Dress Rehearsal

Giulio is set to get his adenoids out on Thursday. He has suffered from ear infections since he was four months old and by now has had more rounds of anti-biotics than I'd like to count. Along the way he has also suffered from two extreme allergic reactions to penicillian, one in which he wound up in the hospital, and another four day hospital stay over what was on its way to becoming mastoiditis. Everyone has told me that this surgery will change all that, that the rounds of antibiotics, the doctors' visits, the stress everytime he so much as coughs will vanish. Here's hoping. He was set to have the operation last week. We booked the operation 40 days earlier, and then 10 days before the set date he had to go the hospital for various tests and it was then that they gave us the definitive date for the operation. Which was just as well because organizing an overnight stay in a hospital required military precision and planning.
Our plan was that Lorenzo and I would be at the hospital all day with Giulio, and then in the evening I would go home to Livia and Lorenzo would stay overnight with Giulio. In Italian hospitals a parent or grandparent must be with the child at all times, which includes sleeping on a cot next to the child's hospital bed during the night. I remember my one overnight stay in a hospital when I was 9, they kicked the parents out at 8pm and practically barred them from re-entering before morning. (My dad still managed to sneak back in and sat by my bed until I fell asleep.) Even in Italy it wasn't always like this. Lorenzo has the horrific childhood memory when due to some illness he was isolated in hospital from his parents for something like 10 days! He remembers calling for his mother and not understanding why she wouldn't or couldn't come.
Luckily such draconian methods have gone by the wayside, perhaps to the point where we have gone a little too far in the other direction. There is nothing like trying to keep an energetic toddler entertained for four days on in a hospital ward to make you question if your parental presence is always absolutely necessary. Perhaps the hospitals smartened up to the fact that with mom or dad always present, the nurses would have more time to take care of patients, rather than running down the hallway after them. The only time we weren't allowed to stay overnight was when Livia was a few days old and being treated for jaundice. Ironically those first few days after birth is the one time when a woman is hormonally wired to not want her baby away from her for a moment, where as when they are older there are many times when you would pay to have them far away from you.....
Anyway, at least this time we had advanced notice, in the past Giulio's hospital stays have always come without any warning. Lorenzo asked for days off from work, and I moved my students and classes around in order to have the whole day free. I begged the lady as Livia's daycare for permission to leave her from 6:30am until 4pm, when Terry would go and get her and keep her until I came home, hopefully around 6:30 or 7. I felt terrible about leaving Livia all day, but as Lorenzo pointed out, Giulio was going to want his mommy. I lovingly packed his suitcase, and nervously presided over his cough that seemed to be only a cough, but was worrisome all the same. And we worried about the operation itself, how long it would take, how Giulio would feel afterwards, if he would be ok with the anesthetic. He needed the operation, WE needed him to have this operation, and would this cough keep him from having the operation because they had told us that if Giulio was sick they wouldn't do it? Then there was organizing for when Giulio was home again, how much school would he need to miss, I moved around more classes, promising to make them up the next week.
On Thursday morning we got up 5:45 and Lorenzo and Giulio were out the door by 6:15, the operation was set to take place around 7:30. I left around 6:40, left Livia at daycare and headed off to the hospital. Oh, yes, this was the other thing, the operation was not at our local hospital, the one five minutes from our house where both Giulio and Livia were born, and home to Giulio's previous hospital stays, but instead at a hospital 30 kilometers from home where they are well known for their ENTs. That was the other factor in this long day, the traffic. At any rate, I made good time and I was almost there when my phone rang. It was Lorenzo. I looked at the clock, only 7:15, still too early for any action.
"Yes?"
"CeeCee--we forgot the impegnativo from Giulio's pediatrician, I don't know if they will admit him without it."
"WHAT???!!"
The impegnativo is the pink slip of paper where your GP or Ped has to state what treatment needs to be done and why. This way the public health system pays for the treatment, it is certifying that this is a necessary operation, and it is being performed by doctors who are part of the NHS. If we didn't have it, it was very unlikely that they would admit Giulio for the operation, because it meant that the hospital would risk not being payed. Without the impegnativo the NHS wouldn't reimburse them for the cost of the operation, meaning it would be up to us to pay. But we could also just as easily promise to pay and then slip away without doing so.
I wasn't just irate about the forgotten impegnativo, I was irate about the WE. What WE?!! I hadn't known that we needed any sort of impegnativo, I had just spoken to Giulio's doctor a few days ago about a prescription and if I had known I would had asked her then for this super important piece of paper. Lorenzo had said nothing to me about needing an impegnativo, I had watched him check the list of papers we needed to bring with us just the night before. And now it seemed for a one small piece of paper, they wouldn't do the operation at all. I didn't know whether to laugh of cry. It's easy to sigh and say, oh Italy and its' bureucracy, but try getting admitted for an operation in the States saying you left your insurance information at home, but you would be sure and bring it tomorrow. They wouldn't let you into the parking lot.
