… WHILE WE MAKE OTHER PLANS

We had planned a trip in mid-September … after the craziness and crowds of August had subsided … so innkeepers could catch their collective breaths, and would greet the year’s final guests with enthusiasm, not exasperation. The weather wouldn’t be so unbearably hot. Prices would go from gouge to normal. We’d drive south … starting in Rome, next the Amalfi Coast, back up to Naples, with a direct route east across the boot to Sulmona, and finally, with heads turned toward home, a stop in Orvieto. B&Bs known for fine foods … wineries we loved … genealogy … gelato.

And while I have not previously written about personal matters, in this time of heightened awareness when every sniffle seems a symptom, I consider this a Public Service Announcement … hiding in a story, our story. David’s story.

On August 1, a Thursday, David woke up and said he could barely breathe. He had had some shortness of breath for a few days … the residual of the bronchitis, we thought. In fact, later that morning (at the recommendation of his pulmonologist), David had appointments with a cardiologist and for a chest x-ray.

“It’s hard to breathe.”

We drove to the emergency room at the local hospital, 10 minutes away.

David was triaged, and taken into a treatment room quickly. I wanted to go with him … because the last time he was here, the attending physician hadn’t really believed his complaint … and I felt sure that if The Linda had been in the exam room, I would have insisted on more care than “take 2 ibruprofen and don’t bother to call me.” Please … per favore … I explained that I wanted to translate. No, they replied … but they let me stay in the Waiting for Treatment area behind the security door, rather than in the general waiting area.

I canceled the cardiologist appointment and the x-ray.

After an hour or so, I walked down the hall … and found David in the first room in the first curtained area. A full-face mask was giving him oxygen. They are going to admit me upstairs, he said. He was relieved to see me … as was I, to see him being treated. The ER doctor said he was responding well to therapy, but a chest x-ray showed that he had pneumonia in the right lung … and they had scheduled an echocardiogram for the next day. Protocol …? Precaution …? I stayed with David, talking with the nice nurses or hiding behind the curtain when Nurse Nasty walked by.

By mid-afternoon, an orderly arrived with a wheelchair. They gave David oxygen via nose tubes, and we headed upstairs to his room.

Two beds, David had the one near the window.

He settled in, as much as one can settle into a hospital bed with a cannula strapped to your face and an IV needle sticking into your forearm.

I called our American insurance company to see what I needed to do. The first of several calls, long calls. Tend to your husband … call us again, we’ll help however we can … yes there is coverage, especially in an emergency.

Hospital dinner is the early-bird special … in Italy that means 6.00 p.m. We discussed what stuff I should bring back the next day … and I began calling friends to find rides to and from the hospital. Visiting hours begin at 12.30, and while there is supposedly a break during the afternoon when visitors are no longer welcome … spoiler alert … The Linda was there throughout the afternoon until her ride arrived to take her home.

I kissed David … a domani.

I got into our Jetta … the car that had been mine in L.A., but which Italy said I couldn’t drive … and went to the dairy for milk, then headed home. Take that Motorizzazione and your layers of laws about licenses.

After I fed the kitties (priorities), I filled a backpack with clothes, a phone charger, Kindle, and a toothbrush and such, and set it by the door. The patient and I chatted and WhatsApped. He would get IV antibiotics twice a day and an inhaler treatment three times a day.

By the time I arrived the next afternoon, David had already had his echocardiogram. They said I have a tired heart, he said … but the doctors offered no more of an explanation and David, still surprised to find himself in the hospital, asked no questions. It was too vague a term to google, and we were left to wonder.

It seemed David would be here more than 1 night.

I WhatsApped David’s pulmonologist, who said he would come by to see David when he made his rounds. He said that the local hospital was fine for treating pneumonia … and didn’t agree to a transfer to the more renowned Careggi, in Florence, when we asked.

I spent a long time talking with our insurance company … and they assured me that emergency room visits and emergency admissions were covered. We discussed payment, direct or reimbursement. They mentioned that I could apply for pre-approval, but processing was about 5 business days … and I hoped David would be home by then. The list of documents was daunting, and since it wasn’t required, even the agent said not to do it. Everyone was understanding and nice.

My cousins called from Florida … and hearing their voices reassured me.

Friday afternoon, David & I knew he’d spend the weekend in the hospital (though the IV meds should have been an earlier clue). We also realized that his roommate, Marco … who had had a heart attack at the beach … was the father of a friend of ours.

