Calm Amid Chaos

For two weeks in January, Peter Rhee was everywhere — on TV, in newspapers and on the Web as the Tucson trauma chief issuing status reports on the congresswoman shot in the forehead while meeting with constituents outside a grocery store; receiving a standing ovation from a grateful community at a memorial service in a packed Arizona auditorium; and sitting behind the first lady as her guest for the State of the Union address in Washington, D.C.

Rhee’s job, saving lives every day as the medical director of trauma and critical care at University Medical Center in Tucson, Ariz., suddenly thrust him into the national spotlight — his 15 minutes of fame, he says — when a gunman opened fire outside a Safeway store on the morning of Jan. 8 and killed six people. Eleven victims, including Rep. Gabrielle Giffords, were transported to University Medical Center, where Rhee is credited with keeping the wounded alive.

Rhee, HS 83, whose name now generates 2.9 million hits in a Google search, maintains that his life has not been forever changed by the tragedy in Tucson and the ensuing attention.

“It’s just a blip,” he says of his spot on the media radar.

Medical Rock Star

“Peter,” he says in introduction, smiling and extending his right hand before leading the way to a standard-issue hospital office and offering a bottle of water.

A first impression of the chief trauma surgeon is that he is a gentle man quick to smile, not an irrepressible and boisterous rock star, words used to describe him by the Associated Press.

The New York Times said some of his comments during press conferences in the days following the mass shooting came off as abrasive. Elsewhere, he’s been called pompous and arrogant.

“Arrogant? I guess maybe to a degree, I don’t know. I would not say that I’m boisterous. The one story that I did read about being irrepressible hit me a little bit, I guess. I actually looked it up in Wikipedia to see what the heck that meant,” Rhee says, chuckling.

Someone printed the definition of irrepressible — impossible to restrain or control — and taped it to his office door.

Rhee also is aware of an Associated Press headline: “Giffords’ Doctors Balancing Role as Rock Stars.”

“I think it is funny because they were focusing on different things about my life. On day three, they were focusing on my military background, and that got to be a part of it. Then they added on the rock star thing, irrepressible surgeon and so on and so on,” Rhee says. “I think they were more interested in my TV personality than anything else. I thought that was kind of curious.”

Rhee has received letters, postcards, monetary donations to the hospital and thousands of e-mails and Facebook messages.

“I’ve heard from everybody. ‘I’m so-and-so from Caldwell dorm,’” he says of several Tech classmates who have sent him messages. “I was contacted by my junior high girlfriend, high school stuff like crazy, college stuff, probably not as much medical school people, then residency days, internship days, fellowship days. Everybody’s been coming out of the woodwork about this. It’s been 999-to-1 positive, all great things.”

Rhee says he has responded to many of the messages and laughs as he admits he replied to the junior high girlfriend and told her what a crush he had on her back in the day.

Saturday, January 8

Rhee planned to spend his day off “hanging around the house doing fix-up things.”

“I was out for a run,” he says. “We get all the alerts through our smart phones. I was listening to music, then this thing comes in.” Rhee learned there were multiple gunshot victims but did not know that a congresswoman was one of the people shot or that anyone had died at the scene.

If there could be such a thing as a good time for a traumatic event to occur in Tucson, it would be Saturday morning, Rhee says.

“At a normal Level 1 trauma center, you can expect at a minimum that there’s at least a trauma surgeon at the hospital to accept any patient that comes in 24-seven, 365,” Rhee says, noting that the next closest such facility is in Phoenix, more than two hours away. “I already had two teams in the hospital at that particular time period. I called in to make sure they were set and ready. I asked who was on call, who was coming off call and who else was in the hospital at that time.

“The team from the night before was still working, and the team coming in for the next day was here as well. There’s an overlap period when they turn over patients, check on each other’s work and that sort of thing. As trauma surgeons, we also do surgical critical care. We’re the intensivists for surgical patients, so I had another surgeon in the hospital seeing the ICU patients,” he says.

Rhee continued making calls while running back home.

“My wife had my car ready with my scrubs so I could jump straight into the car,” says Rhee, who activated a command center and ensured trauma bays and operating rooms were readied by phone.

He remembers his first reaction when he rushed into the hospital. “‘Wow, there are a lot of people here.’ Normally I do these type of mass casualties at nighttime, so I’m usually by myself handling 10, 20 patients. But here we had such an abundance of doctors in the trauma center. I coordinated them and got information so I knew what needed to be done next. It only took a few minutes, but that was the initial thing I had to do.

