The Story of Kneeling Guy

After we arrived to Lucca in 2020 and the lockdowns started to be lifted, we began to recognize our “neighbors” on the streets. We live near one of the main entrances to Lucca and on the busiest shopping street of the city. So, we see visitors, tourists, Lucchesi, and our neighbors on a regular basis. Our neighbors include people that live close by, those that work in the businesses, and a variety of interesting characters. Some are well loved characters, such as Mario, who wanders the streets of Lucca singing, greeting the locals, and begging from others.

We also noticed a guy outside our palazzo that kneeled on a pad most evenings while begging. How could he kneel for so long without being in terrible pain??? We call him “Kneeling Guy”. Very creative, eh? He doesn’t really beg, but holds up a sign that says “Un Po di Aiuto” which roughly translates to “Some Help?”. I also noticed that many the locals stopped and chatted with him; he stands up and engages with them in lively conversations, just like many other groups on the streets. He often talked to the shopkeeper across the street. After a while, I greeted him with a friendly “Buono Sera” or “Good Evening”. He seemed like a healthy man in his late 40’s and Jim and I wondered what his story was.

One evening I was sitting on the step waiting for someone to arrive and we acknowledged each other. A person then left the B&B across the street and left the front door open. You don’t do that on our street – too busy! “Kneeling Guy” and I both looked at the door and exchanged puzzled looks. He got up, closed the door and I acknowledged his neighborly action. Our first interaction beyond simple greetings. I never gave him any money and he never asked for any or even seemed to expect it from me.

Over time we chatted briefly. He spoke Italian and was quite difficult for me to understand. For Christmas 2021 I made American-style muffins and gave them to many of our acquaintances. I gave him some muffins and a monetary gift. He was very appreciative and there were many “Buon Natale” greetings exchanged.

Through 2022 we continued to chat. I asked his name at one point but didn’t really understand what he said. I learned that he had a heart condition and was not allowed to work. One day Jim and I were walking down our street for the Italian tradition of an evening stroll called “passegiate”. I was shocked to see him in a different place – he was always right outside our door. Not every evening but several times I week. He saw my shocked looked and explained that it was just too busy at his usual location so he decided to move. Funny how we react when things unexpectedly change in our world.

The week before Christmas I saw him on the street, still in his “new” location. I gave him the gift and again he seemed quite pleased. He even mentioned the muffins that I gave him last year – I was touched that he remembered the gift! We chatted for a few minutes and he mentioned something about getting a new job, but I didn’t fully understand what he said.

For Christmas this year, I didn’t plan to bake but I wanted to give him a gift. I want it to be appropriate and useful, but more like a gift than a handout. I discussed this with my Italian tutor and she suggested socks or a hat, common gifts in Italy. There is a family that has sells socks from a stand on our street; I also consider them neighbors. They helped me select some warm socks and they even put them in a festive red bag with a bow. Perfetto! I included a Christmas card with a monetary gift and now I just need to carry it each evening when we out until I saw him again.

The next evening, we saw him again and he stopped us to chat. Again, he thanked us for the gifts and then shared his good news with us. That day he had succeeded in finalizing a contract for a new job. It sounded like he would be delivering the vehicles and then taking the train back. But that could be wrong… my comprehension with him is pretty low. The contract part is key; in Italy, with a work contract you have many protections and it is assumed to be a long-term position. He said that he would start at four days a week, but that it would increase. He would be starting on January 2nd and would need to buy some new clothes (which I assumed would be purchased with our monetary gift).

He also said that he would be here this evening and the next, but then no more. That is, no more kneeling on the street and he pointed to his sign. And he told us this with such gratefulness but not with a sense of shame either. He said that he hoped in the future to see us on the street but not kneeling, instead he would be walking on the street, greeting those that he knows. And he would greet us. We stood on the street celebrating his news and congratulating him. He remained kneeling, but not for much longer…


When Jim and I moved to Lucca, we set a goal for ourselves to “become part of the community” which includes learning the language, developing friends (both expats and Italians) and eventually to volunteer in the community. But that evening on our street, while celebrating with “Kneeling Guy,” I truly felt like a member of my community and especially my special neighborhood.

And none of my blog posts can be complete without some pretty pictures, so here are a few pictures that I took of my “neighborhood” – within a minute’s walk of our front door.

