In an Italian Hospital

(Don’t worry, everything is fine. Explanation of the photo above is for those intrepid readers who make it to the end.)

Like so many aspects of our life in Italy, the medical system has been full of surprises.

The first few times I went to the local hospitals I was pretty stunned. Many of the facilities were built in the 1960s, with that certain ambiance that only hulking cement structures with interiors that have that special-shade-of-green walls, plastic chairs, and fluorescent lights can deliver. I’ve sometimes spent half of an hour finding where I am supposed to go in these large labyrinths. If you are admitted for a stay, the food is notoriously terrible, so family members often bring in home-cooked dishes.

A few years ago, one of my doctors determined that I needed to have a procedure, which required a trip to the hospital. On the day of surgery, we wandered around until we found the correct waiting room, which was next door to the well-marked morgue.

Soon, I was lying on the gurney, waiting for surgery. No one asked for my name, date of birth, or to confirm the procedure I was about to have. Instead, my doctor/surgeon greeted me by name and was telling me stories about his teenage son who wanted to become a videogame developer and asked if I have any leads in California. The nurses were touching me, a lot. They patted my head and used my body as a desk, resting their clipboards on my stomach to take notes. As they were petting me I was told that all would be fine.

I was wheeled into the operating room and moved onto the table. I said hello to the crew, but I didn’t meet an anesthesiologist. I joked that I was a little concerned by this, and they told me that she was finishing her coffee and would arrive shortly.

A man came in wheeling an instrument they needed, replacing one that wasn’t working. My doctor/surgeon said to the technician that he’d never used this piece of equipment before, and was told that they all worked pretty much the same. Before I had time to worry, I was out. Guess my anesthesiologist had finished her coffee.

Next think I knew, I was in post-op, struggling to regain consciousness while petting my dog, Lola. In the hospital bed. Cuddled next to me. In the recovery room. John said that he went outside to give Lola some water, as she was in the shade under a porch on a really hot day. The nurse said to bring her in—Lola would be cooler and it would do me good to recover with her next to me. And it did.

And I never saw a bill.

Italian healthcare is often ranked #2 in the world, after France, with Italians having one of the longest lifespans in the world (all delivered at one of the lowest cost per patient globally). The quality of care varies from region to region, and we are lucky to be in Tuscany, which is one of the best.

I got a call at night from a friend whose husband had become oddly lethargic and unresponsive to conversation. She needed help getting him to the hospital as they live up a rough dirt road, and the ambulance (which is free, BTW) couldn’t get to their house. We called on a friend with a four-wheel drive to get him down the driveway to our car, and we drove him to the emergency room.

The doctor was puzzled by what was going on. Our friend was very fatigued and running a slight fever. The doctor wanted to be cautious, so she kept him overnight for observation. And she kept him for two weeks while she figured out what was wrong. Turns out he had sepsis resulting from a previous infection that hadn’t fully resolved. A more pressured hospital environment, motivated to get people out quickly, might have missed this condition as it took a persistent and curious doctor, observation time, and many tests to diagnose. And sepsis is a very serious, sometimes fatal condition, especially in older adults.

And they will never see a bill.

Sebastian was about twelve when we went to his new pediatrician for a check-up. Mid-exam the doctor said that she wanted to introduce Sebastian to her daughter, who was about his age. She got out her phone and called her daughter to have her meet Sebastian. (We happened to catch the moment above.) She followed up with us after the visit, and arranged to take them both on a “date” for the afternoon to a local pool. After that, his doctor and her family invited him on vacation to Calabria, which he declined. Almost a decade later, Sebastian remembers this with great amusement and affection, and reminded me of it for this article.

All check-ups are free.

The photo at the top was taken by John years ago when Donella was in a horse show. Things unfolded in a split second, and what he assumed he was getting—Donella and her mount sailing over a jump—turned out to be an unexpected parting of ways between human and horse. She landed on her arm, hard, and was in a lot of pain afterwards. We went to the emergency room to make sure there wasn’t a fracture.

