I've seen a lot of different things going on in <a href="http://rcnd.com">Dallas. Radiology</a> there tends to be extensive and brutal.
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At 5 foot 7, with a salt-and-pepper beard and a slightly roly-poly shape, Pepe looks more like Santa Claus' little brother than the fast-talking, speed-walking adrenaline junkie he really is. He constantly jokes about his diminutive size: "I'm a giant compared to some children." Pepe is always smiling and has a high puns-per-minute index, which results in groaners like this: "What do you call a lady of the evening who likes Italian food? A pasta-tute!"
But his philosophy of medicine is down to earth. "Every person in the ER should be treated the way you'd want a member of your family treated," he says. And the tools he carries are the trappings of high-pressure work. Pepe totes three cell phones, a Blackberry and a pager--and one of them is always going off. He has the premier emergency medicine experts in the world on speed-dial.
It is the day after the levees broke in New Orleans, releasing Hurricane Katrina's floodwaters into the poorest neighborhoods. In Dallas, Southwestern faculty members, led by Dr. Fowler, are setting up "surge capacity" medical facilities to treat casualties.
Though tales of horror and bedlam are being beamed out of the ruined city, Pepe wants to be in the thick of it. "I felt Katrina was going to be the biggest medical disaster in United States history," he says. "We had a lot to learn from this. I didn't want to be on the sidelines."
When Pepe and Swienton arrive in Baton Rouge, they snag one of the last rental cars and make their way to the Katrina command center.
The center buzzes with local, state and federal officials. Behind glass in another room, CNN and other media outlets train cameras on the activity. But for several hours the two docs stand around, feeling awkward and unnecessary. "Why are we here?" Pepe wonders.
Pulled into a meeting with top leaders of Louisiana's emergency response team, they realize the bustle hides barely contained chaos. "A health-care disaster is evolving before your eyes," someone tells Swienton. Sick and dying people are trapped in hospitals, nursing facilities, on the tops of their homes.
When Pepe and Swienton ask basic questions, though, they get wildly different answers. The New Orleans International Airport is in a state of anarchy. No, it's under control. Hundreds of people are stranded on an overpass. No, they've been rescued.
Communications have broken down. Land lines aren't functioning, and cell phone circuits are jammed. Nothing is working but Blackberries--and those intermittently.
In the absence of facts, no one can make decisions. The chain of command seems to have collapsed.
Needing hard information, someone sends a helicopter to the airport to bring back several nurses, who describe disintegrating conditions. While Swienton works to set up a surge capacity facility in an abandoned Kmart, Pepe is dispatched to New Orleans by helicopter for reconnaissance. Pepe also wants to find the head of the city's EMS. She and her team have disappeared.
Then the media start reporting that people are taking potshots at rescuers. Going in under fire doesn't bother Pepe; he's waded into numerous volatile situations during his career, but the pilots don't want to risk it. A couple of heavily armed state troopers agree to drive Pepe there--after making sure he can use a weapon if necessary.
After years of learning to confront emergencies, improvising whenever necessary, not much can rattle Pepe. Like his father, Pepe has the ability to remain calm under the worst conditions, to impose order on disorder, to think on his feet. He surrounds himself with like-minded people.
A colleague calls him a "trailblazer with a machete" who brings in people with unique skills to set up the infrastructure. Within a few hours, Pepe and members of his hand-picked emergency medicine faculty--dubbed the Katrina Medical Relief Team--are in the eye of chaos.
From his spot in the back seat, Pepe reckons that the ruined city looks like a scene from the Apocalypse. As they move in deeper, the streets appear more like Escape From New York: creepy shadows, fires burning in the distance, flooded houses, people moving like wraiths. An occasional yell. The crackle of gunshots.
It is just before midnight on Thursday, September 1. The state trooper guides Pepe through the haunted city. He drives them to the Poydras Center, through deep water, amid swimming rats, and to the gates of City Hall. They make it to the flooded Charity Hospital, where the power is down, patients are on ventilators powered by generators and the staff is running out of fuel, food and water. Doctors have to post guards with weapons to keep out desperate civilians.