These are several brief (maybe not so brief) chapters from a book I wrote about my life that I think my neuro colleagues would find interesting. I’m in the process of looking for a publisher. I do hope that those with delicate ears on the neuro list will not be offended by my explicit language. Although some may not agree, I think it adds some color. I’m really not writing for a professional crowd. Also, I’m sure that the grammarians on the list would take issue with some of my sentence structures. I decided to write what I think is in a less formal manner and I ignored a lot of the mistakes that pop up when I click on grammar check. Please take into consideration that a lot of what I have written is presently anachronistic. Thanks for your interest.
A cliche’ from the Peanuts strip.
It was November 1976 in Vicenza.
I found office space during a previous trip I
made to Italy while in the Army at Frankfurt.
It was in a small multi-specialty complex in
the center of the city.
Looked like a good location.
The office was small but enough space for a
reflex hammer and safety pin.
Those were mainly the armamentarium for a
The receptionist was beautiful and she told me
she would get the word out regarding my availability.
Who would not look and listen to her?
I put up my shingle
along with the other professionals on the wall outside the building. I waited
for the herds of patients but only got a few strays.
I should have done more research regarding what private practice was at that time in Italy. There was no quota for entrance into medical school. The whole country was overloaded with physicians, in fact, there were about 70,000 unemployed or under-employed. Most of them were not specialized, just neo-graduates looking for a job. I thought that being specialized I would not be part of their competition and for the most part I wasn’t. But, there was a general atmosphere of cutthroat competition. Just too many physicians in all specialties. I didn’t know, and I sure as hell should have, that there were already 7 practicing neurologists in Vicenza at that time for a population of about 120,000. Stateside statistics at that time, which I still think is valid, is that one neurologist for 100,000 people is the right match, right for a productive practice and right for patient care. Obviously, only a small fraction of the 100,000 have neurological problems or need evaluation. I knew some of this but thought than an American trained specialist with a foreign name would be attractive. Italy was not at all xenophobic or anti-Semitic. No one there would associate me with being Jewish. My last name is so very German. And the Italians loved the Germans. I could never figure out why after what they went through during the war. Maybe it was more envy than love. It was quite obvious that, after the war, Germany was leaving Italy in the dust with progress it made in all fields. So, I became the German doctor as far as everyone was concerned. I thought that maybe it was better that way, better for business. What I didn’t know is what the common knowledge was of what a neurologist does. For years, it was always neuropsychiatry. It had recently split and seems that the public relations people failed; the word seems to have never gotten out. For patients with emotional problems, it seemed saying that going to a neurologist was much more acceptable than saying they were seeing a psychiatrist. Apparently wanting to avoid social stigma. So, the practicing neurologists were really doing what I call “little league psychiatry”. They would listen to patients and then write a series of prescriptions. To me, this was professional prostitution and I never accepted becoming a hooker. Psychotherapy was unheard of. The real neurology was done at the main provincial hospital. If a patient was hospitalized, care would be taken over by the hospital staff. Following a hospitalized patient was impossible. This I knew but thought that I could satisfy myself doing strictly outpatient work at my office. I wasn’t looking for wealth; just enough to live comfortably. And, I had enough of bureaucracy and on-call obligations over the previous 8 years. Malpractice insurance was ridiculously cheap. Only about $300 a year!
So, my first patient was a young guy who told me that his problem was that he planned to get married the next day and was having second thoughts! I looked at him and tried to think what the fuck this has to do with neurology! I didn’t know how to proceed; after all, he did pay for his visit. I felt that I did have to say and do something. I asked him if at least he had a headache. No luck! No headache! I asked if he was fainting. No luck again! No fainting! I asked if anyone in his family had neurological disease. He didn’t know what that was! I gave up! I told him to go find a psychologist, or a priest, or a friend, or his mother! I didn’t do a damn thing for him and told him to get his money back for the visit. Not a good beginning. Obviously I couldn’t tell him to go see a psychiatrist since that was what he was avoiding in the first place. Wait, it gets better. The second patient I saw was a 12-year-old girl who came with her mother. After a detailed history and examination, it was quite obvious to me that she had a seizure disorder, epilepsy, absence spells. I ordered all the necessary tests (blood tests, EEG, skull X-rays, etc., etc.) and ordered the proper medication and learned later on that she did very well. From a professional standpoint, things started looking better for me after this second patient. But, the third came and I went back to square one. She was a pretty 20-year-old girl. She was very nervous and embarrassed and it took forever for her to tell me what her problem was. I was patient and coaxed her along. She finally turned red and told me that when she has sex with her boyfriend she has an immediate orgasm and thinks it’s all over. She stops and her boyfriend gets pissed. He apparently was just getting started. I thought that, for her, isn’t she lucky! I told her that women could have multiple orgasms and that she shouldn’t stop after the first. She told me that she never heard about that. She seemed so happy and thanked me so much. I did take her money! The next patient put me behind square one. He was a 30-year-old office worker. He told me that he gets an erection when he is near a cemetery! In fact, he finds himself going to cemeteries more and more recently! Necrophilia! I did know that he had a serious problem. I spent the next hour trying to convince him to see a psychiatrist, a good psychiatrist. He initially resisted but I told him what neurologists do and what psychiatrists do and that I think that his problem is serious but can be helped with proper management. I think he got the picture. I gave him a referral. I never knew if he followed through. I didn’t do a damn thing for him neurologically, but I do think that I oriented him towards proper care and it was a lot of work. I took his money! However, I wanted out of this stuff. If this was private practice in neurology, I thought that maybe I should go and wash windows! The next day I went to the main hospital and spoke with the director of the neurology division. I knew that I could never get a position there because it was government run and I was not an Italian citizen. Also, there were no positions open. I wanted to be in neurology land and told him I would work there for nothing and see what happens. He was only too happy to get free help. I made the right choice because working there for several weeks and meeting colleagues, the world opened up for me.
