House Calls
Doctor Visits
Dr. Ricci, my pediatrician, was probably an oldish man—of course I thought he was ancient. He was bald and smooth and a little rotund and I believe he spoke to us in English, although I am not sure. I don’t know how often he came to visit, since I don’t remember being sick particularly often, but he came enough that he was part of the rhythm of my childhood. He would bustle through the front door with a little black case, rounded, like him, at the top. It was the shape of my mother’s miniature purses but in his case large enough to hold a stethoscope curled like a snake always at the ready to listen to the sounds of my body. I associated the bag that held so many things with the carpet bag in Mary Poppins or Santa’s bag of gifts—a. peculiar disciplinary magic.
Dr. Ricci was not, in fact, a disciplinarian. My mother believed in a very restricted diet for what the Victorian in her and the Victorianist in me cannot help calling “invalids,” no matter how brief the sickness. For her, for me, it was always chicken broth with tiny pasta—pastina in brodo. The pasta could be whatever shape I liked; my mother kept miniature shells, ovals, and tiny butterflies in our pantry for emergencies. It was Dr. Ricci who gave me permission to grate parmesan cheese on top, even at my sickest. “If she craves it, it will be good for her,” he said to my mother in either English or Italian. I listen now for his voice but I cannot make out the words, only the meaning. Parmesan or parmigiano? Surely not bramare for “to crave,” a word I just now had to look up. Perhaps lasciala stare or “leave her alone.” If I can’t quite listen well enough to his voice through the years, I know he listened to me.
For a long time, I thought of Dr. Ricci as a visitor, a special visitor summoned for special circumstances. The only time I recall visited him in his office was after I was hit by a motorcycle crossing the street at Piazza Navona from the restaurant where my family was in the middle of a long and boozy lunch to go play in the square by the fountain. I don’t remember the office as much as the feeling—like visiting my father at work where he would give me a special bluish grey paper to draw or write on. I do remember that it was strange to see Dr. Ricci surrounded by the tools of his trade: the black bag, opened, as it were, and spread around. Dr. Ricci examined the cut on my wrist which was oddly the only sign of contact with the motorcycle, aside from some bruising on my face. It was a small puncture really-- a very neat and symmetrical hole. Gently, he held my wrist up to the light so I could look through the hole; it was a strangely warm gesture, inviting me to share with him a curiosity that took the place of fear. Although it took me some time and some writing to remember this detail, Dr. Ricci was not the one to sew up my cut. “She’s a pretty young girl, “ I now remember him saying to my mother—and I now hear the Italian, una bella ragazzina. He told her he wanted a plastic surgeon to treat me so that there would be no scar. I don’t recall anything about the plastic surgeon, although, if I like, I can be reminded of him (surely a him) by looking at the tiny scar on my wrist that whitened over time and then settled unchanging into my changing skin, always just visible.
When we moved to the U.S. there were no longer any house calls. I think of Dr. Ricci now in an era in which the sick must take the time and effort to decide whether they are quite sick enough to get out of bed and arrange for transportation to a doctor’s office or a hospital. The very question, “Am I sick enough?” is exhausting for the ill and for those taking care of them. It is a diagnostic moment, but also one that must factor in the long wait at the office or emergency room (of course the less sick they are the longer they can expect to wait). If the sick or their carers decide that the problem is serious but not an emergency, there is pressure to dress, to wash their face, to put on a public one. An ambulance relieves the sick from getting out of their pajamas but can sometimes—and unpredictably—cost thousands of dollars. The calculus, the decision, in an adult who is conscious, rest with the patient. I have rehearsed this question many times: when my husband had kidney stones, my sons asthma, my older son cancer. At what point are the comforts of home insufficient, even dangerous? Sometimes the answer is easy—as when my husband fell off a ladder stringing Christmas lights—sometimes the question itself can make you ill.
