An American in Turin

A Foray Into the Italian Healthcare System

Nobody wants to be sick on vacation. You plan for months for the perfect trip, and then life happens. After my son’s and my 2022 trip to Venice was derailed by canceled flights and a family health crisis at home my wife, Amena Ali decided a make-good trip to Northern Italy for us this summer was in order.

Our 10-day, 7-city whistle-stop tour was to start in Turin and end in Bologna, making sure we saw, ate, and experienced as much as possible. But two days before departure, it hit me. Sore throat, coughing, and 101-degree fever. The debate over whether I should stay home or go lasted more than a day, But when the fever broke and after two negative covid tests, I decided to brave the trip.?

We arrived in Turin on a Friday morning, and I felt miserable. Given my cough, sore throat, and congestion, I was convinced I needed antibiotics and started exploring options. At home, I would have headed to an urgent care clinic, but trying to find something similar in Italy proved challenging. Our AirBNB hosts as well as a nearby pharmacist suggested that the only viable option was a hospital emergency room.??

Good, Fast and Cheap–Pick Two

We arrived at the Mauriziano Umberto hospital in the early afternoon. The ER waiting room was full of patients, and I braced myself for a long afternoon. But to my surprise, upon checking in with the fluent English speaker behind the counter, I was quickly whisked into triage. The ER nurse was also fluent in English and after almost no time, took my vitals, conducted an intake interview, and arranged for me to be escorted through the bowels of the hospital to the ENT department for examination. The whole process took less than 15 minutes.?

There is a famous saying referring to goods and services. “Good, fast, and cheap. Pick two.” Upon arriving at the ENT department, within a couple of minutes, I was being examined by a doctor. The problem was she was an ENT. To a hammer, everything looks like a nail.?

The doctor examined my throat. She felt my glands. She asked if I had any pain in my ears. She didn’t listen to my chest. She didn’t test me for strep or any other form of infection. She concluded that my throat didn’t appear to have a bacterial infection and wanted to hold off prescribing antibiotics. She asserted that the best treatment would be to reduce the swelling and use pain relievers, allowing my body to fight the infection on its own. Of course, she did say, if my symptoms got worse, I should come back. I feared her approach of avoiding antibiotics would not solve the underlying problem, which turned out to be true.

Though disappointed by the outcome, there were two consolations. First, I was in and out of the hospital in about 45 minutes–unheard of in most ER settings. No doubt that was because I was a tourist–there’s no way the two dozen Italians in the ER waiting room had a similar experience.?

Second, when I asked the ENT doctor if there was a charge for the visit, I was told that tourists don’t pay for healthcare while on holiday in Italy. Coming from a country where healthcare providers stick it to uninsured patients, I was shocked and amazed. But in the end, the visit didn’t solve my problem. Fast and cheap, but not good, at least in terms of results.?

If at First You Don’t Succeed…

Despite the prescriptions, by Sunday morning, my symptoms had worsened significantly. Having barely slept, I was up early, ready to go back to the ER. Amena convinced me that I needed to try a different hospital, the one recommended by our AirBNB hosts. So at 8:30 am, she and I headed out to the Ospedale Molinetti.?

It turned out to be a completely different experience. After about 20 minutes, I was called into a small office to speak with an intake nurse who spoke virtually no English. Using a combination of broken Italian, Spanish, and Google Translate, I conveyed my situation. After being whisked off for a Covid test (which again came back negative), I was deposited in a waiting room for patients only–the security guard told Amena she couldn’t wait with me, so she had to wait outside the hospital.?

The wait to see the doctor was relatively short, so I was fully expecting a repeat of my expedited experience from Friday. I couldn’t have been more wrong. The walk down a hallway to the exam room was vaguely reminiscent of the early images from when Italy was Ground Zero for the Covid pandemic. There were patients on gurneys and in wheelchairs lining both sides of the hallway. Some were sleeping, some were crying out in pain, some blankly staring. It looked like purgatory.

Unlike the ENT at the prior hospital, this time the ER doctor was laser-focused on getting to the root cause of my distress rather than treating my symptoms. Apart from a thorough exam of my throat, sinuses, and breathing, his nurse took an EKG and drew blood for labs. The doctor told me that the labs would take a couple of hours. My illusion of being in and out in an hour was shattered, but at least finally I was going to get the care I needed.

