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Strong Medicine

One of the real oddities about being an expat is dealing with healthcare in a different culture, different legal system, and a different language. I think most people think, “medicine is medicine, right?” but the differences are profound. Living here in what some derisively label Gringolandia can bring the differences home.

Take how hospitals approach inpatient services. In Mexico, nurses are something less than a licensed practical type in the states. Most here are more administrative helpers than anything else. Hospitals expect a family member to stay with you (the patient) in the hospital to help with basic care! Going in for surgery? You will probably be reminded to arrange a group of friends to come and donate blood for you. And the blood donor restrictions go all the way to how many hours since your last meal, so while you’re sitting around waiting to give blood, you’ll also be worrying about those (there are too soon AND too late limits). Of course, every visiting tourist who ends up hospitalized in Mexico also reacts in horror when the hospital refuses to release you before you pay your bill! But from the hospital’s standpoint, it has no way to collect once you’re gone, so you’re not leaving until they stamp la cuenta with pagado.

Mexico has free national health care, and it provides health services directly equivalent to the cost (nada). It is not uncommon to hear of local hospitals short on basic medicines (e.g., antibiotics) or bandages. Very good private hospitals are available, and the prices here are much less costly than in the States. Partly that’s because of the Mexican health market. Mexicans rarely go to the doctor. They don’t trust the government ones, and they don’t see the point in paying for the private ones. Without much demand, there is little inflationary price pressure. Also–and very importantly–there is little or none of the malpractice legal regime so familiar in the states. Just doesn’t happen much here.

All these factors play out in an unusual way at lakeside. In an area with slightly more than 50,000 people, we have at least three hospitals, three specialty clinics, and a Cruz Roja (Red Cross) facility. And twenty dentists and no one knows how many farmacias! This surfeit of health care is driven by the expats, those (like us) who have insurance coverage or others who simply pay as you go. Costs have been rising as local doctors/hospitals realize there is a captive population here which doesn’t want to travel up to Guadalajara (which is the medical centro for Mexico) and is willing to pay a premium for English-fluent (relatively speaking) staff and doctors. Dentistry is still pretty cheap for the same reasons I mentioned, and often the care and equipment are state of the art. I know I have mentioned before the immediate 3D printing for crowns which is common here.

What goes on behind the scenes of all these health services is even more interesting. Expats highlight the relative costs (still a deal), the quality care (doctors still make house calls), and the great availability. But it’s a totally different health system. Mexico in general has a “you get what you want” approach to medicines, services, and regulations, and many expats forget that. The view among medical professionals here is, “if you as the patient want to try something, you should be able to do so.” In the States or Canada, the medical industry is tightly regulated from top to bottom, and constantly checked through the government inspection and legal regimes. Here you can find a doctor who will work for you with any treatment you can imagine, for any reason. You take the risk, so it’s up to you. And doctors will gladly refer you for more tests and treatments, if that’s what you want.

Take stem cells, for example. In the United States, the Food and Drug Administration (FDA) has approved stem cell treatments for blood disorders like leukemia and lymphoma, conditions like osteoarthritis and Crohn’s disease, and cord blood stem cell therapy for certain cancers and blood disorders. There are numerous clinical trials underway with promising possibilities. Meanwhile, unlicensed clinics and doctors in the States have pushed unapproved stem cell treatments, resulting in hundreds of deaths and severe complications. In the States. With all that regulation and all those lawsuits.

In our little pueblo, there are two stem cell clinics and many private doctors offering stem cell treatments. Now it’s just possible that tiny Ajijic is a hotbed of cutting-edge stem cell medicine. And it’s also possible local doctors are just providing for the treatment expats are requesting. And it’s also possible some quackery is involved. If you peruse social media, there are many testimonials from local expats to this doctor or that treatment. What you have to understand is there is no medical evidence behind these testimonials. There is ample anecdote, and people swear they got better. But the plural of anecdote is not data.

People misunderstand the placebo effect, and think it means the result (“I got better”) is fake. It’s not. The improvement post-treatment due to the placebo effect is oftentimes real. That’s why the placebo effect is so important in medicine: just doing something (for example, giving someone a sugar pill which has no utility), results in a positive outcome. Why? Medicine does not know why, they just know it happens. What are some theories? One is that the appearance of treatment “tricks” the patient’s psyche into greater effort (The medicine will work, my body needs to help, too).

Another is even more simple: what happens most times you get sick? Well, you get well, treatment or no. Barring an accident, you’ll get sick hundreds or thousands of times (for many diseases, like West Nile or Dengue, the vast majority of people are asymptomatic: they had it and never even know they had it), and you eventually get better. Ok, eventually you get one that you just up-and-die from, but the most likely outcome of most sickness is: health. And this could show up in the placebo results, too.

So when you read about all the people saying, “I got stem cells, and my sciatica cleared up” or whatever, remember (1) they may not know whether they got stem cells or not, (2) sciatica can resolve on its own, (3) the placebo effect is real and could be the cause, or (4) they may be the leading edge of a medical breakthrough. But what you should never do is to confuse how medicine is practiced here with how it is practiced back home, wherever that is. It’s not that one way is better than another; just that they’re different, and the differences are important.

On Leadership

I generally avoid jumping headlong into the daily political sewage of a Presidential campaign, but sometimes the subject matter gets too close to home, and the level of feces gets so high, I just can’t resist.

This is one of those times.

Vice President Kamala Harris has chosen Minnesota Governor Tim Walz as her running mate in the 2024 campaign for President. Among the personal achievements attesting to his leadership is a career in the US Army National Guard, reaching the rank of Command Sergeant Major (CSM), the highest enlisted rank in the service, a feat which is indeed rare. You don’t achieve that rank without impressing many people for many different reasons, and it is indeed something to celebrate and honor.

Predictably, Governor Walz’ record has come under attack. These charges against him surfaced during his first campaign for the US House of Representatives, and again when he ran and won for Governor. However, the scrutiny of a national campaign is unlike any other. What are the charges?

