Dr. Disaster

When the world is falling to pieces, emergency doctor Paul Pepe makes order from chaos

Comments (0) By Glenna Whitley Thursday, Nov 24 2005

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What Pepe sees when they get to the Superdome is a sea of people camped out in their own stinking filth, like refugees from a Third World country. He will never forget these sights, sounds and smells.

On Friday, when Pepe makes it to the New Orleans airport, he encounters an even bigger nightmare.

Dr. Ray Fowler directed the medical set-up of "surge capacity" facilities at Reunion Arena and the Dallas Convention Center, which screened 12,500 Katrina and Rita evacuees.

Dr. Pepe talks with Dr. Brent Treichler, a fellow ER doctor, outside the entrance to the Parkland ER--which treats an average of 300 people a day.

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He can hear the thwop-thwop of helicopters taking off and landing on the tarmac every few minutes. Ambulances are unloading the sick and dying from nursing homes and hospitals. Healthy people fleeing the flood are crammed in the hallways; later estimates put the crowd at 10,000. The airport reeks of feces and urine and sweat and mildew and rotting garbage.

Medical tents have been set up inside the sweltering D concourse near the gates, where Pepe finds one of his newest faculty members from Southwestern, Dr. Kelly Klein. A feisty, down-to-earth New Yorker who's done a fellowship in disaster medicine, Klein belongs to a federal "DMAT"--Disaster Medical Assistance Team--that arrived in New Orleans earlier in the week.

An exhausted Klein is doing triage among very sick, mostly elderly people. Triage means "sort," and it's a fundamental of emergency medicine. Doctors must separate patients into those who can wait for treatment, those who need immediate attention and the dead or dying. Many of these patients are stoic, but others moan, cry or plead for help.

Those Klein has black-tagged "expectant"--expected to die--are being placed in the downstairs baggage area and given only "comfort care," such as morphine. Though people are crammed so tight it's difficult to walk among them, here it is oddly quiet.

People who share the same nursing home are holding hands, sometimes praying. Klein recalls that there were more than 110 expectants--people with IVs, Foley catheters in their urethras, diapers that need to be changed. Few have medical records or medications with them. Some are no longer responding. Some are dead.

Klein tells Pepe that they ran out of gloves and most other supplies within 24 hours of the first patients arriving at the airport. They hadn't anticipated so many extremely ill people. They had so few resources that early on, Klein's team is forced to make a decision: They will not do CPR, intubate or practice any other advanced life support. It is necessary in these conditions, but it goes against their training. Then doctors must take old people off stretchers and out of wheelchairs, lying them on the floor, to bring in new arrivals. And the sick just keep coming.

Pepe is horrified; the scene looks like the aftermath of a military battle. He picks his way through the chaos to ask how he can help. Pepe can see that Klein and the other "young champions" are struggling with their anger at how the elderly and dying patients are being treated--and how little they are able to do.

He also senses paranoia among some doctors as more evacuees, some armed, flood into the airport. They are scrounging for food and water, crapping and urinating on floors. A nurse gets stabbed. There is no evacuation plan and no chain of command. Klein tells Pepe people need to be triaged to buses or helicopters, not stacked up like cordwood. The chaos is costing lives.

A Louisiana state official will later wonder out loud if Pepe has been cloned--for the next few days it seems as if he is everywhere.

Riding with state troopers, Pepe finds pockets of stranded people and relays the information back to Baton Rouge. He learns that the New Orleans EMS squad has been rescued by the fire department and is camped out at a nursing home in Gretna. And from the command center he talks to faculty members in Dallas, who are setting up the "surge capacity" facilities at Reunion Arena and the Convention Center. He grabs only a few hours of sleep a day, either in a dorm at LSU or on the floor of the office in Baton Rouge.

But Pepe's biggest successes come from "his guys," doctors like Klein and Swienton, as well as Dr. Mike Proctor, senior medical advisor for U.S. Homeland Security's Office of Domestic Preparedness. They've been given a mandate to get people the hell out of the New Orleans airport.

At midnight on Saturday, Pepe manages to get a call through to Swienton, who sounds depressed. He can't break through the logjam. Doctors are arguing in the halls. A few seem on the verge of psychotic breakdowns. The leader in charge of transportation has no evacuation plan but has tried to throw Swienton and Proctor out of the airport for usurping his role.

"If they evacuate everybody," he asks a flabbergasted Swienton, "what are all my DMAT people going to do?"

But by 7:30 a.m. on Sunday morning, when Pepe calls again, Swienton and Proctor have broken through the gridlock. Swienton, an Air Force veteran, has made contact with a three-star general, who sends planes into the airport despite the lack of landing lights or air control, putting one down every 15 minutes. FEMA and EMS officials try to stop them from loading people, Swienton says, because "they hadn't been medically screened." Absurd. He and Proctor turn to air marshals for help, and people start flying out. Another friend knows Al Gore; the former vice president brings in two airplanes and flies 300 patients to Tennessee.