We were sent to orthopedics, and her exam and X-rays took longer than they should have because all the doctors were laughing so hard at the photo. They would ask her a question, start to diagnose, and then see someone walking by the door and have to call them in to see the photo. I think she made the day of dozens of doctors and nurses that day, and it turned out to be a bad sprain, but fortunately not a break.

And we never saw a bill.

I haven’t yet figured out when payment is required. For blood tests and scans that are follow-ups to regular doctor visits there is a co-pay, on a sliding income scale. It is usually less than €50. But emergencies and more serious treatments seems to be completely covered. I see certain doctors privately for exams, but if there are any treatments needed it gets put through the public system.

It’s not always warm and fuzzy. I get my mammograms by being sent a letter telling me to show up to a mobile mammogram truck at a certain time. I arrive and knock on the door of the RV. A male technician opens it, gestures towards the machine, tells me to take off my shirt and proceeds to prod and squish. All in plain view of the unlocked door. This is not the experience I was used to in California with background sounds of whale calls, soft lights, and cotton gowns.

But, I never see a bill.

What I love about these experiences is that the personal and the professional co-mingle. I am sure that this is partially because of a different litigation climate, but I think there is more to it. As we found in schools, there seem to be fewer people hiding behind their professional masks, bolstering an aura of authority. Most people here are completely normal in their professional roles—more like what you’d expect if you had a coffee with them—while delivering excellent results. There’s something so self-accepting and confident, so relaxed and competent about many of my interactions with Italians that I love to see this attitude extend into the high-stakes world of medicine.

Witches and Wise Men

Just when I think I can’t take it anymore, there’s one more Italian holiday.

When American friends complain about the intensity of the holidays, I scoff. The Italian season continues in full swing until January 6th.

The merry-go-round of festivities starts on December 8th, The Feast of the Immaculate Conception, a national holiday, and the unofficial marker of when it’s OK to put up Christmas lights. Those of you with a good sense of the human gestation period might have figured out that this feast is not to mark the conception of Jesus, but rather Mary. Church fathers, in the 8th century, decided that her purity couldn’t be contaminated by having been conceived in lust, hence they created this holiday. For those not church-bound, the highlight of this day is a huge family lunch.

We roll directly into December 10th, when the village celebrates our ancient wooden carving of Our Lady of Loreto—the Virgin again—and hosts a procession carrying the statue past a series of nativity scenes starring locals. Street lights are extinguished and the village streets are lit solely by candles.

Then the main events hit—Christmas and New Year’s Eve and Day. Marked by huge family lunches. Think the holidays are over? Nope. The march continues to January 6th, the Epiphany, another national holiday.

One of my favorite things about living here occurs on several nights between Christmas Day and Epiphany—the living nativity, or presepe vivente—in a nearby hamlet. I have been twelve times and the magic hasn’t faded. A cluster of nondescript, fairly modern houses, and the adjacent garden plots and fields, transform into ancient Jerusalem. It’s epic—200 volunteers, 50 scenes of ancient life lit by 1500 candles, spread over a route more than a kilometer long, with music from Ben Hur blasting over speakers.

It has it all—nasty Romans running a slave market, donkeys turning an oil press, women washing clothes in a stream—all culminating in a manger with Mary, Joseph, and baby Jesus, along with a donkey and a cow. There’s even a field of lepers, of course.

We did a video one year answering some pressing questions—is it bad to be cast as a leper? Does the woman washing clothes have cold hands? What happens to the baby Jesus when he gets older?

The selection of the sacred family is managed carefully by the organizers to not hurt any feelings. Local couples who have recently given birth take turns, with girl newborns being as likely as boys. There have even been twins starring as the baby Jesus. Also, parents are parents—you don’t need to be married to be Mary and Joseph. This year, Jesus was a bit fussy near the end of his shift so he got a bottle, while a concerned and watchful cow looked on.

The sheer pageant of it sweeps me along—Italians have a special gift for spectacle—it is not a surprise that opera was created here. This year around 10,000 people will come. It’s all volunteer and raises money for charity. The event happens for five nights between December 26th and January 6th—it can’t start earlier because there wouldn’t be a baby Jesus. The three wise men don’t show up until the Epiphany on January 6th. They enter with great fanfare and head to the manger.