First, he made an off-hand claim, during a 2018 meeting to consider new gun control restrictions in his state, that “We can make sure those weapons of war, that I carried in war (emphasis added), are only carried in war.” Gov. Walz never served in war, or even in a war zone. He did deploy to Europe during Operation Enduring Freedom, but saw nothing even vaguely resembling combat. The charge against him is “stolen valor,” that is claiming the honor due only combat veterans. He has made this claim only once, and it was about the weapons, not his service. I am inclined to pass this off as an inartful phrase. If more such video clips emerge (remember, scrutiny), it would be a major problem.

Second, he has referred to himself as a retired CSM, which is incorrect. Upon retirement, his rank reverted to Master Sergeant, as he had not completed the full requirements for the higher rank. As a person who left reserve duty as a Major, I can assure you my permanent rank is Captain, as I did not meet the requirements to retain the title of field grade officer. It’s a technicality, but not one to be taken lightly: it will say “CPT, USA” on my niche in Arlington National Cemetery. Walz has at times referred to himself as a former CSM, which is correct. Again, I believe we should give him the benefit of the doubt on this, as it is a technical issue about which only those very familiar with ranks and privileges would know or care.

Finally, Walz was CSM for a US Army National Guard artillery battalion when he retired. The unit was subsequently deployed into combat in Iraq, leading to the charge he abandoned his unit on the verge of deployment. There are things one needs to understand about this situation. First off, the battalion CSM is considered one of the “top three” in the unit: the commander (a Lieutenant Colonel), the executive officer (usually a Major), and the CSM, the senior enlisted person. This is the leadership team and the US Army makes it point to ensure the leadership team is intact before deploying a unit to combat: it undermines unit morale when the troops see a senior leader leaving when they are going into a fight. It can’t always be avoided, but it is a rare event.

A US Army Reserve or National Guard deployment is negotiated long in advance of formal orders. It begins with the Department of the Army contacting the unit and engaging in a ‘frank and earnest’ discussion about deployment. Yes, your unit readiness report is great, but how is morale? Your leadership team is excellent, but are they all ready to go? CSM, what about the troops: are there many pregnancies among the spouses, or children with special needs or any other considerations weighing on the deployment? How will it affect the community, as these are citizen-soldiers? Only when the Army leadership has completed a face-to-face discussion with the unit leadership is a deployment order agreed to and issued.

Much is made of the date of then CSM Walz’s retirement, and the fact it predates the deployment order. Now you know why that is irrelevant. If you don’t believe me, look into the statements from CSM Walz’s colleagues at the time, who explain that he confided in them he was considering retiring to run for Congress in lieu of deploying. So he knew about the probable deployment, knew what it meant to his unit, and chose to leave. He is also quoted by these colleagues as indicating he could do more for the common good in Congress than in the battalion. There is a ring of truth to that statement, if also a whiff of ambition.

There are four hundred and thirty five members of the US House of Representatives, and I can guarantee you every new one is last in line for influence. It is not that they are unimportant, just that their prospects to make a difference are in the future. There is only one Command Sergeant Major in a battalion, responsible for being the senior enlisted advisor to the Commander. They are critical to the success or failure of the mission, as the Army is more dependent on its non-commissioned officer corps than any other service. Being the Battalion CSM of a deployed unit in combat is the pinnacle of an enlisted redleg’s (artilleryman’s) career.

Those charging Gov. Walz with cowardice or desertion go too far; there is no evidence to support that. And yes, the Army deployed his unit and it performed its mission with a replacement as CSM; that is what the Army does. Yet the fact remains that he cites his military service proudly, while at the critical moment, he did not answer the call. He probably chose wisely: his post-military political career has been quite successful.

Sometimes military leaders have to make terrible choices, like which part of the unit to sacrifice to save the rest. Sometimes they have to make sacrifices themselves. Then-CSM Walz did not “abandon” his unit. At the critical moment, heading into combat for which he had spent a career preparing, he consciously chose to pursue a more promising future. Whatever choice leaders make tells you much about them as leaders, much more than what rank they wore, or what office they achieved.

What Just Happened? Immunity from Hysteria

The Chief Justice of the Supreme Court walks into a bar. The bartender asks “what are you drinking?”

The Justice says, “I’ll have an Old Fashioned. Anything new happening today?”

The bartender shrugs, “not unless you count that the American justice system is dying.”

“Is that so?” the Justice replies. “Make it a double then!”

Have you read the Supreme Court ruling in the case of Trump vs the United States? At one hundred and nineteen pages, few have. But that didn’t stop the hype machine from making instant analysis, just to get you riled. Fear not, I have now read it, along with a bunch (technical term) of legal analysis–both for and against. And now I’ll give you what you need to consider to form an enlightened opinion.

Put away your tinfoil, they’re not coming for you

First off, let’s demolish some partisan talking points, so they don’t cloud our thinking. Prior to the announcement, which came on the last possible day for release, some talking heads speculated that the Supreme Court had already given former President Trump what he wanted, since the delay involved in their deliberations pushed the trial charges brought by special counsel Jack Smith almost certainly past the election in November. According to this line of (dare I call it) thinking, the Supreme Court was in the tank for Trump, regardless of what they decided, since Trump could not be found guilty before voters chose for President. Except for the fact that he is already once-convicted, many times indicted, and is there anybody who doesn’t have a formed opinion about Donald J. Trump? Some may not know whether they will or won’t vote for him, but no conviction was going to stop him from being the GOP nominee. And by the way, there was a very good reason for the long delay: this was a seminal case in American jurisprudence!

From the breathless discussion about Seal Team Six (more on that later), you might think the President was once not above the law, but suddenly that changed on July first. Except it didn’t. Since the Clinton presidency, all Attorneys General and all Departments of Justice have held that a sitting President cannot be charged or indicted for official acts during his term in office. So the President, while in office, has always been somewhat “above the law.” That was so for Clinton, Bush, Obama, Trump, and Biden. Any one of them could dial up the Seal Team, and face no criminal charge.

