Surviving Toddler Injuries and Italian Hospitals

It’s something we all dread, that inevitable moment when your child has hurt themselves and needs urgent care. Luckily for us and our three-year old son–on this occasion, a couple months ago–it wasn’t that serious. We ended up with a foot sprain. However, the accident and immediate days following felt scary, especially for me as an American who is still slightly unfamiliar with how the healthcare system works in Italy. 

Let me first briefly describe my impressions of some of the public Italian hospitals I have seen since living in Northern Italy. What I have experienced are a few big architectural masterpieces crumbling around the edges. The irony is that the eye meets this beautiful old building with soaring columns, ceiling art and ancient stone flooring and then darts to peeling wall paint, hand-made directional signs, cheap extensions, dark tunnels connecting buildings and what seems to be a lot of organized chaos. I dare not even estimate the decades since major updates or renovations, since this depends on the hospital and obviously where funds have been invested. My personal experience is limited to Mangiagalli and Macedonio Melloni in Milan, Gaslini in Genova, and recently Maggiore della Carità in Novara, which is where we ended up for my son’s sprained foot. A few recently-built, modern hospitals do exist, such as the one we have in Arona, except in this specific case there are limited care options. All this being said, the actual care in this country I have ever personally received – at both public hospitals and private clinics – has been good and effective and the professionals are usually helpful and caring. 

Now, back to what happened. As during most evenings, Cesare had been playing with our couch cushions, which we had piled on the floor so that he could go under and over to explore and build with Papà. We went from laughing one second to one long, silent cry preceding a pained scream when our son’s foot landed and twisted strangely on the corner of a pillow. I swear that I had also heard a slight ‘pop!’ that brought me back to difficult childhood memories of tearing ligaments while playing rec basketball. Once calmed down, our son seemed to be back to normal but he wouldn’t put any weight down on the slightly-swollen foot. After some ice and a good night’s sleep, he still wasn’t walking and so I decided to take him to see his pediatrician.

This is when things became confusing for me, as it wasn’t clear what I was supposed to do. We weren’t in an emergency situation, so I wouldn’t have thought to take him to the hospital ER. However, the ER was the suggestion that emerged later on from a few trusted sources as well as hospital workers. Instead, I first went to our pediatrician’s office, which luckily enough just happened to be open for visits that morning. 

Our pediatrician took one look at the foot and wrote us two official slips, our tickets to be seen by any public hospital’s orthopedist as well as by the radiology lab. “Don’t go here to this hospital,” she said, “go to the bigger hospital 45 minutes away because they are better with these sorts of injuries.”  I paused for a moment at this idea that perhaps I could end up at some point with a hospital that wasn’t particularly talented in one area… but okay let’s roll with it, “va bene.” 

What I have learned through this experience is that our pediatrician had followed protocol in writing us those tickets but we still had to wait in every line imaginable. Even if we would have escaped the standard runaround, the emergency room route would have likely been the same wait because patients with serious injuries always precede those who can afford to wait longer. I must say that paying a small combined fee of less than 70 euro for the x-ray and visit was a financial relief when compared to some of the hospital fees back home. Should we have gone directly to the ER the same package would still have had a small fee to my understanding, thus having only relieved us of the first stop to the pediatrician’s office and perhaps the confusion on where to have started at the hospital. A true emergency would not demand any out-of-pocket cost, however, as that would come out of the greater public healthcare system that works from tax dollars.

As with most things in Italy where reputation and word of mouth mean everything, I took our pediatrician’s recommendation and drove the extra 20 minutes to reach Novara. Parking was challenging, but I managed to find a public parking lot several blocks away from the hospital, not having understood by glance at the road work, scaffolding, and old campus downtown to know if I could arrive any closer. Since he wasn’t able to walk, I put my son in his stroller and booked it into the children’s ward amid a sprawling campus of old and new buildings, cars and crowds, all the while thinking that thankfully I knew where I needed to go, per our pediatrician’s ticket as well as the advice of the young man at the entrance information desk. Beads of sweat across my brow, I wheeled our way through the masses only to be told that I needed to cross back and return to Radiology, because our directions had been wrong. Children don’t have a separate radiology department, they take x-rays where adults do them in the general radiology lab. Right, so why had I been directed to the children’s ward to begin with? Huff…

This was the first of several times when someone asked me why we hadn’t just gone to the ER, confused by the tickets that our pediatrician had written for us.

As if it was all so obvious! Yes, frustration hit me, and I sputtered through choppy Italian as my brain fogged over. All the while, I was responding and asking more questions because nothing was clear. Neither the signs, help desk, nor my own pediatrician seemed to know how things worked at this hospital. I then ran back to where this new person had told me to go, all the while glancing at the time because at lunchtime we would most likely need to wait even longer.

