Difficult Worm

A story of sickness and health in Italy

I ask my wife, “Do you hear that?”


In the distance, behind our apartment, there’s the whine of truck traffic on the main road on the mountain; closer, two motor scooters accelerate up the street behind us. There’s that, but also, softer, somewhere in our building, ton-ton, ton-ton, ton-ton.

“Like a phone off the hook,” I say, “or an emergency signal.”

“I don’t hear it.” It’s after eleven at night. She’s getting out of the shower. “It was heaven down there today,” she says.

Down the coast in Pesaro this afternoon, she went to Marcello and got her hair done. It can take up to three hours for her to move through all the stations of the salon. There must be eight to ten, each with its designated, uniformed, and probably licensed professional. The penultimate stop, before dry and sculpt, is Marcello. He’s funny, Italian-guy thin and fashionable. He cuts. But it’s the guy who shampoos and massages that my wife loves. He gives her long, luxurious head rubs. She says it went 15 minutes or so today, maybe longer.


Another scooter goes up the hill, an older one. The engine sounds hoarse.

“I’ve been calling him Marco for the past ten years,” she says. “I mentioned him at the desk today when I was leaving, they said his name is Rafaello. I apologized to him. ‘Why didn’t you tell me?’ ‘Call me Rafaello, call me Marco,’ he said. ‘Either one is okay.’”

“I could do that for you,” I say.


“Head massage.”


“I don’t think so. You don’t have the hands.”

I hold up my hands, trill my fingers at her.

“I know,” she says. “But when I ask you for neck massage, or a shoulder or back massage, you’re too hard, or you can’t find the right spots. And after minute or two, you get tired. Your heart’s not in it.”

She’s right. “My heart’s not in it,” I say. “You’re right.”

“You see?”

“But head massage, I’d give you both heart and hands.”

“No thank you.”

“Both heart and both hands. That’s double both.”

“It’s not like any schmo can do a head massage.”

“How hard can it be? I could just watch Marco Rafaello.”

“No, thank you.”

“I could watch him, then have him give me a head massage.”

“He’s had training. There’s technique. There are zones, areas that he knows.”

“Okay, but let’s say he gives me a head massage, visiting all my zones, and I really pay attention. I watch in the mirror. The process sinks in. Then I can give you one.”

“You can’t watch in the mirror. Your head’s wet. It’s in the sink.”

Ton-ton, ton-ton. “You don’t hear that?”

She checks out her hair in the mirror, picks up her toothbrush. “He’s Neapolitan. All I heard was that motorino a minute ago.”

Now I can’t hear it anymore. Did I really hear it? Should I put it down for auditory hallucination?

Later, in bed, she says, “I think I’ve read this book already.” Cristo Si E’ Fermato a Eboli.

Since she started reading it, she’s told me that two or three times.

She waits a few seconds, tells me I should have my hearing checked.

“I heard you. I think you read it in English.”

“It’s bleak.”


“Life is bleak,” I say. “Unless it isn’t. Head massage, for example.”

She shuts off her light, tells me she needs to go up and see Zia tomorrow.

Her old aunt has been in the hospital for a couple weeks now. She’s ninety-two. She was weak. She couldn’t eat. She had a temperature. She and her caretaker, her badante, went up the hill to the hospital, to pronto soccorso, their emergency facility. Next thing you know auntie’s admitted, and next thing you know next, she’s in isolation. She’s a regal old girl, even in the hospital. Past stays in the hospital she gets up in the morning and puts on her make-up, lipstick, the works; wears her plush vestaglia, prepares to hold court. This time she’s whacked.

“What is it?” my wife asked the nurse a week ago. Carts rolled up and down the hall. It was dinner time in the hospital.

“It’s something.”

“I’m sure it’s something,” my wife says. “But what? Why is she in isolation?”

“We think it’s a kind of worm.”

I’m in the hallway listening, working on my medical vocabulary. (Life is bleak. You never know.) “Worm?” I say. I look in at auntie, sitting in a chair. Shadows under her eyes, pale blue institutional sickwear. She nods hello in my direction, wags a skeletal digit at me, tells me not to come in.

“She means a bug,” my wife says.

“Something in the intestine,” the nurse says.

“Virus?” my wife says.

“We’re running all the tests. In the meantime, antibiotics.”

And isolation. Every visit for the next 3-4 days, my wife ties on the backwards green gown, slips into matching poofy footies, gloves. No mask. Evidently this is not an airborne worm.

Four days go by. The nurse says there are still no results.

“I think they know what it is,” my wife says. “They’re just not telling us.”