But that was only a departmental policy, not a decision from any court. Many courts had mentioned it, but the Supreme Court had never decisively ruled on it. The only case involving Presidential immunity was Nixon vs Fitzgerald, which held that in civil cases, the President “is entitled to absolute immunity from damages liability predicated on his official acts.” So this Trump case was incredibly important, as there was little precedent, except as noted. That precedent laid out important reasons a President could not be sued for damages, as it would prevent the President from completing his duties. So the concept of the President, as President, not being the same under the law was well understood. And the understanding included the concept that political or policy disagreements were best dealt with in the political process, up to and including impeachment.

What did the Supreme Court hold in Trump vs. the United States? It created a three part test for immunity.

For official acts that are part of the President’s core functions, he has absolute immunity. So in appointing ambassadors or judges, ordering the military, hiring or firing federal officials and the like, the only appropriate redress is via elections or impeachment. No prosecutor can charge him, try him, or convict him.
For all other official acts, he has presumptive immunity. These are acts where as President he shares authority, say, with the Congress, for example in executing appropriations. Presumptive immunity means a prosecutor could charge/try/convict him, but first the prosecutor must convince the judge that such an action will not infringe on the President’s ability to do his job. Which is a very high bar.
For all unofficial acts, the President has no immunity. If President Trump decides to rob a 7/11, he can be perp-walked into trial.

While some are acting like American justice just died, I would note that some honesty peaked through the blustery hyperbole. In the New York Times, Maggie Haberman wrote, “The broad contours of the ruling — that presidents would be entitled to substantial protection for official acts — had been expected by political and court watchers for months.” If you only follow the news through the lens of Donald Trump, you might not know this, but informed opinion had pretty much figured this ruling out in advance. While the case was named for the former President, and directly affects his possible trials, the Supreme Court had a duty to provide a ruling protecting the Presidency, the nation, and the Constitution. Neither to protect Donald Trump, nor “get him.”

What the decision did was create a very clear test for the lower court to administer. Some of Jack Smith’s charges against former President Trump are now excluded as core functions. Some will have presumptive immunity. Some may be unofficial, and can proceed to trial. That won’t happen fast enough for anti-Trump partisans, but adherence to the Constitution is more important than getting Trump. The other, very important effect of this ruling is what it preempted. I can guarantee you that if the ruling had been of the “no-immunity” variety, many charges were pending. Charges against Presidents Clinton & Obama for drone strikes, including ones which killed American citizens. Charges against Biden as an accessory to murder for the illegal immigrant attacks in Texas and Georgia. I’m sure the left would have found more things with which to charge Bush and Trump.

It doesn’t matter whether you think any of these charges would have stuck. The precedent would be, charge the President you don’t like. And it would have been debilitating to the presidency, as Chief Justice Roberts noted in the majority opinion. That was the world we avoided, and it was not hypothetical. It was only waiting to be born.

Finally, what of the oft-quoted “Seal Team Six” hypothetical? If anybody mentions this to you, you will immediately know they are either mouthing a meaningless partisan talking point, or seriously confused. “Wait just a minute, Pat, didn’t Justice Sotomayor raise this very issue in her dissent?” Yes, yes she did. Her dissents are legend among serious jurists. That’s not me talking: she onetime got so lost in the emotions of her argument, she incurred a written rebuke (in Daimler vs Bauman) from Justice Ruth Bader Ginsberg! One can only imagine how bad things must be for RBG to have publicly criticized a fellow justice.

To make the point, arguing that this ruling fails to protect us from Seal Team Six is like arguing that the Covid vaccine doesn’t prevent cancer. Right. It doesn’t, nor was it intended to. President Biden can indeed order the Seal team to assassinate former President Trump right now. What does protect us from such an action? Not a Supreme Court decision on Presidential immunity, but the republican (note the small “r”) values of our government which demand fealty to a Constitution, not a person. An illegal order will not be followed by the chain of command, not only because they have no immunity (which in my example, President Biden would have!), but because they know it is wrong. If you think that is too slim a reed for protection, riddle me this: during the fifty-some odd years of the Cold War, nothing kept the President from ordering a random, reasonless nuclear strike. Yet I will bet–if you’re old enough–you never lost a moment of sleep about it. For the same reason.

Justice Sotomayor does make a strong argument that since all Presidents up to this point thought they were criminally liable after office, what could be the possible threat impeding them from executing their duties? But she gives the game away by failing to note the change: when has any former President faced four indictments and eighty-eight felony counts, suddenly applied in the months preceding an re-election campaign? And she signs off not with the customary “respectfully dissent” but “with fear for our democracy (sic).” With that, she models Lieutenant Commander Galloway in “A Few Good Men.”

"Oh, well, if you strenuously object, then I should take time to reconsider. " — She should have said “strenuously

So stop with the Seal Team Six (and other equally ridiculous hypotheticals) already. Understand that a world where a sitting or former President could be charged, tried, and convicted for official actions was not a hypothetical, but a nightmare waiting to happen. Consider what is going on in the news, the courts and public opinion not in terms of Trump, but in terms of how things will be when Trump is only in the history books.

The decision in Trump vs. the United States serves to enable a presidency without enabling any specific abuses. It prevents the kind of litigation which would only serve to tie the executive branch in knots. Whether it helps Trump in the short term is not the most significant factor. But hey, revel in another round of hypotheticals if you prefer.

Postscript: The immunity ruling highlights another problem with the need to “get Trump” before this year’s election. The New York state felony trial, a state jurisdiction and dealing with strictly non-presidential conduct, was the one trial most secured from Trump’s ability to pardon, immunize, or halt if he were to regain office. Judge Merchan pushed the trial forward relentlessly, despite objections by Trump’s defense team and counsel from outside observers that there were many reasons to take one’s time. This became the first trial to convict a former President on a felony charge. Now, because the judge admitted to court evidence from White House personnel, he has delayed sentencing at least until September, as he considers whether his admission of such evidence was prohibited by the ruling in Trump vs the United States. Whatever you thought of the case (I wasn’t a fan, although it was obvious Trump was guilty as charged), once again haste has complicated the outcome.

Faith, Reason, & Ignorance

Science is a body of knowledge stemming from a process of experimentation. Scientific theories explain the phenomena being investigated. When something new is discovered, a new theory must replace the old one; hence science is never “settled” but always dynamic.

