My experiences with the Italian Health System

When Jim and I started seriously considering moving to Italy, we investigated the Italian health system. It is as different from America’s as you can get…  The Italian constitution states that “The Republic safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent.” And we learned that Italy has a highly rated medical system – second in the world, according to Wikipedia! I want to use this blog post to share my personal experiences with the medical system, including my recent Total Knee Replacement surgery. No pretty pictures in this blog post…

Year 1 (and 2!) – Private Medical Insurance

We applied for Elective Residence Visas to allow us to move to Italy. One of the many requirements was to show that we had Private Medical Insurance because the Italian Government recognizes that there are many actions that must be taken before new immigrants are eligible to become part of the Italian health system. During a pre-move visit, we signed up for a plan that covered major and unplanned medical expenses – similar to what we would call catastrophic coverage in the USA. The coverage values seemed low to us (€30000 each) but our lawyer said that it seemed adequate to him. The annual cost was €1614 for both of us. We expected not to use the insurance, but unexpectedly Jim needed hernia surgery. I wrote about this experience in one of my earlier blog posts. We had to pay all costs at the hospital but the insurance reimbursed us for all of it! Because of COVID, we still weren’t able to sign up for the Italian medical system as our insurance was getting ready to expire. We renewed the policy and used it one other time, with the same results – all costs covered with no deductibles. During this period, we paid the full cost for our prescription medicines, but they cost us less than half of the co-pays that we had in America with our health insurance.

Participation in the Italian Health System

Once we became official residents, we were able to sign up for the Italian Health System and received our coveted Tessera Sanitara cards. We had read many places that this insurance is “free” but also read that there were costs involved. It turns out that the Constitution and the laws state that it is “free” but with the kind of visa that we have, we were required to make a voluntary contribution for the insurance. LOL! The first of many bits of confusion regarding the Italian Health System. We pay €2788 per year for this “public” insurance.  We selected a primary doctor that speaks some English and has an office close by.

Working with our primary doctor

I don’t actually visit our primary doctor frequently. After my initial visit and a review of my medical histories, he provided prescriptions for my regular medications and encouraged me to use WhatsApp to send further requests to him. So, whenever I need a prescription for medicine, a referral for a special visit, or a medical test, I simply send him a message with WhatsApp. He writes the prescription and leaves it at the pharmacy in his building and I pick it up that day or sometimes the next. Very easy and efficient but a bit impersonal! Many prescriptions cost nothing, some have a co-pay up to €20.

When it is time for a visit to our primary doctor, I send him a message via WhatsApp and he tells us when to come. Usually that day or the next. When you enter the waiting room for several doctors, you simply ask the group of people waiting “L’ultimo per Dottore Morotti” or “Who is the last person waiting for Doctor Morotti?” Someone should acknowledge that they are the last and you sit down and wait your turn; you need to remember who was last, so that you can enter the doctor’s office after that person finishes. When the next person enters the waiting room with the same question, you acknowledge that you were last and they now know where they fall in line. When the doctor is ready for the next patient, he simply appears at the door and says “Chi è il prossimo?” or “Who is next?” This sounds like a wonderful and informal approach, but seldom works as smoothly as it should. They typically are confused by my pronunciation and there are often disagreements about who is actually last or next. This approach is so characteristic of the Italian culture… I giggle to myself every time I watch it in action.

Once it is your turn and you are in the doctor’s office, you share your questions, requests, concerns, problems. There is no nurse, no unnecessary blood pressure readings or weigh-ins and frankly I can’t remember him actually examining me.  He fills out needed forms and prescriptions and hands them to you.  At the end of any visit to a doctor, they give you a one-page summary of the results. You wait while they type and print it or simply hand write it. The doctor may keep some records for their patients but the expectation is that you maintain your own records. There is no charge to see your primary doctor. Once I needed to pay to have a specific form completed and I had to pay €50 for the administrative costs. He took out his credit card machine and I gave him a credit card… no billing department needed! A specialist visit typically requires a payment of around €30.

Working with a private orthopedic doctor

When my knee started hurting in November 2020, we still weren’t covered by the Italian Health System so I went to a private doctor. Once we were covered, I continued to see the same doctor as I had a lot of confidence in him. His office is run a little closer to an American doctor’s office. He has a receptionist who checks you in, accepts the payment, and schedules appointments. This doctor speaks some English and his receptionist speaks English very well.  During an early visit he reviewed my Xrays and MRIs and said that my right knee was in terrible shape. I would need a total knee replacement within a year or two. I was definitely in pain but had no idea that my knee was so bad. Jim had struggled for years with his knees and visited the same doctor. The doctor said that mine was much worse and I would “get to go first”. My initial visit was €130 and included a cortisone shot.