Epiphany Eve, on January 5th, is a big deal for children. A witch called La Befana flies on her broom to leave candy and toys for the good kids, and coal for the bad ones.

And, yes, Epiphany is celebrated by a having big lunch.

What a Decade in Italy Does to You

A few reasons why we are still here after twelve years.

Community is inescapable, in a way that is different from what I experienced in America. In a small example, when I go to a cafe to write, which is pretty often, I am the only person there who is alone. Literally. And I’m definitely the only ambiance-ruining sucker working on a computer. I have never seen a “to go” paper cup, except during Covid when the cafes were closed and everyone gathered outside to drink their espressos from tiny plastic cups, clustered with friends, chatting in the freezing cold. On my last trip to California, I was surprised by the change at Peet’s Coffee due to mobile to-go ordering. The long line of customers waiting for coffee and socializing was gone and I was the only customer physically in the store. The barista was swamped with orders coming in on his computer screen, and he never looked up, or made eye contact with me.

Here in Italy, trips to the cafe provide the cadence and spice for the day. People gather once or twice a day at the stand up bar, throw back very good shots of coffee, and laugh and joke with friends. They see the same group several times a day, yet there is always seems to be a sense of delight in getting together.

Self-acceptance and calm. We had a friend visit who runs a successful and demanding business, and is an author, and she was captivated by the co-owner of a local pizza place in the village square. This restaurant sells customized squares of pizza—one large sheet pan may contain a dozen different squares. The husband cooks and the wife takes orders, dispenses drinks, serves food, and works the register, all with unflappable calm. Even with twenty people jostling at the counter, all vying for her attention, she moves at the same pace, doesn’t seem frazzled or tense, and greets everyone with warmth and a look in the eye. She gets an enormous amount done, but without stress. My friend went back a second time to watch her in action.

My friend who works for a large, worldwide consulting firm in Milan has not found that this calm and self-acceptance scales to her workplace. She sees more of the dark side of Italy as there are so few good job opportunities that people who work at a company like hers will do anything to stay there, fueling long hours and a stifled culture. She feels like this hinders creativity and innovation.

After my mother died, several years ago, I shared the news with friends in the village and, without fail, got the same response. E’ la vita. “It’s life.” The first couple of times it happened, the response felt a little cold. But I’ve realized that it is part of this larger worldview of acceptance—certain things can be changed, but much cannot and it is better to embrace and accept.

Europe is small. I love to have adventures and the scale of this continent cries out for exploration. Within a two hour flight the options seem impossible to exhaust. Over the last decade we’ve traveled to Lebanon, Turkey, Sweden, Croatia, Corsica, Austria, the Netherlands, Switzerland, and Germany, and frequently get to the UK and France. All are inexpensive to reach—we’ve used a mix of trains (including a few memorable night trains), ferries, planes, and automobiles. I love that I can get to another world—architecture, language, food, attitudes—in less time than it would have taken me to drive from Northern to Southern California.

This sense of belonging to Europe has been profound for the kids. They have an expansiveness to their thinking and a range of future options that span countries and cultures. This excites and challenges them.

The historical scale feels as small as the geographical one. Millennia are crossed within in a few footsteps. It’s not infrequent that we are in places where Bronze Age discoveries merge into Etruscan, Roman, Visigoth, and Byzantine ones, and the march of time continues through medieval, the reconstruction after the bombings of WWII, and new construction. I am constantly brought face to face with my existence being a tiny blip in time, and I like that. Even now, as I type, I look over to the painting on the wall, and the terracotta on the floor, all of which date to the last time this house was remodeled— In 1777.

Raising kids has been easier. I discovered that our kids were a lot less fragile than I thought when we lived in Berkeley. They were twelve and eight when we left and I’d fallen into the trap of micromanaging—tried to influence which teachers they got, oversaw homework, searched for the “right” extracurricular activities, and encouraged certain friends over others. Turns out they needed none of that.

