Thursday, February 15, 2007
The Doctor Wears Prada
When I first moved to Italy, I lived in the small farm town of Lariano (which I have written about here). One of the interviews I did while there was with our family physician, Dottoressa Marcella Caporello. It was a good interview, too good to keep all to myself. So I am presenting it below in this blog.
Dr. Caporello was born and grew up in Rome. This sophisticated urbanite, who is fluent in English, has now lived in Lariano for almost three decades. In her position of close and privileged proximity to its citizenry she knows the town in a special way. She is warm and friendly with her patients and has a sense of confidence and air of self-possession that immediately inspires trust.
Although she has an office assistant to help with the usually overflowing waiting room, Dr. Caporello answers her own phone and, at times, still even makes house calls. Patients do not make appointments but simply arrive during office hours and are seen on a first come, first serve basis. The order is maintained informally by the patients themselves. When someone arrives they ask the room at large, Chi è l'ultimo? (Who is the last?), thereby learning their place in line.
Observing this system in operation was interesting for someone accustomed to doctors' receptionists seated safely behind the barrier of sliding-glass windows, the all-powerful appointment book in front of them, ruling patient traffic. At first I was nervous, unsure this humble democracy of the waiting room could actually work. But over time I came to appreciate it. Rarely did anyone try to cut in line, as we say. When it did happen, it was usually tolerated, the only objection being a silent exchange of world weary glances. In most cases the interloper would be a very old person who would trudge forward to stand nose to the closed consulting room door as if to say, I'm entitled, I don't have time to waste anymore.
Dr. Caporello shares consulting space with four other public health system doctors in a one-story row of rooms on Lariano's main street. Our conversation took place in her office one day about four years ago. She began the interview by talking about the high local birthrate.
Earlier this week, curious about whether the fertility trend is continuing, I called Dr. Caporello and asked her for an update. She told me the boom is still booming with tante pance in giro (many pregnant bellies in and around) in Lariano.
“We have many young couples who have many children,” Dr. Caporello began. “The birthrate here is very high.”
“A baby boom?” I asked.
“Yes, it is in contradistinction to Italy. The national birthrate is zero.”
She shrugged away any particular explanation. Unlike many other rural areas where the children when grown often move to urban areas, here they are staying and raising their own families, Caporello said.
She gave most weight to the factor of Rome being only an hour away by train, allowing local residents to commute to work in the city.
I asked Caporello about Lariano, whether it has changed much in the time she has lived there.
“Twenty-five years ago I came here and I thought I was in the medieval age,” she said. “I took a medical degree in Rome in 1978 and came here to practice. When I arrived they didn't believe I was a doctor. I was very young. I wasn't experienced. And they stared at me.”
She repeated a typical conversation of that time with her patients.
“I am a doctor,” I said.
“No, you're a nurse.”
“No, I am a doctor.”
“You are a midwife?”
“No, I am a doctor.”
“You studied like the men!”
“No, I studied better.”
It was very hard and very slow, she said, of those early days. She had to fight to win acceptance from the Larianesi, as the locals are called. One memory especially made her laugh. When my patients would see me still here at 1 pm, they would say, “But don't you have to go home to cook?”
Caporello summarized what she thinks is underway today in her adopted hometown.
“I think that Lariano is changing like all the world is changing because change is the art of life. I think that Lariano, as well as all Italy, is changing because the problem is communications. We are all in a network with the world so we are necessarily influenced. And this is not all negative. Personally, I do not refuse any influence. I am very sure of my culture, of my European-Italian identity.”
She repeated this last statement, stressing its importance to her.
“I hope I can take from everyone something good that can improve my life, public and private. If I really don't see an enemy in a person, maybe I don't have a problem so great with them.” She paused for a moment and then added that her experiences may be different because she sees people in her role as a doctor. “Perhaps this alters relationships.”
She smiled suddenly and said she wanted to tell me a little story.
“I was very unhappy in Lariano in the first years,” she said “I was very young. I had not achieved a philosophy of life like I have now. And so I was unhappy and I thought I am among barbarians, these people are ignorant and impolite. I didn't want my life to end up here.
“In 1984 I went on vacation – my daughter was very little, two years old. We went for a week to England to the Isle of Wight. In that hotel there were only young English families, with young children. We were the only strangers. So I began to speak to them, while we were waiting in line for breakfast, times like that.
“When they learned I was a doctor, they were very amazed in the same way as the Lariano people – 'really, you are a doctor!' When I spoke to them about my work, they said the same things, the very same things as my Lariano patients. They were angry with the doctors because they wouldn't come to their homes when their babies were sick, they were angry the doctors didn't give them the medicine they wanted.
“But they said these things in English so they sounded different to me, more beautiful than in the guttural sounding dialect of the Larianesi. But they said exactly the same things – they said these things in a language, English, that is very important, the language of power. And for me that was a revelation. And in that moment I began to love my patients. And I had a different relationship to my job. And my patients began to love me.”
What was the revelation, I asked her.
“The revelation was that people are the same everywhere,” she said. “Maybe some people are more polite, but...” she shrugs.
by Rebecca Helm-Ropelato
Copyright © Rebecca Helm-Ropelato