No scientific theory seems more well-attested than gravity. Everyone knows what gravity is: the attraction between any two objects of mass. Everyone knows that gravity is real; a common joke for people who describe some scientific finding as “just a theory” is to suggest they test the “theory” of gravity by jumping out a window. We can even calculate gravity’s effects with great accuracy and precision. For the longest time, scientists could do all these things without being able to show “how” one body attracted another. Many scientists searched (still do) for “gravitons,” invisible particles which moved between the masses to connect them. But they remain elusive.

Only in 1915 did Albert Einstein explain that mass distorts or bends “space-time,” causing smaller objects to move toward larger ones (i.e., gravity). Got that? Probably not. Most folks could spend a lifetime studying space-time and not quite get it. Mostly because it cannot be seen. We can measure how it works, see its effects in things like gravity, but the thing itself, space-time? Well, it remains elusive. But it does explain gravity, so we accept it.

Image depicting mass (the Earth) distorting space-time

What does that mean, that we accept it? It works, at least as far as we can tell. We believe it. We have faith in the scientists, the scientific method, and the theory.

Oh, there’s that word. “But, Pat,” you object, “we can prove it exists and works, so that’s not faith, it’s science!” Perhaps. But does gravity work the same way at the quantum level (very small) as it does on the cosmic level (very large)? Science still can’t tell if it does. But we trust in the scientists, the experimental results, because they represent what we can experience in real life: gravity. That trust, despite not being able to see gravitons or know exactly how space-time works? That’s faith, baby.

In a similar manner, consider mathematics, a pure art where truth is not abstract. Numbers are concrete things, and mathematical equations have a right and wrong answer. At the most basic level of math, there are equations and proofs which defy uncertainty. But the deeper you go in math, the fuzzier it gets. Get into algebra and physics, and you run into things called irrational numbers: numbers that can only be approximated, because the full understanding of the number is a non-repeating decimal sequence: √2 or π are irrational numbers. They are very real, but never exact.

Deeper still lie complex or imaginary numbers. What!?!? What is the square root of a negative number? Any negative times itself is positive, so the question in unsolvable without the creation of another axis (think of real plus and minus numbers being along a line) of numbers which have the identifier “i” added. Now the square root of negative four is two i (√-4 = 2i). Try to find these numbers in real life, and they remain (again) elusive . . . but important. Much of what we understand about electricity stems from working with imaginary numbers, and the same concepts are critical in calculus, necessary in so many other technological endeavors. The very name imaginary numbers points out the fact these can’t be seen, can’t be found, only theorized: believed in. Because they work.

“To have faith is to be sure of the things we hope for, to be certain of the things we cannot see.”

Hebrews 11:1

I frequently see friends on social media making derogatory statements about faith, of the sort, “I believe in reason, not faith,” “faith is blindly accepting some dogma or belief,” or “faith is unREASONABLE.” If faith were any of those things, I would agree with them. The truth is, faith is none of them, and the so-called reasonable people rely on faith, too. Religious faith is simply trust in God, a simple statement carried even on American currency (i.e., “In God We Trust”). Faith is not something we do, it is a gift, free to be accepted or rejected. The faithful receive the gift and trust the Giver, believing what God has said about how to live and what awaits those who do so faithfully. Those who reject the gift do not see (cannot see) what the faithful see.

Try avoiding these, if you want to stay away from faith

Perhaps you have heard the phrase “for those with faith, no explanation is necessary; for those without faith, no explanation is possible” often applied to miraculous events. The faithful can simply accept what they see; the faithless can only question, but not explain. As is often the case, Saint Augustine of Hippo put it succinctly: crede ut intellegas, or “believe so that you may understand.” The faithful believe because it works: life becomes intelligible, even joyful, when one suddenly sees the world through the eyes of faith. Not carefree nor easy, mind you. But joy-filled. It just works.

What do we call people who refuse to believe something, even if it works? Some might be ignorant, simply unable to understand. Others might be delusional, unable to discern what’s real or what’s not. All of these folks deserve our empathy, as they face challenges no one would want to face. But what about people who know better, but still refuse to accept? That’s what I call un-reasonable!

Eurobservations

Random musings from our six-week excursion, starting in Amsterdam, through Milan and Puglia, down to Sicily and back up to Vicenza:

