The case was straightforward, exactly what we needed on a busy morning. A 40-year-old construction worker had given me a history that sounded as if he had reviewed the signs of acute appendicitis just before walking into the clinic. He’d had two days of central abdominal pain that had now migrated into his right lower quadrant, mild nausea, no appetite, no vomiting, and no diarrhea. “A slam dunk,” I thought. “Appendicitis until proven otherwise.” I asked him to lie down on the exam table, but my mind had already begun to move to the next question: Where could I send him for surgery?
My wife and I were volunteering in New Orleans East, just north of the devastated lower Ninth Ward. Nine months earlier, Hurricane Katrina had tried to wash away the Big Easy, and almost everything, including the health-care system, was still broken. In a parking lot across from a flooded-out high school, a charitable group had set up a cluster of trailers to serve as a clinic. A hundred people were being treated daily, many lining up in the predawn hours hoping to be seen.
At the city’s few functioning emergency rooms, the waiting time was up to two hours. And that was just to get a patient out of the ambulance. Once inside the ER, it was another 6 to 12 hours to get seen. “Unless you are bleeding or having chest pain, it’s a long wait wherever you go in this city,” the paramedics told me.
