No one expects to have to go to the ER while on vacation. I did so in Rome and feel compelled to share my experience. In a nutshell, I hope foreigners suffering health emergencies in the United States get some of the same courtesies and care I received.
The vacation — a reunion with my mother-in-law’s side of the family — had been planned for three years, ever since all of us last met in Southern California in 2022. My husband’s aunts and uncles and their significant others, his first cousins, their spouses and their kids — 25 people ranging from five to 70+ — all descended on a villa in Rome for some unbridled fun. We were a motley crowd of Canadians, Americans, Australians and English folk raring to get our vacation started with tours of the Sistine Chapel, St. Peter’s Basilica, Colosseum, Gladiator School and more. And of course there would copious consumption of gelato, bread and wine.
I didn’t find Rome too crowded save for Trevi fountain but exceedingly hot. We could have been characters in Dante’s Inferno with the city experiencing scorching temperatures in the mid-90s daily. Both my son, Ishaan, and I wore hats throughout, not something we commonly do in the Bay Area where we live. One such hot day was July 15, when we toured the Sistine Chapel and St. Peter’s Basilica. After returning from the tour in the late afternoon, we cooled down by showering. Others hit the pool.
“I can’t see my right hand. I am seeing through it”
In the evening, my son, 16, and about to start 11th grade, came up to me in our common lounging area and said, “I can’t see my right hand. I am seeing through it.” He added that there was something wrong with his face. I paused when he said this but quickly dismissed it. I told him to go lie down, drink water and rest, maybe try to sleep a little.
But his words gnawed at me. In 15-20 minutes, I went downstairs to the bedroom. Ishaan talked with me, but the word usage was not appropriate. I began searching for heat stroke symptoms — did they include speech issues? They did, but the other symptoms didn’t match exactly. Ishaan was not flushed or showing signs of a fever.
And then I remembered — my dearly departed brother (some of you may know that my older brother died of kidney cancer when he was 44) had episodes where the doctor suspected stroke. Could this be a teen stroke? Ishaan’s symptoms seemed to match. My heart sank. I knew he had to be seen by a doctor.
Ishaan was very irritable. He shouted, “It hurts.” Befuddled, I asked “What hurts?” He answered impatiently, as if it should be obvious, “My head!”
I told Shalin, my husband, to talk to the villa owner and caretaker so we could figure out whether a doctor could come. Soon enough, Alkesh, Shalin’s cousin’s husband, decided that he was going to drive Ishaan to the nearest hospital emergency room. Four of us jumped in the car. I quickly informed my daughter, Eshaa, 13, that her brother wasn’t feeling well and we were off to the local hospital. She would remain in the villa surrounded by family. I knew she would be ok.
Luckily, the hospital was 10 minutes away. Soon enough, we were called in and processed and Ishaan was hooked up to a machine monitoring his vitals. And then began the wait. I can’t quite recall how much time went by before the nurse disconnected him from the vitals machine and moved us to a different room with two other seniors, one lying down, one seated. He created an IV channel and took Ishaan’s blood for lab work. Shortly after, Ishaan, who was sitting, received pain medication through the IV for his headache.
Should I Stay or Should I Go?
He was steadily improving and I was WhatsApping my husband, discussing what our next move should be. Shalin said if Ishaan was feeling better, we should leave the hospital. When I mentioned that to the nurse, he said it’s your call, but the doctor wants to do a CT scan. It could be a transient ischemic attack he said — in other words, a mini, temporary stroke.
Good lord.
I knew that I needed information and guidance to be able to take the right decision about whether to take Ishaan home. I immediately messaged and called a dear family friend and physician — Dr. Kanishka Bhattacharya — who regards me as his little sister. I call him by his nickname, “Bappa” and add a “da” suffix to denote respect for an older brother. When he heard all the symptoms and what the Rome nurse was advising, Bappa da was very clear: Stay and get the bloodwork and CT scan done. Don’t leave without paperwork and CT results.
I informed my husband around 10 p.m. that he should go back to the villa with Alkesh and eat dinner. And then return. Based on my experience in American hospitals and ERs, I knew this was going to be a long night. I didn’t know when the doctor would actually see Ishaan.
“I Love You. I Love You.“
Soon, Ishaan was moved into a room with other patients in their beds and asked to lie down. By this time, his headache was subsiding. A doctor would be coming to see him soon, the nurse informed me. Thereafter, a young doctor — I assumed she was the medical resident on night duty — came to talk to us. And while the nurse was able to communicate in English just fine, she was fluent.
She did a physical exam. I was too nervous to even ask whether the evaluation was all normal. But I was able to ask the stupidest question on the planet: “What is the name of this hospital?” I had jumped into the car and hadn’t bothered to ask which hospital we were going to.
It was “Università Campus Bio-Medico di Roma.” A quick search revealed that it was a private research university in Rome. Hurrah, I exclaimed internally. Ishaan was in an academic medical center!
He was now lying in bed with just a light T-shirt and his shorts with most of his legs in his thin 6 feet, 1 inch frame bare. All the other patients had a white bed sheet covering them. I asked Ishaan, then begged him to allow me to ask the nurse for a bedsheet so I could drape it over him. He initially declined, but then finally relented. I got the bedsheet from the nurse and as I draped it on him, Ishaan probably felt the warmth seeping over his body. He must have realized that his Ma instinctively knew how good the covering would feel on him. His affection mixed with gratitude found expression in three simple words.
“I love you. I love you,” he said.