The cortisone shot helped a lot and I was back to walking the streets and wall of Lucca pain free. About six months later the pain started to return and we were getting ready for Derek and Dani’s visit to Italy. I had plans for lots of fun activities and did not want to be in pain for their visit! I returned to the doctor and got a second cortisone shot (only €50 this time) and was pain free again. The doctor indicated that I should plan to have knee surgery in 2022. But the bad news was that the cortisone shot lasted only about a week… After an exchange of emails, we targeted February 2022 for the surgery. I was in pain during their visit and skipped a few of the activities, but it didn’t stop me from enjoying my time with them.

Surgery – private or public insurance?

We had planned to use our private medical insurance because the doctor is a private doctor. But then we learned that we could not renew the same private medical insurance policy because we were now residents; that kind of policy is only for non-residents. So, we asked our insurance company for a similar policy for residents. Bad news, cost was higher and all pre-existing conditions were excluded. I had heard horror stories about people waiting many months for knee operations using the public insurance and was in too much pain for that. I visited my primary doctor to ask how long it would take to get a public orthopedic doctor and get the surgery scheduled. I explained my situation and he confirmed that my orthopedic doctor was the best in Lucca and said that he would certainly accept my Tessera Sanitara (i.e., the public insurance) for my surgery. Another moment of confusion – could my private doctor use the public insurance for the surgery??? I contacted my doctor and waited anxiously for the response. Of course, they would accept the Tessera Sanitara. Certainly no one would be expected to pay the full cost of the surgery! Confused but happy!!!!

Time for surgery – Total Knee Replacement

I won’t provide the full story of the surgery and recovery. If you are familiar with this surgery, you’ll know that it is particularly painful and a difficult recovery. Instead, I’ll provide a list of some of the similarities and differences between an Italian and American hospital visit:

Different – my hospital is a 9-minute walk from my apartment… if I could walk that far. It likely took Jim 12 minutes to drive there…

Similar – pre surgical tests and meeting with the anesthesiologist scheduled a few days before surgery

Different – bring your own crutches, pajamas (no gowns provided!) and all toiletries

Similar – bland food. Even the pasta.

Probably similar – no visitors because of COVID

Different – minimal pain meds. I received intravenous acetaminophen (Tylenol) several times a day. When the pain got bad, I insisted on a stronger pain medicine and received “something like” morphine. Two times.

Similar – high quality staff (doctors, nurses, aides, therapists, etc.).

Different – 6 nights in the hospital versus 0-2 in America

Different – cost for doctors, surgery, hospital, Xrays, physical therapy in hospital, etc. was €0.

Recovery – Total Knee Replacement

From the moment I heard the word “surgery” I started worrying about all of the steps in our apartment. We live on the 3rd, 4th, and 5th floors (with the ground floor designated as zero). There are two different sets of stone steps before reaching the elevator then once you reach our apartment, we have four more sets of stairs. Some have just a few steps… one has 12 steps. There are two ground-floor Airbnb apartments in our palazzo complex that are owned by our neighbors. We rented one of them for my first two weeks home from the hospital. The apartment was perfect for those initial weeks, including a front door that opened directly onto a paved road for my first walks. Most of the streets in Lucca have cobblestones, so a paved street seemed like a luxury.

Given that my knee would hardly bend, it was not easy to get into our Mini Cooper. My doctor referred me to Marco, a physical therapist who comes to your house. He comes 3 days a week and I do need to cover the cost of these sessions. We have had several friends visit us and provide meals. A month or two ago we met a woman who recently moved to Lucca. It turns out that she was a nurse in America and worked at a hospital in Reston, Virginia that we visited more than we would have liked. Joanne visited us nearly daily, giving me my blood thinner injections, changing the bandages, and answering my stupid questions.

I have now moved back to my apartment. Marco walked me to my apartment from the rented Airbnb. He gave me instructions on how to tackle each set of stairs. My days are now filled with PT exercises, time using an automated knee bender, and walks around town. I’m also trying to pick up my daily chores. The weather yesterday was unseasonably warm so after our walk, we stopped for a Spritz at PuntoZero, a café across the street from our apartment. Allesio surprised us with a candle in our Aperitivo snack.