I know I sound like a broken record at this point, but it still amazes me that casual American culture has so overtaken Europe. Even baseball caps are no longer a dead giveaway of American tourists. I can’t tell you how many middle-aged (aka “adult”) men I saw wearing t-shirts with vulgar English-language slogans (e.g., “if you can read this, f*ck you!”) who were clearly locals. Athletic shoes (I am old enough to have typed tennis shoes before correcting myself) for all, athleisure apparel wear for women, be-sloganned t-shirts for men (although still no shorts, gracias a Dios!). Yes, Europeans still dress well for work or to go out at night (i.e., when they want to be dressy), but otherwise they look as slovenly as any middle-American mall cohort. *sigh*
Vaping was a constant wherever we went: far too many people in Europe have not gotten the message it’s as bad as smoking. There was a lot of toking in Amsterdam, a lot of regular smoking the farther we went south in Italy. Restaurants and businesses upheld all the correct laws about non-smoking, but often it was easy to be surrounded by a cloud of smoke out and about.
Why has Europe perfected healthy, delicious snacks and quick meals, and the US hasn’t? We got bagged cornetti (fruit-filled rolls) on the trains in Europe, and they tasted fresh and good, even after a few days. You could buy snacks from an automat machine and they tasted good. Coffee vending machines? Excellent! Even the prepared meals/snacks in the supermarket were well-done, easy to prepare, and healthy. Contrast that with America: pizza rolls (motto: “no animals or vegetables were harmed in the manufacture of this product”), desiccated 7-11 hot dogs, stale Twinkies from a vending machine last inspected in 2011. Didn’t we invent fast food? And why does US fast food have unpronounceable ingredients? It’s enough to make one believe in the conspiracy theories!
Evolution has not caught up with the Italian people in light of the cell phone. Watching a young Italian woman hold a phone video conversation on a train was worth the price of admission. One hand cradling the device, the other gesturing wildly. Then a sudden pause, as she shifted the phone to the other hand, and resumed gesturing with the first. And so on, back-n-forth. Until they master hands-free technology in Europe, the Italians are throttled.
Permissive parenting is a drag. I like to be around kids; I really enjoy playing games with my grandkids. But I am used to, and expect, parents to teach children their place in society. I had a chance to book a “quiet car” on TrenItalia and thought “why?” Well I learned why, because the two Italian families in our car let their children play tag, run, and scream around the car for an hour. Likewise, our attempt to sit in a cafe near Bari and enjoy the outdoor setting was ever-so-slightly disturbed by two Italian grandparents who seemed to really enjoy their grandson chasing pigeons in the park. Shrieking at the top of his lungs. For half-an-hour straight. So loud the three local men listening to the live feed of the calcio (soccer) match couldn’t hear the broadcast. Ay-ay-ay!
The Dutch like fried food. . . a lot. I learned that Dutch expats miss most bitterballen: fried, battered meatballs. They also crave raw herring sandwiches. I thought this was because of all the coffee shops and MJ use, but it long predates that. I never want to hear anybody criticize pizza rolls again.
Italian cuisine, in its many forms, is amazing. But is it okay to admit that while every place in Italy claims to be unique and special in its pasta/cheese/tomatoes/ragu/etc., that in the end, the similarities are far greater than the differences? It’s all good; it’s often great. But I’m sorry, it is all not that different. And it is still hard to find any other cuisine in Italy, except in larger cities.
If you are going to travel by train in Europe at all, make sure and google some combination of the name of the country you will be in, the month, and the words “train strike.” They are so regular that they actually frequently announce them. Few things would be worse than finding that the train service to your airport is disrupted on the day you’re leaving.
Before we left I was cleaning out my clothes closet and decided it was finally time to throw out my twenty-year-old cargo pants. Damn if they’re not back in fashion, all over Europe. I could have been vintage! Ditto for mom jeans, but I don’t have any.
My suspicion that a sport coat was all it took to pass as “not an American tourist” still has a perfect record. Since I bought a good, lightweight, navy blue sport coat and started wearing it–especially on travel days–I have never had anyone walk up to me and start speaking in English. Or ask where in America I was from. The sport coat is not exactly a style setter, but it is enough to look like a serious adult (even me!), it’s comfortable (if you research and buy the right product), and it holds up even to machine washing. I do need to learn the phrase “Sorry, I don’t speak ______” because I do get asked for directions, time, weather, etc.
If you really want to score some points travelling, learn a little about the national politics where you are headed and ask a local (e.g., a garrulous taxi driver) what they think of a party, a candidate, or an issue. Most Europeans I met are amazed to find an American who knows a little about their national politics, and they will willingly vent on the subject. It’s fun, educational, and passes the time.
The Chinese tourist wave, which washed over Europe just before Covid, has still not resurfaced. Which is not to say places aren’t crowded with tourists, just not large Chinese tour groups.

Night trains in Europe?

Overnight train travel is returning to Europe after a few decade hiatus. Should you try it? Bottom Line Up Front from the late Amy Winehouse:

Way back in the Cold War, I got a few chances to take the train system in western Europe, and it was a great experience: inexpensive, efficient, timely (especially when run by Germans). A few times I got to take night trains, in second-class cars where the opposing seats pulled out and together to form one large bed for the four-to-six riders. It wasn’t exactly comfortable, but it worked. I even got one opportunity to take an overnighter which crossed from (then) Czechoslovakia through East Germany into West Germany. I had a sleeper berth on that one, with the added service of a East German Border Polizei shining a night-stick sized flashlight in my face at zero dark thirty.

I enjoyed the trains, especially the night trains; there is something about the gentle rocking motion, the fun of waking up at your destination, the freedom to walk around and enjoy the scenery, or go eat in a cafe car that just appealed to me.

The end of the Cold War and the gradual elimination of borders and customs among European countries should have been a golden age for trains. But as it happened, governments looked at the cost of maintaining national rail systems and they blinked. Deregulation allowed cut rate air carries like RyanAir to offer low-cost travel in direct competition. And the big national railways were directed to compete with each other, rather than cooperate. Long-range overnight train travel was among the casualties.

Recently, there has been a surge of interest in bringing back overnight trains. Some countries are limiting middle distance flights for ecological reasons. The rail system has solid infrastructure and most of the waste or redundancy has been wrung out of the system. So several companies or national lines are re-introducing overnighter trains.

When planning our current trip, I stumbled across the website “The Man in Seat 61” (link here) and it gave detailed instructions for almost any European rail adventure. Sure enough, there were such instructions to get from Amsterdam, where our cruise ended, to southern Italy, where our expat investigation began. We signed up for the OBB Nightjet train, run by Austria, which took us from Amsterdam Centraal to Zurich Hauptbanhof. There we caught another famous line across the Alps to Milan for a day stop. Then back to a day trip on a Frecciarossa high-speed (300 kph) train all the way to Bari. After a tour in Sicily, we signed up for a Trenitalia sleeper train which not only took us from Palermo, Sicily, to Rome, it also is the only train which boards a ferry (to cross the Messina Strait).

Sleeper car on the ferry, headed across the Strait of Messina

I was most looking forward to the Nightjet experience, but it didn’t live up to my expectations. First, it leaves at almost nine pm, which means you’ll be spending some quality time in the train station with all your luggage. When time came to board, the car concierge couldn’t find the correct key to unlock the inner security door, leaving a pile of customers stuck halfway into the train. This was an augur of things to come. She was very good at telling us what she couldn’t do, but less helpful otherwise. She did explain that the “call button” worked (i.e., it rang in her work area) but she would rarely be there so don’t bother. Hmmmmm.

One of four beds shown: one more folds down on the left, and there are two up top across from each other

We booked a two person sleeper, which was private and cozy. There was an adequate air system which seemed to provide the warm/cool air desired, good storage space, and a hidden wash basin. The bed was comfy enough, although I did flag down the concierge and have her open the middle row bed (each cabin has four beds, three on one side and one on the other) since the rounded-off top of the cabin made my head and feet touch the opposing walls. We filled out a nice little card (in four languages) with a selection of six breakfast items like coffee, brötchen (fresh German rolls) cheese and various meats.