“As the trauma captain, what I have to try to do is make sure the people have the right resources and I don’t get bogged down with one patient. When you do that, you lose the experienced person doing something that others could do. My job is getting that patient who needs surgery with the right surgeon,” he says.

‘Make Sure Everybody Survives’

Giffords was in surgery less than 40 minutes after her arrival at the hospital.

“Thirty-eight minutes from the patient coming in is a long time in some ways,” Rhee says. “We have the capability of taking a patient to the operating room within three minutes, but in this kind of situation with Gabrielle Giffords, with a penetrating injury to the brain, 38 minutes is about as good as it’s going to get. We were able to get her to the operating room very quickly and get things moving on her.”

During a televised press conference following the mass shooting, Rhee said he was 101 percent sure that he could keep Giffords alive. He stands by that statement but does not include a percentage.

“Based on her injuries, somebody who’s shot in the head who comes to me alive I’m pretty sure I’ll be able to keep them alive,” he says.

Rhee moved from trauma bay to trauma bay assessing the wounded. “I have to make sure everybody survives. I’m constantly triaging,” he says. “I made sure that Gabrielle got into the operating room and they were going to start on her. I’m in the room every five, 10 minutes making sure things are going forward and they’re doing what I want them to do,” he says.

“I’m popping in and out of the rooms. I have experienced trauma surgeons in there, so what I’ll do is get a brief on what’s going on with their patients, what the main injuries are and what their needs are. If it comes to a real problematic situation, then I’ll scrub in and help them.”

Rhee quickly ascertained during triage that the youngest victim, 9-year-old Christina Taylor Green, was dead on arrival.

“We take kids who are already deceased to the intensive care unit because they have people who are accustomed to taking care of family members. They have the right social workers and chaplains and so forth, and the pediatrician can be a liaison for me to help talk to the family members while I’m trying to take care of the live patients,” says Rhee, acknowledging that “organ donation is a huge issue. Normally, we don’t have them in mass casualty scenarios.”

Christina’s organs have helped at least three children. Her parents have said Christina’s corneas saved the eyesight of two children. Another little girl’s life was saved by the donation of organs.

‘I Do This Every Day’

“What I was really focusing on in the second hour was informing the family members who were there. You have family members pouring in at that time period. We were able to identify who they were. The incident command was set up so that they knew where to take the family members. They took them to the cafeteria, then I pulled them into an isolated room and then let them know individually what information I had,” Rhee says.

“Once I had pulled them all out and counseled them all, there was one family that was remaining. I went in there, and they said, ‘Do you know anything about such-and-such?’ I said, ‘Well, it’s not on the list, which probably means good to go, has not been injured. Right now, that’s not one of the patients that I’m caring for.’ It turned out to be one of the people who died at the scene. The family was here waiting and hoping I would have some information for them.

“I do this every day. We deal with telling people that their family member has died on a daily basis. It’s always tough. There’s never an easy one,” he says. “I’ve had mass casualties in the military where 200 people are coming in in an hour. Of course, in a military environment you don’t have to worry about family. Here, I had a whole cafeteria full of family.

“I kid around and say that I don’t have an amygdala, which is the emotional portion of your brain, but I would say it’s probably due to the fact that we do it all the time, from the very first day in medical school when you’re starting to dissect a human body until now. You’re gradually indoctrinated into this process. Eventually, over time, you learn how to do it better.”

Of course he gets attached to patients, Rhee says.

“I don’t cry or break down too often. I do remember one case. It was six in the morning, this 6-year-old girl got shot in the chest. We did some things and kept her alive quite a while, but she eventually died on the operating table. That was a very stressful time period because I had just moved to this hospital. I moved here myself and had to leave my family behind. I had a 6-year-old girl. That hit home.”

Finding His Place at Georgia Tech

Born in Seoul, South Korea, Rhee lived with his family in Uganda from the ages of 5 to 9 while his father worked there as a Peace Corps surgeon.

“The memories I have of living in Uganda are the best of my life. Things were simple. It was a happy time period for everybody. We had nothing. We had nothing to worry about in many senses. It was really basic in a way. Then the Asians were kicked out of Uganda,” Rhee says.

The family moved to the United States when Rhee was in fourth grade.

“When we came here, my father took the shortest path to practice, which is anesthesiology. I remember when he was a surgeon, but I remember also him being an intern again and a resident again and all of those things,” he says.

Rhee did not want to follow in his father’s footsteps, but the years of training had nothing to do with it. “I didn’t want to be a doctor because the Asian culture pushes their kids to be doctors and lawyers. It was just pure rebelling,” he says.

