Emergency hospital visit in Naples, Italy

By Philip Wagenaar, MD
This item appears on page 51 of the September 2016 issue.

I was shaking uncontrollably and curled up in the fetal position in the corner of my sofa when my friends found me in my stateroom. 

“What happened to you?” 

“I don’t know,” I replied. 

They immediately called the ship’s onboard emergency number (911), ordered a wheelchair and took me to the doctor’s office six decks down and several long halls away. It was April 2016.

When the nurse asked me what the problem was, I could hardly answer her. “I feel just miserable,” I said.

Blood tests showed that I suddenly had developed severe anemia (low capacity of the blood to carry oxygen). I immediately knew what was wrong. The kidney normally produces a hormone instrumental in the production of red blood cells by the bone marrow, but in certain people who have kidney failure, the kidney stops making the hormone and anemia may develop.

Before I had left home to take the cruise, my hematologist in Seattle gave me iron injections and hormones (erythropoietin, or EPO) to prevent this from happening, and he figured the effect of the injections would last for four months. They did not last, however, and my anemia had returned after nine weeks.

Blood transfusion needed

The ship’s physician said he would arrange for a blood transfusion to increase my hemoglobin, but blood compatible with mine was not available on the cruise ship. Consequently, I would have to debark and go to a hospital in Naples, Italy, where we would dock in four days.

My oldest daughter, Audrey, promptly flew from Seattle to Naples, where, upon her arrival, we met in the medical office of the MS Rotterdam (the Holland America Line ship I was on). 

In Naples, an ambulance took me on a winding and potholed journey to the pronto soccorso, the local 24-hour accident-and-emergency department, while Audrey followed in a taxi. In Italy, all emergency departments are located in public hospitals. Italian law dictates that, in an emergency, foreigners must be treated at no charge.

Upon my arrival at the hospital, I was put on a gurney covered with plastic pads. I remained clad in the travel clothes in which I arrived. Attendants pushed the stretcher from left to right and right to left as my poor body was subjected to various radiology tests. I felt myself move over all kinds of wires, but it’s likely that I was imagining that.

Audrey suddenly disappeared, and I was alone, being scraped over the wires. I cried out for Audrey’s help. Finally, the transfer stopped and I ended up in a long hall with about 20 other gurneys in front of me, all patient-occupied. This is where I would remain for the next 48 hours.

A nurse inserted a needle inside one of my blood vessels, and, hours later, blood was dripping into my vein originating from two bags. Each bag looked as if it had two pieces of meat in it surrounded by blood. I wondered what those pieces of meat were. It looked so different from any transfusion I had ever seen. I never got an answer to that question, as nobody spoke English and my Italian was not good enough.

Lack of basic toiletries

I became restless and thirsty. I had not had any water for hours. I asked Audrey for water. 

“I have to go and buy it. There is no gratis water here,” she said. 

She returned and I took a few sips, which eased my parched throat. I drifted in and out of sleep, then I had to go to the bathroom. Making my way, I tried to get off the stretcher, but it was too high off the ground. All of a sudden, six people grabbed me, lowered me and guided me to the toilet. 

Where was the toilet paper? Audrey threw a roll at me, which she later told me had been provided by the relatives of a friendly patient. 

Afterward, I wanted to wash my hands, but there was no soap in any of the bathrooms!

Next, I felt six people lift me gently back onto the gurney. 

“It smells so bad here,” I remarked. 

“And how!” Audrey replied.

Finally, food was wheeled in. I took a tiny piece of bread but found it inedible. I drifted in and out of sleep. There was no place for Audrey to lie down, though; she had only a straight chair.

For two days and two nights, Audrey and I were in that horrible place. It was one of the worst experiences I ever had. I don’t know what I would have done if she had not been with me. I would have had no drinking water, no food, no way of going to the toilet, no toilet paper and none of her wonderful ministrations.

Picking up my luggage

On the day I was admitted to the hospital, my luggage was sent to the hotel where Audrey was supposed to spend the night, so at one point she arranged for a taxi driver to bring the luggage to the hospital and meet her out front. 

However, it was very difficult for her to find the hospital exit, as there were no signs. She wandered around and around and finally asked patients for help. By the time she found the exit, the taxi driver had returned the luggage to the hotel, as nobody had shown up to pay him. 

Luckily, outside the hospital, Audrey found somebody who, for 20, offered to take her back to the hotel to pick up the suitcases.

After the bags found their way back to the hall where I was lying, Audrey had to squeeze them underneath my gurney to prevent them from being stolen. (After all, we were in Naples.)

Heading home

Forty-eight hours after I entered the hospital, my son, Paul, arrived from Denver. He arranged for a cursory discharge exam by a doctor, after which our trio left the facility. We overnighted at the Holiday Inn Naples, and Paul arranged for our transportation back to the States. 

We had to transfer planes in Paris, where, to make the connection to our Delta Air Lines flight to Seattle in the 1½-hour window of time that we had, Audrey and Paul had to run, literally sprint, pushing me in a wheelchair, through numerous corridors and past multiple gates to, with the help of an escort, arrive at the Delta gate just six minutes before the plane’s departure. 

