SELVA – JULY 2024
“There Will Be a Way”
For a moment, it felt like we, the perennial nerds, were in the presence of a sci-fi fantasy’s mystical guide when the young, tall, blonde, woman with a striking presence calmly pronounced in perfect English “There will be a way…because your life depends on it.”
Her unexplained confidence in us overcoming the obstacles to filling Bill’s new prescriptions, even though she could not help us, was stunning. “There will be a way…” echoed between us when we exited her hidden pharmacy into the hot sun on a busy pedestrian mall in Bressanone, Italy just before it closed for lunch on Saturday afternoon.
We were buoyed by her confidence in us, or in the universe, and yet did not know how we would succeed in this quest, a quest for which she seemed to be changing the trajectory, but in an unknown way. We were midway through the all-day, roundtrip journey from Selva to the Bressanone ER for the second time in 6 days.
“There Will Be a Way”
For a moment, it felt like we, the perennial nerds, were in the presence of a sci-fi fantasy’s mystical guide when the young, tall, blonde, woman with a striking presence calmly pronounced in perfect English “There will be a way…because your life depends on it.”
Her unexplained confidence in us overcoming the obstacles to filling Bill’s new prescriptions, even though she could not help us, was stunning. “There will be a way…” echoed between us when we exited her hidden pharmacy into the hot sun on a busy pedestrian mall in Bressanone, Italy just before it closed for lunch on Saturday afternoon.
We were buoyed by her confidence in us, or in the universe, and yet did not know how we would succeed in this quest, a quest for which she seemed to be changing the trajectory, but in an unknown way. We were midway through the all-day, roundtrip journey from Selva to the Bressanone ER for the second time in 6 days.
We expected to spend our 2nd day in Selva hiking in these mountains, not looking back at them on our way to a city ER.
On Monday, the ER doctor could not explain Bill’s sudden, profound fatigue that had begun 3 days earlier. He ran tests and meticulously examined the EKG strips Bill provided from his files and those from his new electronic, recording, stethoscope and agreed with him that the feared AFib was not the cause of his fatigue. The competent-appearing physician was very blunt about not having an explanation, wished us a “Happy Holiday,” and sent us out the door into the downpour.
This first ER visit had been on Monday. We awoke Saturday morning, 6 days later, to find a patient portal communication from the desert cardiologist Bill had first seen 6 months ago. He was replying to Bill’s fax from earlier in the week summarizing Bill’s ER visit. The cardiologist recommended he immediately start 2 specific medications to treat his AFib. “Oh!” Bill read the cardiologist’s portal correspondence at 5:40 am and 2 hours later, we again boarded the crowded bus for the 2-hour ride to the Bressanone ER.
Hours later, after the jostling ride to the valley and a long stint in a waiting room, the new ER doctor proclaimed Bill’s fresh EKG looked good enough and there was no reason for Bill to be treated for AFib, despite the specific treatment plan from Bill’s US cardiologist in his hand. Quiet panic struck us both: waiting for Bill to present with a blood clot in his brain to prove the need for treatment wasn’t an option. We had no leverage. All either of us could think was “But, but, but….”
A polite but difficult exchange ensued between Bill and the Italian ER doctor. After many stumbles with his English, the befuddled physician left the room. In hindsight, we suspect he stepped-out to confer with a hospital cardiologist because when he returned to the treatment room, he was cheery and onboard with the US cardiologist’s recommendations.
Hiking in Sella Group would have to wait (as seen from our balcony).
We dashed off to the pharmacy closest to the bus stop for our return trip to Selva to fill Bill’s 2 new prescriptions. The pharmacist noted the ER doctor had written the prescriptions for 2 boxes of 28 tablets, for each prescription, and Bill needed 3 boxes of each to tide him over until we got home. After the shortest bit of pleading, she yielded and sold us 3 boxes of the calcium channel blocker (CCB), without explanation of why she was defying the doctor’s orders. She, however, did not have the second drug in stock.
Again following Google maps, we made a hot, hurried, 15-minute walk to the next closest pharmacy, which also did not stock the second medication, an anticoagulant. The clock was ticking— all retail shops would soon begin their 3-hour lunch closure.