Maybe it’s the geriatric ward, but, except at mealtime, it seems like they only have half the team on the field in this hospital, unlike in the US, where there are crowds of nurses, techs, blood-letters, orderlies, social workers, housekeepers, chaplains, and of course clusters of doctors and pre-doctors that swarm into rooms to perform detailed oral interrogations and dissections of the patient’s condition. In the US, the goal is get you on the entrance ramp to wellness as fast as possible and shove you out the door. Here you are invited to stay. Bring someone with you, invite them to stay, too, all day, all night, just in case there is a little ordinary work to be done, like a trip to the bathroom or a walk down the hall.

We see Renzini one day on the floor. He’s an affable doctor in a lab coat, there most of the day, available for conference.


“He won’t even come in my room,” the aunt tells us. “He just stands in the doorway and says, ‘Signora, we have to wait for the test results.”

“What is it?” my wife asks the doctor now.

“Signora, we’re not sure yet.” Worm, bug, microbe, virus.

The silence is the worrisome part. You get sick over here, the diagnosis is often shrouded in mystery. Especially if it’s something serious, something likely to kill you, they would prefer not to talk about it.

Odd, because Italians love talking about their health.

Every visit to Italy we make, I stand on the walk in front of our building and talk to Mario. He lives a couple floors above us. He tells me about his most recent medical complaints and the cures he goes for. The cure, as I understand it, is a kind of medical vacation. You visit a spa for a few days, where your ailments are treated with baths and muds, drinks and foods, massages and manipulations. If you’re lucky, they have a specialist on staff who helps you to find a few new complaints as well; you can stay an extra day or two and head those problems off at the pass.

Then there’s Signora Loridana. My wife buys nativity figures from a woman in a Catholic Church accessory store down in Rimini. While I wander around admiring crucifixes and statues of Padre Pio (available in sizes ranging from keychain bob to lifesize), sliding past manikins modeling priestwear for all ranks and all seasons, Signora Loridana shares her list of afflictions with my wife: bad sleep, headache, stomach ache, sort throat, dizziness, auras, vapors, numbness, twinges. I draw near to listen. One day she says her liver hurts her. She can feel her liver from the inside of her body. She has liver ache.

The most important thing for an Italian is to not get cold.

The scarf is standard equipment, long enough for multiple wraps under the chin. Even well into May, everyone wears a jacket and scarf and layer upon layer of long sleeve shirts and sweaters. The aggregate effect is contained heat and protection from a corrente. A puff of air can lead precipitously to a stiff neck and who knows what else. Close that window, shut that door. I have ridden in cars in August, when it’s 90 degrees outside, with the windows shut tight to keep the air outside where it belongs.

No AC. Absolutely not. AC is manufactured corrente.

The next time we drive up to the hospital we are finally told something specific. The worm has a name: clostridium. This seems like progress, but we are also told clostridium comes in many different forms. They aren’t sure which clostridium it is.

“I think they know,” my wife says. “They’re just not telling us.”

Another week of isolation. Another week of antibiotics.


I do what Americans do: I Google clostridium. It’s official generic name is clostridium difficile. It’s a difficult worm. There are indeed hundreds of sub-varieties, listed in alphabetical order, among which I note: clostridium asparagiforme (please don’t eat the asparagus), clostridium cadaveris (clearly the worst), clostridium innocuum (if you have get it…), clostridium putrificum (ick).

“All those antibiotics,” I say to my wife. “The biome in her gut must be wasted.”


At home, I listen to the radio.

“Your gut is a biome, an ecosystem,” I say. “Antibiotics are a nuclear option. They kill everything. Zia needs to eat stuff to restore good bacteria in her gut.” I consult my medical handbook (Wikipedia) and list good foods for auntie to eat: chicory, garlic, onion, leek, artichoke. Asparagus. (Really?) Italians eat stuff like this. It shouldn’t be a problem. Artichokes are in season right now.

“In particularly challenging cases,” I say, “fecal transplants have shown promise as a treatment.”

I explain about fecal transplants.

“She would never agree to that.”

“I think it was Fresh Air I was listening to…”

“Forget it,” she says. “Never, ever. Ever.”

Finally, a few days earlier than we expect, we get the call. They’ve given auntie her walking papers.

While the badante helps get auntie dressed, my wife consults with Renzini on what happens next, when auntie should come back for tests, what she should eat, a prescription to be filled. The foods listed in my handbook, he says she shouldn’t eat any of those.

The four of us ride down the hill, auntie in the front next to me. She’s dressed to the nines, in God knows how many layers. Vera, the badante, has worked wonders on her hair. She could hold her own next to Marco Rafaello. I keep the windows shut for auntie’s benefit, even though our black car has been heating up in the sun for 2-3 hours.

I ask her, “Are you okay, Zia?”

She nods. I swear she’s broken a sweat.

I tell her it’s a beautiful day.

She nods gravely, says yes, summer seems to have arrived.

In the car, it’s sweltering.

“Maybe you could put a window down just a little,” she says.

Sure, auntie. I really think that would make us all feel a little better.

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