45 Seconds: Memoirs of an ER Doctor from Joplin

Subject: 45 Seconds: Memoirs of an ER Doctor from Joplin
Emergency Department after May 22 tornado Joplin MO
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 5:42 pm 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 breakingshowering 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 thhospital 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 EF5 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 forhelp 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 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 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.

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 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 EF5 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 Regional 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

Bruce Feldman Blog ...an incredible story...PROS FOR AFRICA

Just wanted to share Bruce's Blog on Pros For Africa....Roy Williams giving back in Africa



May, 16, 2011   Roy Williams, the former Oklahoma star, has been a guy I've tried to follow his entire NFL career. As much as I remember that spectacular play he made in the Red River Rivalry, where he flew, Superman style, in from the blindside over a Texas running back to jar the ball loose from Texas quarterback Chris Simms, I also think back to the way he opened up about the stigma he had faced when he was younger, struggling in school as "a resource kid." Initially, that ESPN The Magazine feature on Williams was going to focus on him being such an "instinctive" player, but the more I talked to him and those close to him, the more it proved to be something much more than that. He spoke about how that label and other more blunt labels affected him growing up and he hoped by telling his story it would have an impact on other kids who might be dealing with similar issues.
A few weeks ago, I noticed a tweet from colleague John Saunders, where he mentioned Williams and a cause the five-time Pro Bowler is involved with called Pros For Africa. The more I read about Pros For Africa, which was formed by a group of old Oklahoma Sooners, the more curious I became.
Jay Mitchel, an Oklahoma City attorney who attempted to walk-on at OU for basketball in the late 90's, had become close friends with Williams and reached out to him two years ago to see if the Sooner great would be willing to raise awareness and money for a project in Africa that was the brainchild of his boss, Reggie Whitten, another Oklahoma City-based attorney. Whitten had begun plans to help a school run by Sister Rosemary Nyirumbe called the St. Monica's Girls Tailoring Centre in Gulu, Uganda after he had taken a life-changing trip to Africa in the wake of his son's death. Whitten chose Uganda because of the gruesome conditions for children in a country that has been so ravaged by war that the average age in northern Uganda is merely 15-years old. Many of these children's parents have been killed or died from disease.

"Northern Uganda has been ravaged by war and disease for more than 20 years," says Mitchel. "According to the United Nations, at one time it was one of the worst places on the planet for children. These kids need help. It's not their fault they were born into such terrible conditions. They are no different than us and so grateful when we come to visit. It's amazing to see how happy and content the people of Uganda are with so little.
To say Williams was moved would be an understatement: "I said 'I want to go as well. I am in.'"
Whitten, Mitchel and Williams along with another co-founder, Bill Horn, were able to also recruit fellow Sooner stars Mark Clayton, Tommie Harris and Adrian Peterson. "Jay called people he knew from college and I had hosted Tommie and Mark on their recruiting visits," said Williams. "They know I wouldn't get into something that doesn't have some substance behind it. They wanted to get on board too."


Even though the four OU All-Americans had grown up out of state with Harris, Clayton and Peterson being Texans and Williams, a Californian, they developed strong roots in the Oklahoma community and have left quite a legacy for OU football. It has grown to take on even more meaning thanks to the inspiring off-field work they're doing.
"Football is just what we do. It doesn't define who we are," Williams says. "We are some young men who love to give back. When I was in college, my hand was always the first hand to go up when Coach (Bob) Stoops would ask 'Who wants to go visit a hospital?' I know the importance of being able to give back and uplift somebody when we're in that position. If you spend 30 minutes or an hour to go to a hospital or visit somebody just to give some encouraging words or listen to them, that goes miles and miles."
They formed Pros For Africa, a nonprofit organization based in Oklahoma City. Last year, after taking 8-10 shots each and a weekly diet of Malaria pills, the group flew 19 hours from Oklahoma to Dallas through London en route to Africa with a team of physicians and engineers to provide humanitarian aid. They each paid their own way to get over there. The NFL stars dug water wells, started construction on a second school and distributed food.
Williams was overwhelmed by what he saw and by what he felt.