After another tense wait in the growing line at the 3rd pharmacy, our goddess in a white coat smiled and said “Yes, we always keep one box of this drug on hand,” and she reached beneath the counter for it. She could order a second box of the anticoagulant for delivery in the late afternoon but could not sell us the 3rd box Bill needed because it would violate the prescription as written. She would not budge on ordering the 3rd box.
We quickly decided to take the single box so Bill could start the medication and to bring this tense travel day to Bressanone to a close. There was no point in hanging around Bressanone for hours and returning to Selva past our dinner time with only one of the two additional boxes of medication needed. We thanked her profusely and then she pronounced “There will be a way” to obtain the third box.
She was right, there was time and there were options, but we were not eager to devote another 6 to 8 hours for a 3rd trip to the ER to obtain an additional prescription to cover Bill until we got home.
Two hours later, when we stepped off the bus in Selva, we had 3 plans. Plan A involved Bill going to the forever-grumpy pharmacist in Selva in hopes he would pass his hand over the hardcopy prescription for the second drug, the Eliquis, like the first pharmacist had done with his CCB prescription and produce 2 more boxes of Eliquis for a total of 3. It was a reach for Bill, who is more shame-averse with strangers than I am, but he was committed to giving it a try.
Plan B would begin with Bill requesting a new prescription for a 3rd box of Eliquis from the local physician in Selva on Monday or Tuesday. Over our years of travel, we had noticed almost all Italian villages had an inconspicuously placed door to a physician’s walk-in office, usually on the backside of a small building near the town center. We envisioned Bill calling on the doctor in Selva, explaining that he was short 3 days of the Eliquis after his ER visit, and he needed an additional prescription based on his US cardiologist’s treatment plan. The third option was Bill making a third trip to Bressanone’s ER, which I suggested he could do alone.
We kept to the lower trails, like in the beautiful Vallunga (Long Valley).
When the only Selva pharmacy opened the same afternoon, Bill went in search of the soft edges on the matter of filling his prescription with 2, not one, boxes of the anticoagulant. Like we had come to expect, the never-smiling pharmacist said he didn’t have the drug on the shelf but could order it, and he would have it by 10 am Sunday morning, the next day. We had learned from ordering our favorite sunscreen from Italian pharmacies in the past, that they had a nifty fulfillment system which would sometimes supply a product in the afternoon when ordered in the morning.
Without looking up and with his usual flat affect and cryptic English, the pharmacist said he could order 1 box of Bill’s medication, a box of 60. Fireworks, bells, and whistles went off in Bill’s head while he casually concurred with the proposed order. Problem solved: Bill would be receiving 1 box, which was authorized on the prescription, but a box of 60 tablets instead of the specified 28. “There had been a way!” Just like that, the problem was solved. He picked up his box of 60 pills the next morning.
The door to the tucked-away physician’s office in Selva.
Though we had never filled a prescription in Italy, we had observed over the years that they quickly filled prescriptions by handing little, prepackaged, pressed paper boxes containing medications to their customers. There was no counting of pills, no prescriptions with your name plastered on a bottle, no explanation of dosing, resulting in a new prescription being filled in a minute or 2 while you held your place at the cash register. Such a quick system. All the pharmacists were, however, extremely methodical in comparing the factory printed label on the delivered box with the customer’s paper prescription in hand.
The next day, Bill noticed that the second ER doctor had written the Eliquis prescription for half the usual starting dose of the medication, perhaps a reflection of his initial reluctance to prescribe at all. Disappointed the process for procuring his new medications was not completed like he had thought, Bill did view it as a small problem, one with soft edges.
After again conferring with the US cardiologist through his patient portal about the proper dose, Bill implemented dormant Plan B, which was seeking an additional prescription from the Selva physician to double his stash of the second drug to cover him until we returned to the States.
Bill opened the inconspicuous door to the Selva doctor’s office and conferred with the English-speaking woman seated there. She reassured him to also take a seat, and he would be called after her. During his 5” wait to be summoned by the doctor, Bill abandoned his planned presentation.
