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


Editor’s Note: Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22 when an EF-5 tornado struck the hospital.
 
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 4 pm ED 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 ED and hospital.

At 5:42 pm, a security guard yelled to everyone, “Take cover! We are about to get hit by a tornado!” While others scattered to various places, I ran with a pregnant RN, Shilo Cook, to the only place that I was familiar with in the hospital without windows — a small doctor’s office in the ED. 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-5 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 ED, find the rest of the staff and patients, and assess our losses.

“Like a bomb went off” — That’s the only way that I can describe what we saw next.  Patients were coming into the ED 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 ED.  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 ED.

I remember a patient in his early 20s 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 old 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 RNs 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 could blow up at any minute.

Things were no better outside of the ED. 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 news footage from bombings in Bagdad.  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 RNs, 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 the 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 that now resembled flattened recycled aluminum cans the tornado had crumpled  in her iron hands. An EF-5 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 ED 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 that compares 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, RNs, techs, and all of the staff from St. John’s.  I have worked at St John’s for approximately two 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.
 
To 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’s 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. John’s Regional Medical Center, Joplin, MO

See images of the hospital at http://www.flickr.com/photos/MercyHealth

  1. #1 by Ruth - June 1st, 2011 at 15:32

    You are a hero. What would we do without people like you?

  2. #2 by Myles Riner - June 1st, 2011 at 19:21

    Puts all the bitching and moaning about health care reform in a new perspective, doesn’t it?

  3. #3 by mojtaba - June 2nd, 2011 at 01:23

    …for this reason,I am proud of being an emergency physician
    (emergency resident from Iran)

  4. #4 by Shawn McBride - June 2nd, 2011 at 13:55

    I’d like permission to re-publish this in GA HFMA Scroll. Who can I speak with quickly about that?

  5. #5 by Melissa - June 2nd, 2011 at 13:59

    God bless you all and may we react with a similar presence of mind and knowledge if a disaster occurs at our hospital. I wonder what training of disaster medicine (if any) you had received prior to this tragedy?

  6. #6 by Kim - June 2nd, 2011 at 16:46

    Wow. Reminds us exactly why we do this job and what’s really important. Thank you for sharing your experience. My prayers are with everyone in Joplin as the recovery continues.

  7. #7 by diane jessop - June 3rd, 2011 at 11:52

    I know that you were doing your job, but I am
    heartened to know that people like yourself are
    on the front lines every day. We keep hearing that our work badges are FEMA passes in the event of a disaster. Now I believe it. We just had 4 tornadoes in Massachusetts and I was on
    the edge of one. I can’t imagine being in the middle but your story helped me visualize it. Thank You and much love to you for all you did. Diane Jessop (Medical SLP in NH and MA)

  8. #8 by Deb - June 3rd, 2011 at 15:03

    i am an RN and can only imagine what all of you went through. I read your story and cried as you recounted the horror of the disaster. My heart goes out to you and all of the folks in Joplin. God Bless you and keep living and doing what you do. You really do make a difference on this earth. Many hugs.

  9. #9 by rapnzl - June 5th, 2011 at 23:02

    In between grueling hospital shifts, I discovered that St. Johns had been hit. Tornadoes are no stranger to this nurse, and all I could think about for days is how on earth you came through this color-coded worst-case disaster that no one can ever plan for. You, the other doctors and nurses and EMS – everyone – are heroes. Should something even close ever happen here, I pray I am surrounded by professionals just like you, Dr. Kikta. May you sleep peacefully.

  10. #10 by dr.antony - June 6th, 2011 at 20:52

    Good to know you Dr.Kikta.
    You have set examples for others.You are a hero already. I had read about your work from another blog ( Doris,A social workers blog)

  11. #11 by Joyce, chrg poster - June 8th, 2011 at 17:09

    Reading your story brought tears to my eyes and a smile to my heart. God Bless you and all who responded to this terrible event. You have a special place in many hearts.

  12. #12 by Aambeien Genezen - August 31st, 2011 at 08:26

    I read about this in a Dutch paper, this was so sick!

  13. #13 by abonnement flair - February 23rd, 2012 at 09:13

    @ aambeien genezen, I read the same thing! Ware really scared..

  14. #14 by Danial Garcia - February 22nd, 2013 at 01:15

    I guess this stories is the reason people join healthcare but somehow they forget it while going about their daily routines. Thanks for the reminder.
    http://www.docboard.org/ok/ok.htm

  15. #15 by aambeien behandelen - March 19th, 2013 at 05:36

    Wow, what a story! I always hear of those tornado’s on the news and see the images of it. But like you say: it’s always different when you see it in person.

    But the way you describe everything is very admirable. When I read this story I see everything happen in the back of my head. But I cant imagine how it was for you.

    I watched the pictures on Flickr and it always seem very unreal. But thanks for sharing your experience!

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