Bargain Hunting

drawing by Suzanne Dunaway

My patient Gayle lived hand to mouth with an Italian mechanic boyfriend, her sole income selling homemade preserves at the weekly village market. She decided to consult me after giving up on her National Health Service General Practitioner: she’d been experiencing gnawing abdominal pain for months, then started having bloody diarrhea. It was obvious that she needed colonoscopy to figure out what was going on, and fast, but how was she to get one? Her local public hospital had an eight-month waiting list, and she couldn’t afford €900 to have it done in the private clinica I usually recommend.

Gayle asked around and found a cut-rate private operator who quoted her €250. I turned thumbs down at her doing such an invasive procedure with someone I didn’t know – I’ve seen too many colonoscopies gone wrong. Sometimes the doctor got only halfway up the colon and turned back. Other times he or she saw polyps but left them in place instead of removing them, or omitted biopsies that need doing. In the worst case, a hole was poked right through the bowel wall.

Next I asked my trusted gastroenterologist colleague whether he could get her hospitalized on the public ward where he worked. He rolled his eyes and told me his hospital was so short of beds that an ulcerative colitis patient of his was parked at that very moment in the Emergency Room hallway with a high fever, passing bloody diarrheal stools every hour, waiting for a hospital bed to open up and in the meantime getting no treatment at all. No chance that my patient, who was sick but not at death’s door, could get admitted.

For decades, there’s been a tug-of-war on between full-time National Health Service hospital doctors who want to supplement their salaries with private practice, and governments that aim to keep public medicine strictly public. An uneasy compromise lets hospital docs see paying patients, but – theoretically – only inside the hospital. This has been dubbed intramoenia, Latin for within the walls. If you get a colonoscopy on the public system you’ll pay next to nothing, but unless you arrange it a year ahead of time you’ll feel every painful twist of the tube. If you do your colonoscopy privately in the same hospital, with the same gastroenterologist, in intramoenia, an anesthesiologist will be glad to knock you out for the duration.

In their battle to hold on to outside offices, the physicians have found strange bedfellows in the left-wing hospital workers’ trade union, which opposes on principle the mixing of public and private medicine on hospital grounds. Both groups have been appeased by a sleight-of-hand redefinition of “hospital grounds” that can stretch to include offices anywhere in town…

Back to Gayle. My trusted colleague eventually came up with a splendid solution: he referred her to his own trusted colleague who did the exam on intramoenia three weeks later for €450, about what Gayle and her boyfriend could scrape together. The diagnosis? Crohn’s disease, which now that it had been diagnosed could be treated perfectly well in the public system where she doesn’t have to pay a penny. Much of my professional life is spent helping patients run this kind of daily slalom between public and private medicine. Quite a job in its own right.

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A Medical Error

drawing by Suzanne Dunaway

He’s a dermatology Chief Of Staff, she’s a prominent psychoanalyst, both have offices in their mammoth apartment in a classy Rome neighborhood. One afternoon she greeted a new patient, had him lie down on the analytic couch, and got him talking. For 20 minutes she listened from behind his head, emitting an occasional “um-hmm,” then made a first stab at an interpretation: “You seem very focused on your psoriasis. I wonder what all this concern might come from.” He replied, “Of course I’m focused on my psoriasis, that’s why I took an appointment with the dermatologist.” This is a true story.

Welcome back to Stethoscope On Rome!  As an adoptive Italian I wouldn't dream of posting in August...

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Warm Water Wizardry

Date: December 24, 1994. Place: Indian Springs Spa, Calistoga, California, two hours north of San Francisco. My second-husband-to-be Alvin Curran and I emerged from our mud packs so blissed out we couldn’t imagine trudging back down to where we were staying in the city, so we asked for a room for the night. “All booked up,” replied the receptionist from under her teased beehive, “And since it’s Christmas Eve so will be everywhere else in town that has a hot pool.” We kept pestering her until she admitted, “Well there is this one place, a good 45 minutes from here, they might have room. But it’s kind of, umm, funky.”

I dialed the number. Yes, they did have hot spring water and yes, they did have a free room. “We have a problem, though,” I said. “We only meant to go to Calistoga for mudpacks, so we didn’t bring any bathing suits along.” “Oh, that’s ok,” said the voice, “We can arrange something.”

The drive took a solid hour through driving rain, over roads that shrank to lanes then to trails, and by the time we handed over our parking fee at the gate of Harbin Hot Springs night had fallen. As we inched forward through the mud, pale figures began to emerge from the darkness, swinging flashlights, and sporting boots but not another stitch of clothing. Both “funky” and “we can arrange something” suddenly made sense: this joint was nudist!

The next morning as we stood soaking to our chins along the edge of the warm pool, exchanging smiles with fellow-hedonists, a burly fellow climbed in as naked as the rest of us, scanned the faces, chose mine, and extended his hand saying, “You look like you could use a watsu.” “A what?” “Close your eyes and I’ll show you…” The WATer shiatSU treatment he gave me, swishes and stretches and massages on the surface of the water, was a blissful pas de deux that must have lasted only ten minutes but felt like forever. In my life I’d had lots of massages and other kinds of body work, but watsu was in its own league.

As I later learned, watsu was invented in the early 1980s by Harold Dull, who moved to Harbin after making his name as a poet in San Francisco. His inventive spirit transported zen shiatsu, which he had studied in Japan with its inventor, Shizuto Masunaga, to the warm spring waters of the hippie spa. The experience is relaxing and energizing at the same time, somewhere between meditating, flying, and dropping mescaline. At least that’s what it felt like to me.

After some years of making runs up to Harbin every time I was in California, in 2000 I decided I’d try seeing what it was like to take on the other role. Giving watsu treatments turned out to be nearly as mind-blowing as receiving them, and three hundred hours of training later I was ready to start practicing bodywork on days I wasn’t seeing patients with colds and cystitis.

There was only one hitch: finding the right pool. A watsu pool has to be large enough to swing a client around, calm and quiet enough to permit complete relaxation, just the right depth, and just the right temperature (34º-35º Centigrade, 93º-97º Fahrenheit). Jacuzzis are too small, heated swimming pools not heated enough. Italy’s many famous hot springs can be great for watsu, but the closest to me is an hour and a half drive.

After an exhaustive hunt I found a place inside Rome that qualified, barely: an off-kilter urban spa provocatively named Extasia. The water was so shallow I had to work literally on my knees, and the risk that my client might get skewered on a sharp corner that stuck out into the tiny pool kept me figuratively on my toes. Plus we all couldn’t help but notice one tall white-coated employee who was always popping in and out of the reception area, sporting a short skirt and a strangely prominent Adam’s apple. I did manage give a couple of dozen sessions…

…until one day I heard the place had been closed down – by the vice squad. When eventually they did re-open, they thought it more prudent to bar outside therapists.

I moved on to the lovely swimming pool in the basement of the Grand Palace Hotel on Via Veneto, which they were willing, for a reasonable sum, to heat to watsu temperatures on special request. But around 2010 it too closed down, voluntarily, and when it reopened two years later the new management couldn’t be talked into hosting such a suspicious-sounding activity as water-based massage. Alas, I don’t yet have a decent substitute yet anywhere in Rome – the only appropriate pool I’ve found prices itself out of the running. All suggestions are welcome.

Saddest of all, my beloved Harbin Hot Springs was destroyed in the northern California fires of 2015. It is still struggling to rebuild.

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