There's No Place Like Home

The Wizard of Oz and Twister used to be two of my favorite movies.  After the recent devastation in Joplin, however, I find them hard to watch.  While I have lived in St. Louis all of my life, I never felt truly threatened by tornadoes, until this year. This year is different.

Now, when the sirens wail, I wonder, are we prepared for a emergency, Joplin-style? Moreover, how can you prepare to lose everything?

In response to that question, I would like to share this brief account of the first 45 seconds of the day of the Joplin devastation.  Written by an ER physician on duty at the Mercy Hospital in Joplin, it is unforgettable. As he says, "You never know that it will be the  most important day of your life until the day is over. "

45 Seconds: Memoirs of an ER Doctor  from May 22, 2011:

My name is Dr. Kevin Kikta, and I was  one of two emergency room doctors who were on duty at St. John’s  Regional Medical Center in Joplin, MO on Sunday May 22, 2011.    
   
 You never know that it will be the  most important day of your life until the day is over. The day  started like any other day for me: waking up, eating, going to the gym,  showering, and going to my 400pm ER shift. As I drove to the hospital I  mentally prepared for my shift as I always do, but nothing could ever  have prepared me for what was going to happen on this shift.  Things were normal for the first hour and half.  At approximately 5:30 pm we received a warning that a tornado had been  spotted. Although I work in Joplin and went to medical school in  Oklahoma, I live in New Jersey, and I have never seen or been in a  tornado.  I learned that a  “code gray” was being  called.  We were to start bringing patients to safer spots within  the ER and hospital.  
   
At 5: 42pm a security guard yelled to  everyone, “Take cover! We are about to get hit by a tornado!”  I  ran with a pregnant RN, Shilo Cook, while others scattered to various  places, to the only place that I was familiar with in the hospital  without windows, a small doctor’s office in the ER. Together, Shilo and  I tremored and huddled under a desk.  We heard a loud horrifying  sound like a large locomotive ripping through the hospital.  The  whole hospital shook and vibrated as we heard glass shattering, light  bulbs popping, walls collapsing, people screaming,  the ceiling  caving in above us, and water pipes breaking, showering water down on  everything.  We suffered this in complete darkness, unaware of  anyone else’s status, worried, scared. We could feel a tight pressure in  our heads as the tornado annihilated the hospital and the surrounding  area.  The whole process took about 45 seconds, but seemed like  eternity. The hospital had just taken a direct hit from a category EF-4  tornado.  
   
Then it was over.  Just 45  seconds.  45 long seconds.  We looked at each other, terrified, and thanked God that we were alive. We didn’t know, but hoped that it was safe enough to go back out to the ER, find the rest of  the staff and patients, and assess our loses.  
   
“Like a bomb went off. ”  That’s  the only way that I can describe what we saw next.  Patients were  coming into the ER in droves.  It was absolute, utter chaos.   They were limping, bleeding, crying, terrified, with debris and glass  sticking out of them, just thankful to be alive.  The floor was  covered with about 3 inches of water, there was no power, not even backup generators, rendering it completely dark and eerie in the ER.  The frightening aroma of methane gas leaking from the broken  gas lines permeated the air; we knew, but did not dare mention aloud,  what that meant.  I redoubled my pace.  

We had to use flashlights to direct  ourselves to the crying and wounded.  Where did all the flashlights  come from ?  I’ll never know, but immediately, and thankfully, my  years of training in emergency procedures kicked in.  There was no  power, but our mental generators, were up and running, and on high test adrenaline.  We had no cell phone service in the first hour, so we  were not even able to call for help and backup in the ER.  
   
I remember a patient in his early 20’s  gasping for breath, telling me that he was going to die.  After a  quick exam, I removed the large shard of glass from his back, made the clinical diagnosis of a pneumothorax (collapsed lung) and gathered  supplies from wherever I could locate them to  insert a  thoracostomy tube in him.  He was a trooper. I’ll never forget his courage.  He allowed me to do this without any local anesthetic  since none could be found. With his life threatening injuries I knew he  was running out of time, and it had to be done. Quickly.  Imagine my relief when I heard a big rush of air, and breath  sounds again: fortunately,  I was able to get him transported  out.  I immediately moved on to the next patient, an asthmatic in status  asthmaticus.  We didn’t even have the option of trying a nebulizer  treatment or steroids, but I was able to get him intubated using a  flashlight that I held in my mouth.  A small child of approximately  3-4 years of age was crying; he had a large avulsion of skin to his neck  and spine.  The gaping wound revealed his cervical spine and upper  thoracic spine bones.  I could actually count his vertebrae with my  fingers.  This was a child, his whole life ahead of him, suffering  life threatening wounds in front of me, his eyes pleading me to help  him.  We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down  upon all of us. Fortunately, we were able to get him immobilized with  towels, and start an IV with fluids and pain meds before shipping him out.  We felt paralyzed and helpless ourselves.   I  didn’t even know a lot of the RN’s I was working with.  They were  from departments scattered all over the hospital. It didn’t  matter.  We worked as a team, determined to save lives.  There were no specialists available-- my orthopedist was trapped in the  OR.  We were it, and we knew we had to get patients out of the  hospital as quickly as possible.  As we were shuffling them out,  the fire department showed up and  helped us to evacuate.  Together we worked furiously, motivated by the knowledge and fear  that the methane leaks could cause  the hospital to blow up at any minute.  