Bill would not explain the 2 visits to the Bressanone ER nor share his sheafs of paper, including reports, medication recommendations, and EKGs. Instead, Bill opened with “I’m a tourist in Selva for 2 months and need a prescription for my heart medication”. A little perplexed by Bill’s abbreviated pronouncement, the doctor paused, then asked “Do you have a box?” By chance, along with his growing stack of papers, Bill had a box of Eliquis with him and was able to quickly present it.
Bill’s stash of Italian prescription medications & his new electronic stethoscope.
After a brief exchange about the number of tablets, 28 or 60, Bill was handed the prescription and charged 10 Euros for it being written; there was no fee for the visit. This aligned with our experience years ago in Italy when attempting to buy a product that was over the counter in the US but only available by prescription in Italy: if you already had it in hand, you could get more; if you didn’t, you were out of luck.
The grumpy Selva pharmacist looked quizzically at Bill when he showed him the new prescription and they replayed their previous roles in the discussion of a box of 28 tablets or 60. When he picked them up the next day, he would have enough tablets to double his Eliquis dose to the prescribed level and enough at the higher dose to get home. Especially since these Bristol-Myers Squibb boxes from Dublin were priced at about 50 Euros, compared to the $550 at home, Bill was even more pleased with his stash. Apparently, US patients like Bill will be paying inflated prices for Eliquis until 2028 while the rest of the world has already been buying the product at generic prices. If Bill had been an Italian citizen, the box of pills would have been 2 Euros instead of 50.
Well Now….
The next day, a couple of hours after taking his 2 new heart meds, Bill was unexpectedly feeling better. It was a moderate hike for us, about 8 miles and a 1000 feet of elevation gain. In the last 45” of the outing, well protected from the sudden, fierce downpour and accompanying chill by our new $10 vinyl coats, Bill was still bubbly about how much better he felt.
The view of Selva from the end of our sprint up Stevia trail.
We both were ecstatic from nearly matching our times up this trail from 2018, a feat we never expected to accomplish. It was the end of our 1st of 8 weeks in Selva and we were buoyed by a new confidence. We had climbed at a rate of 1000’ per mile for almost 2 miles, when our usual rate on this valley’s hills was about 100’ per mile.
It was a stellar romp on Stevia for both of us, with our heart rates topping out in the 170’s beats per minute, but it was also an inflection point for Bill. The new question was: how many years, or maybe decades, had he been suffering from diminished heart function?
Overjoyed from being at 8000’ without altitude intolerance.
Taking ibuprofen when Bill was exerting over 6,000’ above sea level had been essential aid for him to keep going for 10 years, but it was contraindicated with one of his new meds. He complied, didn’t take ibuprofen, and much to his surprise, didn’t need it. He blasted to the top of the trail, ending at 7100’ without his usual altitude intolerance.
Suddenly, Bill had more questions than answers and yet it didn’t really matter. He felt well like he hadn’t in years. But the questions came anyway: “I wonder what I will feel like in the Grand Canyon this year?” a place he had always fought against the altitude effects. “And what about that time in 2012 when you feared you had had a heart attack? And what about that time in Solden, Italy at 10,000’ when you could barely go on? And what about when you suddenly couldn’t hold your usual steady pace on Cactus-2-Clouds last December?” There was more to know.
Settling In
A full week after Bill wrapped up 3 visits with Italian doctors and 7 visits to pharmacies for medications, we were still re-equilibrating from the many dramas. We both felt like we had dodged a bullet and were both having restless sleep. I had gone from having predictably dull but current dreams to experiencing the craziness most of us only know at night.
One of my most bizarre dreams was of a woman telling me about a beautiful evening gown she had bought and additionally, she hadn’t been invited to a wedding because she didn’t meet the body weight criteria, all while a human-sized, very curly, auburn-haired poodle whizzed between us riding a knee scooter like is often used by people with lower leg injuries. Unlike many of my dreams to which I can spot material from my day that has been twisted into my dreams, I was left with “Huh?” It was strangely troubling but all I could do was hope that the players did not show up again and that this phase would quickly pass.
Suppressing our anxiety about all the “What ifs?” for those first 10 days while Bill was dealing with doctors and pharmacists was still rippling through our beings another 10 days later. Suddenly, our European holiday had passed the halfway point, and we wondered where the time had gone.
