Destroyed Joplin hospital, workers find a way back
Monday, October 3, 2011
JOPLIN, Mo. (AP) — The hospital had always been there for the victims of calamity. It had saved lives, healed the desperately sick, patched up the bruised and bloodied and made them whole again.
It was always a haven — never a victim, itself. Until one spring afternoon when that all changed.
On that day in late May, a black-and-green monster swooped in, its shoulders nearly a mile wide, its savagery unimaginable. One of America's worst tornadoes in half a century took dead aim at St. John's Regional Medical Center, barreling through halls, gnawing at walls, ripping open ceilings. Concrete crumbled. Steel twisted. Pipes burst. Windows exploded. The building groaned in agony.
And when it was over, this hospital whose roots here date back to the 1890s was wounded — mortally, it seemed. Its ghostly, nine-story shell looked like the remnants of a nuclear blast.
But this was not the end.
Not for the doctors who toiled in dust and darkness in the building's final hours, scrambling to remove glass from the wounded, insert IVs and carry the sick to safety.
Or for the nurses who shielded patients with their own bodies, pumped air into the lungs of those struggling to breathe, and jumped into pickup trucks to keep people alive.
Their building would crumble around them, but their hospital would survive. That was never in doubt.
There was tension in the woman's voice, almost a sense of foreboding.
"Execute Condition Gray," she announced on the public address system. Tracy Hernandez had heard plenty of tornado warnings in 30 years of nursing. On May 22, it sounded more ominous.
The lights went out. A generator kicked in, but only for a second. The ground shook, a freight-train-like roar rumbled through the building and Hernandez felt all the air being sucked out of the emergency room. Her ears popped.
"Do you feel that?" she asked another nurse. "It's coming."
The two nurses covered their elderly stroke patient with a sheet and draped their bodies over her while the woman's daughter watched, her face frozen with fear. "She kept looking at me like, 'Are we going to be OK?'" Hernandez recalls.
Terry Burns, a surgical technician, had the same question. He was one floor above.
He wondered if that eerie creaking signaled the building's collapse. He, too, had used his 190-pound frame as armor, covering two nurses protecting a patient in the surgery recovery room.
"Keep your head down!" he yelled, clutching a rattling cart. "Keep your head down!"
When the wind seemed to subside, Burns grabbed a flashlight and moved into the hallway. The back end of 200 mph gusts pushed and pulled him like a marionette, sucking him closer and closer to a shattered second-floor window. He could see menacing skies as he gripped the ragged metal frame with his left hand and pressed his right hand and feet against a wall.
As ceiling tiles fell and glass shattered, Burns' mind raced: How are we going to get out? Who can I help? Who's coming to help us? Is the hospital going to going to explode? The smell of methane gas — from broken gas lines — was overpowering.
He'd talked with his wife briefly as the storm hit, but worried what had happened since. The phones were dead. "I didn't know if I had family left, if I had a hospital left, if any of our patients were left, if anybody upstairs was left," he says.
There was chaos everywhere.
Patients screaming. Insulation falling, kicking up blinding dust. Water from broken pipes gushed down in the emergency room; soon it was ankle deep. With no power, staff resorted to flashlights or the illumination from cell phones to guide them to patients begging for help.
Within moments, the bloodied and dazed stumbled into the emergency room.
It reminded Hernandez of a zombie movie. Two wet and terrified teens celebrating high school graduation arrived in their fancy dresses. One had wood and glass wedged in her head and back. Another young woman's scalp had been peeled back. Hernandez stopped the bleeding and sent her to another hospital;
"There were several people that we knew weren't going to make it," she says. "You had to let that go. You have to go on to the next person that you know you can help. ... It was fix someone so they can live long enough to go (elsewhere to) get fixed."
Many supplies and medicines were wet, destroyed or out of reach.
When Dr. Kevin Kitka treated a man gasping for air, he pulled a large piece of glass from his back and diagnosed a collapsed lung. Knowing the injury was life-threatening and time was short, the doctor inserted a tube into the man's chest — but had no anesthetic to dull the pain. The patient never complained. Soon, he was breathing normally.