At any rate, since I was practically there, I parked the car and went in the hospital to track down Lorenzo. I found him with a surprisingly cheerful (he hadn't eaten or drunk anything that morning) Giulio in tow. "Hi Mommy!" he cried, running over to me. "Hey, baby." I said, shooting snake eyes at Lorenzo over Giulio's head as I bent down to hug him.
"Ok," I said, straightening up. "What do we have to do?"
The first thing was to head up to the ward where Giulio's operation would be. There we found other parents with children and suitcases, and all surely, I thought grimly, with their impegnativi in hand. We explained our situation to Giulio's doctor, who referred us to the head nurse who did pre-surgery admittance for the ward. Her response when we told her that we didn't have the impegnativo was to beat her head on the door frame for a moment.
"I can't do anything," she said when she lifted her head. "Downstairs they won't admit him without it, meaning he won't be in the computer. For me, as long as you hear from his pediatrician and they promise to send the impegnativo over today, I don't have a problem. See what they say downstairs at Patient Admittance."
I looked at the clock, it was five minutes to 8, Giulio's pediatrician doesn't start taking calls until 8:30. You can call between 8:30 to 9:30 to get an appointment either for that day, or if you are calling about a check-up, later in the week. You call, describe your kid's symptons and she will tell you if they need to be seen that day or if you can wait and see for a day or so. Usually she will ask to see you that day. You also call about doctor's notes, prescriptions, and impegnativi, which she writes out and leaves in a basket in her office waiting room, with the child's name written on the outside for you to pick up. I decided to take a chance and go ahead and call, maybe she was answering early this morning. I immediately got her voice mail. Damn. I shook my head at Lorenzo, and then we went downstairs and outside where the phone reception was better, huddling in a tense group around Giulio's suitcase. I kept picking up the phone, calling, getting the dr's voice mail, cursing, and hanging up again. My stomach churned. Giulio needed this operation today, we had planned for today, I wasn't going to let some minor detail like an impegnativo stop me. At 8:32, the doctor picked up, I threw the phone at Lorenzo and let him ask her to help us. She was sympathetic, but she wasn't going to be in the office before the afternoon, one of us could come by and get the slip at 2, but not unfortunately not before then. It would have to do. We went back to the Patient Admittance desk downstairs, where Lorenzo had been rejected earlier to see what they would say about the impegnativo now that we had talked to the pediatrician. The lady wasn't moved. It wasn't us, she said, it was those doctors, always promising these forms, then forgetting to send them, and then the hospital gets stuck with the bill. She shook her head. I sat there on a bench next to the desk with Giulio in my lap and fixed her with my saddest,-come-on- we're-mothers,- I- know-you-have-been-here -too-look. I could see her weaken. "I will go there personally to pick up the form, this way you won't have to wait." I said. The woman was silent a moment. "Fine," she said. "It's not the parents,"she said again, typing away into the computer. "It's those doctors. Bring the form here as soon as you can!" We offered her thanks and our most dazzling smiles, and clutching the necessary admittance forms, ran upstairs once again to the third floor.
The head nurse was glad to see us, even though it was now 9:15. Smiling she ushured us into her office to start filling out forms. "Ok," she said, as I sat down across the table from her. "So, he hasn't eaten anything today, right? Any allergies? Ok......Now, how is he doing? Any health problems?" "Um," I said. "He has a bit of a cough, but other than that he is fine." She looked up from her paperwork. "Let me hear him cough." Giulio coughed. The nurse narrowed her eyes a moment. "Better check his temperature," she said, tucking a thermometer under his right arm. She continued with her questions. "Now Giulio there is a big girl in the same room as you, and you have to listen and do what she says." Giulio solemnly nodded. He knew all about listenting to older kids and doing what they said from preschool. I placed a well trained Mother's hand on Giulio's forehead and back. He didn't feel feverish. If we were at home right now, I would send him to school based on this forehead temperture reading. God Giulio, don't be sick, please don't be sick. We have made it this far, don't be sick. Giulio coughed again, this time it sounded more chesty, sick-y than the one he produced only moments before. The nurse got up and took the thermometer from his mouth. "Uh-uh." She shook her head. "He's got 98.9. Let me get the doctor." She left the room and came back almost immediately with someone in a long white coat. He looked in Giulio's mouth, ("well, he doesn't have tonsellitis.") and informed us that in doing surgery with even a low fever considerably raised the risks. Giulio would not be getting his andenoids out today. "Come back next week and we will do it then." The nurse smiled sympathetically, told us that the impegnativo that the pediatrician gave me today would still be good for next week, that she would see us soon, and escorted us out the door. It's didn't seem possible. We had overcome a lack of blood relatives, crazy work schedules, adversity, the Italian NHS, and low cell phone reception, only to be thwarted by a 98.9 fever. Defeated we slumped back to the car, Lorenzo headed off to the office, Giulio and I went home and watched "Babe".
The surgery was rescheduled, but this time Lorenzo is going by himself with Giulio, I have to work and I can't miss anymore lessons as this is the last week of school, and I don't feel like asking for any more favours from people, even if they would be more than willing to oblige. No, this time Lorenzo will be on his own. At least this time he has the impegnativo.