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Condition Gray: Inside the hospital as the Joplin tornado hit

By ERIC ADLER and LAURA BAUER
The Kansas City Star

JOPLIN, Mo. | Looking back, they remember the quiet — like a last, deep breath before death.

In the nursery of St. John’s Regional Medical Center, newborns napped in bassinets. Ventilators hummed in an intensive-care unit.

In the emergency room, nurse Tracy Hernandez checked an older woman for a stroke, one of the few serious cases in the ER all day.

In an operating room down a second-floor hallway, orthopedic surgeon James “Dusty” Smith opened an infected hip.

One floor above, John Seay, a 60-year-old mechanic from Welch, Okla., visited with his 83-year-old mother. Frail from congestive heart failure, she doubted she’d be getting better and had picked out a pink dress for her burial.

Then, in the west, the air began to spin.

Condition Gray.

The announcement over the hospital speakers warned of a potential tornado. Prepare.

No one panicked. Such calls are routine in Joplin, a zinc- and lead-mining town carved from the rock and fields of Tornado Alley.

Nurses pulled shades over windows to shield from flying debris. They rolled equipment from the halls, on the off chance patients would have to be moved there.

Off chance, because this storm wasn’t expected to hit them. Visitors watched it on television with nonchalance. Radar showed funnel clouds tracking north.

In a neighborhood across from St. John’s, Amanda and Bradley German sat in a friend’s home with their sons, Brody, 6, and James, 9, heedless of the weather alert. Small hail fell. The friend tossed hailstones playfully into the house.

“We were joking about it,” Amanda German would say. “We hear the storm sirens all the time.”

What no one anticipated was the dark monster developing to the west, two miles outside their windows.

The sky turned the green of a violent bruise.

Execute Condition Gray: Get patients to safety!

• • •

It’s been four weeks since an EF-5 tornado slammed to the ground in Joplin, its 200-mph winds scouring a three-quarter-mile-wide, six-mile-long band of devastation.

When it was over, this city of 50,000 would reel, broken and bloodied.

For the watching world, the image of the hollowed shell of St. John’s was ground zero. For 115 years, the hospital system created by the Catholic order of the Sisters of Mercy healed the community’s illnesses and injuries. In seconds, the nine-story symbol of the city’s strength and caring, built and expanded since 1968, would stand gravely injured itself.

Yet in many ways, the story of what happened inside the walls of St. John’s might better stand as a microcosm of the horrors, heroism and humanity that played out across Joplin that night.

Witness upon witness recounts a stream of “walking wounded,” individuals impaled by wood, glass or metal, limbs missing, flesh torn from their bodies, lurching toward the hospital. Many remain haunted by the carnage they saw.

But that night at the hospital, they said, also will be remembered as one of the city’s proudest.

There was the surgeon who operated by flashlight as the hospital crashed around him. The ER doc who plunged a chest tube through the ribs of a young man to keep him from dying.

Nurses used their bodies to blanket vulnerable patients from wind-hurled debris. A floor tech plucked a flying man from the air. Employees wielded axes to free drugs from locked cabinets.

And then there were the strangers. Hundreds rushed in convoys of pickup trucks, descending on the hospital to speed the wounded away.

Hospital visitors left the sides of their dead and dying loved ones to carry fragile patients down blackened hallways, guided by the dim light of cell phones.

“We did what we had to do,” said John Seay.

• • •

At 5:41 p.m., the tornado descends, a black, twisting wall on the western horizon. It splinters houses, strips trees, heaves cars. Hailstones crash through glass like sledgehammers. Rain pounds down in a stinging curtain.

Minutes away, St. John’s waits — 183 patients in its 367 licensed beds; some 25 patients in the ER; 100 staff on duty; an unknown number of visitors in the patient rooms, halls and waiting areas.

In the ER, Angie Abner, 40 — a paramedic who became a nurse only a year ago, and who has missed work the last two days because of food poisoning — has been doing triage. Now, minutes after the call Execute Condition Gray, she is struggling to get patients to safety, into hallways and away from windows.

People, having grown too used to these warnings and then seeing storms peter out, refuse to move.

“Folks, this is for your own safety,” Abner belts, emphatic. “You have to listen to me!”