Here in Italy, they chose to go to the local village schools, not speaking any Italian at the start. They had enormous help from two lovely friends of ours during the first year, who supported them with language and homework, and then they picked up the reins themselves. My not meddling encouraged their growth as independent and self-managed learners (and people), which was already who they were at their core.

It’s a lot safer here than it was in our old neighborhood in California so they had more physical freedom from the start. When Sebastian was eight, I’d often have no idea where he was. But the village is small, the center car-free, and there was almost nothing that could go wrong. He reveled in this freedom—though he did discover that his every move was being watched by a network of grandmothers—an example of which I will share soon.

Donella got her scooter license, and a Vespa, when she was 14. It’s the way it is done here—give kids a chance to learn on scooters before they get their license to drive a car at 18. I was terrified every time she left the driveway, but a sense of autonomy and freedom at that age seemed like too important a thing to say no to.

Stunning beauty is almost everywhere I look. It fills my very being.

I live slightly out of focus. I’ve always had bad vision and yearned for things around me to be crystal clear. This myopia has spread to most elements of my life in Italy. Due to language, culture, social networks, and village history I often don’t know exactly what is going on. This can be frustrating, like when I’m at a doctor or the vet. I get about three or four lines down from the big “E” on the eye chart of understanding, but nowhere near the fine print at the bottom. To offset this is the delight of the “Flaneur Effect”. One of the definitions of flaneur is “the connoisseur of the street.” Sometimes a bit of blur can make other things pop more clearly. That has been one of my great discoveries of this adventure, that my type A self doesn’t have to know everything in an attempt to control it all. And that there is great pleasure, and a different kind of understanding, in stepping back and attempting to observe new things through the fog.

Thanks to everyone reading and sharing, and especially to my paid subscribers on Substack, who are putting fuel in my writing tank.

How to Move to Italy

I would have imagined an Epiphany would be loud. A moment accompanied by a flash of bright light that might leave a permanent mark on an object close by. Something between Harry Potter’s lightning bolt scar, a slice of toast with the image of Christ on it, and the sword in the rock at Rocamadour. The type of word that should always capitalized. All this was if I’d ever considered having an Epiphany at all, which I’d never given much thought to, before it happened.

I was Epiphanied when I was in the kitchen on a totally ordinary night while making a simple salad, not even bothering to add a shallot and mustard to the olive oil and vinegar. Many years after it happened to me, I wonder what others are doing the exact moment when it hits, the moment when it’s clear that their life, from top to bottom, has to change because they are stuck, and not living the lives they really want to be living. It struck me, with force and complete clarity, between whisking the dressing and pouring it on and I agreed it was right.

Something had to change. And nothing after was like it was before. And all roads finally led to Italy—but not Rome.

The passage above is from a book I am writing about our 12 years of living here. I often share on Itch the things that capture my attention about living in Italy, but nothing about how we actually did this move, and why. The book (fingers crossed) goes into detail, but here are a few headlines about how we approached making this change, which have become clearer to me over time.

Change. As a family, we’d always loved to travel—Europe in particular. John and Donella were as avid to have adventures as I was. Sebastian was eight and up for whatever his older sister thought was a good idea. The routine of our California life, no matter how wonderful discrete elements were, started to feel a bit stifling and we were restless. As a friend recently told me, you gave yourselves a great gift—the permission to change.

One year only. The framing of the move was as a family year abroad—a kind of sabbatical from our “real” lives. We said we’d keep going with this idea until someone said “no”—and no one did. The kids’ school said it would a worthwhile thing to do and that they’d catch up easily; the real estate agent told us we could easily rent our house furnished; and our clients didn’t care where our base of operations was. This idea, before I had a fancy term for it of prototyping a life change, was the most critical thing we did. We could have stepped back into our old life in an instant, so we didn’t have anything to look back on and mourn. It allowed us to live in the moment and move forward without regrets.