Things were no better outside of the  ER. I saw a man crushed under a large SUV, still alive, begging for  help; another one was dead, impaled by a street sign through his chest. Wounded people were walking, staggering, all over, dazed and shocked. All around us was chaos, reminding me of  scenes in a war movie, or newsreels from bombings in Baghdad. Except this was right in front of me  and it had happened in  just 45 seconds. My own car was blown away.  Gone.  Seemingly evaporated.  We searched within a half mile radius later that  night, but never found the car, only the littered,  crumpled  remains of former cars. And a John Deere tractor  that had blown in from miles away.  
   
Tragedy has a way of revealing human  goodness.  As I worked , surrounded  by devastation and  suffering, I realized I was not alone.  The people of the  community of Joplin were absolutely incredible.  Within minutes of  the horrific event, local residents showed up in pickups and sport  utility vehicles, all offering to help transport the wounded to other facilities, including Freeman, the trauma center literally across the  street. Ironically, it had  sustained only minimal damage and  was functioning (although I’m sure overwhelmed).  I carried on, grateful for the help of the community.  At one point I had placed a conscious intubated patient in the back of a pickup truck with someone, a layman, for transport. The patient was self-ventilating  himself, and I gave instructions to someone with absolutely no medical  knowledge on how to bag the patient until they got to Freeman.  
   
Within hours I estimated that over 100  EMS units showed up from various towns, counties and  four different states. Considering the circumstances, their response  time was miraculous.  Roads were blocked with downed utility lines,  smashed up cars in piles, and they still made it through. We continued to carry patients out of  the hospital on anything that we could find: sheets, stretchers, broken  doors, mattresses, wheelchairs—anything that could be used as a  transport mechanism. 

As I finished up what I could do at St  John’s, I walked with two RN’s , Shilo Cook and Julie Vandorn,  to  a makeshift MASH center that was being set up miles away at Memorial  Hall. We walked where flourishing neighborhoods once stood,  astonished to see only the disastrous remains of flattened homes,  body parts, and dead people everywhere.  I saw a small dog just  wimpering in circles over his master who was dead,  unaware that  his master would not ever play with him again.  At one point we  tended to a young woman who just stood crying over her dead mother who  was crushed by her own home.  The young woman covered her mother up  with a blanket and then asked all of us,  “What should I do?”  We had no answer for her, but silence and tears.  
   
By this time news crews and  photographers were starting to swarm around, and we were able to get a  ride to Memorial Hall from another RN.  The chaos was slightly more controlled at Memorial Hall.  I was relieved to see many of my  colleagues, doctors from every specialty, helping out.  It was  amazing to be able to see life again.  It was also amazing to see  how fast workers mobilized to set up this MASH unit under the circumstances. Supplies, food, drink, generators, exam tables, all were  there—except pharmaceutical pain meds. I sutured multiple lacerations,  and splinted many fractures, including some open with bone exposed, and  then intubated another patient with severe COPD, slightly better controlled conditions this time, but still less than  optimal.   

But we really needed pain meds.  I managed to go back to St John’s with another physician, pharmacist,  and a sheriff’s officer. Luckily, security let us in to a highly guarded  pharmacy to bring back a garbage bucket sized supply of pain  meds.   
   
At about midnight I walked around the  parking lot of St. John’s with local law enforcement officers looking  for anyone who might be alive or trapped in crushed cars. They  spray painted “X”s on the fortunate vehicles that had been searched  without finding anyone inside. The unfortunate vehicles wore “X’s” and  sprayed-on numerals, indicating the  number of  dead  inside,  crushed in their cars, cars  which now  resembled flattened recycled aluminum cans the tornado had  crumpled  in her iron hands, an EF4 tornado, one of the  worst in history, whipping through this quiet town with demonic strength.   I continued back to Memorial Hall into the early  morning hours until my ER colleagues told me it was time for me to go  home.  I was completely exhausted.  I had seen enough of my first tornado.  How can one describe these  indescribable scenes of destruction?   The next day I saw news  coverage of this horrible, deadly tornado.  It was excellent  coverage, and Mike Bettes from the Weather Channel did a great job, but  there is nothing that pictures and video can depict  compared to  seeing it in person. That video will play forever in my mind.

I would like to express my sincerest  gratitude to everyone involved in helping during this nightmarish  disaster.  My fellow doctors, RN’s, techs, and all of the staff  from St. John’s.  I have worked at St John’s for approximately 2  years, and I have always been proud to say that I was a physician at St  John’s in Joplin, MO.  The smart, selfless and immediate response  of the professionals and the community during this  catastrophe proves to me that St John’s and the surrounding community are special.  I am beyond proud of the members of this community, the health care workers from states away,  and especially Freeman Medical Center, I commend everyone on  unselfishly coming together and giving 110% the way that you all did,  even in your own time of need. St John ‘s Medical Center is gone, but  her spirit and goodness lives on in each of you.  
   
EMS, you should be proud of  yourselves.  You were all excellent, and did a great job despite  incredible difficulties and against all odds. For all of the injured  who I treated, although I do not remember your names (nor would I  expect you to remember mine), I will never forget your faces.  I’m  glad that I was able to make a difference and help in the best way that  I knew how, and hopefully give some of you a chance at rebuilding your lives again.  For those whom I was not able to get to  or treat, I apologize whole- heartedly. Last, but not least, thank you, and  God Bless you, Mercy/St John for providing incredible care in good times  and  even more so, in times  of the unthinkable, and  for  all the training that enabled  us to be a team and treat the people  and save lives.

 Sincerely, 
 Kevin J. Kikta, DO 
 Department of Emergency  Medicine   
 Mercy/St Johns Regional Medical  Center, Joplin, MO