A man waves her off and tries to leave.

“No, sir!” she snaps. “You are my responsibility and you’re not going anywhere!”

Upstairs, in the third-floor intensive-care unit, nurse Tammy Fritchey, a 27-year-veteran, places blankets and pillows over patients who are too sick to move, the ones on ventilators. With two other nurses, she will soon huddle in an interior office.

“God,” she’ll pray silently, holding tight to another nurse. “Please help our patients.”

On other floors, patients able to walk are placed in hardback chairs or wheelchairs and lined up down the hallways. Others are rolled out in their beds.

Condition Grays are practiced as drills at least a dozen times a year. All hospitals, as part of their accreditation, have emergency codes and plans for storms, abducted babies, gunmen on the premises.

But this is no drill.

In Room 587, Connie Lansdown, 62, has just taken a shower. Weak and recovering from a hysterectomy, a treatment for possible cancer, she wears a hospital gown, a robe and flip-flops.

Below, near Room 381, the mechanic John Seay stands in the hall next to his mother’s bed. She’s on oxygen and has been visiting with more than a dozen relatives all afternoon. Seay is calm, sure nothing will happen.

So is Belinda Pfeiffer, 58, who with her brother Rodney Stover, 60, is in the hallway with their 85-year-old father, Ralph Stover. He’s to be released the next day into rehab after complications from a recent corneal transplant. Pfeiffer feels so calm she feeds her dad spoonfuls of pureed beef and green beans near Room 386.

In the eighth-floor obstetrics unit, fathers are close by their newborn babies. In the operating room, surgeon Dusty Smith, wearing a sterile mask and baby-blue scrubs, is just about to drain a woman’s infected hip joint. The woman is anesthetized. His scalpel is at work.

Near the ER’s glass doors, Kevin Kikta, 40, one of only two emergency physicians on duty, stands with a patient’s chart. He looks up and sees a security guard tearing down the corridor.

“Take cover!” the guard shouts. “We’re gonna get hit!”

• • •

Wind roars with such force the steel beams supporting the hospital’s top floors twist four inches.

Glass explodes from every window; the air turns cold; lights flicker and die. The building jolts and is cloaked in blackness. Both generators, main and backup, have been blasted from their foundations.

Water pipes burst, showering everything. Ceilings cave; wires hang in the air like spider webs and spill on the floor. Explosive natural gas spews from broken pipes on the lower floors.

The wind’s power is tremendous. Connie Lansdown, the hysterectomy patient, watches the storm yank a man from a reclining chair and drag him down the hall.

“This is no place to be!” she thinks, hurrying into a windowless room and pressing her shoulder against the door.

X-ray machines, respirators, computer monitors and doors ripped from their hinges ricochet down the halls, spin and crash through the air.

Fathers in the nursery drape themselves over their newborns.

In her bed, John Seay’s mother is being sucked down the corridor. Knocked to a knee, he covers her with one arm.

“I gotcha,” he says.

He drives his foot into the floor to stop the movement, but can’t. They sail down the hall and crash.

He looks at his mother. Her eyes are shut; her oxygen mask is still on. She looks OK.

“I’m going to check on the others,” he tells her and leaves to search for their relatives.

Outside the ER, the wind catapults a man through the emergency unit’s blown-out entryway, where St. John’s floor tech Ben Graskemper, 31, a volunteer firefighter as imposing as a bouncer, snatches him from the air and shields him beneath his body.

“Please, God,” Graskemper hears the man mutter, “don’t let us die.”

Kikta, the ER doc, and nurse Shilo Cook, who is pregnant, crawl beneath a desk, convinced that when they emerge, the entire hospital will be gone.

One floor above, Belinda Pfeiffer and her brother can’t hold on to their 85-year-old father. He’s in a chair. Medical equipment caroms off the walls, bangs toward their father. They and a nurse cover and surround him like a tent. They grip his chair. They grip him.

The tornado’s suction is too much. Debris pummels Rodney Stover’s back, buckling him to his knees.

Both children are pulled from their father.

Pfeiffer flies 15 feet into a room and toward an opening where a window had been. A door hits her mid-path and knocks her to the floor. Rodney crashes in the bathroom. The brother and sister look at each other.

