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Sunday, May 29, 2011

Joplin, Missouri: A Day of Prayer and Remembrance

On May 22, 2011 my family and I found ourselves cautiously watching the dark clouds and the fury of the evening storm. Yet we felt the safety and warmth of our home. Meanwhile, at hour and a half from our home, a town was being hit by a devastating tornado. 

"As day turned into evening in Joplin, a city of 50,000 about 70 miles west of Springfield, the skies brought the deadliest tornado since modern recordkeeping began in 1950. First reported on the ground at 5:41 p.m., the EF5 storm ripped for 20 minutes through business and residential areas, killing at least 139 people." Source

"About 8,000 building units, including apartments, were damaged or destroyed. The Joplin Area Chamber of Commerce estimates that 300 businesses with about 4,000 employees were affected. Insurers’ losses may reach $3 billion, according to an estimate from catastrophe risk-modeler Eqecat Inc." Source



Photo source

Local communities and national organizations have showed an outpouring support for the residents of Joplin. The National Association of Social Workers, Missouri Chapter has joined this effort through their "Missouri Social Work Disaster Relief Fund" and "Volunteer Program."

"Social workers have always been at the forefront of helping others. In our Missouri disasters, several of our social workers have been personally affected and need help themselves. A few have lost their homes, others their jobs, and their businesses (including private practices). Some may have even lost loved ones. Your donation will help them re-establish their lives, so they can continue to help others." NASW-MO

Gov. Jay Nixon has declared Sunday May 29, one week after the devastating tornado that struck Joplin, as an official State Day of Prayer and Remembrance. 

The Governor and local clergy has also organized a memorial service for the victims of the devastating tornado. President Barack Obama will attend the service. "In the most trying times of disaster, grief and loss, Missourians come together to provide support, strength and assistance. During this day of prayer and this memorial service, I invite all Missourians to pause and remember their neighbors and draw upon the resources of their faith in the support of their fellow Missourians." Office of Missouri Governor

The following story by Dr. Kevin Kikta has been published on the St John's/Mercy website. It's a heartfelt story of what he lived in the ER at the St John's Hospital in Joplin on May 22, 2011. The most encouraging story I've read from the Joplin disaster. 





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 4:00 pm 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 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 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 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 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


Friday, May 27, 2011

Monday Nightmare




“It’s all over the news!”  Ms. Dempsey exclaimed, cradling her head in her hands with propped elbows resting on the dining room table.  “My daughter is dead!” Ms. Dempsey broke down in tears.

“She refused to eat her breakfast,” Nurse Cecilia said, as I entered the dining room.   

“Ms. Dempsey, do you want to drink your orange juice?” I offered, hoping that she would calm down. 

“No. I don’t want anything.” Ms. Dempsey saddened voice and tearfulness began to attract the other residents’ attention. 

I decided to wheel Ms. Dempsey to her room for more privacy. 

“Ms. Dempsey, what’s going on?” 

“Don’t you know? It’s all over the news.” She pointed at the television over her dresser. “My daughter Laura is dead!” 

The news sent a chill down my spine. It was Monday, usually my busy day to catch up with weekend events which occurred in the nursing home in my absence.

I wondered why no one had mentioned Ms. Dempsey’s daughter’s death? Where is the family? 

I told myself to calm down and think rationally. 

“Ms. Dempsey, have you talked to anyone in your family?”

“My son was here, but he left.”

The son left? Why would he leave, not telling anyone of the death? I was certainly confused.

“My daughter has had problems with her husband,” Ms. Dempsey began. “They argue all the time, and her heart was too weak. I think she...“ Ms. Dempsey’s words trailed and she gasped for air.  She started sobbing inconsolably. I hugged her, feeling with my lack of information to relate to her seeming despairing situation. 

I attempted to ask further questions, but Ms. Dempsey didn’t seem to listen.  She continued narrating family events involving conflicts and her belief she made erroneous decisions in response to these particular situations. 

I listened for about half an hour.  My quiet listening seemed to help tranquilize her, at least for those moments. Then she buried her face in her hands again and started to cry. 

“Ms. Dempsey, I am going to call your family,” I said.

“I don’t think it will do any good,” she said, continuing to sob. 

Nurse Cecilia came in with a box of Kleenex and a glass of water for Ms. Dempsey. Taking  them, she gently dried her eyes, and then took a generous sip of water. She seemed somewhat comforted. 

While Nurse Cecilia assisted Ms. Dempsey, I rushed to the nurse’s station and looked up the emergency contact information in Ms. Dempsey chart. I reached for a cordless phone and rushed back to her room.

