Thursday, August 17, 2017

Learning Experiences

My early professional life was short on patients but long on learning experiences.
Over dinner I asked an anesthesiologist friend of the family what anesthetic was preferred in Italy for childbirth. “Il grido,” he replied, “The scream.” As though it were an explanation he continued, “Remember that the book of Genesis says women shall bring forth children in pain.” Even today, most public obstetrical wards don’t offer either epidurals or painkillers.
I learned from patients’ horror stories that Italian surgeons didn’t use local anesthesia when they sewed up lacerations, or prescribe strong analgesics after surgery; cancer patients got morphine only when death was days away. Patient activist movements have improved things a bit by now, and since the turn of the millennium I can even prescribe the equivalent of Percocet. But those ER docs are still doing their stitching without lidocaine.
I learned from personal experience that a physician who goes to a drug store to buy morphine in Italy, to keep in the office for emergencies, is seen as a drug addict. The first time I filled in a triplicate prescription for 4 vials and handed it to a pharmacist along with my medical license he looked at me crosswise and said they were out of it. So was a second, a third, and a fourth. Being treated like a criminal makes you feel like one, and for years whenever it came time to replace my expired vials I would put on my best clothes, as I would to go shopping on Via Borgognona, and even so my heart would pound. I can only imagine how hard it must be for cancer patients who need to buy morphine for their own use.
Shortly after I moved to Rome Giovanni Agnelli, C.E.O. of Fiat, nicknamed “Rake of the Riviera,” fell and broke his hip. His personal physician, according to the front-page story in La Repubblica, was treating him at home with the leg under traction. I was floored – from what I knew bed rest with traction had been ditched years earlier in favor of immediate surgery, which had patients up and around in days with fewer complications. What I found astonishing was not that an Italian doctor might be behind the times, by now no news to me, but that the richest man in Italy would be under the care of an ignoramus. Lesson: loyalty trumps competence. P.S. A week later buried on page 17 was a one-line report that Agnelli had been flown to New York for surgery.