“Where’s Dad?”

• • •

In the operating room, physician’s assistant Chris Jones pushes with his legs, driving his 5-foot-11, 190-pound body against the wind beating against the door.

He has no idea whether his wife and two children, ages 2 and 9, are safe at home.

Surgeon Dusty Smith also worries about his wife and their twin 5-year-old sons. His mother’s town, Tuscaloosa, Ala., was devastated a month before by just this kind of storm.

Seconds ago, before the OR door burst open, the white bony crown of the patient’s hip lay beneath Smith’s scalpel. The surgery team’s ears popped. When the lights went out, a patient care tech grabbed a blue flashlight, shining its beam into the incision.

Now, water three inches deep begins to saturate their shoes, soaking their scrubs. Ceiling tiles rain down.

Smith arches over the patient, his body an umbrella to protect the wound.

“You all right, buddy?” Smith calls over to his assistant.

He doesn’t look up. Eyes fixed, he must finish this surgery. Stay focused.

The pressure against the door is tremendous. Debris slams against the other side, whips beneath the door, slashing cuts into Jones’ and the doctor’s ankles.

“This better end soon,” Jones says. “I don’t think I can hold this much longer.”

And then it’s over.

• • •

In 45 seconds, the tornado all but eviscerated the hospital. Neighbors will later discover crumpled wheelchairs caught in the debris of their homes. Medical records and X-rays will be found nearly 100 miles away.

• • •

In the ER: chaos.

Patients are screaming as nurses Angie Abner, Tracy Hernandez and others emerge from the rubble. Water mixes with blood.

Hernandez looks out the gaping hole that was the emergency room entrance. A helicopter lies on its side like a dead beast. Next to it, in the pouring rain, is a female deer.

“It was just standing out there,” Hernandez would recall. “Just terrified. Trembling. In shock.”

A young man clambers over the ER doors, an arc of blood from the brachial artery of his right arm spurting three feet in front of him.

“Where did you come from?” Abner shouts.

But her mind also is on co-worker Shilo Cook, the pregnant nurse. She wants to know if Cook and her baby are OK. What about her other colleagues? Alive? Dead?

“The park!” the man says, meaning Cunningham Park across the street.

Patients already inside the ER mostly seem uninjured. But already what seems like hundreds of wounded are staggering toward the hospital.

Teenage girls, battered in the storm after Joplin High School’s graduation, stumble and limp toward the hospital in pretty summer dresses soaked in blood.

“Dr. Kikta,” Abner calls. “I have a guy bleeding to death in here. You have to come quick!”

• • •

Citywide, texts flash on the phones of hospital staff riding out the storm in their homes: St. John’s has been hit.

Many don’t wait for the word. In their cars and pickups, they weave past downed trees and drive over tangled power lines.

Also mobilizing: the staff of Freeman Health System, the competing hospital in town. Less than a mile south of St. John’s, it is virtually untouched by the storm.

Freeman’s ER has four physicians on this night. Within hours, 135 doctors will flood the hospital, 110 from Freeman, others from St. John’s and the region.

Sharell Questelle, 43, a St. John’s ER nurse for 12 years, is speeding from her home 15 miles north toward her hospital in a pickup with her adult son and his girlfriend. She spots the storm-battered building in the distance.

“Oh my God! Oh my God!” she says, turning to her son, Dakotah. “You have to get me up there!”

Near the hospital, Questelle jumps from the cab. She runs across the north parking lot, past piles of twisted cars and the shattered tail of the helicopter, toward the ER. Inside, in darkness, she hears crying and screams and is convinced all her co-workers are dead.

Angie Abner emerges. Questelle stands terrified. In many ways, Questelle has been Abner’s idol. The young nurse can’t stomach seeing her so shaken.

Abner clasps Questelle’s face in her hands.

“Look me in the eyes,” Abner commands. “We are alive. You’ve got to do what you do. Get these people out!”

• • •

Upstairs, John Seay’s mother lies in her bed in the third-floor hallway where he’d left her for just a few minutes.

For years, Seay has helped care for ill family — his sister, after she had a stroke; his father, disabled from World War II. His dad was at Normandy, in the third wave at Omaha Beach. Seay himself is a Vietnam vet, a sailor.