Kitka also tended to a small boy who had a fist-size hole in the back of his neck. The doctor could see his spine, count his vertebrae. Kitka stabilized him and shipped him out.
Outside, there was more horror: A man impaled by a street sign. Another crushed under his mangled SUV, which was buried under a peeled-off emergency room roof.
A trembling deer stood next to a crushed helicopter, its skids on the side.
Inside, dogs and cats, lost and scared, scurried into the emergency room.
Pete Anastosopolos, the hospital's materials coordinator, was evacuating patients when two young men calling themselves the "rescue team" volunteered to help. "Sure," he said. "Go, get a patient."
"As God is my witness, later I see them, they were trying to steal the ATM out of the main hallway," he recalls. "Part of me was like, 'Stop them!' Part of me was like, 'the hell with it. I've got to get these people out of here.'" (The ATM remained.)
One of the first patients Anastosopolos encountered was dead; the body was purple and so bruised, he couldn't tell if it was a man or women. Six people would die at St. John's.
He later found an elderly man, an 18-inch rod sticking into his chest and coming out his left side.
"I said, 'Come on sir, we've GOT to go,'" Anastosopolos recalls.
"He said, 'Son, just leave me to die.' I said, 'No, you're going.'"
Anastosopolos escorted the man down the stairs, then moved on to others — among them a 450-pound man, conveyed down by a team of rescuers on his mattress as two nurses manually pumped air into the patient's lungs.
Through hours of evacuations, Anastosopolos wore flip-flops; shards of glass dug into the soles of his feet. He just snapped them off, wincing as he sloshed through water that turned pink from blood.
He grew so thirsty he smashed open the vending machine glass with a stanchion, snatching water bottles.
Don't ask me how I got them, he told his boss. "You don't want to know," he said. "It wouldn't look good on my evaluation.'"
In an hour and a half, the hospital evacuated 183 patients.
The makeshift hospital moved a few miles away to Memorial Hall, the town's community center. The injured arrived by school bus, ambulance, emergency crews (from four states) and pickups driven by good Samaritans; they'd maneuvered around downed trees and power lines, even bodies in the road.
Soon, there were hundreds, on tables, stretchers, the floor, any spot there was room.
At least two critically injured people died at Memorial Hall. But lives were saved, too.
Dr. Sean Smith — who rode out the tornado in his home storm shelter, 17 miles away — treated one woman whose heart stopped after arriving. He had no oxygen, no cardiac monitors. He put a tube in her trachea, used a bag to push air into her lungs and inserted IVs for heart and blood pressure medication.
Her pulse was restored and she was transferred.
To this day, Smith doesn't know if she survived.
As night faded into dawn, exhausted hospital workers tried to snatch some sleep.
Tracy Hernandez retreated to the parking lot, stretching out in a pickup truck, joined by a dachshund that had run into the emergency room. She didn't know it then but her bright orange Dodge Daytona pickup, now a mangled heap, had been featured prominently on The Weather Channel.
Her husband and son were watching 50 miles away. They'd spend agonizing hours, not knowing if she was alive.
On the day after, St. John's faced one question: What's next?
"Our immediate response was our building was destroyed. What do we have to do to get it back up and running?" says Smith, president of Mercy's clinic group in Joplin and Kansas.
With its 367 beds, St. John's had served four states: Missouri, Kansas, Arkansas and Oklahoma. It was one of two large hospitals in Joplin, a presence since it opened in 1896, offering 25-cent medical plans to lead and zinc miners. More than a century later, it was essential.
But a hospital is a finely tuned machine. It depends on medicines and modern equipment, schedules and supplies and hundreds of highly skilled people working together. How would St. John's, now badly broken and missing many of its parts, regroup — and do it fast?
"We had to start from scratch," Smith says. "We could not use most of the medications. The bandages, the dressings, the IVs, everything was damaged from the water or the tornado."
St. John's had some salvageable beds. But it was missing most everything else. Heart monitors. Defibrillators. IV poles. Oxygen containers. And of course, a roof. "It was as if you've never built a house," Smith says, "and you have until 6 p.m. tonight to put one together. What do you need?"