Bill did start occasionally experiencing mini versions of his initial, profound fatigue though only in response to hiking uphill, not just when strolling, like with the first episode. He quickly learned to listen to his body and to stop pushing when it resisted. If he slowed his tempo, his heart would catch-up in a couple of minutes, and he would be able to resume his familiar pace. Having to yield to his body was frustrating but it was a simple and effective accommodation, as was being more aggressive about hydration. Being on anticoagulants also meant he had to be more cautious about avoiding falls on the trail or getting clipped by a speeding e-mountain bike. Bill framed his situation as having a new body he had to learn about and luckily, most of the lessons were simple.
Mercifully for us, the Hong Kongers faded somewhere in this valley behind us.
Trail Culture
Over the years, we had admonished Americans planning a trip to the Dolomites to abandon their notion of being in solitude, of being there when other people were not. It’s not the spacious US West where people regularly die in the forests because they get lost; the Dolomites is where people live and work and they, and tourists like us, show up everywhere (especially when you think you are alone and can pee unseen). Instead, we encourage American visitors to embrace the cultural experience of the human overlay and immerse themselves in it.
More than 20 years ago when we started coming to the Dolomites, the trails were largely populated by Germans, Austrians, and the local Italians. With changing economics, Russians and Eastern Europeans increased in numbers and then faded. Next, it was “The (dreaded) Italians,” the southern Italians who were viewed as ill-mannered aliens by the locals. Covid changed everything and now the mix of international visitors is different every summer.
Our Ortisei hostess mentioned this year, there was an influx of Asians from unfamiliar countries, like Korea, Thailand, and Hong Kong. One group of Asians really caught our eyes because they had very unusual facial features and some were quite tall with large frames. We were amused by them because they were taking photos of EVERYTHING. All we could think was “You haven’t seen anything yet” when observing some of their shot selections.
Our most unexpected cultural encounter out of Selva was a couple of weeks later upon seeing group of a dozen or so young travelers from Hong Kong. They were lean and small framed but unexpectedly wild and loud on the trails, like they were at a carnival.
Within minutes of seeing their group at a scenic mountain hut, the hut hostess came running out, scolding a Hong Konger in Italian, shaking her kitchen towel at him. He was sitting on top of her pristine picnic table, which she informed him was only for eating. Surely, she was displeased with the general loud behavior of the sprawling group that swamped the outdoor space of her hut without buying anything, but he was the only one she chased away.
Later, their loud, raucous group drew scowls and mutterings from an oncoming Italian woman on the trail. We could not translate her words, but her tone and finger gesture circling her ear conveyed her disapproval of their crazy behavior, particularly with the obnoxious, low flying, drone they set loose.
We had the misfortune of being on the trail with them for too many minutes, minutes that seemed like hours, that day. Our pleasure from being on the quiet, scenic trail after the rains had stopped was marred by their screaming and erratic movements. They twirled their trekking poles around like eggbeaters, keeping us on guard to not have a foot stabbed or be tripped by their self-absorbed carelessness.
Two days later, our hearts sank when we encountered this same group at the beginning of an all-day hike. I dreaded the thought of us being swarmed by them on this stunning trail with their flinging poles and their damn drone. Bill’s summary statement was that they “Had an interesting sense of personal space,” which was quite an understatement.
Over the years, we had admonished Americans planning a trip to the Dolomites to abandon their notion of being in solitude, of being there when other people were not. It’s not the spacious US West where people regularly die in the forests because they get lost; the Dolomites is where people live and work and they, and tourists like us, show up everywhere (especially when you think you are alone and can pee unseen). Instead, we encourage American visitors to embrace the cultural experience of the human overlay and immerse themselves in it.
More than 20 years ago when we started coming to the Dolomites, the trails were largely populated by Germans, Austrians, and the local Italians. With changing economics, Russians and Eastern Europeans increased in numbers and then faded. Next, it was “The (dreaded) Italians,” the southern Italians who were viewed as ill-mannered aliens by the locals. Covid changed everything and now the mix of international visitors is different every summer.
Our Ortisei hostess mentioned this year, there was an influx of Asians from unfamiliar countries, like Korea, Thailand, and Hong Kong. One group of Asians really caught our eyes because they had very unusual facial features and some were quite tall with large frames. We were amused by them because they were taking photos of EVERYTHING. All we could think was “You haven’t seen anything yet” when observing some of their shot selections.
