Update from Italy: My Tuscan Mammogram

Vatican mammaries look way better than stock mammogram photos. Photo by Catalin Paterau on Unsplash.

Frances Mayes would probably never write about mammograms. Tuscan sun always sells, but Tuscan breast cancer-screening? I value all aspects of cultural foray and I’m a huge fan of universal healthcare so stay with me here.

This time last year in Florence we were halfway through a hard lockdown, and we didn’t know it would start to open up again on May 4. As far as we knew we were on that spaceship from Wall*E and navigating our new forever normal. Streets were empty. Ambulance sirens blared night and day. Cops yelled at us through megaphones to get back home if it looked like we were doing anything close to lingering or loitering. No one was accessing healthcare for routine reasons, and the hospital crisis was heavy upon us. At least one person in our wider community died from cancer diagnosed too late, which her surviving family attributes to her fear of seeing a doctor in those months.

But somehow we did make it through all that intact, touch wood. Jason went back to his office in early May, and I resumed my routine in early June. The school year started and our kids got trained in distancing and hand sanitizing. The school has a policy: any Covid symptoms in a kid must result in the kid staying home and returning to school only with a Covid-negative test result. One tiny wrinkle: we were not in the Italian public healthcare system for complicated reasons due to immigration status and tax status. Of course the kids got sniffles and colds. The hoops we had to jump through and the fees we paid to get them Covid tests miles outside of town were insane. Four hundred euros later one memorable week last fall, we agreed that we had to look into it. Then, after Christmas, when Eleanor famously got carsick and threw up into her face mask, Jason redoubled his efforts to not only buy us a new vehicle that would make everyone barf less, but also get us enrolled in Italian healthcare so that we could get a Covid test less than 10 miles from home.

Jason’s visa expressly prohibits him from accessing Italian healthcare. My immigration status is dependent on his, and the kids are with me, but I don’t have the public healthcare proscription. However, until last year, I had no Italian income, ergo paid no Italian taxes. And then when I did accrue Italian income, I did not pay IRPEF – the employer contribution to universal healthcare. These various bureaucratic conundrums went on for years until we worked out the paid enrollment option. We wired something like a thousand euros to the region and were issued healthcare cards the next day. I quickly located primary care physicians in town for the kids and me in the same practice a short walk from our palazzo. More importantly for our immediate needs, we can now obtain Covid tests in the normal, free, km0 way that everyone else in the Italian healthcare system can.

I was thrilled to finally get my card. We are happy to pay the annual premium even though Italians do not pay this fee. I tucked the card into my wallet and focused on feeling relieved.

The very next week an official envelope arrived at our address from a healthcare entity called ISPRO. Hmm what’s this? I thought. I opened it and read through it. I was being called for a mammogram! I read through the pages and understood I had been automatically scheduled due to my age and sex. No cost to me. Proactively contacted. Tuscan region, etc. etc. Jason met me at home for lunch that day and I told him the Tuscan region had contacted me. Now that I was 100% official in the healthcare system, naturally they want to check out my boobies. I never had a screen for breast cancer in the US, probably because they scheduled me when I was 40 and I promptly got pregnant with Eleanor, then was breastfeeding until we moved to Italy. For reasons that became very clear to me today, even though any reasonable woman might suspect them, no woman who is pregnant or breastfeeding should ever have a mammogram.

The Florentine hospital complex is a bit out of town. Jason first suggested I might ride my bike there, but the weather did not really cooperate. the day was socked in with leaden skies. Our angel of a neighbor Chiara took the kids for lunch while we drove out to my Tuscan mammogram appointment.

The Villa delle Rose is set back from the hospital, with an old strada bianca parking lot of white gravel. It was almost empty when we pulled up. I walked into the practically deserted villa clutching my raft of papers and was promptly greeted by a young woman in a very smart pair of glasses. I handed her my paperwork. She processed me in no time and sent me on my way down to the waiting room. A particular hallmark of Italian healthcare is the absolutely skeleton crew of admin staff compared to the US. There was literally one receptionist and one page of paperwork for me to complete, and the receptionist didn’t even want it. “You’ll give this directly to your screener,” she told me with a solemn face, handing me a thin paper slip with a number.

Of course, being me, and having a tendency toward inappropriate humor when faced with anxiety-inducing situation, all I could think of was Mardi Gras and wondered if I would get a string of beads. I sat down in the waiting area where two other women were also waiting. The waiting area seemed clean but a bit neglected. Posterboards with empty flyer pockets. They both nodded and greeted me cordially, looking up with buongiorno buongiorno. The digital numbers lit up scarlet on the board. It was like being at the meat market in the Mercato Sant’Ambrogio. I checked my number. F0013. I settled in and started to read my phone, but the numbers moved fast. In no time I was in the screening room. The kindly tech told me to disrobe from the waist. She kept up a patter I followed decently, no, no family history, not pregnant, never had a ‘gram before.

I stepped out of the tiny waiting room with my boobs out, relieved that the tech was a capable sixty-year-old woman in a lab coat with a halo of curly hair and a no-nonsense demeanor. No cape, no cover, which was surprising in a country where Alitalia flight attendants look like Diego della Palma runway models. I was surprised a local luxe brand missed this opportunity, but you know, how American of me to even think that. (“Gucci should really brand some cute mammogram capes! People would love that.”) She opened up the ultra high tech rocket ship of a machine and maneuvered my boobs, one at a time, onto the platen glass, apologizing profusely multiple times for how annoying this was going to be. Her demeanor reminded me of the Sant’Ambrogio butcher handling fresh chicken roasts. The machine flattened (ow – really flattened) and scanned each boob at two angles. Capable tech lady thanked me, told me to get dressed, and sent me on my way after giving a quick patter of instructions for exam result and callbacks for an echogram if needed.

And so, less than thirty minutes after I arrived, and having seen at least five other women getting screened, my appointment was complete. Proactive. No-nonsense. Every time I have an interaction with healthcare in Italy I am so relieved for the level of attention and care given. With a minimum of fuss, and a few humane comments about how this is no one’s favorite activity. I suppose my inner Finn thinks this is the way things should just be. Practical. Manageable. Especially after my healthcare-heavy years in the US from 2009-2011, then 2014-2015.

So, thank you, Italy, for looking after me. I am grateful. And thank you Jason for driving me out there on those crazy donkey cart roads that were paved in the hills around Careggi sometime around 1900.

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