Here are some observations about Palermo that may be of use to you (your mileage may vary).

This is a hospital owned by Italians, staffed by Italians and part of the Italian culture. We are guests here. My

There is no problem walking around Palermo. It is safe and secure. You can get a (one day old) USA Today down the street at the newsstand in front of the big cathedral. However, be VERY careful crossing streets, pretty much a death-defying act. Scooters come fast from nowhere. Scoot quickly across the street and don’t ever trust traffic lights. The hotel will draw you maps of nice places to eat that are walking distance. Get to know the American nurses too. They all know where to go. Dining in Palermo is problematic as virtually none of them speak any English and the menus are all in straight up Italian. You won’t have a clue what you’re ordering and will most probably end up with a big cold dead fish with an apple in its mouth if you take potluck. Do not tip anywhere, including cabs. I think it is a very good idea to bring some kind of a hand held computer with Italian phrases and menu items translated to English and vice versa.

There are numerous walking tours around Palermo that are very serviceable for photo taking. If you are a photo nut, make sure you have a camera with no shutter lag. Photos of people and things present instantly and will not wait a few seconds for the shutter to activate after the camera computer thinks about the exposure for a while. The food and Sicilian wine is excellent. They don’t have any liquor stores and liquor is pretty rare. If you like a drink before retiring, BYOB. The dining room at the hotel is on the top floor and has a spectacular view of the city. Very formal and expensive. Finding stores for sundry items such as toothpaste and the like are very rare. Bring EVERYTHING you need.

Driving in Palermo is a bit more problematic than in Pittsburgh, but not impossible. There are rules of the road in Palermo are different Because there is a lot of competition for vanishingly small road spaces. There are rules, and the inhabitants of Palermo know those rules and you don’t. It is a lot like being on a race track. You’re going fast and six inches away from the next racer, but everyone is trained and experienced doing that so it works. The rub comes when you put someone not trained and experienced on the same roadway. So, when you drive, simply follow the flow and pick your battles wisely. If you and someone else are competing for the same space, don’t back off too quickly. They can smell fear, and if they do, they’ll take advantage of it. Be carefully aggressive. Many times if it’s a draw, the other car will flash their lights at you and that’s your cue to go for it. Don’t hesitate or someone else will get it. Watch out for scooters who will do almost anything to gain an advantage. They are aggressive but very savvy and will not take impossible chances. They will look out for you.

The rental car guy will pick you up in front of the hotel at the appointed time and drive you to the rental car place where you will do paperwork. Then they will point you in the right direction and hive you maps showing you the route. First you will get on the major highway leading to Catania. Never mind the route number, just always look for signs leading to Catania and you will be on the right route. See the map. STAY OUT OF THE LEFT LANE. There are several species of left lane inhabitants. BMWs, Audis and Mercedes will be traveling about 120 mph. Ferraris and Porsches will be doing about 140. Superbikers might hit 160 and they go by so fast they’re blurred. You’ll hear them before you see them. High-end automobile drivers are merely arrogant. Superbike riders are wild eyed crazy and afraid of nothing. None have any sense of humor about you being in their way. Don’t force duals for right of way with vehicles going twice as fast as you.

As you proceed west, you will actually go around Catania and head North to Taormina, which you will see from the highway and get off at the exit. Taormina is built entirely on the side of a mountain and is spectacularly beautiful. Expect to have a major hassle finding your hotel and very narrow congested streets. You will probably get real time directions by phone from the hotel desk. Once you arrive, there is no place to park and they hotel will take care of your car. Then walk around to your heart’s content, take lots of pictures and buy knick-knacks. Dinner in open-air cafes that have a phenomenal view. Sleep off your full bottle of wine and then hit the bricks in the morning to see Mt. Etna. The map will lead the way. You can get as high as the major lava beds and a good view of the smoking crater, but if you want to go to the summit, it is a formal all day tour. Then follow the signs back to Catania and head North to Messina, where you will see the Italian Mainland and then head west along the Northern coast back toward Palermo. About halfway you are forced to get off the Interstate and on to a two lane running along the coast which is quite beautiful and you will arrive in Cefalu, which is beautiful and you should stop and hoof around a bit. Lots of touring motorcycles on this route.

Then you will get back on the Interstate and arrive in Palermo again where danger lurks. The map will show you the street to exit the Interstate that allegedly goes straight to the hotel. Seems simple enough. And you will see the sign for that street from the Interstate. But when you exit, there are five ways to go and no street signs so the real chances of getting the right street are about 20%. If you turn onto the WRONG street, you will be instantly lost in Palermo, and let me tell you, lost in Palermo is seriously lost. No one speaks English, there are no English signs and street names are hard to discern if they exist at all. I spent about an hour touring Palermo in traffic before I finally found something that looked familiar and discovered the hotel by dumb luck. Then I found out that there is a 24 hour phone number for the hospital interpreters that you can call anytime and get advice for anything in English. This will save you. I highly recommend this trip. The following Saturday, a trip to Corleone for obvious reasons is in order, about an hour from Palermo. Get your photo taken at the Corleone city limits sign. Agrigento is said also to be very beautiful if you have time.