Our most unexpected cultural encounter out of Selva was a couple of weeks later upon seeing group of a dozen or so young travelers from Hong Kong. They were lean and small framed but unexpectedly wild and loud on the trails, like they were at a carnival.
Within minutes of seeing their group at a scenic mountain hut, the hut hostess came running out, scolding a Hong Konger in Italian, shaking her kitchen towel at him. He was sitting on top of her pristine picnic table, which she informed him was only for eating. Surely, she was displeased with the general loud behavior of the sprawling group that swamped the outdoor space of her hut without buying anything, but he was the only one she chased away.
Later, their loud, raucous group drew scowls and mutterings from an oncoming Italian woman on the trail. We could not translate her words, but her tone and finger gesture circling her ear conveyed her disapproval of their crazy behavior, particularly with the obnoxious, low flying, drone they set loose.
We had the misfortune of being on the trail with them for too many minutes, minutes that seemed like hours, that day. Our pleasure from being on the quiet, scenic trail after the rains had stopped was marred by their screaming and erratic movements. They twirled their trekking poles around like eggbeaters, keeping us on guard to not have a foot stabbed or be tripped by their self-absorbed carelessness.
Two days later, our hearts sank when we encountered this same group at the beginning of an all-day hike. I dreaded the thought of us being swarmed by them on this stunning trail with their flinging poles and their damn drone. Bill’s summary statement was that they “Had an interesting sense of personal space,” which was quite an understatement.
We enjoyed this favorite view after lunch in peace.
This day’s challenge was passing these dozen people, seemingly with no trail manners, one-at-a-time, on a narrow, switchbacked trail. We knew they spoke English, so we systematically said “Passing on your right” without slowing. It seemed that sharing the trail with others was an unfamiliar ritual. We got around them and, much to our surprise and relief, never saw them again, though heard their drone once more.
I had targeted what looked like one of their Hong Konger tour guides for having a little chat with her. The next time they caught up with us, I was going to initiate a private, 1 minute talk about pole etiquette before they hurt someone. I would have loved to teach “Trail Etiquette 101,” but would settle for delivering a brief, emotionally neutral, tip. But they turned off the main route, or turned around, and peace on the trail was restored. Only after we had finished our picnic hours later, was I convinced we had seen them for the last time.
I thought again about this Hong Kong group with passive Italian guides a few days later when we were on another challenging trail with spectacular panoramas but with a couple of hundred hikers, not just their small group. We spent the day exchanging smiles and greetings in our best guess of the most likely appropriate of our 3 languages.
We shared a few laughs with the international crowd, which included many Italians, like with one oncoming man who plastered himself against a huge rock to let us pass on a dicey bit of trail. With great earnestness, he carefully ran through his list of spoken languages to find a match with mine, all to tell me that my inside-out pant’s pocket was sticking out—such disarming seriousness over something so silly was unexpectedly humorous.
It was a shame that the Hong Kongers could not immerse themselves with the other hikers like most had done on this very different day. Instead, they had treated us like we were invisible, would not make eye contact or chat with us, and hogged the trail. They could have had a typical Dolomites, congenial cultural experience and had their eyes opened to another way of being, but instead, they remained insular, like the Americans in years past that wanted to replicate their familiar “solitude in the wilderness” experience.
Italian purchases for Barb’s air pollution survival kit.
Closing Out July in Selva
The end of July was a roller coaster ride of emotions for all of us Dem’s who had practically turned into bedwetters after Biden’s disastrous debate with Trump. Bill’s sleep was disrupted by visitations from Biden and fears for our future.
On that trajectory-turning Sunday night (for us), when slipping between the covers, Bill spotted Biden’s withdrawal announcement as an alert on his phone. The next morning when we awoke, it was Kamala taking on the world. Interwoven with the galloping news cycle, Bill had new cardiac sensations and worries, and I was stopped in my tracks with asthma from air pollution, with my breathing being diminished for more than a week after the air cleared. Even with the burdens of our personal dramas, we were incredibly buoyed by the US political scene being turned on its head. Go Kamala! We could not guess what the political state of affairs would be like when we returned home from 3 months in Italy in a month.