"It is so sad," he said. "There are kids everywhere. When you driving along the road to go to Gulu (Uganda), you see kids sharing watering holes with livestock. People always ask, 'Why do you have to go to Africa?' Well, until you see what it's really like over there, you don't realize how huge the need is. If you see how bad they are living, you'll think our homeless here in the States are living in luxury. They can put their hand out and people may give them money. They can go to a Salvation Army and someone will give them food. They can go to a shelter and have a roof over the heads. In Africa, it's so sad. Those are ever-lasting memories.


"I was just looking at some of the pictures we have with the kids. In spite of all the hardships that they go through, they still smile. We complain about a car cutting us off or traffic, where we honk our horns, but come on now. We worry about petty stuff. They have huge problems over there and they don't even complain about anything."


The group, which raised a little over $100,000 for the children of Africa in 2010, returned to Africa for two weeks in March with an even bigger contingent that included almost a dozen NFL players, among others recent Oklahoma star Gerald McCoy as well as the Starkey Hearing Foundation, which fitted more than 2,000 hearing aids on the trip.
According to Mitchel, hearing loss is a major issue facing the people in Africa, explaining that a basic ear infection in Africa may cause hearing loss if untreated. Other contributing factors include disease, trauma, genetics and other conditions. (Starkey teaches them to clean their ears, but with little access to medicine or medical treatment there isn't much anyone can do).


"I'm so happy that we added Starkey," said Williams. "To see a child's face, where they go from a blank look and then when you put that hearing aid on them and they hear for the first time, they start smiling and they start crying. And it's not just that fact that they're hearing for the first time, but they're hearing your voice, so it means that much more to you.


"When you hear more and more people want to get involved, you can feel the camaraderie, where you have that feeling that I am apart of something special. And that makes you appreciate what you're a part of even more. Then when you go on the trip to Africa, you see it. "Wow, look at the lives that we're able to impact. Look at these smiles on these kids and women's faces. Even talking about it makes it grow and appreciate it even more.


"I tell people all of the time when I speak to kids: It's not about how much money you have in the bank or what kind car you drive. Life is about the kind of impact you have on other people's lives while you're here. I ask them, 'What kind of legacy are you going to leave when you're dead and gone?' I want my legacy to live on through these young kids and women that we're helping so they can bless somebody else."
The Sooners support group also has branched out to form Pros 4 Vets, with country music star Toby Keith. Pros 4 Vets has recently put on a football camp for kids at Fort Hood and several of the football players have visited VA hospitals with P4V.

"It's so close to my heart because my grandpa was a vet," Williams says. "Whenever I go to a VA and talk with some of the older guys, I remember my time sitting with my grandpa. When they're talking, I feel like I've heard a lot of these stories before because it's like I'm listening to my grandpa again. I soak that up as much as I can."


Mitchel is bringing another contingent back to Africa in August with plans to start the construction of a third school in southern Sudan. The group is expected to also include some NBA players. Just last week, Mitchel and his brother Jared, staged a three-day Pros For Africa event in their hometown of Woodward, Okla. Clayton, Williams and more recent OU players Quinton Carter, Brody Eldridge and Reggie Smith attended the event that culminated with a dodgeball tournament. In all, Pros For Africa raised almost $20,000 for the children of Africa at the event.
Mitchel says the organization is in the process of planning several fundraisers, but don't have anything on paper. They are hoping to host one in New York with the Jets' Santonio Holmes as well as one in Tampa with McCoy.


Williams said he will be more hands on with the organizations after his football career is over. He hopes to continue to build on the momentum: "We want to partner up with more organization to reach more people," he said. "We would love to be able to actually go to each one of the countries in Africa to hand out hearing aids, dig some water wells. pass out clothes and conduct medical clinics. We want to be able to impact all of the countries over there to give them motivation to uplift them."