The ride itself was uneventful: a few stops, no interruptions, and very sleep-able. Some of the staff took to holding a conversation outside our cabin, but they moved on before it turned into a problem. Around seven in the morning, the concierge was due to deliver our breakfast order. By seven-thirty, I was getting concerned, since we were due to arrive before eight-thirty. She knocked on the cabin door to announce she had only some yogurt, coffee, and orange juice, and would we like that? You take what you can get, so we agreed. But what was the purpose of the elaborate order the night before? Finally, the train arrived on time in Zurich.

The Trenitalia night train boarded in Palermo just before seven in the evening, but it had no cafe car, so we were warned to bring a meal along if we wanted one. The cabin was smaller than the Nightjet one. Both were clearly refurbished stock from the 1970s/80s. Again, possibly four beds, good storage (although much of it is overhead, tough to use for a large suitcase), and a hidden sink. The cabin steward surprised us with some travel snacks, bottled water, and I was even able to buy a small bottle of wine.

The cabin was a little stuffy, so we turned on the air conditioning. It worked well for about ninety-minutes, then suddenly switched to heat. The cabin quickly turned into a sauna, so I jumped out to find the steward. I flagged him down, and explained what the problem was; he was probably the least-English-fluent person we met on the entire trip. But he nodded, put his hand on the air vent (warm), checked the control (set to coldest), shook his head, then . . . opened the window. That was it. He couldn’t turn the heat off, but he could open the window. Which sounds ok, except the train was travelling at more than one-hundred miles per hour. At that speed, the sound is deafening, worse still when you pass another train going in the opposite direction.

Sample test question: Pat leaves Palermo going east at 100 mph. His air conditioning stops working in ninety minutes. Assuming otherwise normal conditions, how long does it take for Pat to fall asleep?

A) Instantly, but he wakes every few seconds due to the noise.

B) thirty minutes, but the dripping sweat wakes him up.

C) two hours, then he dreams of murdering the cabin steward.

D) All of the above.
From the revised SAT

Granted, we made it from Amsterdam to Zurich, and Palermo to Rome, in one piece. And the cost was less than separate airline tickets and a hotel room. But the experience was decidedly bargain, but not at cut-rate prices. Maybe it will take a little longer for the night train experience to peak.

Our trips in business or first class aboard Trenitalia were better: faster, cleaner, more comfortable, better food, wifi, and customer service. If you book far enough in advance, they can be very economical, but that is an art form in itself, and I recommend the Seat 61 website for all the key tips.

So for the time being, only consider a sleeper train if it has a new cabin. Stick to day trips on the high speed lines, and leave the sleeping to hotels. Maybe someday the sleeper will return!

Sicily

Word association time: what word comes to mind when someone says Sicily? Probably mafia or Godfather, first. Maybe cannoli, but that could be linked to the famous “Leave the gun, take the cannoli” line from the movie, too. Until fairly recently, it was fair to connect the largest island in the Mediterranean Sea with organized crime. Mafia control, portrayed in the Godfather movie trilogy, got so bad in the 1990s that they literally blew up several judges who had the audacity to question their hold. But la Cosa Nostra (as they are known) overplayed their hand, and the bombing led to a sustained campaign to break them down. Successive Italian governments tracked them down, and even Pope Francis joined in, excommunicating them in 2014. After thirty years, organized crime has returned to the shadows, unable to flex its muscles in the daylight.

But Sicily remains a poor, underdeveloped place with an abundance of history and culture. Whether the former attributes outweigh the latter is a matter of personal opinion.

We started our tour in Palermo, the island’s one-time capital and largest city. Palermo was a royal city, and a must-see part of the Grand Tour for European nobility in the eighteenth century. It has a proud heritage that mixes Phoenician, Roman, Greek, Norman, Arab, and Spanish influences. But today these influences largely reside in monuments and meals, and the main feel of the city is a blue-collar, slightly grimy vibe. I’d call it Naples without the cachet.

The other large city is Catania, on the east coast, literally in the shadow of Mount Etna. It has some of the same challenges, but seems a little more successful, having more a university town vibe than Palermo. The volcano is a must-see tourist stop, so that’s one advantage; it also accounts for unique soil and terroir, benefiting wines, cheeses, vegetables and the like.

One small lava field on Etna, which dominates the eastern shore

Getting around Sicily is a challenge. First, it’s large. Second, it is mountainous. It does have a bus, train, and car routes, but all of it runs on a sinuous network that could make a Formula One driver queasy. Palermo and Catania have decent airports, the latter subject to Mount Etna’s whims. So you can spend a lot of time getting from one site to another, or even around a town.

Monks built a earthen wall to protect against the 1669 Etna eruption. Now they have a two-tiered campus

The small towns in Sicily are inviting, once you can get to them. There life operates on a different level. They benefit from the fertile volcanic soil and the warm and (usually) moist climate, but mostly from the history. On the island, you can find some of the best Greek temples, Roman villas, baroque churches, and even Punic sites.

Maybe you like history?

How about scenery?

Of course there’s always the food:

Sicilian street food lunch at Florio winery

Sicily? Worth a visit. Given the geography, I suggest a tour, especially one themed to what you like: history? Food? Wine? Your ethnic background? One challenge is that Sicily is already warm in the traditional “shoulder” season, so the crowds start building earlier in the Spring than elsewhere in Europe. As to our sweepstakes for another expat site, this visit confirmed it is off our list. While it is charming and alluring, it is too hard to get to and too hard to get around. If I was an Italian-American looking to rediscover my Sicilian roots, it might be a different story.

Hands down, still the best photo of the trip!

Bari, Puglia

I know, you’re thinking, “Bari? Why are you in Bari? Wait, where is Bari?” Answering the last question first, Bari is a port city on the Adriatic coast of Italy, across from Albania, and it’s the capital of the Italian region of Puglia, often referred to in English as Apulia. But to make it easy, Puglia is the heel of the Italian “boot.”