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Sicily is rugged, lush and beautiful. Mountains shrouded in clouds. The Airport is sparse by contemporary European standards, but clean and functional. Hot and humid, even in May. Palermo is very third world in that there are no big office buildings. Streets are narrow and crowded. Lots of old churches and historical artifacts abound. But I wouldn’t call it poor. Seems to be a lot of industry and industrious people on their way somewhere. Reminds me a little of parts of Belfast I think. Also parts of Prague.

The people are very nondescript and adhere to no stereotype. Most males don’t look like Al Pacino. I’m told that born and bred Sicilians are darker complected and darker skinned than garden variety Italians, but I don’t see a definite trend. Females are however very female. Italian women have learned the gentle art of making the best use of whatever female accouterments they happen to be endowed with, and that’s the truth. I have figured out that it’s very useful to know just a few routine phrases in Italian. I’m working on: “You’re soooo pretty and I’m soooo far from home…..”

To my ear, Sicilians speak standard Italian. Pretty much like Tommy Chong does it on “The Pope: Live at the Vatican” track from the Cheech & Chong album. It is also true that Sicilians talk with their hands, especially in minor traffic disagreements. These scenarios really have to be seen to be fully appreciated. Rapid-fire double-jointed hand gestures integrated with facial expressions ranging from shock and disbelief to homicidal rage to suicidal depression. Tonal voices ranging from Harvey Fierstein to Mariah Cary and beyond. And they have a lot to be upset about. If there is any semblance of traffic regulation, I don’t see any evidence of it. Sicilians drive with their horns. The louder the horn, the more respect it gets. The longer the horn is on, the less likely the driver will back off for anything. Getting from point A to point B is simply a matter of bullying, honking, brief stops to insure opponents are fully appraised of the driver’s ire, mid road u-turns to arrive at a destination and opening the back door to pour the terrified passenger out onto the sidewalk.

Europe, especially Italy, has a great love for motorcycle racing, a sport only seen in Speed Channel reruns in the USA. It’s highly publicized here. The current world superbike circuit champion is an Italian, Valentino Rossi, and he is a national hero here. Rated a half page photo in the newspaper when he won his last race and I walked into the hotel room, flicked on the tube to find him midway into winning the French Grand Prix. He’s unbelievable. Poetry in motion (210 mph). Speaking of speed, they have what appear to be something like “roundabouts” in the UK, circular paths where vehicles enter at one of several entrances and exit at one or more others. What happens in between bears no resemblance to Newtonian physics. Instant death to those unacclimatized. Stay away from them. Foreigners have entered weeks ago and have never been seen again.

The hospital is absolutely beautiful and state of the art. They only do transplants (heart, liver and lung) and also some high-risk cardiac and abdominal procedures. Critical Care (anesthesia based) Fellows come from training programs mainly in Italy. Patients come mainly from Italy I’m told, but I note some Arabs and denizens of the Pacific Rim hanging around. I am also told that all this expensive stuff is provided gratis to Italian citizens supported by the National Health Service. At least one Italian-American told me there is a cash on the barrelhead deal available for foreigners, but I am told that isn’t so here.

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Watching girls (known as young women in the USA) seems to be the National sport in Italy. The entire population actively participates in it. Females go very far out of their way to dress in manners that show off whatever attribute looks best. Males gawk with wide eyes and open mouths. They usually also offer up some comments as to the quality and quantity of the attributes in view; comments that would get American males jailed immediately. These remarks are met with tosses of the head and uplifted noses. These females are about as unaware of what’s hanging out as Jackie Bisset was as she cavorted in the cold briney for “The Deep” in a one millimeter thick white t-shirt. It’s quite a bit of fun to watch.

Otherwise, I strongly recommend being VERY careful being a pedestrian in Palermo. Instant death awaits unpredictably. There is no safe passage, even the sidewalks. Traffic pays absolutely no attention at all to any rules of the road. There is no guarantee that a green walking signal will not be breached. The best course is to actually run, not walk across any road as quickly as possible, even in a walking light. Motorscooters come out of nowhere and they ignore everything in their paths.

Motorized two wheeled vehicles are a big part of the traffic in Palermo because petrol costs around US$6.50 per gallon. You don’t see any Hummers or SUVs in Palermo. Most of the cars are tiny and get good mileage. But there are a lot of motorscooters and motorcycles and every one of them is what the British calls “filtering” through traffic. Up over sidewalks, in between lanes and cars, through alleys and at high rates of speed. The mix consists of everything from tiny mo-peds that whine like sewing machines to the Kings of the Road.

Not too often, but notably you’ll hear the searing howl of a Japanese four cylinder superbike engine. Nothing sounds like that but a four cylinder superbike engine. A leather clad, Shoei helmeted sportsman laying on the tank, weaving in and out of lanes at 6000 RPM in third gear, a sneer on his lips, ain’t afraid to die, they get instant respect. Everyone gets out of their way instinctively as the aura of death-dicing hangs heavy in the air. And as Richard Pryor once remarked: “Death ain’t fussy…more than happy to jump down YOUR throat if you get too close”.

Live fast, die young and leave a lot of surgical residents to experience placing lines.