The days passed, similar to the one before. Walking from bed to bathroom, bathroom to bed. It wasn’t until well into the next week that they would let David walk out of the room.

Nurses we knew came to visit David … dancer Giulia was even on duty one afternoon, and we hugged. Petra was out of town, but kept checking in via WhatsApp. Tiziana walked over a couple of days … and took me to zumba one evening. Stefie came by.

The following Wednesday, as I was in the car heading to the hospital, David called. His voice was filled with concern … the cardiologist had just finished another echocardiogram and there was a problem. The car barely stopped, and I raced upstairs. The dottoressa explained to me that there was a problem with David’s heart, and they wanted to do an angiogram. They were scheduling it the next morning at Santa Maria Annunziata… a place everyone called Ponte a Niccheri … the cardiac hospital in Florence’s southern suburb. Everyone said it was a great facility, the best in Tuscany. If they needed to place a stent, David would stay there overnight … otherwise, he’d come back here right away.

The dottoressa was nice and generous with her time. She recommended that David give up wine now, but thought, eventually, he could enjoy a glass. She also suggested we check the Mayo Clinic website for more information.

The good news that day was that a chest x-ray showed the pneumonia was cured.

The next morning it was barely 9.00 when David called to say the angio was finished … and that blood flow through his heart was normal and the valves were fine, without damage. Hence, no plasty … no stent … required. Great news! The ambulance brought him back in time for lunch.

Italian hospital food is edible. Prosciutto … tortelli al ragù … fish (not sticks) …

It was Thursday, and the nurses were saying that David probably would be discharged the next day. And that the cardiologist would explain everything to both of us.

Dottoressa and I also talked about paying the bill. She called administration and discussed our unusual situation. We had two options … pay now, then get reimbursed by our American insurance OR have the hospital send us a bill which we would submit to our insurance for direct payment to the hospital. We picked send us the bill, please. I said I was relieved … I thought it might be like a parking garage, where we had to pay before the exit gate opened. Dottoressa laughed.

Friday morning, the cardiologist talked with David. When I arrived at 12.30, I barely had a chance to talk with the doctor … because, unbeknownst to me, there is a sign-up sheet to actually talk with a doctor. I foolishly had waited in line … like people do at every other store, shop, company, and corporation in Italy. (I was prepared to go all Shirley MacLaine on them had they been difficult.)

At first reluctant … because “we already explained this all to David” … the doctors told me that David’s left ventricle was only pumping at 35%, he must take all of the pills the nurses would give him, and come back for a follow-up appointment on September 13. They also said he would have to give up all wine and eat a low animal fat, weight loss diet. I asked if they had some guidelines to give me (so I could show the recommendations to David) … and the doctor gave me a look as if to say, Skinny lady, you know what to do.

We have vacation plans, I explained, and will be away on September 13 … can we please reschedule the follow-up for a week later? The doctor looked at me. Sternly. First, we had to squeeze David into that September 13 date because it’s very important he be seen in that timeframe, 4 weeks of meds. Second, it would be risky to delay the follow-up … and we encourage you to cancel your vacation. His tone and the message were sobering.

35%.

I walked back to David’s room … and in my most gentle and persuasive voice, convinced him that we had to postpone our trip. Naples will be there in a few months, I said.

David agreed, and called the hotels who canceled without penalty.

The large envelope had all of the paperwork, including a list of 9 pills to take from morning — noon — evening — night … and boxes of pills.

No wheelchair on discharge, we walked slowly downstairs and met Giuliano in the parking lot.

I read the paperwork several times. Cardiomyopathy … EF 35% … I visited the Mayo Clinic website several times (sistolic). I made a chart of the meds (8.00, 12.00, 16.00, 18.00, 22.00) … and posted it on the fridge and left a copy on the dining table.

I was familiarizing myself with the terms of heart disease. EF is Ejection Fraction, how well the left ventricle pumps. Normal is 55% to 70%, below 40% is heart failure. Heart. Failure.

Those first few days were … strange, uncertain, nervous. I didn’t know what to expect. Should I expect something? What? I was anxious if I didn’t see David for a few minutes … at the store, in the garden. I reassured myself that the doctors would not have discharged him if he were an immediate risk.

It was easy to reduce salt (already moderate, a no-salt-shaker-on-the-table family) … a bit less olive oil (the only kind we have) … reduce, replate … lighten, limit. How delicious to have a garden full of veggies steps from our back door.

