Socialized Medicine--Trauma and Rewards of Free Health Care

Living in a foreign country is not supposed to be without challenges—that's part of the appeal. After nearly seven years as an American in Rome, I have gotten used to life with a mid-afternoon siesta for pharmacies, banks and many stores. The traffic is no longer maddening. The endless bureaucracy is starting to make some sense. And I'm finally OK with life without a clothes dryer—even with two small children.

The dolce vita is worth all the hassles, except one: health care. Medical care under a public health system—where patients do not feel that they can be involved or even ask questions about their own treatment—is beyond my grasp. The World Health Organization has ranked Italy's health system as one of the top three in the world. But in my experience, all that is undermined by the fact that patients' rights are secondary and information is withheld from their families.

For someone used to private health care—even with all its complications and problems—trying to understand a public health care system is impossible. Private health care does exist in Italy and anyone who can possibly afford it or who has insurance—mostly foreigners—readily dodge the public system. That's why it took us seven years to experience public care firsthand. But in March, when my two-week-old baby stopped breathing and turned a deep, cold-water blue, we had to act fast. There was no time to get through traffic-clogged streets to a private clinic.

Instead, we sprinted through the cobbled streets of the old neighborhood of Trastevere with the bundled infant we believed was surely dead. We arrived at the closest hospital, Fatebenefratelli Ospedale on Tiberina Island, where Matthew was admitted to the emergency room. He was breathing again, but his lips and fingernails were still blue. We asked the attending doctor if he would consult with our pediatrician, a bilingual Italian doctor who happened to be on a skiing holiday. The emergency room doctor flatly declined. "Your pediatrician isn't here right now," he said. "I am." Chest X-rays were ordered and we stood among the other emergency room patients until we could go to the infant ward. I asked the doctor if I would be able to stay with my son. "No," he said again. "Your son is too sick." Then he disappeared behind automatic doors as we lunged toward him for more information. Nearly an hour later, we were shown to the nursery.

A nurse took Matthew from my arms and told me that visiting hours would start within the next half-hour. As she closed the door (with an automatic lock), I realized the staff didn't even know his first name. Twenty minutes passed like an hour and women slowly began to file into the waiting room to see their sick babies.

Only one parent could visit the babies during this particular visiting time and, since almost all of them were being nursed, it was the mothers. At exactly 2:15, the automatic door swung open and the women ran to the ward. Each baby was known only by the number stuck to his or her bed. Matthew was number nine. We put on gowns, washed our hands and entered a dingy gray room with 30 cribs. This was the Level 1 ward, where babies were being treated for moderate illnesses like jaundice, and where preemies were being fattened up to go home. The nurses had placed 30 chairs in a semi-circle and we all quickly grabbed our babies, weighed them and put them to our breasts.

After 10 minutes, a young nurse's aide ordered the mothers to switch to the other breast—an outdated approach to modern theories of nursing. After 30 minutes a bell rang and we got in line to weigh our babies. If they had not eaten enough (determined by their before and after weight) to make it to the next visiting hour, three hours later, they were given a milk-based formula—even if we objected. If we wanted soy milk as a supplement, we had to buy it ourselves. After the half-hour visit, a kindly nurse gave me a sheet of information that outlined the policy for delivering expressed breast milk if I needed to supplement Matthew's feeding. We had one hour until milk collection time.

When I went back for the 5:15 visit, my baby was gone. I searched in tears. When I asked where "nine" was, a stern aide nodded her head to the Level 2-intensive care-ward. Another nurse abruptly stopped me at the door and quietly led me to Matthew who, dressed only in his diaper, was sleeping inside an incubator with a monitor attached to his little foot. He was now known as "18."

I pleaded that I needed to talk to a doctor about his condition, but the nurse said the doctor's consultation was at 10:30 the next morning. The nurse then gave me a bottle of artificial milk and showed me how to feed him through the holes in the incubator. Since he didn't have an IV and the monitor was hooked on with Velcro, I asked why I couldn't nurse him myself. "We don't allow that," she said. "No one has time to dress and undress the babies for something like that."

After the visit, I joined the other women sitting around a table expressing milk. We agreed that we were not all that happy with the situation. "That's the way it is here," said the mother of premature four-week-old triplets. She had it worse: she had one baby in each of the three separate nursery wards. "But the medical care is good," she said. "The doctors are scrupulous and the babies leave healthy." When we finished expressing our milk, we waited until the "delivery hour" and handed it in to the keeper of the milk bank. A mother whispered to me that at least it was better than a neighboring hospital where they mix all the expressed milk together, pasteurize it, and dole it out. (A spokesman for the Bambino Gesu Hospital in Rome later confirmed this practice.) At least here, each baby got his or her own mother's milk.