Epilogue… 22 April 2023

What a wonderful morning! Jim and I met a friend for coffee and breakfast this morning. An older Italian woman came in… one that I see there often. A few weeks ago we started chatting beyond the standard “Buon giorno”. Today we had a good 10 minute chat including exchanging names. Paola is my new Italian friend! As we were leaving, the man formerly known as “Kneeling Guy” steps in. I asked him how he was and he said “Molto bene! Tutto bene” – very well, everything is good. Work is going well and he is enjoying a few days off because of the national holiday on 25 April. His posture has changed. His face has changed. He is a proud man.

This is also the start of our local Festival of Santa Zita that fills up our oval piazza with flower vendors. What a glorious morning!

Is JoAn still blogging?

It has been 159 days since my last blog post…  Here’s where I should provide a compelling reason, but “I’ve been too busy” just seems lame! Just a few years ago I worked full time, volunteered weekly, was a serious birder, and planned fabulous trips to Italy. I suppose the best explanation is that I am now living “La Dolce Vita” at a (slower) speed than ever before. Why blog when I could visit with friends? Have an apertivo? Take a walk around the city? Play a game of Mahjong?

So, this blog post is going to be my “catch up” blog that gives a quick overview of our special visitors, recent trips, winery visits, and an Italian wedding. I’ll finish up with some updates on day-to-day life in Lucca.

Special Visitors

Visit from Dave, Jill, and their friends

Dave, a former colleague of JoAn’s, visited Lucca for four days with Jill, his wife, and their friends. They had visited Lucca several times, but never stayed here before. We loved showing them our city and they were even here for Lucca’s biggest procession of the year. (September)

Visit from Mickey and several of her friends

Now this was a complicated visit! Mickey, my sister, and Vicki, her best friend, stayed for a month and her five friends stayed for two+ weeks. Their trip included day trips to Florence, Cinque Terre, Pisa, and a nearby winery. They all travelled by train to Rome for several days, including a trip down to Pompeii. Of course, we spent a good amount of time wandering through Lucca as well. I suppose the trip would have been better if some of them didn’t miss a train connection and if two of them didn’t get COVID! Despite the challenges, it was wonderful to spend time with my sister and her friends. (October)

Visit from Derek and Dani

We had a short visit from Derek, our son, and Dani, his girlfriend, in November. After their short trip to Dublin, we prepared a traditional American Thanksgiving and shared with it them and some local American friends. We spent a day in Florence with them and another day at a winery in Chianti. A short but sweet visit! (November)

Recent Trips

Trip to Val D’Aosta and Piedmont with Gary and Ilene

An 8-day trip with four people in a Mini Cooper required planning and an installation of a luggage carrier.  We headed way up north in Italy to Monte Bianco/Mont Blanc. We explored the area… and struggled with all of the French words and pronunciations. Then we headed to Piedmont region where the emphasis was on winery visits and the famous Alba White Truffle. But my favorite activity was the visit to the Hazelnut farm! (October)

Trip to Lisbon

Mickey, Vicki and I went to Lisbon for a few days. Why Lisbon? Megan, my niece, and her family moved to Lisbon in early 2020. In the meantime, her daughter has grown from a baby to a pre-schooler full of energy and her own personality. AND Megan had a baby boy. So, we enjoyed seeing Lisbon with Megan and Ben as well as hanging out with them and the children. We even saw the house that they purchased and the big renovation plans for the next year or two. (November)

Trip to Bolzano for their Christmas market

Jim and I took a two-day trip to Bolzano in Northern Italy to enjoy the biggest Christmas market in Italy and to see the area. I posted a description (in Italian and English) and a bunch of pictures on my Facebook page here. (December)

Winery Visits

La Sala Winery with friends from Virginia

I connected with Bill on Facebook before his month-long trip to Lucca because we had mutual friends, the owners and staff of Pazzo Pomodoro, our favorite Italian restaurant in Virginia! Jimmy, one of the owners, was going to be in Florence and planned a lovely wine tasting at La Sala in the Chianti Classico region. Bill, Jim and I jumped into our Mini Cooper and met Jimmy, family, and friends at La Sala. We enjoyed a wonderful wine tasting including our second-ever barrel tasting. We enjoyed a lunch nearby then wandered to the nearby town of Panzano. We had a wonderful time getting to know Bill and shared a passion for older Italian wines. (July)

Barone Ricasoli winery with friends from Lucca

This wine tour came in four parts – castle tour with incredible history, wine making tour, wine tasting, and then a four-course lunch with wine pairings.  I recruited Gary, Ilene, Guy and Lita to accompany us and we headed deep into the Chianti Classico region. This castle was built between Florence and Siena so that the Florentines could keep a watchful eye for any invaders from Siena. Incredible history, fabulous views, and delicious wine and food. It was such a lovely day that we repeated it with Derek and Dani! (July)

Tempranillo Wine Festival in Tuscany???