And while we were both stunned by the diagnosis, I realized it was a blessing … without the hospital stay, the heart disease could have progressed, would have gone unnoticed. Until …?

Special shout outs to Tiziana, Michela, Giuliano, Daniele, Gianluca, Piero, Sergio, Massimo and Giovanna, Andrea … (I have my license now.)

Epilogue. The canceled cardiologist appointment was now more important than ever. We rescheduled it for the first appointment available, three weeks after his discharge.

We left that appointment doubly happy … David’s echocardiogram showed his EF was up to 40%, thanks to the meds, and also that this doctor, Dr. C, works at Ponte a Niccheri (making him one of the best cardiologists in Tuscany). He suggested an MRI … to determine if it was a chronic condition or an infection caused by the pneumona. He told David to keep the follow up appointment at the hospital and come back to see him in 3 weeks after that.

The MRI, at Ponte a Niccheri, was the test that never was. The radiologist was hyper-vigilant and wouldn’t do the procedure due to David’s crustacean allergy … a/k/a iodine allergy. I’ll have a side dish of crab cakes, please. At that time, I hadn’t realized (a) a MRI sometimes used dye, thinking only CT scans used injections, or (b) there is a non-iodine dye available. So we went home, frustrated. On a humorous note … and one needs to find a humorous note wherever one can [smile] … when we told Dr. C what happened, he said everyone thinks that the radiologist is a stronzo (jerk), and are looking forward to his retirement in a few months.

The hospital appointment also went very well. David’s EF was still 40 to 43%. The doctor wrote 40% on the records, so she’d have flexibility in medications. She ordered a 24-hour Holter monitor to see overall heart function … and that test, too, had good results. David decided to scrap the hospital and stick with Dr. C.

There is a waiting list of about one year to see a cardiologist at the Mayo Clinic.

So that fall, we went to Los Angeles to see a specialist at UCLA. He confirmed Dr. C’s interpretation … and we exhaled with the second reassurance. That cardiologist was nice at the initial appointment, but brusque when reviewing the echocardiogram (in a why-are-you-here-when-you-don’t-really-have-heart-disease kind of way). The cardiomyopathy appeared to be what they called stress-induced … an infection from the pneumonia. He told David to continue with the meds and come back in a year. A serious, chronic condition turned out to be temporary … and while it was caused by the pneumonia, the heart was sending clues that it also was in distress.

Dr. C was glad to hear that his diagnosis matched the UCLA cardiologist. The one-year follow up will be with him.

PSA. Now, the Public Service Announcement part of this story … and the reason I’m writing about something much more personal, more private. (When I was diagnosed with glaucoma at a young age, it made my friends aware of this silent eye condition. A good side effect.)

Symptoms.

Symptoms should not be ignored. Things that, in retrospect, were outward symptoms of a serious problem.

Sweating … it was July in hot, muggy Italy, and most people perspire or sweat or glow, but this was extreme. As in, wet to the touch / wringing out a t-shirt midway through zumba. External body temperature … while David never complained of having a fever, he was hot to the touch. As in, I’m usually cold and he was decidedly hot. Body odor … David commented that his deoderant wasn’t working very well, and I had noticed a change. As in, it’s time to buy a stronger brand. (I did mention this to the pulmonologist … but not being a lung-related symptom, he didn’t recognize it).

So, pay attention to changes, to new things, to differences … in yourself and loved ones … because they might be symptoms. Think about one symptom, pay close attention to several symptoms. Do research … talk to family, friends, doctors … be proactive. This ends my PSA.

Stay healthy out there.

You will now be returned to our (regularly) scheduled stories.

ZUCCHINI-CHOCOLATE CHIP CAKE

3 eggs
1-½ cup sugar
1-⅛ cup oil
2 tsp. vanilla extract
4-½ cups grated zucchini
4-½ cups flour
2 tsp. baking powder
3/4 tsp. baking soda
½ tsp. salt
1 cup chocolate chips
1 cup walnuts, coarsely chopped

- Preheat oven to 350° F (170° C). Butter and flour two 8 x 4” loaf pan.
- In large bowl, mix sugar and eggs, then add oil, followed by zucchini.
- Stir in flour and other dry ingredients.
- Add walnuts and chocolate chips.
- Pour into the prepared pan.
- Bake for 30 to 35 minutes, until done.
- Serve at any temperature.
Enjoy!