Experiences of a med student with an incurable travel bug.

Archive for May, 2011

Doctor details devastation of Joplin

This incredible account of the Joplin tornado was originally published in The City Wire. It’s a long read, but well worth it. This is why most of us go into medicine — to help in a time of need. It’s not about insurance premiums, or the paycheck. It’s about the people, and helping where help is needed most. Hats off to all the healthcare workers and community members who stepped up during this incredible tragedy.

“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 400pm ER shift. As I drove to the hospital I mentally prepared for my shift as I always do, but nothing could ever have prepared me for what was going to happen on this shift.Things were normal for the first hour and half.

At approximately 5:30 pm we received a warning that a tornado had been spotted. . Although I work in Joplin and went to medical school in Oklahoma, I live in New Jersey, and I have never seen or been in a tornado.  I learned that a “code gray” was being called.  We were to start bringing patients to safer spots within the ED and hospital.

At 5: 42pm a security guard yelled to everyone, “Take cover! We are about to get hit by a tornado!”  I ran with a pregnant RN, Shilo Cook, while others scattered to various places, to the only place that I was familiar with in the hospital without windows, a small doctor’s office in the ED. Together, Shilo and I tremored and huddled under a desk.  We heard a loud horrifying sound like a large locomotive ripping through the hospital.  The whole hospital shook and vibrated as we heard glass shattering, light bulbs popping, walls collapsing, people screaming,  the ceiling caving in above us, and water pipes breaking, showering water down on everything.

We suffered this in complete darkness, unaware of anyone else’s status, worried, scared. We could feel a tight pressure in our heads as the tornado annihilated the hospital and the surrounding area.  The whole process took about 45 seconds, but seemed like eternity. The hospital had just taken a direct hit from a category EF-4 tornado.

Then it was over.  Just 45 seconds.   45 long seconds.  We looked at each other, terrified, and thanked God that we were alive.  We didn’t know, but hoped that it was safe enough to go back out to the ED, find the rest of the staff and patients, and assess our loses.

Med flight helicopter at St. John's Regional Medical Center

“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.

At one point I had placed a conscious intubated patient in the back of a pickup truck with someone, a layman, for transport. The patient was self-ventilating himself, and I gave instructions to someone with absolutely no medical knowledge on how to bag the patient until they got to Freeman.

Within hours I estimated that over 100 EMS units showed up from various towns, counties and four different states.Considering the circumstances, their response time was miraculous. Roads were blocked with downed utility lines, smashed up cars in piles, and they still made it through.

We continued to carry patients out of the hospital on anything that we could find: sheets, stretchers, broken doors, mattresses,wheelchairs — anything that could be used as a transport mechanism.

As I finished up what I could do at St John’s, I walked with two RN’s, Shilo Cook and Julie Vandorn, to a makeshift MASH center that was being set up miles away at Memorial Hall.

We walked where flourishing neighborhoods once stood,astonished to see only the disastrous remains of flattened homes, body parts, and dead people everywhere.  I saw a small dog just 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 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” andsprayed-on numerals, indicating the number of dead inside, crushed in their cars, cars which now resembled flattened recycled aluminum cans the tornado had crumpled  in her iron hands, an EF4 tornado, one of the worst in history, whipping through this quiet town with demonic strength.

I continued back to Memorial hall into the early morning hours until my ER colleagues told me it was time for me to go home. I was completely exhausted. I had seen enough of my first tornado.

How can one describe these indescribable scenes of destruction? The next day I saw news coverage of this horrible, deadly tornado. It was excellent coverage, and Mike Bettes from the Weather Channel did a great job, but there is nothing that pictures and video can depict compared to seeing it in person. That video will play forever in my mind.

I would like to express my sincerest gratitude to everyone involved in helping during this nightmarish disaster.  My fellow doctors, RN’s, techs, and all of the staff from St. John’s.  I have worked at St John’s for approximately 2 years, and I have always been proud to say that I was a physician at St John’s in Joplin, MO.  The smart, selfless and immediate response of the professionals and the community during this catastrophe proves to me that St John’s and the surrounding community are special. I am beyond proud.