I have months to go before I am fully recovered but I feel very blessed by the good medical care that I have received and the many family members and friends that have supported me through texts, phone calls, visits and meals. And most of all the help provided by Jim all day and all night.

Two quiet months but more freedom now!

It’s been about two months since my last blog post. I’ve thought about writing, but not much has happened for the last two months. The coronavirus restrictions have varied between very strict and strict, so our activities have been greatly limited. But there are a few updates to share.

One year anniversary of living in Italy: We arrived in Lucca on March 9th one year ago, excited to start this new chapter of our lives. COVID and coronavirus were new words/ideas for us, but so was so much around us. The excitement of retiring and moving to Italy sustained us for most of the year and we treasured our opportunity to spend so much time in Lucca and wander around Tuscany occasionally. As we passed a year, I found myself grumbling… second Easter in lockdown, second time we’ve celebrated Jim’s birthday in lockdown, second time for this and second time for that. But I know that we have been so greatly blessed to pass the pandemic here and (being retired) were not greatly impacted financially. I still need to remind myself of this every few days…

Medical care: we now have full access to the Italian medical system. For our first year in Italy, we delayed most medical activities and only dealt with issues that needed to be handled – because of the pandemic and our medical insurance only covered larger issues.  We now have a general physician, are catching on preventive medical activities, and addressing issues that we have ignored.

Eye surgery for Jim: The biggest medical issues was that Jim needed outpatient surgery on his left eye – Epiretinal Membrane (ERM) Surgery. This is not a typical / routine surgery so we had the condition and recommendation confirmed by two doctors in Italy and more confirmation from Jim’s doctor and ophthalmologist in Virginia. After waiting for a few months, he was scheduled for outpatient surgery last week. Everything went smoothly during the hour-long surgery and all indications are that the problem will be fully resolved. The recovery has been a bit more involved than we expected with three different eye drops four times daily AND he needs to keep his head down as much as possible. We have been very impressed with the medical care, with multiple follow-up visits. No cost for the surgery and the eye drops cost about €12 each.

Language study: Jim and I are continuing to study with online tutors. As part of our Integration Agreement with the Italian Government, we need to achieve a competency level of A2 within two years of arriving. Because I started studying the language a few years before we moved here, I was ready and took my A2 test on April 15th and should hear the results soon. However, that doesn’t mean that I’m fluent or anywhere close. That became clear to me after a very confusing episode at a medical clinic when I went for my appointment at 14:00 on April 8th rather than 8am on April 14th. Oh well… 

Driver’s license: I am now turning my attention to studying for the driver’s license test. The test is a challenge even for Italians and is in Italian only. The test has 40 true/false questions drawn from a known set of 7000 possible questions. You can get a maximum of four wrong in order to pass. I can drive with my US driver’s license and an international driver’s permit until January 2022. There is a lot of new vocabulary to learn, including 100 new verbs: to tail, move away, support, take advantage of, compress; squeeze, flow out, avoid, brake, throw/jettison, crack/deteriorate, …

Time with friends: We have been fortunate that we’ve been able to continue meeting with friends, including having two people (and their children) to our house at a time. We’ve continuing meeting with Brian and Victoria for Bible studies and enjoyed Easter with them and their two daughters. We’ve had Pasquale (an Italian friend) for dinner weekly, had a few cooking lessons from Evelin (Pasquale’s chef), enjoyed a brunch at Sharri and Jedd’s house, and visited with Nicola and Rebecca when Vinarkia was opened for takeout. And I have certainly appreciated staying in contact with family and friends through social media and phone calls.

Here are two pictures that I’ve took one evening from our apartment:

A quiet evening in Lucca
Moon rising over San Francesca

San Frediano, a nearby church replaced a bell in its tower and installed a new system that allows their bells to be played by electric motors or moved by string. The changes were announced in the local newspaper and we enjoyed a mini concert from our apartment on Sunday. I’ve included a bit of the audio and a picture.

Church bells from San Frediano
San Frediano, ready to share her new bell with the community

Starting today the coronavirus restrictions have been eased. We now have a Yellow status, meaning that we can travel within Tuscany and other Yellow regions, restaurants are opened for outdoor dining and there are plans in place to start opening museums and cinemas. And talk of opening up Italy for tourist in the months to come! Will we see you in Italy this year?