The Beconcini winery discovered Tempranillo wines on their property a few years after they purchased it. Tempranillo is native to Spain so there are several theories about how it ended up in Tuscany. I like the one that has the Spanish pilgrims bringing it here on their journeys. However it got here, we like their wine! Each Fall after harvest, this winery holds a festival where many people from the area come to enjoy a great meal and their delicious wine. Last year we went with Gary and Ilene. The event was so much fun that Ilene spread the word amongst the expat community here and there were about 20 expats from Lucca at the event. Thanks for the picture, Ilene.  (September)

Italian Wedding

Rebecca and Nicola’s Wedding

Rebecca and Nicola, Italian friends, own Vinarkià our favorite wine-cocktail-dinner bar that is steps from our front door. We met them the week that they opened in 2020 and have developed a strong friendship with them. We were thrilled to attend their wedding in August. Many of the traditions were similar (but not identical) to those in America and then there were some surprises for us too. Mostly we were just delighted to attend their beautiful ceremony with their family and friends. (August)

Day-to-Day Life

  • Italian language. Jim and I are continuing to study the Italian language, each working with a tutor one-on-one. I am working on becoming more comfortable using the grammar that I know, rather than learning new grammar. For my homework I read an article than write a few paragraphs about a related subject. Topics are varied from the structure of our governments to pieces of art. During our one-hour session, we discuss the topic, mistakes that I made in my writing, and work on my pronunciation. I’m now able to chit chat with Italians about lots of different topics and my stress level is down when talking on the phone. I hope that with a few more years of study I should be comfortable have substantial conversations with Italians – at their speed and with ample use of hand movements!
  • My knee. I’m approaching the one-year anniversary of my total knee replacement. I’m still slow on steps but my knee is no longer holding me back from exploring Lucca or any towns that we visit. I average about 7000 steps a day and have hit 17000 several times post-surgery. I’m satisfied with that!
  • Mahjong. This game has always interested me but I really had no idea how to play it. Several women expats in Lucca have begun playing weekly. Most of us are newbies, so it is a low stress learning environment. I’m having lots of fun learning the game and spending time with these friends – and have even gotten Mahjong a few times!

We are about a week away from Christmas and are currently staying busy enjoying the local activities and decorations, doing a bit of shopping and planning a lovely meal with friends. Jim and I hope that you have wonderful Christmas and New Year’s celebrations. One of my resolutions will surely be to blog more regularly!

Life in Lucca

I often get (and appreciate!) the compliments on my blog posts where we visit cities, churches, events, etc. and I post lots of pretty pictures. But I also get questions about day-to-day life in Italy. That’s a bit tougher to capture in a blog post, so this one includes a series of “vignettes” that I’ve collected over the last month to give a sense of the what it is like to live in Lucca.

Free coffee at our favorite bar!

Our favorite bar is across the street from our apartment; we often have coffee there in the morning or a Spritz in the evening. BTW, a “bar” in Italy is mostly for coffee and small snacks, but this one does serve wine and some cocktails in the early evening. It opened a year or so ago and we have been very impressed with Alessio, the young man who opened it. He is a hard worker and is very friendly to us and everyone else. He speaks little to no English. Over time, we are building a friendship – a few sentences at a time. My first fun outing after knee surgery was to his bar for a Spritz and he surprised me with sparkly candles with our snack. Fast forward to last week…  we noticed that Alessio was gone for several days and the young woman who also works there seemed to be covering all of the hours. On Tuesday we saw her opening around 8:30am and closing at 7pm. That’s a long day to be running a busy bar by yourself! This morning we had coffee there and was pleased to see that the Alessio has returned. I told him that she had done a great job while he was out and had been working very long hours. He was very pleased to hear this and explained that he had been away for his birthday. When we finished our coffee and Jim’s breakfast pastry, Alessio informed us that it was his treat. Not sure why… because we gave him feedback on his staff or because it was his birthday or something else? But it was a very nice gesture and makes us feel like we truly belong here. (23 June 2022)

Italy or America?

