As an American living in Umbria, I often get asked my opinion of Italy’s national health plan. The inquisitors are either my liberal friends envious of our comprehensive, low cost health coverage, or my more conservative friends suspicious of “Obamacare” and anything that bears the slightest whiff of socialism. So for those who envy my “free” healthcare, I say, it doesn’t come without caveats. And for those are sure that socialized medicine is the work of the Devil, I say, don’t knock it until you’ve tried it.

Last year, our then-2-month old daughter, Naomi, was sleeping peacefully while my husband, Paolo, and I were eating lunch. From nowhere, she began what appeared to be a small seizure—her legs and arms shook violently and her head tilted back unnaturally; it appeared she was choking and could not breathe. I grabbed her and turned her on her stomach, slapped her on the back several times, and then put my finger in her mouth out of fear she had swallowed her tongue. She resumed breathing normally, and never even woke from her sleep. The entire episode last 15 seconds, maximum. It only felt like a lifetime. We called her pediatrician, who told us to take her to the pediatric ward of the hospital to have her checked out.

Which brought me to one of my most telling experiences with the Italian healthcare system.

Let me start by saying I am a fan of Italy’s national health system, and of socialized medicine in general. I lived most of my life in the US, where I either skipped or paid out of pocket for needed medical procedures when I was uninsured or under-insured  (ah, the caprices of self-employment). For years, I advocated for my elderly parents, whose Medicare and Medigap insurance very often left them with deductibles they could not pay. I wrote letters asking for their medical debts to be reduced or forgiven. I phoned lists of doctors and specialists, searching for one who would accept their insurance. I negotiated payment plans with hospitals. All this for a couple who actually has health insurance. So when presented with the notion that of all a country’s citizens, regardless of their ability to pay, are entitled to free and/or affordable, quality healthcare, then yes, that’s an idea I can get behind.

My experiences with healthcare in Italy have been overwhelmingly positive. The care is thorough, modern, and attentive. Wait times are manageable, even if a lot of Italians think otherwise. (Any time I’m waiting to have some lab work done or to pick up a prescription at our hospital, and an Italian complains about the wait, I always defend the system, and tell him or her that in the US, you can wait just as long and then get handed a bill you can’t afford to pay, something that simply doesn’t happen in Italy.) When we took Naomi in after her spasm, we were seen immediately, and she was admitted for monitoring within an hour. The pediatricians ordered a number of tests that would have had me hearing “cha-ching” in the US. She stayed in the hospital and was monitored closely for three nights, then finally sent home with meds and an appointment to follow up in a week, and no bill.

And I can go on. When my husband broke his foot (he fell down a flight of stairs while trying to kick me in the butt, but that’s a story for another blog), we were in and out of the ER, with a cast, in less than two hours. No bill. When I had Naomi via C-section and stayed in the hospital for four nights, a nurse showed up to help me any time she cried for more than two minutes. No bill. Cancerous tumors, malignant moles, dialysis, you name it, Paolo’s family has faced it and overcome it, thanks in no small part to the quality of healthcare in Italy. And with no bills.

But…here’s what you don’t get in public hospitals in Italy. A doctor with a bedside manner. A comfortable bed. A room with a fresh coat of paint. Marginally edible food. A knife, a fork or a coffee cup. Toilet paper. Yes, that’s right, toilet paper.

I should qualify my words by saying that this is my experience at one public hospital in Umbria—I won’t name the hospital but readers who know my geographic location can figure it out—but I’ve been led to believe that this is typical of most public hospitals in Italy. The care is top notch; the comfort is bare bones.

So, if you find yourself having to stay overnight at a hospital in Italy, pack silverware and a coffee cup, because these will not be provided for you. Nor will paper towels or napkins. Pack toilet paper, because although there’s a clean and sanitary bathroom attached to your room, it won’t have toilet paper. Pack a comfy pillow if that’s a priority for you. Pack some snacks and maybe a salt shaker; because the food you’ll be served makes melba toast seem like a flavor explosion.

But most of all, pack your thick skin and your sense of humor. Because while customer service is never a priority anywhere in Italy, nowhere does it seem less so than in its hospitals. You’ll be well cared for from a medical perspective, but most of the doctors, nurses, technicians and support staff you encounter will make it quite well known that they don’t give a flying f**k whether you are comfortable or not, whether your questions have been answered, or, if you’ve got a sick kid, whether you feel like the Worst. Mother. Ever. (In fact, I believe that feeling is encouraged.)

So with that in mind, here are my parting words for a few of the healthcare providers and workers I encountered over those three days:

• To the doctor who scoffed at me (I mean really scoffed!) when I told her that I bought organic baby formula for the times I occasionally need to supplement my breast milk: maybe you want your kid to drink milk from factory-farmed cows pumped full of growth hormones and pesticide-laden grains. I do not.
• To the cleaning lady who came into our room at 6:45 am and told me I had to get out of the folding cot I was sleeping on and put it away: thanks for turning on all the lights and waking my baby. Next time you can breastfeed her, change her diaper and sing her back to sleep instead of just letting her sleep an extra hour or two.
• To the cleaning lady who came in at 6:45 the next morning and commenced yelling at me because the bed was not folded up (I was still in it, nursing Naomi), yet refused to fold it herself and yelled at me some more when I moved to a chair: I’m sorry you have such an unhappy life that you have to try to ruin everyone’s day with your dictatorial attitude. But my baby comes first.
• To the doctor who completed an ultrasound of Naomi’s brain: “O Dio!” is not the thing to say when you’re doing an ultrasound of a baby’s brain and her parents are standing by. Next time you hit the wrong button on the machine, please, just say “whoops” instead.

And my final words to all those I encountered during our hospital stay: Thank you for taking care of my baby. Thank you for being thorough, for leaving nothing to chance and for looking for all possible causes for her choking incident. Thank you for not rushing us out of the hospital because you had the finance department breathing down your neck, worried about whether we could pay our bill. Thank you for not telling me that the tests or treatments Naomi needed were not covered by our insurance. For all of that, I can accept your toilet-paperless bathrooms, your bad attitudes, your crappy food and your absent bedside manners. But for God’s sake, lighten up a little bit. They say laughter is the best medicine, after all.