Upon our arrival in Seattle, my daughter Marion, who had flown there from Florida, suggested we call my hematologist. We did so and were told to come right over. What a relief! After getting intravenous medications and EPO shots in his office, I returned to the retirement home where I live. 

When I saw the hematologist again the next day, I was told that I could not travel for five months.

Facts about Italian public hospitals

After coming home, I read about public and private hospitals in Italy. I quote the following information — extracted from the book “Living and Working in Italy,” edited by Caroline Prosser (Survival Books, London) — from the webpage www.justlanded.com/english/Italy/Italy-Guide/Health/Hospitals-Clinics: “Basic accommodation in public hospitals normally consists of wards with between three and six beds, although single bedrooms are usually available with an en suite bathroom for a supplement of between 60 and 75 per day. You can also usually rent a TV for a small daily fee if it isn’t included. 

“Patients normally need to bring everything they need with them, including towels, toiletries, pajamas or night-dresses and dressing gowns, although meals are provided free of charge. Note, however, that the food may be inedible and you may need some outside assistance (food parcels) if you’re to survive a stay in a public hospital.”

I believe that the Holland America Line port agent in Naples, who was responsible for my welfare once off the ship, should have taken care of most of the above, as I had purchased complete platinum insurance through the cruise line. However, the port agent only directed the ambulance to the hospital and did not stay to see that I was properly treated; Audrey was left to her own devices. Neither the cruise line nor the insurance company followed up at any time. 

What should you do if you have an emergency in Italy?

I am paraphrasing the following from the above-mentioned website. 

It is possible to go directly to a pronto soccorso (hospital emergency ward), where emergency treatment is free. Emergency rooms are found in public hospitals only and not in private hospitals. To call an ambulance, or to receive first-aid assistance, dial the free number 118 anytime anywhere in Italy.

The ambulance will take you to the nearest emergency room. If you do not need an ambulance, you should drive or take a taxi. For a taxi, phone 06 4157 or 06 3570 or 06 6645 anywhere in Italy

If you are planning an extended stay somewhere, try to familiarize yourself with the route before an emergency situation arises. Follow the “PRONTO SOCCORSO” signs near the hospital to guide you.

To obtain emergency medical treatment in the evening (8 p.m.-8 a.m.), on bank holidays and on Sundays, call the guardia medica (the service on call for evenings, Sundays and holidays). You should obtain the relevant phone numbers for this service, which is available in each Italian city, from the tourist office before an emergency occurs.

Free Italian phone numbers

You can call the following numbers for free from anywhere in Italy.

12 — telephone directory assistance

112 — emergency assistance

The different emergency numbers listed below are in the process of being replaced by a single one, 112, which is the international emergency number. Calls to 112 are answered within seconds and in multiple languages. The 112 operator can detect the location of the caller within about five seconds.

113 — police, ambulance, fire 

In some cities, you can call either 112 or 113 and the call will be answered by the same person. It is best to call 112 first in an emergency. If you do not have a phone, ask any passerby or store clerk to call for you.

115 — fire department

116 — ACI (Italian Automobile Club) for road assistance

118 — medical emergency assistance/ambulance

Phone calls in Italy and from US/Canada to Italy and Europe

All landline phone numbers in Italy start with a “0,” thus, when calling, for instance, the Holiday Inn landline in Naples (Napoli in Italian) from anywhere inside Italy, you dial 081 225 0111 (“081” being the area code for Naples and “225 0111” being the Holiday Inn’s phone number).

When dialing from the US, Canada or some Caribbean islands (abbreviated here as “US”) to, using my example above, the Holiday Inn landline in Naples, Italy, you dial 011 39 081 225 0111, where “011” is the international prefix used to leave the US phone system (which allows you to dial to a location outside of the US) and “39” is the country code for Italy (which allows you to enter the Italian phone system).

In other words, when dialing a number in Italy from the US, you use the entire phone number you have been given and precede this by “011” and “39.”

This is different than when calling from the US to a European country other than Italy, in which case you must drop the first digit of the city/area code, which usually is a zero and which is used only for domestic calls.

For example, the city code for Amsterdam, Netherlands, is 020, and these three digits are used for all domestic calls. Thus, if you are in Amsterdam and call the Holiday Inn in Amsterdam on a domestic landline, you dial 020 646 2300, where “020” is the Amsterdam City code and “646 2300” is the local number.

When calling the same number from the US, however, you drop the first “0” of the “020” and use only “20.” That is, you dial 011 (international prefix) + 31 (Netherlands country code) + 20 (Amsterdam city code without the “0”) +646 2300 (the Holiday Inn’s local number).

To call a mobile phone in Italy from the US, use the following dialing code format: 011 + 39 + mobile code + the number. (Note: Mobile codes in Italy start with a “3.”)

Note: The international prefix is sometimes replaced by the “+” symbol.

For more information, go to www.countrycodeshub.com/how-to-call-abroad.php.

To use your own smartphone during travel in different countries, buy an International or Europe SIM card, which will fit into any unlocked phone. 

In summary, before traveling anywhere, it is imperative to find out as much as possible about its emergency medical services and to become familiar with the use of its emergency phone numbers.