Today I spoke to a woman from TurboTax as I am finishing up our American tax returns and I wanted her to review my Foreign Tax Credit form. I explained that I live in Italy now and she asked a question that I get asked quite often – do you like living in Italy better than America? People ask it with much curiosity but I struggle to answer the question. Part of me wants to say with a big grin “Of course!” But it really feels like such an unfair comparison. When we were living in America, we worked 40-60 hours per week. Now we are retired and living in Italy. How can I compare the two? (23 June 2022)

Around the wall on my bicycle

This morning was my second time to ride my bicycle around the wall after my knee surgery. There is a long ramp to ride up onto the wall and I walked my bicycle up it for the first time. Today I was able to ride up the ramp. It felt good to know that my quad muscles were up to the task. I felt much more confident on my bicycle this time. Until I realized that Jim wasn’t behind me. I waited patiently and he finally appeared. Then stopped again. Clearly, he was having problems with his bicycle. I walked my bicycle back to him; he was having a problem with the chain. Not only had the chain fallen off of the gear, but it had gotten wedged between the gear and the bike frame. He was trying to get it sorted out and a police car slowly drove past us. They pulled over and walked back to help us! They had all the right tools – gloves and a key to push the chain out of the stuck spot. Lots of grazie’s later, they slowly pulled off. I always wondered why the police patrolled the wall. (24 June 2022)

Help from the Police

The Gas Bill

Gas is expensive in Italy and it takes a lot to heat a 500-year-old building. Our palazzo has a central system and so the cost for heating is included in our condominium fee. We also get a gas bill every two months that covers the gas used for cooking. Of course, we don’t use much so the bill is low – around €20 or €30 for two months. We have it set up to be paid automatically, so frankly I didn’t really pay attention to it. In March Jim noticed that it was €90! How could that be? Turns out that for the first year or so, our real estate agent was “self-reporting” the actual amount used each month. She stopped doing this and we didn’t realize it. So, the gas company estimated the usage. And their estimates increased substantially for every bill! Jim figured out how to check the meter and we went to the website to “self-report” but our actual was so different from their estimate that they didn’t accept our “self-report” actual value. A few emails later everything seemed to be fixed and we received the next bill with €0 due and a negative balance. And we added a monthly task to our calendar to “self-report”. But we were still out of sync and the website wouldn’t take our actual values. This morning, Jim checked the value and I entered the actual reading into the website and it accepted our “self-report”. I felt a huge sense of accomplishment. Just one more example of the Italian bureaucracy that can drive you crazy… (26 June 2022)

Opera students in Lucca

Lucca is the birthplace of Puccini, who is one of Italy’s most famous opera composers. There are several music schools in town: a high school focused on music, a world-renown school that attracts students and professionals from around the world to study classical music, and many more. The Opera Lucca program brings young people (17 years old to almost 30 this year) to Lucca for the summer to study the Italian language and opera (singing, piano, and even composition). This group has been practicing across the street from our friend Theresa and she has been quite an advocate for them. They held a concert in Lucca in a lovely garden tonight at 7pm. We headed out the door about 10 minutes before 7pm because it is only a 3-minute walk from where we live. But on the way, we found a bunch of our friends sitting at our favorite bar, so had to stop to chat. Several of us then wandered to the venue, assuming that they would start at least 20 minutes late like normal. Oops! This program is led by Americans and so the concert started promptly at 7pm! We were a few minutes late, but sat down trying not to disturb the others. There were about 50 people present – locals, expats, and staff from the Italian school. It really was a lovely concert. (1 July 2022)

Summer Heat

It’s usually very hot here in July and August – like the 96°F expected today. This year the heat started at the end of May and hasn’t let up. We have air conditioning in our apartment, but it is not “central air”. Our apartment has 5 units, scattered among the bigger rooms. And it costs a lot to run them. Many people seldom run them, either because of the high cost or the fear of getting sick from the cold breeze. Jim and I have settled into a routine during these hot days… head outside in the morning for exercise and errands… stay inside with the air conditioning during the hottest part of the day…  back outside after sun down. We turn on the air conditioning in the rooms that we are in and turn it off when we leave the room. Hence the apartment has cool and warm zones throughout the day. No wonder people think that they cause sickness…  (3 July 2022)

Celebrations with friends

So how to celebrate the Fourth of July when living in Italy? We were invited to Gary & Ilene’s house for a BBQ on their terrazzo. Barbara, a visitor from the USA, had mailed us a bunch of Red, White, and Blue party products so we were set. Hot dogs, hamburgers, ribs and all of the fixins. It was a lot of fun to celebrate with a group of Americans and one Brit! The next day was Ilene’s birthday, so we gathered at Vinarkià for a birthday celebration. We share many of these kinds of celebrations with local friends, given that our families are so far away.  (4 and 5 July 2022)