The doctor directed me down a long deserted hall for an X-ray. When I arrived there was a window for registration but no one was there. I sat for about five minutes. Growing impatient, I walked through a door and poked my head into one of the X-ray rooms. A technician, clearly unaware that I had been waiting, motioned me to return to the waiting room. Within a couple of minutes, she called me in, took my X-rays, and sent me back to the main ER waiting room.??

By this point, it was just before 10am, and I had only been at the hospital for about an hour. Encouraging!? Presumably, the lab results would come back before noon, I’d get my prescription and be on my way. But the minutes and hours passed. The ER waiting room went from having a half dozen patients to a dozen, then two dozen. The board in the waiting room showed more than 50 patients being treated in the ER in addition to those waiting. Ambulances pulled up with patients in dire distress–someone having a heart issue, a car accident victim, several very old and frail patients.?

From the relative calm of early Sunday morning, clearly Turin had sprung to life and with it, the demands on the healthcare system. My cough and congestion paled in comparison to the condition of many who arrived as the hours passed. I listened carefully each time the garbled announcement came over the loudspeaker in the waiting room, announcing the next patient to be called back into purgatory, but my name never came.

In Healthcare, Patience is Not a Virtue

The locked entry doors to the clinical area where the ER patients were being treated became a source of fascination. Each time a name was called, a nurse would come out from the beyond and escort the patient back, just as I had been escorted hours earlier. But hovering just outside the doors, other patients and visitors waited for the doors to open. As soon as they did, they would scurry through, unescorted, and disappear into the maw. They would re-emerge a few minutes later and re-take their seats in the waiting room, sometimes reporting to their fellow inmates what they had learned.?

Several times, I had gone back to the intake nurse’s office to ask if there was any way of finding out what was going on with my blood test. I was told to take a seat and wait for my name to be called. But intrigued by the comings and goings of the patients sneaking back into the examination area, I decided to do the same. After all, what did I have to lose??

I positioned myself in front of the door and when it opened, casually slipped into the back. I took a left down the hall, passing the patients in wheelchairs and gurneys, and tried to peek into the exam room where I had met the doctor and nurse hours before, hoping they would be there, hoping they could tell me something, anything.?

My first foray yielded nothing. It didn’t help that I couldn’t understand anything anyone was saying. Deflated, I went back and sat down in the waiting room. But I was convinced that invading the ER was the only way I was ever going to get any information. At about 1:15pm, on my third expedition beyond the locked doors, I passed the nurse’s station and overheard a nurse uttering a flurry of Italian and then my name–Bessalel. It was a revelation!

I poked my head into the nurse’s station and said, “Io sono Bessalel” (I am Bessalel), one of the few phrases I had learned in my half-hearted, pre-trip attempt to learn Italian through Babbel. “Ah,” the nurse replied and immediately came out holding some papers.?

She explained in Italian and some halting English, that the test showed a high infection and I needed to go for a CT scan, She handed me an order for the scan and sent me back down the long desolate hall out of the ER toward radiology.?

With the reception window in radiology still closed and no one in sight, I repeated the process of spelunking through exam rooms until I finally found someone I could show the CT scan order to. Within minutes, a technician who spoke perfect English appeared and the scan was completed. I was then sent back to the ER waiting room and told to wait for my name to be called.

At this point, no one had explained to me exactly what the doctors were looking for. But the battery of tests they performed was impressive, especially compared to my experience at the first hospital. However, I remained in the dark, sitting in an overcrowded waiting room, with no idea how long I’d be there or how to glean any information other than by furtively sneaking back into the ER periodically and ambushing an unsuspecting nurse or doctor.?

After about an hour, I figured enough time had passed that the results of the CT scan should be complete. Either it would show I had pneumonia or not, and that should determine the doctor’s course of action. Dozens of times, the PA system would announce a patient’s name, but again, never mine. So once again, I snuck back into the ER. As luck would have it, I saw the doctor who had examined me. As he approached, I asked him a simple question, “Are we making progress?”?

Without missing a beat, he replied, “I have seen your CT results, and I have my diagnosis, but until radiology signs off on the test, there is nothing I can do.” I suppose hospitals in the US function similarly, but given the chaos in that ER and the clear lack of administrative infrastructure in radiology, I knew the only way to move things along was to take matters into my own hands.

I marched back down the long hall to radiology, into the exam areas, and buttonholed the technician who had performed my exam. I relayed the situation from the ER doctor. The technician kindly offered to ask the radiologist in charge to sign off on the scans.?

