by right.” A raccomandazione has no pretense of being based on merit, and is never put into writing.
According to author Roberto Saviano the protagonists of one major scandal in Naples sincerely had no idea they were doing anything wrong because no money had changed hands, only favors such as giving someone’s brother-in-law a job. The idea that the innocuous and ubiquitous raccomandazione is a form of corruption was greeted by many, says Saviano, “with genuine stupor and indignation.”
As an examining physician for the Social Security Administration, I once experienced the frisson of being the object of a genuine raccomandazione: an under-minister phoned to let me know how displeased the Minister would be if a certain Signora was not given a pension. It was slightly disappointing to find on examination that the Signora in question was morbidly obese and diabetic, thus actually meeting the criteria for disability. Pension applicants devoid of connections sometimes offered small gifts, which I would gently push back across the desk. Once I made an exception, when an elderly woman brought six eggs her chickens had laid two hours earlier. The crime of her bribe paled before the crime of leaving those fresh eggs uneaten. I reprimanded the patient but accepted the loot and handed it around to my staff, who proceeded to stick pinholes in both ends and suck ’em raw. 
I used pull once myself, to fix a traffic ticket. I had entered a freeway by mistake, asked the guys at both toll booths what to do, made a U-turn and drove off as they instructed, and a month later got socked with a fine for half a million lire (more than $500). I called a politician friend, he must have called somebody, and . . . the fine dropped into a black hole. What a perverse pleasure sprouted in my bosom from this tiny dabble in Italian-style transgression! Italians sometimes try these tricks in other countries, irritating the hell out of people.
Being somebody is even more important than knowing somebody. One friend happens to share a name with a star soccer player, and when cops see his license they tear up the speeding ticket. When a patient of mine got admitted to the San Giovanni Hospital for coughing up blood, I had a gastroenterologist friend who works there stop by to chat up the docs, so they’d know she wasn’t just a random carcass. 
A musicologist pal in the States once wrote asking me to go to the Museo Braschi, near Piazza Navona, and buy a postcard of a particular painting that featured a small orchestra. I walked over, saw they didn’t sell postcards . . . and when I tell the story to an Italian that’s as far as I get. “You should have gotten in touch with me,” one interrupted, “My sister-in-law works in the Art Ministry!” Another: “I have a friend who knows the director of the Villa Giulia Museum, she could have made a phone call!” What actually ensued was that I asked a guard, he opened the door to the administrative wing, and I knocked at the office of the museum Director. When she heard my request she complained about the trashy exhibit that was hiding my painting behind a panel, searched unsuccessfully through her personal lecture slides for one that would do, and finally arranged for a museum photographer to come in the next week and take the picture that is now reproduced in my friend’s book. Despite what Italians think, you don’t always need a raccomandazione
This excerpt appeared as "Pulling the Strings" in my July Bedside Manners column for The American In Italia.