I am so ready for this!

End of Year Reflections

At the end of the year, I think that it is natural to reflect on the year that is finished and look forward to the one just about to begin. I think that we all agree that 2020 is a year like no other in our lifetime. We watched movies and read stories about pandemics, but none of us had experienced one. Each of us experienced it differently, depending on our circumstances, our nature, our faith, and those around us. We had the additional unique experience of retiring and moving to a foreign land. So, how did we manage? Here are my reflections of our first ~10 months living in Italy during a pandemic.

Fireworks over Lucca

Our new town: We had visited Lucca three times before we moved here, so we had a good idea of what to expect. Yet on a daily basis, I still see beauty that I missed before. The walls, the streets, the churches, the museums – none are world class (well, except maybe the walls) but all dazzle me! And they are right outside my door! There are some aspects of Lucca that are “on hold” because of the coronavirus, such as concerts, celebrations, shows, and most street performers. We are definitely looking forward to them restarting!

Our new home: We are very thankful to have a beautiful apartment in a 500-year-old “palazzo” with amazing 360° views of Lucca. It’s on the third, fourth and fifth floor, and thankfully we have an elevator. But within the apartment there are still four sets of stairs! The layout is sorta odd, undoubtedly due to the multiple renovations that have taken place. But we use every part of the apartment and it is serving us well. It was renovated about 12 years ago but we have experienced several problems, such as leaking windows, leak in bathroom leading to some mold, steam heat & hot water that stopped and started every few days, and electricity that would shut down if we used too much. We continue to work through the problems; each time learning more and more about how to get things done in this culture.

View from our apartment, looking South

Our residency status: Before coming here, I generally understood the steps needed to become a permanent residence, but I underestimated the time needed to go through the steps and the number of times that I would need to copy our documentation (passport, codice fiscale, bank statements, birth certificates, …) and present it to a person who would painfully take us through the next step. Thankfully we were introduced to Tony, who helps us each step of the way. He tells us what the next step is, what documentation to bring, gets in line early for us, and talks to the person. For this, we give him €20. A very low price to pay for this valuable service! Jim has finished the process but I am still in the middle (due to an error that I made days after our arrival here). But it is nearly time for Jim to start renewing his “permesso di soggiorno”!

Our health: One of my goals for this year was to “Learn about the Italian medical system”. Well, I nailed that goal! Italy has a highly rated national health program that is generally covered by the taxes paid by residents. But in order to move here we need to get private medical insurance to have before we were able to sign up for the national program. We have been to the doctor several times each, gotten Xray’s, MRIs, blood tests, and Jim had a minor operation. So, yeah, I’ve learned a lot about the medical system…  The best parts have been finding good doctors that can speak English (easily or with some difficulty), pharmacists who are really very helpful and relatively low price for services and medicines. But we are still waiting for reimbursement for that operation that occurred at the end of August. In general, our health is probably a lot better than in the past. We walk more, ride bicycles again, and eat fresh & healthy food every day. Just still too much food & wine, so we plan to work on that in 2021…

Our friends: Despite the coronavirus restrictions, we’ve been able to develop friendships with several Italians and American expats. There was an active group of English-speakers that would meet each Monday afternoon in Lucca. Given the coronavirus restrictions, they aren’t so actively currently, but we look forward to engaging with them in the future. So far, all of our Italian friends speak English fluently (or nearly so). I know several non-English speakers, but relationships develop slowly when the conversations can’t go very deep!

Our church: Lucca is sometimes called “The City of 100 Churches” but they are nearly all Catholic… Our faith is very important to us, but we are not Catholic. So, we were thrilled to find a protestant church in one of our early visits to Lucca. Once we arrived, we started attending regularly via Zoom or in person, depending on the coronavirus restrictions. The church and people are wonderful, but frankly we really struggled with the language. A few months ago, we decided that we would attend an English-speaking church in Florence (about an hour drive from here) once things re-open. In the meantime, we watch various church services online and share a Bible study with an American couple here. Maybe one day there will be an international church in Lucca. We are looking for volunteers to come to Italy and help start it!