“Why” merits a longer answer. This part of our trip is to experience a taste of expat life in southern Italy. Like we did in Spain’s Andalucia in January, we’re visiting this expat hot-spot to see how it “feels” to us. No agenda, no list of must-see/do’s, just six nights in Bari Vechia (old town). Southern Italy has become something of a magnet for American expats, especially those with Italian roots. The region has great weather, great food (‘natch), and decent value for cost of living, including housing.

We arrived on a Wednesday evening, expecting a quiet, work-night scene for a regional capital of 300,000+. So we were surprised by large crowds, closed streets, and a very festive atmosphere. When I asked the taxi driver if this was a normal sight for a late Spring weekday, he said, “no, it’s the festival for San Nicolas.”

Basilica of San Nicolas (very Norman or Romanesque!)

Now I knew Bari had an affinity for Saint Nick (San Nicolas de Bari is one of his official titles), and I knew all about Saint Nick in his Santa Claus personna, I even knew he originally was Bishop of Myra, in present-day Turkiye. But his feast day is December 6th, not May 9th. What gives? Seems we stumbled into an interesting historical phenomenon which goes back over 900 years, involving Muslims, Catholics, Orthodox, Turks, Byzantines, Venetians, relics, miracles, and Vladimir Putin. Seriously.

The Saint, back from his boat trip and walk around town

Nicolas was a famous Bishop in Myra, martyred during the Diocletian persecution around 343 Christian Era (CE). He was a Greek living in the Roman Empire, known for his piety and many miracles. Although there are no definitive accounts of his life, his cult emerged after his death. He is beloved by both the Orthodox and Catholic Rites of Christianity, becoming the basis for Santa Claus in the latter, while there are more churches dedicated to him in Moscow than any other Orthodox saint. He is the patron saint of sailors, prostitutes, repentant thieves, brewers, pawn-brokers, and students, groups which are certainly not mutually exclusive.

The saint’s remains resting place, and the devotion they attract

In 1054 CE the Church split into competing Catholic and Orthodox branches in the Great Schism, and in 1087 the Seljuk Turks overran the Bishopric of Myra, capturing the tomb of Saint Nick. A group of merchants and sailors in Bari, Italy, decided to raid and return (most of, Venetians later grabbed the rest) the saint’s remains to Christian hands. They brought them back to Bari on May 9th, establishing a “feast of the translation” (i.e., transportation, which sounds so much better than “theft”) at a new church in Bari. We had wandered into the middle of that feast.

And what a feast. Dignitaries from East and West attend, this year the biggest being the Latin Patriarch of Jerusalem. The statue of San Nicolas is collected up by the faithful and processed down to the docks, where sailors take it out for a night at sea. The next day, they re-enact the “translation” and the faithful gather to welcome their beloved saint home. The statue has a “skirt” attached to it (covering up the men carrying it) so it looks like it “walks” up from the port to the basilica. It moves to a spot on a promenade where it stays while masses of Thanksgiving are held in the Basilica Catholic Church upstairs and the Orthodox Crypt Church below, where the saint’s remains, well, remain. During the final mass, a priest crawls under the altar to the tomb containing the remains, unlocks it, and draws out: water. Although the box containing the bones is sealed, some form of liquid, called manna by the faithful, has been accumulating since the saint died. Of course this manna has miraculous properties and is diluted and widely shared among the believers.

One of the clothes used to collect the manna

What’s really a miracle to me is the way Catholic and Orthodox get along so well during all this, whereas in Jerusalem and elsewhere they are usually at each other’s ecclesiastical throats. For example, even Putin was allowed to make a pilgrimage to Bari in 2007! So Bari is full of Orthodox and Catholic faithful.

The view from our balcony: three eras of church wall

Bari Vecchia, where we stayed, is a typical medieval maze of tiny streets, repurposed castles, palaces and churches, with a blossoming harbor and new city spreading out landward from the small peninsula. The entire area is easily walkable: mostly flat, and our evening passeggiata often went completely around the seafront. There are oodles of cafes serving up espresso, osterias for seafood, pizzerias for focaccia barese. The locals are especially proud of their local pasta, called orecchiette or little ears. Women still set up tables in the narrow streets and make the pasta fresh while you watch. We were impressed with the local Primitivo and Negroamare red varietal wines. The pasta and focaccia were excellent; we have yet to find pulpo (octopus) which rivals what we find in Mexico, but the search goes on!

In addition to all that Saint Nick history, Bari has a surfeit of other historical regimes. Its earliest traces are Phoenician and Greek, then Roman, Byzantine, Norman, and finally Spanish, with each group leaving a mark architecturally. Under the Aragonese Queen Isabella, Bari passed to her daughter Bona Sforza as Duchess. She later married and outlived King Sigismund the Old of Poland, holding both titles (Queen of Poland and Duchess of Bari, among others) at the same time. So much for the patriarchy.

We took two day trips from Bari: thirty minutes south (on the local train) to Polignano a Mare, and forty minutes north to Trani. We wanted to see what smaller, less touristy towns in the area were like. Polignano is a small town famous for its cliffs, and Red Bull even sponsors a cliff diving event there every year. Trani has a bustling port and a fantastic cathedral.

Seaside Cathedral of the Assumption of the Blessed Virgin Mary

To be honest, the entire coast of Puglia is filled with small-to-medium sized towns that are very similar. Each has a small beach or port area, an old city, then a newer development (usually around the main train station) which consists of apartment blocks. Weekend or Summer vacation apartments for Italians stretch out from there. I would be hard-pressed to tell you which to select to visit; all have something to offer, but there isn’t a lot to distinguish between them in my opinion.

Puglia has been a tourist destination for Italians–looking for a quiet, inexpensive beach/shore trip–for a long time. It delivers on that promise, and remains less expensive, less pretentious (I’m looking at you, Amalfi coast), but still pleasant. Whether it has what it takes to be right as an expat haven for us? That’s a question still pending!

I only had to pay the tour guide five Euros to concoct a story requiring everyone to kiss under this arch to ensure a happy marriage.

Un momento milanese

I wish I could give you a full (not fulsome) review of the wonderful northern Italian city of Milano, aka Milan. But we were only there less than twenty-four hours, so a limited review is all I can provide. Suffice it to say the city deserves a much longer investigation, and since it is an international air hub, look to visit it to begin or end your next European journey.