Learning the Language

A few months ago, a friend from the United States asked if I was fluent yet. Sadly, the answer is no. So, I did some research – how long does it take to get fluent or “fluent enough”? The US State Department figures that it takes 600-750 classroom hours to reach “Professional Working Proficiency” in Italian. My back of the envelope estimate says that I’ve had about 300 classroom hours, so I guess that I’m half way there. I think that a better gauge is my ability to converse with Italians that I know that don’t speak English. They tend to speak slowly with me and probably use simpler sentence structure and vocabulary. I can usually understand 80% of what they say and they understand me – despite my imperfect grammar. I’m back to studying with Elenora, my online tutor, whom I worked with during lockdown. We are meeting once per week, but I plan to increase that to twice per week once her schedule frees up. I made slow but steady program working with her. I also plan to return to the Lucca Italian School for a few more weeks this year; at LIS we spend about 4 hours per day listening and speaking only Italian and the immersion is very helpful. (14 July 2022)

Is life perfect here?

Nope, but it is pretty darn good! We are loving day-to-day life in Lucca and haven’t regretted the move.

Chiesa Di San Salvatore in Mustolio, Lucca

Lucca is known as the city of 100 churches. The bigger ones are opened frequently and welcome visitors most days. And the rest seem to be opened at random days and times. When we see one of the smaller churches with an open door, we take the opportunity to step in and see what’s inside.

Yesterday, the door of Chiesa Di San Salvatore in Mustolio was opened and we popped inside. It is a smaller church made from simpler materials (brick instead of marble, two colors on the windows, etc.). I came home and read more about the church THEN had an opportunity to visit again today. I always find it more meaningful when I understand the history and context of what I am seeing.

It’s relatively easy to find dates of constructions and renovations, but I like to get a better sense of the story of the churches that I visit. The Wanderer’s Guide to Lucca by Brian R. Lindquist describes a period of colorful history of the church and its interactions with two larger churches in town: San Michele and San Frediano:

“During the early 1100s San Salvatore was a source of conflict between the churches of San Frediano and San Michele. At that time the canons of San Frediano were becoming a powerful group. They built a magnificent new church and began acquiring widespread property, in the process alienating not only the officers of other churches but at times the Bishop and even the Pope. At the same time San Salvatore was available and had acquired sufficient wealth to be worth a takeover. It was located between San Frediano and San Michele, but closer to the latter and, therefore, the Canons of San Michele saw themselves as the rightful proprietors. In the traditional method of negotiating such disputes, street fights broke out between the two claimants. Stones were thrown, holy services disrupted. The dispute went on for years. In 1140, his patience at an end, the Pope issued a bull granting the church to the monastery of San Frediano. Popes come and go, but grudges live on. The dispute drew the censure of successive popes, until it was finally settled in favor of San Frediano, which had established firm ties at the Vatican; the prior of San Frediano would soon after be appointed a Cardinal.” (Bold is my emphasis)

So, the next time that there is a disagreement in your church, be thankful that there aren’t street fights, thrown stones, and disrupted church services to resolve the differences!

Today the church is the under the care of the Confraternita di Misicordia (Fraternity of Mercy) that provides ambulance service (free of charge!) and other services to the Lucca community. The church has an active congregation and the only non-peaceful interruptions are the ambulance sirens.

The Lintels

The most treasured pieces of artwork of the church today are outside. Above two of the doors are lintels, carved horizontal supports of stone across the top of a doors. These are considered “narrative lintels” as they each tell a story, both related to St. Nicholas. Most of these narrative lintels have been removed and placed in museums. There are only nine remaining on churches in western Tuscany and this church has two of them! These lintels are more than 800 years old and are still in good shape.

The lintel on the right front door tells a story in three episodes:

  1. A pagan king sat at a table with his queen and others. He is being served a drink by a young man whom he had captured and enslaved. St. Nicholas appears and grabs the young man by his hair.
  2. St. Nicholas delivers the young man to his mother and there is a lot of celebrating.
  3. Similar to the first episode, but this time the young man’s father is at the head of the table.

The second lintel is considered to be even more valuable, but I couldn’t find it on my first visit. I wandered around the church with Google Street View and found it on the side of the building…  today there is some construction materials in front of it and an ambulance next to it. Oh boy…  The carving on this lintel represents “the miracle of the washing” of the newborn St. Nicholas who stands up in the tub where two women are washing him.

Two crucifixes

There are two wooden crucifixes in the church from the 1300s. Both of have been restored and repaired several times.

We have probably visited a dozen churches in Lucca – some large and grand and others much simpler. Each one is filled with beautiful artwork that was created to be placed in this (or another) church. Beside admiring the artwork, architecture, and contemplating their history, I take a few minutes to pray for those that serve and attend church there. I am thankful that I have the time to stop and explore them as we wander the city. And that I can share all of this with you.

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.