“When I left high school, the only thing I knew I wanted to do was something in science, and the other thing I knew was that I did not want to be a physician. And Georgia Tech had a $6 application fee,” Rhee says. “I applied mostly in Pennsylvania. That’s where I was from. I chose Tech at the last minute against Carnegie Mellon.

“I was just walking over here and thinking of all the people that were contacting me from Georgia Tech, and there is one person who has not. His name is Stephen Dawkins, and he’s a doctor. He was the influence that turned me to go into medicine,” Rhee says. “He was my RA. His father was a doctor, and he was going to be a doctor. I didn’t know you could be a doctor after going through Georgia Tech, but he showed me the way.”

Dawkins, HS 82, remembers Rhee well.

“There was a small cadre of us who were interested in medicine,” says Dawkins, now the medical director of Caduceus Occupational Medicine in Atlanta. “As such, we were in many classes together or were on a similar track in classes. Because we were unusual for Tech, and such a small group, we were able to identify each other and bond quickly.

“All of us were in Caldwell dorm. I was the floor RA my sophomore year and the building RA my junior and senior years. I selected Peter as one of my floor RAs. Just as now, he served capably, with an appropriate mix of humor, wisdom and guidance,” Dawkins says. “I found that Peter, then and now, demonstrated integrity, which he already had and was nurtured by our collective experience, maturity — being wise without being arrogant — and a compassion for fellow students, which is fundamental for a lifetime commitment to service.”

Rhee changed his major after his sophomore year. His health systems degree from Tech is on his office wall with his master’s in public health from the University of Washington and his medical degree from the Uniformed Services University.

‘I’m Not Unhappy About My Choices’

Rhee says his decision to accept the military’s scholarship offer for medical school was strictly financial.

“I ended up with a 13-year obligation for their education and their schooling. It was paid for, but I think I paid them more than they paid me. I did 24 years for them. The first four years was medical school, 13 years was obligated and seven years was training. That’s how they get you. When you’re young, you don’t know what you’re signing,” he says, smiling broadly.

“Comparing my life to my friends who did not go through the military, who were able to come out and practice and get a job earlier on, I think it’s difficult to say who has a better life, who made the better decision. In hindsight, I’m not unhappy about my choices. I think I did a tremendous amount of sacrificial work dragging my family around, and the choices of where I lived were not necessarily mine. But I wonder if everybody else has their choices all the time either,” Rhee says.

“I don’t regret any of my military career. I think the experiences that I have gotten through it are not duplicative anywhere else in life. I think on a personal, selfish level, I was very benefited by the military. But can I speak for my family and say whether that was good for them when I was never home?”

Rhee’s military service helped prepare him for the life-and-death situations he deals with daily. Rhee was one of the first trauma surgeons at Camp Rhino in Afghanistan in 2001. He was deployed again in 2005, this time to Iraq, where he started a surgical unit in Ramadi.

“Every minute that I was in Iraq I loved being there. I loved being there more than anyplace else in the world. I had spent decades training to be a combat surgeon,” Rhee says. “In contrast to a tank commander, who needs to be in a war to understand and utilize his skills, when I utilize my skills in wartime, I’m benefiting everybody.

“I’m not out there hurting anyone, so what better position could I be in where I can help any human body that comes through my threshold — enemy, soldier, friendly fire? It didn’t matter — civilians, combatants. I got a chance to help all aspects of humanity during the most ridiculous scenario you can imagine, where people were purposely killing each other. I never felt so honored or privileged or useful as when I was in wartime,” he says.

Rhee maintains strong ties with the military. He is a consultant to the Office of Naval Research and the Marine Corps Commandants War Fighting Laboratory. He also is a Uniformed Services University professor and lectures there several times a year.

Life in Tucson

Rhee directed the Navy Trauma Training Center at Los Angeles County-University of Southern California before accepting the University Medical Center post in 2007.

“I wanted a job just like what this one offered — a university-based program, a city of a million people, the only Level 1 trauma center. And this program was completely disrupted at that time, so there was an opportunity to build the program from the ground floor,” he says.

An article in the Los Angeles Times quoted Rhee as saying Tucson was an embarrassing place for a trauma surgeon because of the lack of violence.

“I think that’s a little bit of an overstatement,” he says. “I worked in Los Angeles and Washington, D.C., big cities where urban gang warfare is very plentiful and a common thing. My last job in L.A. County was to train Navy people on gang warfare so they would have an idea what gunshot wounds looked like before they were sent out to the war.

“Tucson has 67 murders a year, which is one of the lowest for a city of its size. If you go up to where this madman shot up a bunch of people, there’s not a single person outside after five o’clock in the afternoon. There’s not a single streetwalker, there’s not a single homeless person. It’s about as nice and affluent as you can have,” Rhee says.