St. John's had one big advantage. As part of a network of 28 Catholic hospitals founded by the Sisters of Mercy, "we were able to pick up the phone in the middle of the night and say, 'We need supplies,'" Smith says.
Within 12 hours, two semis packed with them arrived at Memorial Hall.
Help came from other states, too. Within two days, mobile operating rooms and trailers with MRI and CAT scan machines were heading to Joplin. So were volunteer doctors, nurses and paramedics from across the country.
By then, there was a tentative plan for the next step: A tent hospital that had been set up about 75 miles away in Branson for an earthquake drill was dismantled and hauled to Joplin.
The Missouri National Guard's 117th Engineering Team quickly assembled the MASH-like tent, a network of worm-like white canvas tunnels with sheet-like curtains. It had 60 beds, a pharmacy, an intensive care unit and emergency, waiting and operating rooms. Two helipads were created.
The tent was planted on a parking lot blacktop in the shadow of the old hospital. A bronze-colored statue of Jesus that had stood at the old entrance welcomed visitors.
At 7 a.m. on May 29, one week after the storm, the doors opened. Three minutes later, the first patient. That afternoon, the first surgery — a minor skin abscess removed from a little boy. At 5:45 p.m., about the time the tornado struck seven days earlier, a Catholic bishop blessed the tent with holy water. Bagpipers played "Amazing Grace."
"It was our first big shot in the arm," Smith says. "It was pure elation. It was 'OK. We're here to stay. We're back and running in seven days.'"
On Day 1, Dr. David Hagedorn, an emergency room doctor sporting a black eye from the storm's aftermath (he's not sure how it happened) was embraced by a visitor — a woman whose leg he'd stitched up that night.
While he and others were grateful to be working, they quickly discovered practicing medicine in a tent had its downsides: Noisy, elbow-to-elbow quarters. Limited supplies. No windows or plumbing.
"It's very, very psychologically draining," Hagedorn says, sitting in the tent, his words barely audible amid the whoosh of air conditioning. "You basically have your fellow peers and staff right on top of you and the patient wards are just 20 feet away, so everything is transmitted ... a crying kid or somebody that's in pain and yelling. Then there's the continuous hum and noise of the generators. It's almost mind-numbing."
During his first night shifts when Hagedorn stepped outside for a break, the darkness and devastation were jarring — even for an emergency room veteran.
"I guess the best description would be almost a mild panic attack and I'm not very prone to getting them," he says. "It just about takes your breath away."
Hagedorn quickly overcame his anxiety. "It's part of adapting," he adds. "It's like, 'Pick yourself up and move on.'"
That's been harder for more than 200 St. John's workers with severely damaged or lost homes.
Pete Anastosopolos, the materials manager, had deemed himself "effectively wiped off the planet" the night of the storm. His house was gone (a white Dodge pickup sat in what was his living room), and his hospital was in ruins.
He worked a month straight. "I wanted to make sure I had a job," he says. "I wanted to keep the hospital going. ... And it took me away from thinking, 'poor me.' I didn't want that."
A thick, broad-shouldered man (he prefers the phrase "big boy") with a gift of gab, Anastosopolos masks his pain with humor. He smiles at how he grabbed shoes from a friend's porch when he was left without a complete pair.
He turns more sober describing the day he spotted his ex-wife and their 13-year-old daughter, Zoe, digging through his rubble.
Zoe had unearthed a treasured photo of her taken 10 minutes after her birth — dressed in tie-dye pink and blue. "She said, 'Daddy let me clean this so you'll have it,'" he recalls. She rubbed her thumb across the damp photo. The image disappeared. "She said, 'Daddy are you mad at me?'" He told her no, but says softly, "that was a heartbreaker."
Terry Burns, the surgical technician, found St. John's comforting. It didn't matter that it was a tent, and that he still was recovering from three cracked ribs — the legacy of his near-death experience.
His house had been badly damaged, his church had been leveled, but the hospital —his employer since high school graduation 16 years ago — provided routine in his discombobulated life. "This place is the only stable thing that I have," he says, rubbing a hand over his closely cropped reddish hair. "This is the only normal thing that I have."
