If ever there was a walkable city, it is Trieste. Actually, most Italian cities are perfect for walking – and in fact, la passeggiata is a cultural attribute. I witnessed this yesterday, on Sunday, as families strolled leisurely through the town as dusk approached.
So, today, I had the opportunity to undertake a passeggiata of sorts with a delightful woman who is currently staying in the Ospedale Maggiore psychiatric unit. Imagine visiting a friend staying in the psych ward at one of our hospitals in L.A. and asking for permission to take the patient out for a stroll. I will stand corrected if someone emails me to say this is okay, but I do not think this would be allowed.
Why do we not allow this? I can think of three American reasons: (1) liability, (2) liability, (3) liability. Who, exactly, are we trying to protect?
For the next several days, I have been assigned to shadow Dr. Alessandra Oretti, who is the interim director of the Psychiatric Unit at the Ospedale Maggiore. I met her during my trip last December and found her to be warm and hospitable and wrote her afterwards hoping I could spend more time with her upon my return. Today, on Monday morning, it was anticipated that the six-bed unit in the city’s hospital might be busy after the weekend, but when we arrived at about 11:30 a.m., there were only three beds being used.
While Alessandra was conferring with her team, I went and introduced myself to one of the patients – let’s call her Giulia, because I promised her I would respect her privacy. I introduced myself to her – “mi chiamo Kerry. Sono di Los Angeles.” When I added more detail – sono di Hollywood — that got her attention and she wanted to know if I knew Christian Bale.
I asked her if we could talk, because I wanted to practice Italian. She was a willing partner (molto pazienza), and within a few minutes, I grabbed my dictionary (because there was no WiFi, so I could not use Google translate) and we relied upon that when we reached a roadblock in communication.
We explored self and family. I told her about my two adult children. I learned that she was an only child and an illness she had in the past created some pain in her hips when she walked. She lived at home with her parents and did not work. Giulia is 48 years old and though I could only discern a portion of her story because of our language barrier, it struck me that she longed to live an independent life, but something was keeping her tethered to her parents. We talked about the beauty of the Castelo di Miramare (one of her favorite places and mine too) and how the story of Emperor Maximilian was so sad (triste).
We reached a bit of conversational impasse, so I asked the staff if it would be possible to take Giulia for a walk, if she was open to that? Their response: “if she wants to go, that is her choice.” Wow! And, that, indeed, was her choice.
So, we grabbed our coats and as we walked out of the hospital, she asked if she could hold onto my arm. Here is what we did for the next two hours: strolled up and down the streets of Trieste, looking into shop windows. She clearly loves art and we looked into a window that had tea cups featuring images from Gustav Klimt paintings.
We had coffee, and then we explored a drug store, where she taught me many new words: balsam for hair conditioner, spazzolino for toothbrush, fondotinta for make-up.
We had far surpassed the hour that we said we’d be gone, and she wanted to go down to the harbor to take a photo. While we were there, she did get a phone call from the hospital. “Is everything ok?” She handed the phone to me and I assured them that we were on our way back! But I have to admit, I was completely lost and following her lead.
As we were strolling back to the hospital, I asked her why she still lived with her parents? I suspect this is a tricky story, because she embarked upon a passionate monologue that I could not understand and there were emotions involved that seemed quite complicated. She said she was stupido and I countered, “non è vero. Tu sei intelligente e bellissima.” Since I could not understand the majority of the words (except the repeated mention of her mother) I responded, instead, to the emotion.
Gently I said, as we got closer to the hospital: “Giulia, I have an idea for you.” She was interested to hear. In my super-infantile Italian, I said: “tu sei una donna adulta. È importante che vive con la tua indipendenza. Penso che, forse, trovi una amica (a roommate) e è possibile che dici a tua madre che per sei mese tu provi a vivere con la indipendenza?”
She did not argue. I do not know if this planted a seed. It really does not matter. What I learned today about this very authentic experience, as it plays out in Trieste, is this:
- The hospital is not locked. If someone wants to leave, they can. If you are truly providing a service that is valued, the patient will return if they go out for a stroll.
- Similar to what I described in my first blog about the allure of Italian accoglienza, upon our return, after spending some time having a coffee with Dr. Oretti and one of the psychiatric nurses, Domenico Petrara, I returned to the reception area, and there was Giulia sitting with all the staff and she was drawing. There was no separation; she was included in the conversation.
- Giulia has a story – and the staff in the mental health system makes every attempt to learn about who she is as a person. What does she like to do? What is her family situation? What are her health issues? What does she want? Her diagnosis is just one piece in the overall puzzle of who she is, and that factoid was a non-issue for me as I was granted permission (by her) to go our for a walk.
Twenty-six more days to go. I hope I have enough time to capture everything we all need to know about this remarkable human-focused system of care.