Our language skills: We consider this our full-time job. I’ve been studying Italian off and on since 2017. I’m currently working with an online tutor two times per week and a local tutor once per week. I can comfortably talk with people in stores, ask for desired items, and pay for my purchases with a bit of chit-chat mixed in. Phone calls are still challenging but I was very pleased that I made a follow-up doctor’s appointment last week with no major problem. As part of our “integration agreement” to become permanent residents, we need to pass a language test at the A2 level. I hoping to complete the test this Spring or Summer. Jim essentially started over when we moved here. He works with an online tutor three times a week and I think that he is making great progress. His biggest challenge is that he depends on me to communicate in challenging situations!

Our transportation: We mostly stay in town given the coronavirus restrictions and our primary mode of transportation is walking and riding bicycles. But in late December we purchased a car, making local trips to doctors, supermarkets, and home improvement stores easier. We look forward to the time when we can drive around Tuscany and Italy. We can use our U.S. driver’s license with an International Driver Permit for one year after establishing our formal residency here. Then we need to get an Italian driver licenses. The test is difficult for everyone AND is in Italian. It typically takes expats 3 months of intense studying to pass it. And because we will be considered “new drivers”, we will get provisional licenses and can only drive cars with very small engines. Really… with 45 years of driving experience…

Our finances: We are doing ok, especially given that we retired several years before we expected to. We have a great financial planner who is guiding us through new situations for us. I’ve learned to deal with our bank better but we are still adjusting to managing our cash flow, utilizing debit cards, an Italian credit card, and occasional trips to the bank for withdrawals. Some of their rules still don’t make sense to me. The exchange rate dropped a lot but fortunately our planner suggested that we transfer several months of money before the big drop. I’m hoping for better exchange rates before March! I’ve also started to prepare for the Italian and US tax activities that we’ll tackle in early 2021.

Our retirement: I still can’t believe that we don’t have to go to work on Monday… or next week… or next month…

And what about 2021? Jim gave me a funny look when I said that we ought to come up with goals and objectives for 2021, but all of those years of annual planning cycles have trained me… I won’t bore you with all of the details but two that we are really looking forward to are:

  • Travel within Italy, including Sicily wine tour and regions that we haven’t visited before
  • Welcoming visitors, and helping them learn about the beauty of culture of Italy

We hope and pray that the coronavirus will come under control in 2021 and we will all have a good and healthy year!

It’s Beginning to Look a Lot Like Christmas!

But of course, first there is Thanksgiving… Most years, we stray quite far from the traditional feast. I suppose that we wanted more normalcy this year, so went with the traditional foods of Thanksgiving. However, purchasing and preparing the foods was not so traditional. It is difficult to find the typical ingredients, so we had turkey parts instead of a whole turkey, made the dressing from fresh bread, etc. I made my first ever green bean casserole, but completely from scratch. And 99% of the people around us weren’t celebrating! Normally the American Expats would gather, but not this year. We still spent the day focused on what we are thankful for and had phone calls and messaged with several family members.

On Thanksgiving Day, Lucca turned on its Christmas lights. The streets are beautifully lit and several of the piazzas have special decorations. Each year they pick a different theme for the special decorations; this year it is the poetry of Dante Alighieri.

You may be wondering if the town has any Christmas trees in the piazzas… One is up, but not decorated yet. The Italian tradition is to wait until December. 8th. Most of the shops are stilled closed because of the coronavirus, but they should be reopening on December 3 or 4. An article in a local news site said this about the uniqueness of this year:

“The light – comments the councilor for economic development of the Municipality of Lucca Chiara Martini – is the symbol of hope, we are in a difficult moment for our country, but we did not want to give up Christmas lights to the warmth they can give. The Municipality of Lucca has given its support because even the symbols of tradition are important for a community affected by suffering and economic difficulties and commerce is the living heart of our city: we support our traders, especially small businesses, our restaurants, our bars, our artisans. Never as this year is it important to make our purchases at zero km to help local businesses and reach a spring in which we hope to definitively overcome the health emergency “.

We have been minimizing our Amazon orders, shopping at the local stores that are still open, and waiting for others to reopen soon.

We also set up our tree in our altana, which can be seen from Lucca’s wall. Jim has enjoyed lighting the tree and putting up special lights for Christmas in the altana.

It’s not only beginning to look a lot like Christmas, it’s also starting to feel like Christmas. Our hope and prayer are that you will have a special Christmas and will reflect on God’s awesome power and His amazing love!

6 months in Italy and some glitches!

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. 

More directional signs than an international airport!

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!