After Amsterdam, we booked an overnight train trip on Austria’s OBB Nightjet which took us in early evening from Amsterdam Centraal to a morning arrival in Zurich. There we caught a connection to Milan on a quite picturesque route over, through and under the Alps. More on those train trips will be forthcoming later on our trip.

We arrived in Milano Centrale in the mid afternoon and checked in at the Hotel Bristol immediately next door to the station. The Bristol is a throwback to classy European hotel style with well-decorated rooms, eclectic art, and a breakfast buffet to die for. We explained to the concierge that we were in town for just one meal, right now, which unfortunately falls between the Italian lunch and dinner hours. He directed us to an osteria, Mama Rossa’s, a few blocks away. It was fantastic, and the waiter couldn’t help himself but to give give us an amuse bouche, extra bread, extra wine, and a lesson in Puglian cuisine, once he learned that’s where we were headed next.

Just looking at this again makes my mouth water

We waddled/staggered (did I mention the free apperitivo? The gratis limoncello?) out of Mama’s and jumped on the metro down to the Duomo: Milan’s majestic cathedral. The Duomo is quite literally a site to behold. Every corner, every window, every spire and doorway is covered with frescoes, carving, and religious symbolism. If you go–and you should–take a guided tour or get an audio guide and take your time. But we weren’t there for the tour. We just wanted to visit and pray.

I have mentioned previously that many European churches, basilicas, and cathedrals have tourist charges, but also permit “the faithful” to visit free of charge. The cost is just decorum and limited or no photography. We found the religious entrance and asked if we could go in and pray. The female guard took a look at me, wearing a small back pack and speaking English, and my wife, with a real camera around her neck. She said, “Not now. You should wait for the next Mass.” “Ok,” we replied, “when is it?” “Five-thirty.” “Great,” we said and walked around to a place where we could sit for thirty minutes and wait.

I watched as the guard let one group of locals (no handbags, no back packs, no cameras, speaking Italian) after another through to pray. I could tell she was watching me, watching her. She finally decided we must be legitimate, and she waved us over at five-fifteen. We found our way around to a small chapel directly behind the main altar, where we got the opportunity to attend a full Mass in Italian on a Tuesday evening. We made a point of thanking the guard on the way out!

May the Lord forgive me for a quick shot from behind the main altar!

Exhausted from our “relaxing” overnight train adventure, with bellies full of gnocchi, spinach, and meatballs and livers reeling from wine and spirits, we called it a night, knowing we were on the road again the next morning to Puglia.

This was just a hit-n-run visit; we knew that going in. Milan has so much art, fashion, culture and industry it demands your time. Still, it was a special meal, a special hotel, and a special Mass: of these great visits are made!

Amsterdam

Since our transatlantic cruise deposited us in Amsterdam, we decided to take an extra day and see what this unique and interesting city has to offer. No, not in the way of the red light district, nor in the coffee houses. Both of these quintessential “Amsterdam” things are embarrassing to the locals. They are trying to disperse the brothels, and make tourist use of cannabis more difficult if not illegal. Signs were everywhere prohibiting public joint smoking, but we could barely walk along the canals without choking on the noxious weed. And why would anyone want to take pictures of women who find so-called sex work a career choice?

If you do word association with “Amsterdam” you’ll get a lot of those two social problems (prostitution and marijuana), but what you should get is history, art, architecture, and even food. Which is what we found. Amsterdam is a very walkable city, and has great/affordable public transportation in metros, trains, busses and trams. We only touched the surface of its artistic riches, visiting the Rijksmuseum to see its holdings of Van Gogh, Rembrandt, and Vermeer. Likewise, the Dutch Maritime Museum has a full complement from the days of the Dutch East India Company, when ships like this brought the wealth of the world home to the bustling ports.

We even found a fabulous little museum called “Ons’ Lieve Heer op Solder” or “Our Lord in the Attic.” Seems after the Dutch separated from the Spanish Catholic Hapsburgs, they instituted an unusual form of religious toleration: every person was free to believe in whatever religion they wished in private, but only Dutch Calvinist churches were permitted public worship. All other religious spaces were confiscated and prohibited. This led to the creation of secret “house churches,” invisible from the street, which the authorities tolerated. One such secret church still exists as a museum!

Dutch food is a combination of hearty northern European fare (potatoes, meat and vegetables in pies and rolls), seafood, and influences from the former colonial territories, especially Indonesia. For example, you can get a tasty peanut satay sauce on just about anything the Dutch serve: I got it on a meatball and pickle sandwich! They also love their croquettes, basically ground up whatever in batter and fried.

The Dutch seem to be struggling with their reputation for being tolerant, well-meaning folk. Take their love of bike riding. It works well for them in a place like Amsterdam, it’s efficient, it’s ecological, it’s healthy. Just don’t get in their way. Think about that for a second. When people drive that way in the US, we call their rudeness out. We watched mobs of Dutch cyclists zooming everywhere, among crowds, cars, and clueless tourists, but somehow this was all ok because, well, why? Rude is rude, even on two wheels.

Likewise, we had to literally shove people out of the way to get on and off the tram, which loads from one set of doors and unloads from another. This system should work well, but on more than once occasion we saw locals just enter the trams and block the door, even after a polite English “excuse me.” And yes, everyone speaks English there.

Tack on the aforementioned religious “toleration,” and the way public drinking and smoking is winked at. Dutch officials spend a lot of time and money on public works just to get the streets cleaned up during the work week, money which might be saved with a little more prevention up front. We’re early-to-bed types, but we heard some partiers at the next breakfast table discussing how hard it was to get down the street between the drunks and the vomit . . . on a Sunday night. The government has even taken to advertising in the UK press telling Britons just to just stay home: no more stag/hen parties!

Verdict? Amsterdam is an interesting place, and a unique one. I’d say it’s worth a short visit, easily accomplished in conjunction with a river/ocean cruise or with a stay over at Schipol airport. Have I seen better art, ate better food, met friendlier people? Yes. But the city itself is so different, and the history so rich, it’s worth it even if you have to cough up some second-hand weed, step over the vomit, or get clocked by a biker.