But first a few pictures of the churches and streets illuminated for the Santa Croce festa on 13 September. Normally there is a long procession with people in medieval costumes, religious artifacts, and many local groups. Due to the coronavirus, much of the festival was cancelled or scaled back, but I loved wandering through the streets.

We arrived in Lucca on March 9th, so have now been here for more than six months. It feels the time has flown by, yet this now feels like home. While walking the familiar streets, I recognize many locals and even occasionally run into friends or acquaintances. But I still discover new streets, piazzas and stores. I’m now able to communicate as needed, although my pronunciation and grammar have lots of room for improvement. Phone calls are still tough. We are planning to buy a car within the next month or so and I now feel comfortable driving here.

But things aren’t exactly perfect here. We’ve run into a few glitches recently and both can give you a sense of the crazy bureaucracy here:

Permesso di siggornio: Getting our visa was challenging and took a long time, but it only gave us permission to enter the country. To stay, we need to get our permesso di siggornio (PDS). We applied in March, shortly after our arrival. We got the forms but of course all of the directions were in Italian. I googled and found some instructions on how to complete the non-intuitive forms, lists of documents to include, and tax stamps to attached. We turned them in and waited until the end of August for our appointment at the Questura (immigration office) to get our fingerprints. In the meantime, a local American friend introduced us to Tony, who helps expats and others through the crazy bureaucracy. A day before our appointment he checked on the status of our applications and that is when he discovered that I had made a mistake. A big mistake. I filled out one form because I had convinced myself that the form covered both of us. Nope…  I was supposed to complete one form for each of us. Bottom line, I had only applied for Jim. So, Tony helped me fill out MY form, we submitted all of the documentation again, bought new tax stamps and now I wait until December for my Questura appointment. My visa is valid until the end of February, so I should be OK. Ugh!

For Jim’s appointment at the Questura, we arrived before they opened per Tony’s instructions. There were about 20 people waiting for it to open, all wearing masks and maintaining social distancing. Then the door opened and everyone rushed to the front. Tony was there to maintain our spot and got Jim in for his appointment. That alone was worth the prices we paid for his services!

And no, the Questura appointment is not the end of the process. There are more appointments to finalize the PDS, get the identification card, and sign up for the national health insurance. And a slightly easier version of this is completed annually.

We also need to do several activities as part of an integration plan that we commit to. We are required to take training about the Italian government (a few hours of boring recorded training at a Government training location). Then take a test about the content a few years from now. Why wait two years, you ask? Because that’s how it work. We also need to take a test to show that we can speak and understand basic Italian. There are other activities as well, but those are the key ones.

---

The medical system: One of my goals for this year is to gain an understanding of the medical system. What better way to do that than needing some out-patient surgery! 

It turns out that Jim had a hernia…  We aren’t yet on the National Health Insurance so we have private insurance for at least the first year. We went to a local general physician who speaks English. He confirmed that Jim had a hernia, ordered some blood tests, and referred Jim to a surgeon. He is a doctor in the National Health system, so he doesn’t have a way to accept money from us. The doctors are paid a salary; they aren’t paid by the visit or the patient. Bottom line, the doctor appointment will cost us a nice bottle of wine. The doctors don’t have nurses or staffs. Before the coronavirus if you needed to see the doctor, you went to the office and waited for your turn. Now, you need an appointment. So you call or text the doctor to get an appointment – and they tell you when to come in. No nurse, no staff, just communicate directly with the doctor. To give the doctor the blood test results, Jim put them in an envelope and took them to the pharmacy by the doctor’s office. The doctor picks up results there and leaves info for patients there too. 

Getting Jim an appointment with the surgeon was a challenge for two reasons – I really struggle with speaking on the phone and it was August. Nearly everyone takes vacation in August: some for the entire month, most for a few weeks, but at least for a few days. I got the contact info of someone who could help me get the appointment and we communicated via WhatsApp. We had an appointment for several weeks later. Once we found the location for the appointment, we were pleased to find that the surgeon spoke decent English. He examined Jim and confirmed that he needed surgery, which would be done at the large hospital in Pisa. This would be out patient surgery, likely done via just a few small incisions. Next step is to meet with the anesthesiologist and do some pre-operative tests. 

When someone says Pisa, you likely immediately think of that leaning tower. I think of IKEA, Pisa University, and Cisanello Hospital (one of the best in Italy!).

We arrived at the hospital for the pre-operative testing and followed the directions to Building 10, the Orange area, followed the G route, then went down a floor to search for area 14. There was a long line outside of the pre-operative testing room and I tried to ask a question. They quickly realized that we couldn’t speak Italian well, whisked Jim inside and told me to stay out of the room. After about 3 hours, Jim came out to say that he needed a chest Xray and someone would lead us there. It was so confusing getting around that the “guide” asked 3 people for directions! Jim said most of the people spoke decent English. After about 4 hours total, we left. We walked around the city of Pisa and found a wonderful place for lunch. We got a glance at the tower; it’s still leaning. 

The next day, the surgeon called me. (No, not his assistant or nurse… the surgeon). He said that surgery would be Monday and we were to arrive by 10am. He gave us directions to the place to come for surgery and asked Jim to take a COVID-19 test on Sunday at 9:55am and asked that we pre-pay before the surgery. We had talked to our insurance agent and they will cover 80% of the cost, but we needed to pay up-front and they will reimburse us for 80% of the total.

We decided to pre-pay for the surgery on Friday so that we wouldn’t need to worry about it the day of the surgery. Boy, am I glad that we did that! After going to a few different buildings, we found someone who could help us. Because we aren’t using the National Insurance, no one seems to know how to deal with us. At one point, there were three people helping us and two people were called. After about an hour, they finally took our credit card.

Next step… the COVID test. We were told to go the hospital, parking lot A1, and look for an orange building with a tent next to it. Jim didn’t wait too long to have a swab in the throat and one in the nose. He also learned that we were essentially quarantined until he went to the hospital the next day. They said that they would call if it was positive, otherwise we were to come to the hospital the next morning.

Surgery day! Next problem… because we had paid on the Friday before, the date on some of the paperwork showed surgery on that Friday. Yikes! After lots of phone calls and a 1.5 hour wait, we were brought to Jim’s hospital room. The nurse showed us the room, including the bathroom and two beds. They said that I could sleep in the other bed. For outpatient surgery??? Surgery was scheduled for 1pm, but nothing seemed to be happening. Then they asked me if I wanted lunch and dinner. Of course, I was confused because I’m not the patient and Jim can’t eat. They ended up bringing me a decent lunch and dinner will come for Jim and I. They finally said that the surgery would be later than planned, probably around 2pm. Piano, piano… This “out-patient” surgery was going to include a night in the hospital.

After a few hours, Jim was returned to the room. The surgery was a success and his recovery has been very quick.

Bottom line, the medical care received was top notch. The administration and bureaucracy was very challenging!!!

---

Lots of words in this blog post, but I wanted to convey the complexity of life in Italy when dealing with organizations and government. Be sure to consider that very few of the people that we deal with regarding medical care, immigration, home repair, car purchasing, etc. speak much English. These conversations are typically a mix of Italian and English, with use of Google Translate when needed. But it is all worth it!