The Golden Ticket. After George W was re-elected we decided to pursue dual citizenship. John’s grandparents came from a small town in Calabria and we painstakingly pieced together the voluminous paper trail needed to prove citizenship by blood in Italy. We were successful, and John and the kids held Italian passports. I was a citizen-in-waiting due to my marriage to an Italian. (Little did I know I was marrying an Italian when we said our vows.)

We listened to our hearts. Our Italian passports opened up the EU to us, including the UK at the time, and initially we weren’t even considering Italy. The criteria at the beginning were that our adventure needed to occur somewhere hip and happening, and close to an international airport. We ended up in a place that didn’t even remotely fulfill either requirement. We investigated Amsterdam, Berlin, and London, among other places, but nothing was really getting our hearts pounding. One night, we had dinner in a chaotic, exuberant, family-run Italian restaurant and the idea of moving to Italy hit us. All of us suddenly sat up straighter and started talking at once. We knew we were now on the right path. Plus, it would give us a chance to figure out what being Italian actually meant.

Research. After deciding on Italy, we talked to about a dozen families who’d done similar sabbaticals and learned a great deal. The family who’d had the most profound and interesting experience had lived in a tiny village where they bonded deeply with the locals—a different experience from friends who’d ended up in Florence or Rome with a complete infrastructure for expats—and hyper-local felt like the more interesting path.

Bravery. We investigated international schools and discovered that kids who attended often didn’t learn the language or culture of the country that they were in, beyond the basics. Students were from all over the world, often at the school for just a year or so before they moved on, and although the experience was certainly international, it wasn’t necessarily Italian. Donella (and by extension her little brother) decided that they wanted to go to local schools to become fluent. They started Italian schools not speaking a word of Italian. Now they speak like natives and have often delighted in having not entirely appropriate conversation with friends, in partial dialect, right in front of us and we can’t keep up. It’s handy to have a secret language your parents don’t know.

Off Roading. We were comfortable going “off road” because it was initially only for a year. We chose our village sight unseen, driven by finding an apartment or house where we wanted to live. After looking at about a thousand short-term vacation rentals online we found an apartment that was beautiful, mysterious, and as different from our California home as possible—four restored nuns’ cells in a convent from the 1600s. The owner was willing to rent it out for the year, with everything from sheets to spoons. We weren’t worried about the kids’ education as it didn’t need to track to any American standards. If we went back, they would get back on the path and in the meantime they’d learn far more interesting things than rote curriculum. Our work with clients continued and often involved international travel, so we had the freedom to be based anywhere.

Trusting the universe, and ourselves. I’ve always been a worrier and a planner, but for this move it was all up to chance—the village, the apartment, the school, living in Italy—no way to control anything. We just had to go with it, and I’ve become comfortable in this mode. The universe sent us two perfect mentors for the kids, which was the biggest gift possible. For the first year they’d pick them up from school, have them over for lunch, and help with homework and Italian. We couldn’t have been successful in making the move work for everyone without them.

The Conversation. In retrospect, one thing that amazes me is that at the end of the year we never had The Family Conversation, complete with columns of pros and cons, about whether to go back to California. None of us even thought of discussing a return to our old lives. We were having too much fun, had too much yet to figure out, and we wanted to see where the adventure led next.

Regrets? Almost none, except missing some family moments. People we love come to visit, and for more intense, intimate times than what we often had together back in our frenzied California lives. What we lost in frequency we’ve gained in depth. We’ve all changed in ways that we like. The kids have thanked us multiple times, saying that this was the best thing we could have done for them—and they wonder about who they would have become had they stayed in California, in what they view as the more narrow American path. But, I do miss readily available fresh cilantro and Indian food.

Getting to the Bottom of Italian Wine

“Don’t worry, I wash really well before I get into the barrel to crush the grapes,” Filippo told me.

