Lymphedema Clinic

At 1:00 am the Croce Bianca (White Cross) arrived to pick us up in what they call a ‘pullman’ – the Italian word for coach, but it’s in fact a sort of minibus.

The vehicle we travelled in

This transport is provided to patients who are being treated under the Italian Health System (in our case through Clive’s E112) who would have difficulty going by other means.

We drove through the night, drowsing uneasily, and by the time morning came we were in the mountains.

Snow-covered mountains

By lunchtime we’d reached Sankt Blasien which is where the clinic is – an attractive town, very neat and clean. It was obvious it had snowed a lot; there were great heaps where it had been cleared back. I later heard they’d had 60 cm.

Clive was examined straight away by a doctor, and I stayed on well into the evening.

The evening meal was served at the unhelpfully early hour of 5:30 pm. The patients arrived in dribs and drabs from all directions, up the stairs and down the stairs, limping and staggering. It reminded us so much of a scene from ‘The Walking Dead’ that we got the giggles.

The hotel was a breeze to find – for everyone except me. It was very dark and the streets were practically deserted. Fortunately I came across a charming lad sweeping snow in front of his house. He spoke very good English (he told me he was top of his class) and he conducted me via a shortcut right to the door of the hotel.

Vescia again

This morning we managed to change doctors in Valtopina ASL, quite painlessly, and went to the surgery in Vescia for a second time.

On the right: entrance to the Vescia surgery

The timing was perfect in one sense because late last night Clive discovered a lump under his left arm. He was able to get the doctor to examine it and she confirmed his fears that the lymph node was swollen.

She prescribed a strong antibiotic and a special cream, and told us to come back in a week’s time to see if it has reduced in size.

She also took names and phone numbers of the various characters involved in the lymphedema treatment and E112 saga, saying that she will phone them when she has a moment.

We’re very worried about the swollen lymph node because it can spell all kinds of trouble, but at least we don’t feel quite so alone any more.

A lemon and 4 strawberry trees

Valtopina ASL (Health and Health Administration Centre) is open one morning a week – Thursday – so, after phoning to verify they could help, I went down there today to change doctors.

The clerk behind the hatch greeted me with the stony-faced ‘it isn’t my fault’ look of the Italian bureaucrat and announced that the computer wasn’t working.

“But I phoned first!” I protested.

“If you’d got here fifteen minutes ago, it was working then.”

“Is there any chance it might start working again before you close?”

“I just told you,” (I never heard him) “I’m closing now and taking the computer to the technician.”

So that was that. Complete lemon. But there are 4 mature and beautiful strawberry trees just outside the entrance. I spent a few enjoyable minutes taking photos of them.

Strawberry trees outside Valtopina Health Administration Centre

New doctor

We’ve found a doctor who can’t fail to be an improvement on our last one and also the one that was recommended to us.

Unlike Britain, where doctors operate in Practices and there’s a danger of running into the one you’ve just moved from unless you change Practice as well, in Italy doctors are separate entities.

Sometimes they club together and share relatively modern and well-appointed premises, but usually the surgery (‘ambulatorio’) is in some nook or corner of an old building in the historic centre. Access is often up difficult stairs or across pedestrian-only cobbled courtyards, and there are no signs to guide you on your first visit. You have to ask a passerby, who almost invariably will ‘know’.

This new doctor has 2 surgeries, one in Foligno and the other in Vescia. Vescia is the nearest.

We went to see her yesterday evening, for a pilot visit before we make the official change. There’s no appointment system in Italy: you just turn up within surgery hours – or an hour before if you fancy a gossip - and it’s first come, first served.

When it was our turn, we found her engrossed in a telephone call. She must have taken 3 or 4 more calls during our session, and each time she knew the name of the caller and their precise requirements without looking them up, as well as remembering exactly where she’d got to with us before the interruption. (Doctors in Italy are accessible at most times of the day on their mobile phones.)

It was freezing cold: the heating wasn’t working, she explained from the depths of her fur coat.

As a woman, I do generally prefer a female doctor, and Clive isn’t bothered either way. Vescia was the nearest possibility. So far I feel very optimistic; she’s already inspired me with confidence.

Lymphedema part 2

Continuing our quest for treatment for Clive’s severe lymphedema problem, I spoke to the horse’s mouth of the E112 rejection – a Professor in Perugia Hospital.

This professor promised to speak to the female doctor in Terni whom he had recommended. He phoned us back and reported that she would do her best to bring forward the appointment from the end of April. We should phone her again.

I finally got hold of the female doctor. I gave her some more details about Clive and she decided that it would not be right to ’make him come and go’ as an outpatient.

She referred me to her esteemed colleague in Rome who has some beds at his disposal.

I eventually reached this doctor today. He will examine Clive as an outpatient initially. We should make an appointment – he gave me a phone number – to see him in a few days’ time.

I phoned the number he’d given me. An outgoing message announced there would be a wait of approximately 16 minutes. Meantime the speaking never ceased. An Italian, an English and a French voice took it in turns to tell me they were trying to deal with my call, and every time round there was a noise as if I was going through so that I was continually leaping for the microphone. (I made the call via Skype; I would have gone insane if this had been on the mobile.)

Clive's lower leg

Finally a woman answered.

Name? Is that a surname? Can you spell it? (The initial letters of Italian cities are used for spelling out words.) First name? Is that a first name? Can you spell it? Date of birth? Place of birth? Fiscal code? That can’t be right. There are more names. Why didn’t you tell me there were more names??!! We’ll have to start all over again. Second first-name? Can you spell it? Third first-name? Can you spell it? Date of birth? Place of birth? Fiscal code?

There were 2 or 3 repetitions to check the whole fiscal code, and some confusion as to whether I was the wife or the husband, or whether I was phoning on behalf of my wife or my husband (she got quite ratty at this point although my voice is clearly female).

At long last the offer of a date  – a month hence. We had to put it off a week more because the timing on the earlier day would have meant we got back from Rome well into the night.

The photo, which is of a ruptured lymphedema ulcer on the back of Clive’s lower leg, shows that time is not on our side.