To the members of this community, the health care workers from states away, and especially Freeman Medical Center, I commend everyone on unselfishly coming together and giving 110% the way that you all did, even in your own time of need.St John ‘s Medical Center is gone, but her spirit and goodness lives on in each of you.
EMS, you should be proud of yourselves. You were all excellent, and did a great job despite incredible difficulties and against all odds.

For all of the injured who I treated, although I do not remember your names (nor would I expect you to remember mine) I will never forget your faces.  I’m glad that I was able to make a difference and help in the best way that I knew how, and hopefully give some of you a chance at rebuilding your lives again.  For those whom   I was not able to get to or treat, I apologize whole heartedly.

Last, but not least, thank you, and God Bless you, Mercy/St John for providing incredible care in good times and even more so, in times  of the unthinkable, and for all the training that enabled us to be a team and treat the people and save lives.

Sincerely,
Kevin J. Kikta, DO
Department of Emergency Medicine
Mercy/St Johns Regional Medical Center, Joplin”

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Abortion Saved My Life

Oh, did that get your attention?

Good.

Now go read this. It’s short, but here’s a quick synopsis: A mother of two experienced a difficult pregnancy but attempted to carry to term despite the risks. At 20 weeks she began hemorrhaging, and was virtually left to die in her hospital room because the physician on call refused to do abortions and failed to contact a doctor who would and could — this despite the fact that the fetus was not viable, that it was already dying. Fortunately, a nurse risked her job and contacted a different doctor who was able to save this woman’s life.

Abortion is a medical procedure necessary for adequate women’s healthcare. This story is just one of the many real reasons women get abortions, reasons that we have no right to judge when it is anyone’s body but our own. This woman would have died without the abortion of her already dying fetus. I fail to see the logic in how it makes more sense to let a woman die, leaving her two children motherless and her husband a widow, than to remove fetus that was going to die anyway. To be clear, I do not think this is the only acceptable situation in which women should have abortion access — it’s just one that highlights exactly why not having abortion access is so extremely problematic.

No, I have not been saved by an abortion. But I could be. Or maybe it will be you. Or your sister. Your significant other, mother, daughter, or friend. God forbid you ever be in that situation, don’t you think you’d want the doctor to save your/her life?

I thought so.

Rapture

Well hey there! I’ve been on a bit of a hiatus thanks to med school being all crazy and stuff. This next month isn’t going to be much better what with boards rapidly approaching, and then we start rotations which I hear keep a person pretty busy, but I’ll try to drop a line when I can — that is, if I’m still alive and/or can access teh interwebz Post-Rapture.

Of course, I’ve been anticipating the end of the world for quite some time now, but I assumed it was going to take place in the form of the boards, aka the United States Medical Licensing Examination Step 1, the first of all kinds of insane exams to make sure we’re not too dumb to practice medicine. Fortunately, some kind souls informed me that the boards won’t actually matter because The Rapture is coming, and after that, nothing matters!

For those of you living under a rock or in a dark corner of a library, like I should be — err, like I am, because I’m totally studying a million hours a day for the boards!…* — let me give you a quick update. The Rapture is officially scheduled for 6pm  today, Saturday May 21. In fact, it’s scheduled at 6pm LOCAL TIME for your convenience!! So nice of them to not make us figure out those pesky time zones. So if you’re really excited, head east now and be the first of your friends to experience the 2011 Rapture! Alternatively, you could head west and avoid the thing all together. Just be sure to leave a note for your friends before you go!

Sorry we missed you!

Of course, there are rules about who gets to go. Ever have a crush on someone? That’s lust. You’re gonna have to sit this one out. Judge others? No rapture for you! Steal? Yep, that candy when you were five totally counts. You’re done. Take the Lord’s name in vain? OMG, guess you’re stuck here! Lie? Cheat? Covet? Eaten pork or shellfish? Think anything bad, ever? Not love everyone you’ve ever met? And perhaps my favorite…

…Predict when The Rapture will happen?! NO HEAVEN FOR YOU!

Yep, the Bible actually says we’re not supposed to predict when the Rapture will happen, so all those who expect it to happen today are ineligible to be taken. Guess you’re stuck here with the rest of us! It’s too bad, really — I was looking forward to some Post-Rapture looting tonight. Would’ve been a great study break, except I don’t take breaks because I’m studying all the time, always.* No one can pass the boards if they take breaks from studying!*

*Lies. No Rapture for me.