I punched in Laura’s phone number, wondering if the daughter she believed to be dead would answer.  My heart pounded.

The phone rang three times, but to me felt as though it were forty. 

“Hello?” A woman answered.

“Laura?”  I forgot all etiquette for business phone calls, failing to identify myself, the company, and the reason for the urgency of my call. It was as if my instincts had taken control over all my rationality.  I just wanted to hear Ms. Dempsey’s daughter’s voice, and to know that nothing had happened to her.

“Yes?”

That “yes” sounded magical to me. Like a miracle had occurred. The feeling of relief embraced me. 

“Laura, this is Doris, social worker. I’m here with your mom, and she would like to talk with you.”

“Oh, sure!”

Ms. Dempsey’s eyes opened widely.  She looked puzzled. Then she sighed and tilted her head up, flashing a half smile. 

“Laura is okay!” Ms. Dempsey exclaimed, in a whisper.

“Yes, she is okay,” I said as I handed her the phone receiver. 

Ms. Dempsey clasped the phone to her ear.  She cleared her throat, and with serene voice, she said, “Laura? Honey, I had a bad dream...”



Sunday, May 8, 2011

A Happy Mother's Day for Grandma




“What day is it?”  Ms. Spencer asked to nurse assistant Peggy.
“It’s Sunday,” Peggy said, drawing close to Ms. Spencer. “Anything planned for today?”
“I think my daughter said she would come to see me today.”  Ms. Spencer shook her head.  “Lord, I can’t remember any more!”
Ms. Spencer wheeled down the hall, stationing herself next to the living room area, browsing at magazines. She waited patiently. 
“Grandma! Grandma!” A high-pitched voice echoed throughout the living area.  Ms. Spencer turned around. Her hazel eyes brightened as she spotted little Hayley entering the nursing home, running toward her, enthusiastically and full of youthful energy.
Following Hayley was Ms. Spencer’s daughter, Linda, watching Hayley closely, fearful that her five-year old might run down another resident happenstance to be in the path of her charge to see her grandmother. 
Ms. Spencer and Hayley hugged each other, a long and warm embrace that only grandmas know how to give.    
Linda observed the two of them, and smiled. Her mother had been confused often, but her mind never failed when Hayley was present, her little and playful granddaughter. 
Ms. Spencer and Hayley usually drew into long conversations during their visits.  Hayley would ask multiple questions.  And Ms. Spencer sharpened when Hayley was around. 
“Mom, let’s go to your room.” Linda reached the wheelchair handles, and propelled her mother down the hall.  Hayley happily followed them.
“Grandma, we have presents for you!” Little Hayley couldn’t keep the secret any longer. 
“You do? How nice of you.” Ms Spencer said with a wide smile. 
Once in Ms. Spencer’s room, Hayley helped handling the gifts to her grandma. 
“Mom, happy Mother’s Day!” Linda kissed her mother on the cheek. 
“This is Mother’s Day?”  Ms. Spencer straightened her glasses to start opening the delicately wrapped gifts.  But she first took her time reading a greeting card that Linda had given to her. 
Hayley had wandered and was rummaging through her grandma’s closet.
“Hayley,” her mother called. “Come here to say ‘Happy Mother’s Day’ to grandma.” Linda turned around. “What are you doing?”

Hayley had managed to reach and put on a red cardigan. She walked fashionably, modeling the cardigan that looked more like a long dress on her. 
“Oh, don’t you look pretty?” Ms. Spencer exclaimed and laughed. 
Hayley headed to Ms. Spencer’s night drawer and grabbed one of her books.  Ms. Spencer used to read often, before going to bed, but lately her eyes and mind lessened her enjoyment of reading.  Regardless, she kept her collection of books near her, a reminder of her younger days as an elementary school teacher. Children, and the world of literature she rewarded their inquisitive minds were her passion.
“Are you going to read my book?”  Ms. Spencer winked at Linda, flashing a broad smile.
Hayley drew close to Ms. Spencer, clutched the book near to her heart, motioned her chin up, and glanced at her mother.  Her delightful voice filled the brief silence... 
“When I grow up I want to be like grandma!” Hayley blinked and grinned.
Ms. Spencer remained speechless. Tears glistened in the corner of her eyes. 
Hayley threw herself on Ms. Spencer lap.  “I also want a cookie!”
Linda started to open a box of pastries that she had brought in.
“This is the best Mother’s Day present I’ve ever expected.”  Ms. Spencer said, while taking her glasses off to wipe away her tears. 