Seay’s mother doubted she’d get better. She’d given her rings to her granddaughters and wore a “do not resuscitate” bracelet on her wrist. Everyone hoped she’d have more than a few days to live.

Seay reaches for her arm. It’s limp. He bends down and looks in her face. He touches her shoulder.

Nothing. She’s gone.

He turns and leaves her there in the corridor. All around, people need help.

“I know where she is,” he thinks, both physically and spiritually. He can return to her later. She would have understood. She was a nurse who once trained at St. John’s.

On doors, on backboards, in wheelchairs and wooden chairs, in sheets, on sagging mattresses: For 90 minutes, the 60-year-old mechanic joins a phalanx of nurses and techs and visitors carrying patients over debris and down two, seven, nine flights of stairs.

Seay learned in the Navy how to move around a ship in the dark. Here, in the hospital’s blackness, he’s making his way.

Nearby, Belinda Pfeiffer and her brother, Rodney, find their father lying on his left side. He’s conscious, but the twister flung him into a bathroom wall. They need to get him out of here. Belinda has multiple sclerosis. A nurse will help, but they can’t do it alone.

A man enters the room.

“I’ll help you,” he says.

It’s John Seay.

• • •

In the ICU, nurse Tammy Fritchey feels helpless.

The electricity is out. The ventilators don’t work.

The most fragile patients lie here and in other critical care units. Nurses work furiously, hand-squeezing resuscitator bags to help their patients breathe. They save some, but not all.

By morning’s light, five from these units will be dead.

• • •

“You have to help my baby now!” Amanda German cries.

Kevin Kikta, the ER physician, is strong — 6 feet 2 and 250 pounds, a champion javelin thrower at Rutgers — and he has seen much. But he has never seen a wound like this.

The child in front of him, Brody German, is 6.

Such a deep chunk of his neck muscle has been torn away, Kikta can see bones in the boy’s spine.

Seconds ago, Bradley German ran with his son in his blood-covered arms, tearing across Cunningham Park. They had been at a friend’s house, unconcerned about the storm, until they took cover just before it blew the roof, walls and everything away. Only minutes before, the friend had playfully tossed dime-sized hail at them in the house.

“You’re going to be OK, buddy,” Kikta tells the boy. “You’re going to be OK.”

The boy is screaming, squirming. He needs to calm him.

Water showers from the ceiling, collecting inches deep on the floor. Natural gas sickens the air. Though power is out, Kikta wonders whether a spark could cause the hospital to blow.

The mission is to evacuate: Clear patients quickly and hurry them to other hospitals.

But so many wounded like Brody are streaming in, the ER is forced to triage and treat, patch the worst cases, stabilize on the fly.

Many are horrendous.

Sharell Questelle scrambles in and out of the ER, guiding 10, 15, 20 patients to safety.

Outside, she sees a woman teetering with a metal rod through her shoulder. Questelle hears another woman mumble, “I think I need to sit down.”

“When I turned around,” Questelle would recall, “she literally had a piece of wood going through her forehead and out the back of her head.”

It was 12 inches long.

One man lies dead with a sign post through his chest. Near the front of the hospital, a nurse comforts a man trapped beneath an SUV. The passengers next to him are dead. He will not survive.

A pickup carries a body sheathed in a black bag.

“I was told to bring this here,” the driver says to a nurse. He places the body at the foot of the cross at the hospital’s entrance.

Meantime, Angie Abner can’t shake the image of a beautiful, teenage Hispanic girl — Lacie, or Lacey, she doesn’t know which — staggering into the ER in shorts and tank top, holding a boxer puppy.

She is with her boyfriend. At the center of the girl’s forehead: a square, 5-inch gash. Abner can see her skull.

If the girl sees herself, Abner fears, she will turn hysterical, or pass out.

Abner bandages the girl’s forehead with a towel and then decides she will keep Lacie at her side.

The girl, barefoot, holds on to Abner’s scrubs, puppy in her arms, as Abner leads patients outside.

Then Lacie’s boyfriend crashes. His body is pin-cushioned with debris. Something must have pierced his chest wall. His lungs are collapsing.

