Memoirs of an ER Doctor

You can see my thoughts and pictures of the tornado damage in Joplin on the post after this one, but I wanted to post this message below from a doctor who survived the Joplin tornado.  I can't imagine the trauma the hospital staff had to endure during this storm and the immediate needs seen just after.  I received this from a high school classmate who received it from her cousin who is a nurse in Tulsa.

Common Persons/Uncommon Valor - St. Johns Hospital Doctor

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 4 00pm 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 ED 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 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-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 ED, 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 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 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 could blow up at any minute.

Things were no better outside of the ED. I saw a man 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 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 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 whimpering 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 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.

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 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

Deadly Tornado

I don't know where to start with this post.  David has frequent meetings in Springfield, Mo.  We drove up there yesterday and returned today.  We were expecting to see the "damage" in Joplin from I-44.  We did see a little, but the massive destruction was further north than we thought.  That situation has been so heavy on our hearts, as I am sure it is with all of you.  We did venture north, just to see.  It seemed wrong to just look, and take pictures, but we did. I really wish we could have stopped and helped someone in someway, but those people were not real visible by the 5th day and we did not get out of the pickup. There were many workers and teams of people with food and clothing, etc. Roads were blocked and the destruction was thick....not a clear path much of anywhere.  I am sure much of the piles in high heaps were cleared from the streets so that help could get to the area.

As we approached the area we saw huge trees on houses and roofs blown off and windows blown out.  Most of the residential streets were blocked off.  Today on the way home, we exited the interstate and took another route.  There is no way to describe the scene.  The damage was just block after block and mile after mile of piled and twisted rubble.  Every direction we looked all that could be seen was complete destruction. In the hardest hit areas everything was just leveled.

There were multiple places set up to help people, but the volume of need looked totally overwhelming.  Like, where are all those people sleeping?  When will they have a stable place to "live"?  How will they survive the terrible loss of loved ones?  I am telling you, many will not without a great deal of faith, prayer, and love from others.  There was a visible outreaching to others there, but the needs looked endless.  These situations do make people reach out and be more giving...but still.  It is so overwhelming!

I am posting some pictures, because a picture speaks a thousand words.  If you are alive today; have a home and a car to drive; groceries in your house; and family to love..........and I could go on and on.....then count your blessings and thank God for it all again and again.

This church was destroyed, but most of the pews were intact.

Every business in this strip mall was destroyed.

This was a huge familiar outdoor sporting store. 

Workers trying to restore the electricity..

Too many mangled cars to count....just everywhere.

There was a Wal-Mart back in there somewhere.

 

 There were more destroyed trees than you can imagine.

Are you feeling thankful yet?

You could tell this was an older part of town.

The wealthy, poor, homes or business...none were spared.

I was struck by the two photos above - both the same photo, but the one just above is just a closer shot.  Notice the guitar, and actually there was a case and a couple of guitars laying there in the rubble.  David noticed the Texas flag first in the picture above this one.

Last, but not least is the large St. John hospital that we heard today is off of its foundation and has been totally evacuated now, and the building will have to be taken down.  

I don't share this to be morbid.  I share this to remember how blessed I am and how blessed you are, and to remember those who have lost so much, but who will recover.  Those people have not been forsaken. 

I saw several cars with writing on the back glass that said, "Bring the Joy Back to Joplin".  I pray that joy will be in the hearts of those suffering people soon.   They need our prayers.

Empty Nest Mystery

This morning I went out early to check the nest.  If you have not read about the nest and eggs I have been keeping close watch over, please see the post a little further down the page titled " Nest Watching",  and read it first.  At least read it if you are interested in birds, eggs, and nests.  Anyway, when I went out to do my morning check on the nest, it looked like this.

 

Then after a busy day away from home I hurried out to see if there had been progress in the nest...you know, was the bird nesting or were the eggs hatching........Oh me, I found this.  Where did they go??  I know, I know....I need to get a life, but I just can't help myself....I loved checking on the eggs.

I searched the internet for "eggs removed from nest" - everyone had an opinion about that.  Some said, "Yes the bird can move the eggs to another location", and others said, "No they could not be moved by the birds, but more than likely it was a predator... a cat, squirrel, or SNAKE.....oh me...My next move was to look around for another nest to see if by some strange event the eggs were moved.  WHY would they be moved....they had it made there with a close place to nest, and a covered area so they would not get rained on or blown away????  I found not a clue, not even a crumbled egg shell.  Well, I will never know what happened....poor birdies.  After all the research and wondering, I went out in the yard and searched around for another nest.  Similar eggs had been hatched out in one of my small ornamental trees a few years ago.  Sure enough, a bird flew from the little tree and I found another nest. 

But seriously,  the shells could not have changed colors, now could they?  Come on, from blue with brown specks to white with black specks??  So here comes more nest watching....even if it is getting a little traumatic!!  Oh boy, I really do need to keep my paying day job, so I won't have time for my passions and obsessions.

Maybe the Great Speckled Bird left these eggs for me.

Seems like I remember an old country song, about the 

Great Speckled Bird! Yea, read Roy Acuff.

Kitty Cats

Katie and Andrew walked down to my house for exercise.  The little kitty cats came along for the ride.  One rode in Katie's sweat jacket pocket.....

 

And, this one was clinging tightly to her shoulder.

New Home

Rudy, Christy, and the grands moved in to their new home a couple of months ago.  During my recent stay with them I took a few pictures.  

Gracie has a bright and cheery bedroom.

The dining room is beautiful.

 

 Gillan's bedroom is decorated with guitars....he is a guitar kind of guy.

The kitchen is totally awesome.

 

The grands are at the front door ready for school.

They have the best of both worlds.  They got out of town, but not too far.  Nice country environment with dairy cows to the left of their home - a distant view.  And beautiful black beef cows can be seen in the distant front view.  Close enough to see, but not so close as to smell.  They don't have to tend to them, only enjoy the scene.  They have enough land for a nice yard and extra for some animals if they choose.  I am so happy for them.

Nest Watching

I found this bird nest in an unusual place a few days ago.  It was carefully weaved right on my patio table on the back porch.  Nested, no pun intended - between a large ceramic flower pot and a ceramic candle lantern and against the brick wall.  The nest will be very protected there.  I love to watch the activity of nest building, birds working, and eggs.  The nest stayed empty for a day or two after I found it.  One morning I checked for eggs and the nest was still empty.  Then in a few hours, there it was...the first egg.  

A few hours later, I checked the nest again.....no additional eggs.  Then I checked again about 20 minutes later...you know that obsessive personality I have...bingo, another egg.  And, then there were two.

 

It was another day before there was a third egg.

I finally got a glimpse of the bird with vested interest in the nest, but even my zoom lens could not get a close look.  The mother or father is sitting out on  top of the propane tank lid.  You will have to look closely to see it.

To be continued......

Yes, I am back.  And then, Sunday afternoon there were four.

The parent birds....I guess, have been sweeping in and out of the nest.  I just have to take a peek often to see that the eggs are intact.  When I open the back door a big bird swoops out of the nest and off of the porch and joins another bird, and together they make a lot of squawking out in the yard.  I'll be watching and give you an update as the events heighten. 

 May, 19 - A closer look at one of the nest sitters.