It wasn't until mid-June that the St. John's staff had its first chance to swap stories when about 2,000 workers gathered for a reunion. There was song ("We Will Rise Again"), and there was news: Preliminary sketches of the new hospital were unveiled and a January groundbreaking was announced, evoking cheers.
And there was prayer, too, selected from the page open in the Bible in the chapel that day. It was John 15: "This is my commandment. Love one another as I love you. No one has greater love than to lay down one's life for one's friends."
It was a healing day for Tracy Hernandez, who had wrestled with nightmares and tears.
"Every time you talk about it," she says, "it helps peel another layer away from the pain."
As summer set in, her heart still ached driving to work, noticing how much was gone: The McDonald's where she'd sometimes have lunch. The bank where she'd do errands. She found small pleasure, though, in seeing leaves budding on trees, and other signs of renewal.
And solace, too, knowing she gave it her all in a storm that would eventually claim 162 lives. Hernandez has a calm, quiet confidence. She's not one for second-guessing.
"There's nothing that you could have or would have done differently," she says. "There's nothing in the last 30 years I had done that would have prepared me for this. You go home and you think, 'How can I make what I'm doing better and get through one more day?' .... You hope that soon you'll get in some place with walls ... and you thank God we have what we do have."
The walls are up. The tent was removed piece by piece this summer and by the end of September, only a small part remained. St. John's new home — a temporary insulated metal building — is a vast improvement.
It has the feel of a regular hospital with floors, automatic doors, windows, more privacy and, most importantly, water and toilets.
Next spring, a concrete version of St. John's will be erected a few hundred yards south.
By then, construction will have begun on the new permanent hospital, three miles away. It will start with 327 beds and expand up to 424, have a second campus and cost more than $950 million. The opening date: 2014.
"It was a sprint the first six weeks," Smith says. "We're in a marathon now."
Hagedorn's fine with that. "There's more light at the end of the tunnel," he says. "It doesn't make me feel nearly as empty as it used to."
Anastosopolos already has scoped out the site of the new hospital. He's eager to see the old one leveled. "It needs to go," he says. "I don't even look at it anymore."
St. John's staff will remain dispersed until 2014. About 1,500 workers are in the Joplin area, in the temporary quarters, offices or Mercy clinics. Nearly 400 are at hospitals in nearby communities or elsewhere in the Mercy network as part of a talent sharing plan. Everyone has been paid without interruption.
Tragedy often transforms survivors. It already has changed Hernandez,
"You always hear the phrase, 'Don't sweat the small stuff,'" she says. "Well, it's all small stuff now."
She and her colleagues now have more after-work outings. They also celebrate happy endings.
A secretary recently brought in photos of a little boy Hernandez had treated that night. He had a massive head wound and she couldn't get a breathing tube in him because his jaw was clenched so tight. The pictures showed him happy and smiling — standing where he'd been injured.
"That's the kind of stuff we talk about," she says. "If you keep dwelling on what happened that night, it just hurts too bad."
Terry Burns had found some tranquility doing farm chores or mowing the lawn on 80 rented acres, where he lives temporarily with his wife and two daughters.
He has returned to church in Joplin — a new one, because his old one was destroyed — after some soul searching. "You lose all your hope and faith at the time," he says. "We've all had that doubt feeling. You ask the question, 'Why?'"
He hates talking about the tornado.
"It just brings it all back and you have to relive it — the screams, the cries, the sirens," he says. "Will I ever get over this? I don't know. ... I look back and say, 'What happened to the easy life? What happened to routine?' It all went out the window that night."
His routine now has two rituals:
On his 25-minute drive into work, as he exits I-44, he takes a deep breath, bracing for what he'll see heading to St. John's.
On his way home, he sighs with relief as the hospital — the place where he thrived and almost died — slowly fades from his rearview mirror.
EDITOR'S NOTE — This story includes details from Dr. Kevin Kitka's first-person account, which was posted on the hospital website. Sharon Cohen is a Chicago-based national writer for The Associated Press. She can be reached at firstname.lastname@example.org.
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