“We do get our fair share of gunshots and stabbings. Anytime you have a million people, people get hurt. Wherever there are guns, people get shot,” he says. “There are many, many people who are shot who are not carrying weapons. Bystanders are getting shot all the time. People sleeping in their homes are getting shot all the time because they’re impoverished and can’t afford a home in a nicer neighborhood. So while you’re trying to decide if this is a good guy or not, I have the luxury of not being able to ask that question. I just take care of the human being in front of me.”

A Hero’s Welcome

Rhee stood with President Barack Obama on Jan. 12. Obama visited Giffords and her husband, astronaut Mark Kelly, at the hospital before speaking at a community memorial service at the University of Arizona. Rhee was in the room.

“Out of the privacy of Mark Kelly and the congresswoman, I don’t want to get into too much of the details, but I’m honored to have been there and witnessed it,” Rhee says.

“When I rode with the motorcade over to the memorial service, one of the things I was trying to do was figure out where my family was. I was trying to get them their tickets to get in, so I had to break of rank and go try to find them. Wherever I went, people just started cheering and clapping. I was wondering who was behind me because I didn’t realize they were clapping at me,” he says. “I thought it was silly. Why would they be cheering for me?

“Once I identified where my family was, the police came out and escorted us all to the front. When I walked into the arena, people started cheering and gave me a standing ovation. Again, I thought, this is just silly, you know, because I do this all the time — we coded somebody 30 minutes ago. But this was the first time that the community got the chance to thank people after the madness that had occurred a few days before,” Rhee says.

Rhee’s encounter with Obama wasn’t his first with a U.S. president. As a Navy physician, he traveled to China with Bill Clinton in 1998 as the president’s trauma surgeon.

“When this thing came up with the State of the Union address, obviously I was honored. It was obviously because of the fact that there was a VIP involved, the press issue and all of those things. The University of Arizona people started to chime in on it and making sure that I’d go,” Rhee says.

When asked if he sees himself as a hero, he answers quickly. “No, of course not.”

The positive outpouring for him is from the community looking for someone to thank, Rhee says, and he simply is the face of the University Medical Center.

“They’re trying to thank the medical community, and they’re doing it through me,” Rhee says. “I was the face for the medicine, right? The community of Tucson was coming together, and they were using me to thank, but I didn’t do all the work here.

“It’s not like I’m in an office with you by myself asking you where you’re hurt. Trauma is a team event that has multiple levels of complexity, and everyone, from the CT scanners, radiologists, the techs, the nurses, the orderlies, the janitors turning the rooms over and mopping up the blood so we can get the next patient in the room — everybody that is involved has a significant role.

“I saw it work. I saw it work well,” Rhee says. “With my military background and connections and because of the fortuitous position that Gabrielle Giffords’ husband is a Navy captain, we got everybody involved from Admiral Mullen to the surgeon general.

“I had all the resources of the country. I was able to give Captain Kelly the reassurance that we were doing the best thing, that there was no stone unturned. And when I was ready to finish [Giffords’] acute care process, I was able to pick up the phone and call a very good buddy of mine, John Holcomb, who is a retired colonel running the Houston program. It was a direct handoff,” he says.

The Business at Hand

Rhee is happy in Tucson.

“They say that if you like what you do, you’re not really working for a living. I am at a point where I am doing exactly what I want to do. I can’t imagine another job that I would rather have,” he says.

But Rhee says he won’t push either his 16-year-old son or 10-year-old daughter into a life in medicine.

“That’s a decision they have to make for themselves,” he says. “I think medicine is changing dramatically now, and I probably would not advise them to go into medicine. It’s business, issues with lawsuits. Finances have taken the pure joy out of treating a human being. The complicated barrage of paperwork and billing and those things really have made our profession so different than it was 20 years ago. Right now we’re on a pathway that it will continue for the worse.”

Of his blip on the media radar screen, Rhee says, “There’s a 5 or 10 percent chance I’ll have a good result out of this, meaning that I’ll be able to pull into local resources to provide funding the way it should be. I need [$]15 million a year. I feel that my part-time job is as a beggar. I have to constantly beg for funds for our trauma center to exist.”

Rhee’s cell phone rings. The musical notes of the Stayin’ Alive refrain are the phone’s ring tone. “Ah, ha, ha, ha, stayin’ alive, stayin’ alive.”

He listens, calmly asks questions. “I’ll be right there,” he says.

Rhee moves from behind his desk and heads for the door.

“This guy’s dying. I have to go,” he says.

And he’s gone. It’s just another day on the job for trauma chief Peter Rhee.

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