If you or your parents or friends or relatives are sick enough to leave home in search of help, you cross a threshold. You leave behind the very things—pajamas, soft blankets, hot water bottles, chicken broth, pillow, sleep—that signal both sickness and recovery. You will wear a gown tied loosely at the back for easy access in case—in case of what exactly? You will not want to think about this. You will be cold and the blanket will be thin, although you can ask for another. Likely you will not be allowed to eat or drink, again in case a dramatic intervention is necessary. The waiting room and the other rooms you will wait in will glare with institutional lighting. If you are lucky you will doze in the glare between visits by nurse practitioners, nurses, and—finally—doctors. Everything will take much longer than you think, although you will lose track of time, even if they let you keep your phone which will run out of juice. The odds are—barely-- that you will regret leaving home, although it is certainly possible that you won’t, that only the hospital will do for what you have. It is all about the odds, really, and contemplating the odds is tiring.
Long Distance Calls
I have said there are no more house calls, but recently, of course, there is telemedicine. You can once again be sick at home, although with a difference: you are in your home, but the doctor is not. Ads for telemedicine try simultaneously to minimize this difference and to emphasize it. The ad below is fairly typical in that its visual idiom is symmetry. The patient and doctor or nurse are on the same plane—communicating, it seems, as equals. Perhaps this equality, this balance of power, is made possible by the fact that the person to the right of the screen reads, culturally, as much “nurse” as “doctor” with her long hair, and her crisp uniform, her oddly buxom profile. The identity of patient is signaled by age, and by disability, but also by a mustache turned downwards as it is a frown registering pain-- or perhaps, in medical parlance, “discomfort”. Despite the wheelchair and the frown, the man on the left is equal in size and stature to the woman on the right. He owns an identical computer (or at least an identical monitor), and seems, despite his age, to be equally tech savvy: the conversation bubbles, abstracted of bodily detail, seem to continue without a pause; the contributions from each side appear to be about the same length. Interestingly, the settings from which this man and woman, this medical professional and “her” patient communicate, are also similar, featuring almost identical-- and identically placed—plants. This repetition, this connection, blurs the distinction between houseplant and office plant, home and institution. It is difficult to know whether both sides of the image are intended to be homey and reassuring, or whether both sides are meant to be seen as institutional, professionalized. And this confusion is the point. The magic of the enormous monitor(s) is that one place can be transformed into the other at the moment of contact.
Ads that came out during COVID can have a slightly different take on the home/institution divide. I have seen multiple ads that include some version of the phrase “stay home/stay safe.” This particular one below abandons the figure of the medical professional altogether the and relegates the patient to a watermarked background. The slogan here is almost everything, takes up almost the whole foreground. If we peer beyond the text into the blue background of the image we see that the patient, whose home is represented by the two rectangles of the laptop and the artwork behind her, seems genuinely concerned—perhaps about her symptoms, or perhaps about the efficacy of the technology itself. She may be obeying the injunction to “Try telemedicine first (italics mine)” but this is not an image of technological triumph. She is at home, but home seems blurry and very far away.
Triumph or tentative exploration, telemedicine both is and is not a house call. The verb “to call” and its derivative noun “call,” so easily absorbed into the language of technology, originally , of course, meant to visit,” to visit in person. A house call was a meeting unmediated by technology, although it could of course be mediated by barriers of language, class, gender, or race. It is easy to sentimentalize, to imagine that Dr. Ricci spoke a universal language, and that my mother, who knew quite a bit Italian but probably not specialized medical terms, understood him without effort. It is easy to think of medical knowledge being translated into the more familiar language of food: pasta, parmigiano, the endearingly diminutive pastina. What if instead of a dealing with a fever or a stomach ache—he was happy to be summoned for these—Dr. Ricci had had to contend with a real emergency? In retrospect, the worst thing that happened to me, health-wise, all happened on one day, during one party out in the country, when I fell and hurt my head three times—the last time, no doubt, because I had after two blows to the head lost all sense of balance. My friend’s parents drove me all the way home where Dr. Ricci was waiting. “Let her sleep,” he said, perhaps lasciala stare again. Nowadays, post concussion awareness, post CTE, this would have counted as bad advice. If I had been a child in the U.S. in the 21st century, I would have been rushed to the hospital, scanned, checked for inter-cranial bleeding. I might not have been allowed to sleep, perhaps to eat. I would never have been left alone. It all turned out OK, it all unfolded at home, enfolded in the rhythms of sleeping and waking in my own bed. Home cured me that day, but a return to that time and place seem impossible. As in the ad, home has retreated as a place of healing and we cannot easily return there.