After several days doing pro bono work at the Italian hospital, I became friendly with one of my colleagues, a neurologist, from Naples. We became friends and played tennis together on several occasions. I invited he and his wife for dinner. One word led to another and he told me that he was doing consultations on the side at a clinic for neurologically disabled children and young adults. The clinic was a private daytime residential setting with outpatient service. The place was situated 32 kilometers from Vicenza and my colleague told me he was tired of traveling there 3 times a week. I told him, “Have hammer, will travel!” He arranged for me to take over. It was a roaring success. Everyone there loved me. I did have some experience in pediatric neurology from the Army hospital while at Frankfurt. Once a week we would hold a combined clinic with a pediatrician, psychologist, child psychiatrist, physical and occupational therapist and social worker. I did this for 3 years. I found the same setup at this new place. The pathology was more than interesting. I never knew there were so many neurologically impaired children in such a limited area. In addition to outpatient referrals to that clinic from local physicians, schools, church and parents, I also made house calls with the social worker, a nun, to many remote places up in the hills. I was appalled seeing how many handicapped children were hidden in their homes because the parents were too embarrassed to have them seen. The pathology was phenomenal. I initially had some trouble with the local dialect but got into it pretty fast. My social worker nun was great. Such a help and so important as a breakthrough dealing with ignorant and resistant families. Families probably wouldn’t have opened the door to a physician or teacher or a municipal social worker if they knew it was about their sequestrated child, but, the door was always open for a nun and she was the greatest sidekick. She told me that once she got information from a teacher at a small school way up in the hills that she had a child in her class who was disruptive and couldn’t sit still and that attempts to contact the parents failed. The nun went to the house to talk to the parents in a remote mountain area. When she got there, she found the child locked in a rabbit cage! She told the parents that there was probably another way to deal with the problem. They opened the cage and let the child out. I wonder who was happier, the kid or the rabbits. The nun social worker and I developed a very close relationship and eventually, during our conversations, she found out I was a Jew. I knew it would not matter at all. So, there I was in a most satisfying setting. Three half days a week initially. The money wasn’t great but at least something was coming in. This was already late November. This clinic had a smaller branch on the other side of the mountain. They asked me if I would cover that one too. There was already a neurologist there but at that time he needed some time off for something I don’t remember. It was supposed to be for 2 months. I grabbed at the opportunity and now it was 5 half days a week and a little more money. I found the same staff setup there and, they too, loved me, and they all continued to love me at both clinics for the next 10 years!
However, all this initial success had its down side. Everything that I was doing depended on a yearly contract. Every year, I had to sweat it out waiting for the contracts to be renewed. All depended on money that the agencies had available. My original clinic and the various small town’s city budgets. True, this went on for 10 years but every year there was the fear that there was no more money to fund the teams. Every year, was I “Queen for a Day” and eventually back to where I started? This ambiguity took its toll in my marriage. Growing intolerance regarding my long hours, limited availability and questionable viability. I ask, isn’t limited availability for family stuff for a doctor universal? Should not women who marry physicians be prepared? I think not all are which is certainly true in my case and hopefully not true for any of you reading this. But, I was really only trying to survive in a situation that, from the beginning, seemed like the cards were stacked against me. My destiny, being American, was to stay American. My destiny was to practice in the States, in a group practice like all my peers, buy a nice house maybe even with a pool, drive a Mercedes or Caddy instead of a Fiat and have more patients than I could handle. You can imagine how I felt when I would occasionally go back to the States and visit with some of my physician friends. What elegant houses they had while I was in a rented apartment in Italy. I guess I rationalized thinking they didn’t have the local color I had. They didn’t have a beautiful piazza in the center of the city with colorful shops, local architecture that echoed hundreds of years of culture, churchbells ringing in the distance, people singing in the streets. Most of them didn’t have the mountains for skiing at only a 30-minute drive or the beach an hour away. They had beautiful homes but as far as daily living is concerned, I saw it was shopping centers and work, work and more work. Sure, I did have a lot of work, but not anything like what I saw my friends doing. But, they sure as hell had security which I did not. However, my ultimate conclusion was that I was very happy with the choice I made in spite of the possibility of crises regarding my contracts. I knew I was swimming against the current but I tried to be a strong swimmer.
I think I’ll stop here in spite of the fact that my story is far from over. You can see that I got up to 1995 (1985 plus 10 years). It certainly does not stop there. Hard times and good times did follow. Professional and personal. I don’t want to impose on or monopolize your time. My book is rather lengthy and contains mostly non-medical stuff since it starts when I was about 4 years old living in Williamsburg, Brooklyn, in the Jewish ghetto. I am now 74 and still living in Vicenza Italy. I have been retired since 2007 and not liking it at all! The Italian Health System has mandatory retirement at age 70 and when you are out of the system there are slim pickings on the private side. I still would like to work. I know the immediate response of the reader would be why not come back to the States. The why not is another very long story. Thanks for sharing with me. Fred
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March 13, 2011
(c) 2011 M.H. Rivner