With no lights working, Kikta holds a flashlight between his teeth. He has no bags of blood, no anesthesia.

When the electricity went dead, doctors and nurses lost access to much of the vital medicines in the ER and virtually every other department. The power outage caused the metal cabinets where the drugs are kept to automatically lock.

Soon doctors and others will snatch fire axes to crack through the cabinets’ Plexiglas fronts and pry open the doors.

But the boyfriend is losing color now. Kikta clasps his hand.

“I’m sorry, but this is going to hurt you real bad,” he tells the young man. “This is going to save your life.”

“Do what you have to do,” comes the answer.

Kikta’s scalpel cuts into the man’s chest down to his ribs. He clasps a chest tube, like a sharp hollow screwdriver, and stabs through the muscles of the ribs into the chest cavity.

The man screams. A rush of air. His lungs inflate.

Now Kikta needs to immobilize Brody’s neck. Shilo Cook, the pregnant nurse, and others work with him.

They roll towels as a mock collar to secure Brody’s head. They insert an intravenous line, find morphine to calm him.

“Let’s get him out of here and transferred over to Freeman,” Kikta shouts.

Outside, scores of Joplin residents in pickups, and others from Oklahoma and all around Missouri, load patients and nurses into the truck beds. They speed off to Freeman. School buses roll up to the hospital to take more patients away.

Dozens of ambulances from towns and cities more than 100 miles in every direction, including Kansas City, converge on the town. At intersections, their flashing lights draw the injured, limping, dazed, moving slowly, as one Joplin medic would say, “like something out of a zombie movie.”

A triage center at Memorial Hall is overwhelmed in a matter of minutes. Another is opened at McAuley Catholic High School. Helicopters arrive from throughout the region.

In the ER, Kikta turns to a nurse.

“Where do I go next?”

• • •

In 90 minutes, the hospital is cleared of patients. But the night is far from over.

Few know whether their loved ones are safe. Some text messages are getting through, but downed towers have silenced cell phones.

In nearby Neosho, Mo., word of the destruction at St. John’s sends Casey Himmelsbach, 28, on a frantic 10-hour search to find her mother, Connie Lansdown, recovering from the hysterectomy.

With a flashlight, Himmelsbach enters one of St. John’s outer buildings, flashing its beam in the hollow faces of patients, too sick, shocked or injured to move, sitting on the wet floor in hospital gowns.

At Memorial Hall, she sees images of horror she fears she will never escape. It will be 4 a.m. before she learns that Lansdown had been taken to Freeman and then on to a hospital in Parsons, Kan.

“I thought my family was dead, ’cause nobody came to get me,” Lansdown would say.

Hospital staffers also are desperate to get word about their families.

Dusty Smith, the surgeon who performed a hip operation by flashlight, can’t reach his wife. He has no idea whether she and his twin sons are alive. With his car destroyed, he has no way home.

So he cuts off his clinging, wet scrubs at the knees … and runs. And runs. His course takes him through the band of destruction.

He runs eight miles.

Breathless, he finds his family safe, with no electricity, playing a game of “Happy Birthday” by blowing out candles.

“Why are you all wet?” his wife asks, unaware of the extent of the storm. She never heard warning sirens.

Days later, she will cry in bed at the thought of how close death had come to her husband.

Six blocks from St. John’s, Ben Graskemper finds his parents’ home destroyed, his 5-year-old daughter, Lindsey, safe but crying inside.

“I want my daddy! I want my daddy!” she says. He holds and calms her, then tells his family, “I have to go back and help my people.”

For most, the sense of time over the next many hours and days becomes a blur. The nurses and doctors hop in trucks, shuttle patients to Freeman, grab equipment, hitch rides, walk, run, get to Memorial and McAuley Catholic High any way they can.

Before they leave St. John’s, they search its rooms and halls several times more.

In the parking lot, Sharell Questelle sees a blanket covering a small body.

“Please don’t let that be a child,” she says. She flips the blanket. It’s a withered black and white dog, unmoving, but alive; its leg is broken and later will be amputated. No collar. She takes him home and names him F-5.

• • •

Halls silent now, sun set, completely dark outside. John Seay heads back to the third floor.

He walks down the corridor. His mother lies beneath a sheet.