After five hours in the hospital, I was eager to get my walking papers. I was both astonished and frustrated that the only way to get things to move along was to sneak around from department to department pleading my case. Had I not gone to radiology and tracked down the technician, I’m certain it would have been hours more until the radiologist got around to reviewing my CT scan.

Speaking with the technician felt like progress, but I still had no idea how long it would take for the wheels of bureaucracy to turn. I went back to the ER waiting room and found a couple of chairs hidden from the suspicious eyes of the ER security guard by a vending machine. When the guard wasn’t looking, I beckoned Amena to come sit next to me and keep me company. We managed to go unnoticed by the guard for nearly three hours.

After another excruciating wait for the radiologist to sign off and to hear my name called, I decided to invade the ER again. I really couldn’t understand what was taking so long. I wasn’t the only patient feeling this way. At one point, there were seven patients lined up in front of the locked doors to the ER. When the door opened, all of us scampered in, with no particular destination and only a vague sense that we might learn a little something.?

When there had been just one or two border crossers, the nurses flitting about took no notice. But the sight of seven rogue patients all descending unescorted on the ER at once galvanized a stern middle-aged nurse to start squawking at all of us in Italian. She blocked the hallway, and assertively showed us the door, waiting until we had all retreated to the waiting room before returning to her duties. But like seagulls on a beach, within a few minutes, all of us, one by one, had snuck back into the ER. and were once again wandering the halls looking for anyone to talk to who could give us information.

I am not a patient person by nature. But there are times when you just have to accept that circumstances are out of your control. After talking to the radiology technician, I learned nothing further from my subsequent half-dozen furtive wanderings into the ER. Having Amena sitting with me certainly made the wait more tolerable. But we had tickets to the Juventus Serie A soccer game that evening, and not knowing when we would get out of the ER heightened the frustration of watching the minutes and hours tick by.?

Of course, I was in no shape to go to the game, but I was determined that Amena and our son Jordan Bessalel, CFA wouldn’t miss it. My whole point of going to the ER in the early morning was to get the ordeal over with so we could have our afternoon and evening free. Amena insisted that she didn’t want to leave me at the hospital alone, but I overrode her, convincing her that skipping the game or making Jordan go alone would be worse.?

Around 4:30pm, almost 8 hours after we had arrived at the hospital, Jordan showed up in a cab and spirited Amena away to the game. Somewhat depressed and still feeling terrible, I wistfully watched them drive off and then went back into the ER waiting room, prepared to settle in for a long evening. But miraculously, within ten minutes of their departure, I finally picked out my name in a garbled PA announcement and headed toward the locked ER doors.?

As the doors opened, the doctor who had examined me seven hours earlier emerged. I had worried that his shift might end and I would have to start over with a new doctor. I was grateful that he was still on duty, with his perfect English and his easy, professional demeanor. He escorted me past Dante’s Inferno, the dozens of patients calling out in pain or unconscious, or plaintively looking into each pair of eyes, including mine, that passed them by.?

The diagnosis turned out to be nothing serious. The doctor gave me a couple of prescriptions, including the long-coveted antibiotics. Of course, it being late on a Sunday afternoon in Italy, all of the pharmacies in the entire city were closed. Even the hospital pharmacy. I would have to endure one more sleepless night of endless coughing and congestion, but the next morning, a cure would be in my hands.?

As the doctor wrapped up our final encounter, he contritely apologized to me for the long delay. But at that moment, having seen the misery and chaos that he and his colleagues had been facing all day, my long wait seemed trivial.?

I responded, “Please don’t worry about it. I see what you have been dealing with all day, and you are truly heroes doing incredible work. I am thankful you are here.”? The appreciative expressions on the faces of the doctor and nurse said it all.?

Once again, despite the extensive treatments and testing I had received, as a tourist, I walked out of the hospital owing nothing. Although nine hours in the ER, especially during vacation,?was quite frustrating , when it comes to healthcare, I would gladly take good (and cheap) over fast any time.

Gus Bessalel is the author of the upcoming book, The Startup Lottery: Your Guide to Navigating Risk and Reward. The book is an essential guide for anyone considering a career in startups. To be notified of the book’s release in fall 2023, please visit thestartuplottery.com.?

A former Inc. 500 CEO, serial entrepreneur and 30-year veteran of startup life, Gus has a BA and MBA from Harvard University and started his career in management consulting at Bain & Co. He was also the Co-Founder of Compass Pro Bono, a volunteer consulting organization that advises nonprofits. He mentors young companies and entrepreneurs and writes about startups and business, among other eclectic topics.