Sunday, May 1, 2011

A Daughter's Forgiveness




The afternoon breeze swirled about her delicate body.  Her long, lustrous blonde hair flowing in the wind caught the attention of the maintenance men mowing the grass in the garden surrounding the nursing home.  A gorgeous woman in her early thirties.
She approached the entrance door.  I glanced at her from my office window that faced the facility main door.  My gaze fixed on the visitor. The woman walked elegantly, as if modeling her white causal suit, perfectly complementing her golden stilettos. 

My phone rang shortly after the woman had entered the facility.

“Yes, Lisa?”  I answered to the receptionist.
“Ms. McLaren’s daughter, Laura, is here to see you.”
“Oh!” I blinked. “Laura, the daughter who lives in New York!”  

Ms. McLaren was a new resident in the nursing home.  She had lived alone in her own home, until a recent incident in which she was found by a neighbor, lying on the floor in her garage.  Ms McLaren had apparently fallen, and hurt her foot.  She was unable to move to seek help and remained on the floor for several hours. 

Ms. McLaren was often confused.  She had history of Alzheimer’s dementia, according to the medical records.  Until the incident she had managed to live independently, driving and taking care of her personal affairs.  After that, her physician recommended that she have twenty-four hour care and supervision.

“I’m glad you came to see your mother,” I told Laura. 

“I know she can no longer live alone.” Laura said, her tone revealing her sadness. “I knew there would be a time we’d come to this point.  I tried many times to convince her to come and live with me, but she always refused.” 

“It seems that this is the right time.” I said, optimistically while leading Laura toward her mother’s room. 

I watched as Laura visited with her mother.  Their encounter was cordial, not warm as I had expected.  Ms. McLaren was uncharacteristically outspoken and sarcastic. 

“Now what?” Ms. McLaren glared at Laura. “You have a busy life. I can take care of myself.” Ms. McLaren’s tone was harsh.

I left the room to leave them in privacy, hoping that mother and daughter would be able to come to terms—as it was evident that there was a great deal of animosity between them.

The next day Laura unexpectedly stopped by my office.  I glanced twice at her, trying to make sure she was the same woman I had seen the day before.  Today she wore no make-up.  Her hair was tousled, and she wore baggy sweat pants, a t-shirt and tennis shoes.  

She reminded me of the Cinderella story, but in reverse.  But more amazingly, I noticed that her face and lips showed clear signs of cosmetic surgeries that would have been easily covered with cosmetics.

What’s going on? I pondered. 

“There are some things you need to know,” Laura said, gently. “My mother has always been abusive to me, my entire life, since my first memory.”

I paid close attention to Laura’s words, and relinquished my resistance of showing  sympathy.   My heart reached out to her as she described in detail the challenging life she had with her mother. 

“I had no self-esteem.  I always felt like a looser.  I underwent multiple cosmetic surgeries, trying to look ‘pretty’ as my mother always made me believe I was ‘ugly.’  I never married as I could never manage relationship with my mother’s constant demeaning comments of where it would ultimately go.  I was close to committing suicide until I finally realized I needed help.” 

I continued listening to Laura.  I couldn’t  find comforting words to say even if I felt it were appropriate to say something.  I was clueless about Laura and her mother’s past issues.

Laura told me that she underwent psychotherapy for many years, in which she began to finally understand her personal and psychological problems and, more importantly, how to cope with these problems.  Later, she initiated her own business as an interior decorator, and relocated to the East coast where her career and life began to thrive. 

“She is my mother, and I cannot turn my back to her.”  Her sullen eyes began to spill tears that she gently swept away with the back of her delicate hand. “I have forgiven my mother a long time ago, and even if she continues to speak hurtful words, all I feel inside me is compassion. Compassion because she had a traumatic childhood as well, worse than mine.”

Laura’s green eyes shone as though two suns rising in a warm summer morning.  I saw her real beauty, beyond the cosmetics and skillfully crafted facades. 

Her inner beauty.  
Laura’s heart had healed, and her wise words lead me to think that she had waited for that moment to return to her mother. This time, to take care of her. 

The next morning, Laura and her mother stopped by my office. 

“Thanks for everything,” Laura said.  Ms McLaren smiled, but remained quiet.

Laura wheeled her mother to a shuttle parked in front of the main entrance.  They would head to the airport, to catch their flight to New York.  

That was the beginning of a new chapter in their lives.  The chapter of a mother and daughter’s reconciliation, I hoped. 


Thank you




Thank you all of you who followed my A to Z stories. Thanks for your support and the encouragement to publish the collection of stories. 

I have removed them from my blog as they will be edited and published. A few new stories will be added to the book. 

In the meantime, I will go back to my customary posting, a weekly inspirational story.  

Hope you enjoy them.