It’s unknown how many people Seay pulled from the hospital. In later weeks, his name would appear in the obituary for Ralph Stover, who would die nearly two weeks later from internal injuries suffered this night.

They just wanted to thank him, “for his help carrying our dad to safety after the tornado.”

Seay bends down in the hallway and leans in.

He thinks his mother would be proud of what the nurses did here this night. Maybe proud of him.

He gives her one last kiss on the forehead.

“Goodbye, Mom.”

• • •

As a sign of grit and resilience, St. John’s one week later erected a tent field hospital — dubbed “Mercy M*A*S*H” by staff.

The first surgery patient that day was a little boy with an abscess on his rear end.

Sisters of Mercy officials have vowed to build a new hospital over the next 2½ years, though likely not on the site of the old. They promise a smaller, 150-bed facility before that.

All hospital employees are receiving their regular pay. Those who aren’t needed at the field hospital are being placed at Mercy-affiliated hospitals or others as part of a “talent sharing” program.

Hospital officials overall say they desire to focus on achievement rather than loss. “I think generally people are feeling positive,” said Gary Pulsipher, president and CEO of St. John’s.

But even for those who may one day begin their tornado tales, “I was in St. John’s,” it may be easier to bulldoze the hulk of the old hospital than to sweep away the effects of that night.

The tornado’s death toll citywide had risen to 154 as of Saturday night. Many people still lie hospitalized and in critical condition. Joplin doctors are already seeing serious infections from wounds that were patched in haste out of dire need.

Six people died at St. John’s during the storm; at least three have died of their injuries since.

Memories are creating scars. Images of a pickup truck bed stacked with full body bags haunt one nurse.

“We’ve always stressed dying with dignity,” she said, “and that’s not what this was.”

Privately, some traumatized staff question returning to their jobs. Violent winds and lightning whipped through Joplin one day after the tornado. More than a few St. John’s employees spoke of how they hid, cried and trembled in their homes.

At least a few staff members have already resigned. Angie Abner is one.

Not because she wanted to. Nursing is her passion. She aches to return.

But two days after the tornado, having worked exhaustive hours at Memorial Hall, she went home for a few hours of sleep. At 4 a.m., she said, she was found delirious, sleepwalking down the road from her home in Webb City, north of Joplin, trying to get to St. John’s.

“I was asking for Lacie,” Abner said.

Other nights, her husband has awakened to find her up but still asleep, wrapping toilet paper around furniture like bandages.

Of her actions on May 22, and of those of her co-workers and the patients and the community, she is unequivocal: “I am proud.”

It holds for the others: Kevin Kikta, Sharell Questelle, Dusty Smith, Chris Jones…

All have returned to work.

This week, Brody German, who went through hours of neck and spine surgery at Freeman, was outside playing T-ball. Older brother James is receiving care for a deep cut in his foot.

“Forty-five seconds has left us with a lifetime of things to deal with,” Amanda German says. “That’s the biggest thing. I don’t want them to live the rest of their lives in fear.

“I tell them, ‘We didn’t just live through a tornado. We lived through the tornado. If we can do that, we can do anything.’ ”

St. John’s, before and after
Before: Nine-story building with 367 licensed beds. Emergency and operating rooms on the second floor. Critical care on the third. Nursery on the eighth.

After: A three-tent field hospital with 60 beds, 20 for ER and 40 for patients. The group of tents could withstand 100-mph winds, St. John’s says.

Also: Many physicians and hospital employees lost their homes or businesses. Here are conservative numbers St. John’s initially released:

•81 physicians’ offices damaged or destroyed.

•18 physicians’ homes destroyed and 10 damaged.

•187 co-workers’ houses/apartments destroyed.

About this story
To re-create what happened inside St. John’s on May 22, The Star interviewed more than three dozen people who were in the hospital during the tornado and its immediate aftermath. Quotes from that night are presented as the subjects recalled them.

To reach Eric Adler, call 816-234-4431 or send email to eadler@kcstar.com. To reach Laura Bauer, call 816-234-4944 or send email to lbauer@kcstar.com.

© 2014 Kansas City Star and wire service sources. All Rights Reserved. http://www.kansascity.com