My visit to Filippo Volpi’s winery—note that the word “winery” is not linked as there is no website—started at one of our favorite local restaurants, a Slow Food gem. The wife (he’s in the kitchen, she’s front of house and always greets me enthusiastically by name when I call for a reservation) highly recommended a local, organic wine from Il Bioselvatico. The full perfection of the winery’s name, which means “The Wild Organic” became clear only later. We loved this wine. After two bottles—for the record we were with friends—we decided that we had to learn more and buy some. This was a bit of a challenge as we could only locate a not-frequently-updated Facebook page and a bunch of great reviews. I contacted the owner via Messenger and mentioned where we had encountered his wine, and he encouraged us to come by.

Living for years near Napa Valley, traveling a lot in France, and now living in Italy, I’ve been to my share of big, fancy and small boutique wineries, and thought I knew the drill. Nothing even remotely prepared me for our visit to Il Bioselvatico.

The first surprise was finding it. We entered the address into our GPS and arrived via a tiny country road to a driveway. I was looking around for some sort of sign that marked an entrance to a winery, but there was nothing. We finally found the handwriting on the mailbox.

At the end of a dirt track we pulled up to a house with a couple of outbuildings in the middle of fields of grapevines. Filippo yelled to us from a balcony about where to park and a bearded man with sparkling eyes came out to greet us. He invited us into his house for a coffee, then to the adjoining building where he makes wine. It didn’t take long to show us around. It’s a small operation. It’s only him, working the land he inherited from his father and aunt, and doing everything by hand.

Filippo is charming and passionate, producing wine with ancient techniques, organic and with no added sulfites. He started making wine in 2015 after spending years working in fine restaurants and learning about wines in Burgundy. His wines have gained a devoted following, mainly bought by restaurants. A Michelin one-star chef had called that day about purchasing some of his wine.

The old vines are only one type of grape, Sangiovese, and he has just ten acres. The vineyard is located at the intersection of four Tuscan valleys, one of which is the Val di Chiana, famous for its Chianina beef. Filippo said he gets a couple of these huge cows which graze loose in the fields, eating the grass and doing their bit for fertilizing the vines. After which, he told me, they are very delicious.

All the processing and aging of the wine happens in one room. There are no tastings offered or fancy cellars. He makes only one wine each year, 100% Sangiovese. He picks the grapes from the fields daily as they ripen and presses them throughout the harvest season, adding to the complexity of the wine. There is only one piece of machinery, which he uses only a couple of times a year, this pump.

The grapes are pressed by hand, eschewing modern techniques. Or rather, by more than hand. Filippo showed us two rows of barrels. Between the loose fitting wooden lids and the stew of grapes were sheets of heavy plastic, secured by large bungee cords. Several of the barrels had been pressed four times, others only once. We asked how they were pressed. Standing next to the barrels, the contents of which came to his belly, he said he gets in and stomps. Neither John or I had the courage to ask exactly what he wore during these pressings. After his careful nod to hygiene, noted above, and the sanitation guidelines on the door—plus the fact that we were alive and thriving after having two bottles over a week before—I felt reassured.

After the wine gets adequately macerated by his vigorous actions in the barrel it gets taken outside for the final press.

He was all out of the 2020 vintage, which we had loved, and he hadn’t had a chance to put the labels on the 2021 bottles yet so they weren’t for sale. He did have some magnums of 2020, so we bought two. He described the 2020 as very elegant, and the 2021 as more intense. Every year is very different, he said.

I can’t believe what he has pulled off. We’d visited an organic winery in this same area a couple of years ago where a couple was working hard to make it successful. The only way they could do it was for each to work full-time, and to run an agriturismo in some restored outbuildings, saving the winery work for the time leftover. The wine had been underwhelming, as much as we wanted to like it. What Filippo has accomplished with his ten acres, manual labor, cows, and traditional techniques is impressive.

A few comments that I noted about the wine and the unconventional way it’s made:

“Up front the taste is elegant but in the rear there is a hint of something unexpected.”

“While drinking this wine, and savouring the story of how it is made, I wish this glass was bottomless.”

“Grapes won’t be the only shriveled fruit that went into making this wine.”

“The 2020 vintage, often described as elegant, will leave you wishing there was no end to it.”

“This wine is everything you want it to be… and a weenie more.”

Bottoms up. Thanks again for reading.