Makeshift medicine

NEW ORLEANS -- On a recent weekday morning, an emergency room in the heart of downtown New Orleans was filled with all the typical cases: a man moaning with a hernia, a woman beaten by her boyfriend, a 3-week-old baby who had fallen out of her car seat, a man suffering from chest pains.

But little else is typical these days about the Medical Center of Louisiana, a state-run ER and dental clinic open since March.

For starters, it's located inside the gutted shell of an old Lord & Taylor department store. The radiologists work in what were once the dressing rooms. The wiring is exposed, the CT scan is located in a trailer outside, and the patients' privacy is protected by shower curtains purchased at a nearby Dollar Store.

``If you think about American medicine, people shouldn't be seen in rooms with shower curtains," said ER doctor Jennifer Avegno.

The curtains are, to Avegno, a frustrating symbol of life in New Orleans one year after Hurricane Katrina. Shower curtain dividers, however, may be the least of the city's health care problems.

On the eve of the storm's anniversary, just three of the city's 10 hospitals have reopened. There is no trauma center in New Orleans, there are limited specialists, and just 60 beds for psychiatric patients where there were once 364. Hospital beds for any patient, in fact, are scarce. And so are doctors. And nurses.

Their migration away from New Orleans mirrors that of the city's residents. New Orleans has roughly half the population it had a year ago. But hospital officials say they are struggling to meet demand even in a much smaller city.

The hospitals that are open are overwhelmed by patients. And without an influx of medical staff -- including an estimated 969 nurses needed to fill vacancies -- many officials here are worried not only about a healthcare crisis but a crisis of confidence. How can the city persuade residents to move back, people wonder, when the current state of healthcare in New Orleans leaves so much to be desired?

``It's a system that -- literally every day -- is on the brink. Every day," said Dr. Kevin Jordan , vice president of medical affairs and the chief medical officer at Touro Infirmary, one of the city's three operating hospitals. ``It's a miracle to me that we actually get through a given day -- not just at Touro but citywide."

The problem is partly one of infrastructure. Most of the city's hospitals -- like most of the city itself -- flooded when Katrina breached the levees, essentially gutting the city's healthcare system. Donald Smithburg , chief executive officer of the Louisiana State University Health Care Services Division, compared what happened in New Orleans to what Boston would go through if it lost most of its major hospitals overnight.

``Imagine in Boston that MGH was down. The Brigham was down. Deaconess was down. And Boston Medical Center was down," said Smithburg. ``If you try to think about it in those terms, from a healthcare point of view, it's obviously been a very grave situation."

But officials say rebuilding the infrastructure is only part of the problem. State Health and Hospitals secretary Fred Cerise said the biggest issue is finding doctors and nurses to staff the hospitals.

``These places have beds that you could open to varying degrees," Cerise said. But with a shortage of nurses and the number of doctors in New Orleans down by an estimated 75 percent, hospital officials say they simply don't have the staff to handle more patients right now.

To address that problem, the Louisiana Healthcare Redesign Collaborative, a 40-member panel led by Cerise, recommended this month that the state lobby for $120 million in federal money to help recruit medical professionals to come to a region suffering from ``the largest single displacement of doctors in US history."

Money, however, can do only so much to attract nurses and doctors, said Susan D'Antoni , who recently stepped down as executive director of the Orleans Parish Medical Society. Just like everyone else, D'Antoni said, doctors and nurses are looking for the ``basics of life" -- housing, schooling, and daycare -- all of which are also struggling to rebuild right now in the city. And James Montgomery , Tulane University Hospital's chief executive officer, said many people have an even bigger question on their minds: ``Are the levees going to hold in the next storm?"

Amid this uncertainty, people wait for care. On an average day, Jordan said, as many as 30 people might be waiting for beds at Touro Infirmary. Surgeries get canceled. Patients with minor problems might wait all day in area emergency rooms, and the quest to find empty beds -- especially for psychiatric patients -- can last hours or even days.

``It's pretty dire," said Leah Hedrick , a social worker at Ochsner Hospital, a facility on the edge of town that has seen its volume double since the storm. ``The main thing we're seeing is substance abuse, overdoses. We see over 345 psych-related diagnoses per month in the emergency room, whereas, prior to the storm, we were seeing about 90 a month."

Officials hope University Hospital -- one of the two state-run hospitals in New Orleans -- will help take some pressure off the system when it reopens in November. In the meantime, the Lord & Taylor ER, a stopgap operation that must send patients elsewhere if they need a bed for the night, will remain open.

Dark humor, the crutch of the overworked doctor, pervades everyday life here. On a recent afternoon, when another doctor asked emergency physician Dr. Lisa Mills where she might find a medical report, Mills replied, without missing a beat, ``You could try over in housewares."

Mills, like most doctors here, once worked in nearby Charity Hospital, a venerable if antiquated building that before Katrina housed the city's only trauma center. Now, with many life-threatening traumas going to a clinic that LSU opened in the suburbs last spring and other medical emergencies coming to Lord & Taylor or Tulane's ER, Mills and others pine for the old Charity building.

``That building was beautiful," said Mills. ``It was perhaps a little run down. But it stood for what we were: It was grand. We were grand. And now we're here. It's very frustrating."

But on this day, like most days, Mills, Avegno, and other emergency room physicians didn't have much time to ponder what was lost or what will be. The patients were waiting, the cases piling up, the shower curtains opening and closing.

Kevin Singleton , 47, was lying down behind one, having a heart attack. His blood pressure was sky high -- 211 over 127. He was off his medication, he told the nurse, and had been suffering chest pains for about six weeks.

Mills examined Singleton and knew right away that he needed to be admitted somewhere, that soon she would have to start calling other hospitals to see if they had room, that soon she would be begging and pleading for a bed.

``The dance begins," she said.