Once we finally reached the radiology lab, we were last in line, holding my doctor’s treasured ticket that looked similar to everyone else’s. This wait was another 45 minutes. Time was still on our side, however, and so I held hope to make it in before lunch. Thankfully, the x-ray room door opened and our number was called…

To add an ironic twist, the hospital had invested in a fairly modern and efficient system to provide x-ray results, which actually blew my mind. After completing the x-ray, we left to go get lunch, knowing we would be able to return in 25 minutes to receive our results. Upon return, we were escorted to a dedicated machine, one of four in a small nearby room. After typing in my son’s name and medical ID, the summary of injury was printed on a white sheet of paper and a CD-rom was burned with images of the x-ray for reference, a process that took more or less ten minutes. From that point on, the answers were mine to hold and it was my responsibility to share them with whichever doctor we would go see next. Brilliant!

Our pediatrician had already written us the next prescription visit having anticipated where we would need to go – children’s orthopedics – and so off we went with our results in hand. When we arrived to the children’s ward, we were greeted by many happy and colorful murals decorating the walls and a grand marine-inspired help desk pointing us down one hallway, except that no one was there. A few minutes later a nurse appeared and kindly told me that on Thursdays no one was working, unless for an emergency, and that I would need to come back the following morning for an 8:30 am appointment. Patience…va bene. Before heading home, we stopped at the central reservations office (C.U.P.) to pay in advance for the appointment the following morning, as required.

Now, how it works with appointments is that you return to where you know you need to show up, and it just so happens that 50 other people are waiting to be seen at the same time you are. Lots of handmade signs and computer print-outs on corridor walls create more confusion, all written in Italian with small font. In some cases, it wasn’t clear what I was supposed to do. Take a ticket and wait my turn? Okay. We had a few fresh brioches in hand from our local bakery, so it couldn’t be all bad, right? Luckily, there was also a wonderful playroom for the kids. It was full of toys and games, making it all seem quite bearable. Time ticked by, and I occasionally glanced up at the Madonna, who knowingly looked over me as well and everyone else in the stuffy hallway where we waited.  At one point I had to go hunting for someone – anyone – to furnish the public restroom on our floor with hygenic paper products. This role seemed to fall on one unlucky nurse who happened to cross my path. At least the bathroom itself was clean. Finally, it was time for my number to be called. When I braced myself to jump up…they skipped me! Cosa? 

I scrambled to the front and, in my best ex-New Yorker-needing-a-taxi-way, I leapt at the next nurse who opened a door, showed her my appointment time, and asked when it would be our turn.

“Why hadn’t you shown us your paperwork before?” she asked me.

‘Ah, you mean a pre-paid appointment with a numbered ticket isn’t enough? I also need to show you my paperwork in advance!?’ I sputtered in disbelief. “Va bene, mi scusi, ma cosa faccio adesso?” I asked with a sheepish look begging for forgiveness and special treatment.

“Ci pensiamo noi adesso, Signora, grazie,” she briskly responded, taking my paperwork in hand and closing the door behind her.

How much longer? It had already been two hours since we arrived. I pulled my son and nanny, who had joined to help me that day, out of the playroom to wait with me with the masses so that we could be ready. At this point, human survival instincts began to click into play, and it was nearly every parent for themselves to serve the needs of their own child. Certainly, there were moments when desperation was pushed aside so that the kids with the more severe injuries went first, but it was still a bit intense at times throughout the wait. Soon enough, it was finally our turn, and we were warmly welcomed by several female doctors and nurses into a small office.

Always a magnet for chit-chat about how I ended up in Italy from California, the doctor inspected my son’s foot while casually talking to me and peppering me with questions. Thankfully, Cesare was calm and comfortable enough.

“What a lucky boy he is to be raised with two languages…why on earth did you move to Italy? Ah, yes, love. Poor thing…Well, it’s nothing serious but let’s wrap him and keep him off of it for one week,” she said to me.  A three-year old off his foot for one week, I thought…clouds of exhaustion began blowing in at the idea of how often I would have to carry his 35 pounds around town. Thankfully and most importantly, he was fine, and for this I was grateful.

“Va bene,” I finally responded with a big smile. “ViRingrazio.”

The doctor and nurses were kind and thorough, also suggesting to rub cold arnica gel into his foot for a few days after the cast would be taken off. Their explanation was all I needed to settle my worries, and yet the most traumatic experience of all was that of wrapping the actual foot because this was the scariest part for Cesare. Warm goodbyes followed when I left their office with my crying child, slightly traumatized myself by having had to hold him down while they delicately wrapped him with gauze.

It was touching to be greeted back outside in the hallway by a few pagliacci, who desperately attempted to wipe away his tears for a smile with a few balloons. Nothing the clowns tried had worked, so I used my best joker card of suggesting we stop for gelato and that did the trick. As fast as we could manage, my nanny, Cesare, and I left the hospital relieved, tired, and in search of a good gelateria because we had earned it.

Four weeks later, Cesare is walking again, and all is back to normal. Looking back, I figure that this experience was a good hospital drill for me, although let’s hope the next one isn’t anytime soon!