Electrolyte Imbalance Vs. Neurological Problem
Ishaan was now explaining that he was getting angry earlier during the headache because he knew what he wanted to say but couldn’t find the right word to say it.
Earlier, Bappa da had warned me that staying longer in the ER was essential.
“We need to make sure nothing serious is happening,” he wrote to me. “The differential diagnosis is fluid, electrolyte imbalances vs a neurological problem.”
Realizing that panicking would get me nowhere, I decided to go and eat some dinner, which Shalin had brought. I tend to get “hangry” and the ER is the last place to lose one’s composure. So Shalin, who had by this time returned with dinner, and I switched spots. While he was with Ishaan, the neurologist came by to evaluate Ishaan and told Shalin that the neurological exam was fine. We were not in the clear yet because a CT would be done, but the doctor thought the CT would be clear. This was likely Ishaan’s first migraine and some people get sensory symptoms called “aura“. Migraine is hereditary. Shalin’s father also gets them from time to time.
I returned to Ishaan’s bedside and we were now moved to a single room with a bed and a chair for me. Meanwhile, the blood work was all normal. No sodium-potassium imbalance. Everything now rested on the results of the CT.
Ishaan briefly told me he had an intrusive thought about death to which I said, you should be OK, Ishaan. He was 8 when my brother died and loss is something we have addressed over the years. Despite some dark thoughts, he was well enough to send a message to Eshaa, his sister, that “big bro” was feeling a lot better and that she shouldn’t worry and pass on his message to the rest of the family.
I was heartened by all this but my brother’s untimely passing has made me acutely aware of the possibility of perfectly bad things happening to perfectly good people. I don’t have the luxury of believing in God and that an unknown power protects us all. I know life is random. So what could a bad CT look like?
In crystal clear terms, Bappa da informed me that if the CT shows a bleed in the brain, then Ishaan would need surgery immediately — it would have to be done in Rome. However, if it were clear, then we could leave the hospital with the CD of the scan plus bloodwork results and get Ishaan properly evaluated once we were back Stateside.
So I sat there distracting myself with videos on my phone, giving the phone to Ishaan so he could watch a bit too. Occasionally I bothered the doctor for an update on the CT scan. Ishaan fell asleep. A little after 1:00 a.m., the doctor came and said the CT was clear and that she was going to get the CD of the scan ready.
I heaved a huge sigh of relief and informed Shalin. We would have to determine if it was a migraine once we returned, but at least there was no major neurological problem with Ishaan. We were free to leave.
“We Can’t Ask For Your Insurance”
Shalin was asked to come in to co-sign some paperwork with me prior to Ishaan’s discharge. Previously, Shalin had messaged me that we should have gotten travel insurance and but was thankful that we were financially secure enough to manage whatever expenses were incurred in this Italian ER visit.
Imagine our surprise when the doctor explained we didn’t have to pay anything.
“It’s free,” she said. “We can’t ask for your insurance information. It’s the law.”
Maybe in five years, we might receive a bill since we didn’t have any travel insurance but she didn’t sound very sure. Bewildered, we thanked her profusely and bid goodbye to all the nurses who interacted with us.
I remember thinking that Ishaan received so much great care and fairly quickly. We were in the ER around 7 p.m. and by 1:30 a.m., we left with lab results and a CD of scans. Would that happen in the U.S.?
“You got amazing timely care in Rome,” wrote Bappa da to me later. “Given the pressures the ERs face in USA, this kind of care will be difficult to replicate here.”
He added that all uninsured patients with serious medical issues land up in the ER.
“This usually does not happen in a Nationalized Healthcare System,” he explained, adding that while there are very skilled physicians here in the ERs, the pressure is so much they barely have time.
However, “when a catastrophe happens, they usually measure up well,” he said of U.S. emergency room physicians. For instance, the Boston Marathon bombing, he pointed out.
But here’s my realization: A foreigner in my country suffering an emergency will most likely not receive free care because ours is not a single-payer, nationalized healthcare system. So in addition to the anxiety over what is happening, those visitors will have to contend with a financial hit. My parents traveled with travel insurance back in 2011 and, even then, we paid $5,000 just for an ambulance trip for my mother.
So any foreigner undergoing a medical emergency in the U.S. will receive good, costly care but it will not be prompt. If I were to guess, a similar emergency at night here would require the patient to be kept overnight with no chance of getting a CD ready within a few hours for them to leave.
Am I advocating for single payer here? Maybe. Maybe not. But what about universal healthcare? We do deserve some peace of mind during situations that are well beyond our control. Maybe we look at how Israel does it — an innovative, capitalist economy with four non-profit health plans where every citizen has health insurance and people can choose between those four competing plans.
Do we need this labyrinthine healthcare system that has so many frustrated?
All Hail the Power of Family
Since Ishaan didn’t suffer too much, we were able to get on with our vacation after a day of forced relaxation. But what I will always be thankful for is how the family rallied in our moment of need.
Alkesh didn’t wait for anyone else to offer to drive us to the ER and stayed with Shalin for several hours. Knowing that Eshaa, my 13-year-old daughter was worried, her second cousin Arya and her mother Shikha from London went to her room to keep her company. As did Shivangi, Shalin’s cousin’s wife from Sydney and Kshama, Shalin’s cousin who lives in Charlotte. Knowing that Eshaa wasn’t alone brought me a lot of relief.
What’s next?
Ishaan has an appointment with a neurologist next week – I was pleasantly surprised to get this appointment so quickly. All I need to do is translate the hospital discharge report and lab results from Italian to English.
No doctors or money needed here! It’s ChatGPT to the rescue …