The nurse took my miserable offering and as she logged it in, asked, "That's all you have?" I shrugged and promptly started crying. The remaining feedings and visiting hours of that first day were a blur. Mothers could visit their babies every three hours for 30 minutes up until midnight and then not again until 5:00 a.m. Fathers could visit only at 11:00 a.m. and 8:00 p.m. Parents could not sleep at the hospital. When I arrived early the next morning, an orderly with spectacular tattoos was feeding Matthew his bottle. On the side was written LA (latte artificiale—artificial milk). "You didn't have enough so we had to use artificial," he said. "Can I add more milk to it for next time?" I asked. "No, they discarded it since there wasn't enough."

Any mother who has ever tried to express milk knows that's like throwing away liquid gold. And when I asked why I couldn't at least bottle feed him myself, the young man explained that he was supposed to determine if the bottle was too tiring for my baby. At the next feeding, they were feeding him by tube to his stomach. I still hadn't seen a doctor. My own pediatrician, still on vacation, told me: "A hospital is not a prison, If your baby is well, you can take him home." But no one could tell me if my baby was well or not. And in Italy, doctors who do not practice at a certain facility cannot visit patients, so my pediatrician was out of the loop.

When the consultation hour finally came, all the parents stood in line to talk to the doctor on call. A new doctor came on the ward just after each visiting hour and checked the babies and scribbled in each chart. That meant the doctor in charge of the consultation had to summarize as many as seven doctors' different notes before deciding what to say to the parents. When it was finally our turn, we demanded to know why he was a) in an incubator and b) now being tube fed and c) when could we take him home. The answer: there was still no diagnosis so they were just treating him for any number of illnesses.

Because he had been admitted on a Friday, Monday would be the soonest they could get test results back, but they had put him on antibiotics when they admitted him. Precautionary measure," the doctor said. And the tube feedings? He isn't eating enough with a bottle. I repeated the La Leche League theory that breastfed babies eat when they are hungry and take exactly as much as they need. He smiled and said, "Not here. He has a prescription to drink 100 ml [about 3.5 ounces] of milk seven times a day."

Over the course of the week, each visiting session grew more depressing. Parents and nurses argued loud and often about the delivery times for expressed milk. A young mother of premature twins was five minutes late with her precious milk—and the nurse at the milk bank turned her away. The mother became hysterical, her husband indignant. The three adults screamed at each other as babies who had awakened to the uproar wailed in the background.

Matthew was tube-fed for four of his seven days in the hospital. By the end I was expressing so little milk that I stored it at home until I could meet the required 100 mls without it being discarded. And when they tube fed him, I learned how to hold his little arms still so he wouldn't accidentally knock the tube out of his throat. Every doctor consultation produced new diagnoses and a new prognosis. "He'll have to be here at least another week," we were told by one doctor the day before he was released. The day earlier, we had been told he'd be coming home "tomorrow."

Finally we learned that he had a viral chest infection and that antibiotics would do little good, but since he had started the course, he had to finish it. Three months later, he still has stomach problems as a result of the medication. The abnormality of it all began to seem routine. I asked every day if I could hold my baby, spouting out volumes of research that human touch has been proven to help cure sick babies. On the fifth day of his stay, a nurse who must surely have had children of her own whispered for me to stay a few minutes after the 2:00 p.m. visit ended. The doctors were all at lunch and the ward was empty. She ordered me to crouch down on the floor in the corner near my son's incubator. Another nurse stood guard at the door while this angel wrapped my son in a brown wool blanket and handed him to me to hold while she cleaned his incubator. She cleaned every crevice of the incubator twice.

Holding my baby then was the most beautiful 20 minutes of my entire experience as a mother so far. The next day when I arrived for the early feeding, they had moved my son to the Level 1 ward since he had shown such improvement. I sat in the semi-circle with the other mothers as we held and nursed our babies.

My son was released a day later, and I realized he was actually well. Which made me admit that he had been a very sick baby. While the treatment under the public health care system certainly did not cater to the mothers, the care of my son was more than adequate—if you don't count the negligible amount of human contact.

And when our son was discharged, the doctor who signed him out said there was no charge for his one-week stay in the intensive care ward. Even though we're not Italian and have private insurance, the fact that Matthew was admitted through the emergency room meant he was a ward of state for the week. As such, the Italian government paid the bill unquestioningly. But it seems that the cost of public health care, at least in Italy, is paid on emotional terms. Because patients and their families aren't paying directly for the services there seems to be little concern for their right to know about the treatment of their loved ones. All things being equal, I think I'd rather pay for my health care next time around.