"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 è paese! So 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. 

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This excerpt appeared as "Pulling the Strings" in my July Bedside Manners column for The American In Italia. 

Destiny, Italia?

For Goethe Italy was the idyllic land of golden oranges. For Bertrand Russell its beauty could lift any depression. Franz Liszt and Henry James couldn’t stay away, Axel Munthe came and never left, Queen Christina abdicated the Swedish throne to live out her life in Rome. When D.H. Lawrence was writing Lady Chatterley’s Lover he had not English gamekeepers but Tuscan peasants in front of his eyes. My husband Alvin Curran started to dream of Italy watching Neorealist movies in high school. And if you’re travelling around the peninsula these days you may trip over George Clooney, Brad Pitt, Sting, Willem Dafoe, Johnny Depp, Francis Ford Coppola, or Madonna near their Italian homes.

Not me. Nothing about my childhood in the projects could have made a gypsy see the Bel Paese in her crystal ball. Its only presence in my young universe was in the form of “Italian ice,” a kind of lemony mush sold from a pushcart in soft pleated paper cups that we would squeeze into our mouths like toothpaste from tubes. The closest my mother came to Italian cooking was SpaghettiOs.

As a kid I didn’t know any Italians as such, though they probably lurked among the tribe of Catholics who showed up one day in second grade, after their First Communion, wearing petticoats under party dresses and flaunting stacks of playing cards that bore Madonnas and sparkling hearts in place of pips. 

The Catholic I remember best was a fellow-tomboy who had red hair and must have been Irish. She not only believed in God but had met him when she went to Heaven to visit her little brother who had died: it was a big room lined on both sides by beds. I wonder, is that what planted the idea in my head that American doctors think they're All Mighty?

After we moved out to the suburbs I went to high school with plenty of Italian-Americans, whose home turf mostly lay on the far side of the Long Island Railroad tracks. I was scared of some of the guys, the kind we called hoods, and baffled by some of the girls. They dressed like tramps, but when we changed for gym in the locker room modestly shielded their bras with towels. 

If Italy had ever had a chance to be my teenage fantasyland, it received its final blow one Friday when Madame Gustin, my beloved French teacher, lent me a small-size LP of songs by Georges Brassens. The track I was supposed to listen to was a setting of François Villon’s famous poem about the snows of yesteryear (listen). But in a weekend of playing the record over and over I managed to figure out that the other songs described earthier subjects such as young couples making out on park benches (listen) and a girl nursing a kitten at her breast (listen). Overnight I was a budding Francophile, dreaming of idle afternoons swigging coups de rouge to a soundtrack of risqué songs.

Italy remained beneath my radar all through college and beyond. Nothing about it attracted me, from the spaghetti-and-meatballs cuisine that at the time passed for Italian to the painting galleries of the Metropolitan Museum in New York, where I could appreciate neither the Tuscan Primitives (too stiff) nor the Roman School (way over the top). 

But then one day it was February 1970 and I was happily living out my French dreams in the sidewalk cafés of Aix-En-Provence, when news arrived that my friend Ursula Oppens was going to play a big piano concert at Milan. Reluctantly, out of loyalty, I made a hop across the Italian border to hear her play, meaning to visit the Brera then scoot back to my stoner pals in Aix. 

Instead I was an instant convert. I. In France I had to keep on my toes – a cultural ignoramus by definition, chastised for every grammatical error, attacked for the war in Vietnam as though I hadn’t always been on the other side of the barricades. Across the Alps in Italy, within two days I had discovered another and gentler universe, where people never uttered a word of reproof. They relished every word you tried out in their language. They listened. They accepted you for who you were, even if it was obvious how much better off they thought you’d be if you caught onto their food, their wine, their ways of dressing and singing and putting on makeup. France was history, Italy my new stomping ground as long as I was in Europe. Though it would take eight years before I managed to move there permanently, I was hooked.

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.