Tornadoes, Recovery and My Faith

I know this might sound weird, but my faith was bolstered last year when I went to Joplin to do crisis work and psychological first aid for those who survived the tornado as well as those who were volunteering to help. That may not sound like the place for faith to gain strength, but it is. I have been thinking about the opportunities that present themselves for many, not all, that have been affected by the recent tornadoes in Branson half an hour from where I now live and Harrisburg ten minutes from where I grew up to grow in their faith.

I had a friend that lost a family member due to the Joplin tornado and she was devastated. I also provided support in my role as a counselor to several people that had lost family, loved ones, homes and businesses to the EF 5 tornado that ripped through Joplin. They were struggling with the severity of the damage and the senselessness or the losses that occurred when I first met them.

I agree with them, it is difficult to see why bad things happen, and to feel pain. That said, the worst pain that I have ever experienced brought me into a relationship with Christ. When I was not able to see my son and my father had just committed suicide, I was completely out of hope. I found that hope in Christ, and with that faith I will never be brought down again. I was still unprepared for the sites that I witnessed in Joplin. I am not sure if anything prepares you for a sight like Joplin.

When I went to Joplin, I was astounded at the carnage. I was in shock, but as I looked around when we got into town I saw tent after tent set up. Every single tent that I saw as I walked among them was giving out food, water, blankets, clothing, etc. They had what the people of Joplin were in dire need of. They asked for nothing in return, and were sharing not only supplies, but compassion, smiles and hope. Every tent that I went into was sponsored by a church. When I began talking to the people handing out the supplies, every one of the people that I talked to was a Christian.

Convoy of Hope brought up semi-trucks full of supplies. Convoy of Hope is a Christian ministry. Every where I went I saw Christians helping those in need. They were being Christ-like: loving, feeding and clothing those in need. It helped restore the part of my faith that was getting jaded by the judgmental, hateful people I run into occasionally who are Christian in name only. I saw that the church still comes together to help those who are hurting; whether they are Christian, Atheist, Agnostic or Jewish.

I also noticed that of the people that I talked to, there were two groups that seemed to have an advantage. The Christians that I talked to were doing better at coming to terms with why the devastation and loss had happened. They could look to the sky, even though it was sometimes out of anger or frustration, and say that at least the lost loved ones finally got to go home. "They are in a better place." Several Christians also stated, "I may not understand what is happening or why, but I do know that God has a plan."

The second group that I saw doing well were those in recovery. While many of the people that I talked to did not have a support system to help them or mentors/sponsors to talk to, those in recovery did. They were not searching for someone to talk to or people to help them, they already had the system in place that they needed. That, and I think that already living through hell had prepared them for going through it one more time.

I know that this will not make the loss any better for those who are hurting. What I do know is that when I am struggling through crisis, I have developed a support network that will be there to assist me. I also know that I have a God, an awesome God, that has taken all of my hurts and allowed me to grow from them and use them to help other people. I went from dealing dope to dealing hope, and I owe it all to Christ!

I hope that your faith gives you the insight and strength  that mine has. I also hope that the prayers being sent to you will give you the serenity to stay rational when confronted with adversity, the courage to face it, the hope that life can get better and the optimism to use your faith to make you stronger and overcome any obstacle that this world throws at you. Remember, this world is only temporary!

Joplin - My FIrst Day Experience

I can tell you that I have helped a lot of people through traumatic things in their lives. I mean a lot of them. I have sometimes also experienced them personally but I have always experienced them vicariously through other people. I will also tell you that I had seen the television reports, and had seen the interviews with Joplin residents that had experienced loss. I also had been forewarned by other counselors who had been to Joplin the two previous days, and was debriefed on what to expect from the people who had survived the tornado during the drive to Joplin from Springfield.

I can tell you that all of those things mentioned above had occurred. I felt that I was ready to go and do what I could to support the psychological and emotional needs that the people of Joplin had. I know how to compartmentalize, and deal with the grief and loss that they are experiencing. I have done that before. I am used to dealing with traumatic events. Some of them were horrific, mothers losing sons and wives losing husbands. I had dealt with those types of situations before. I knew I was ready.

I would have been telling you the truth.

I will tell you that I have seen a lot of traumatic things in my life. I mean a lot of them. I have either experienced them personally or vicariously through other people. I will also tell you that I had seen the television reports, and seen videos and pictures of the tornado affected areas of Joplin. I also had been forewarned by other counselors who had been to Joplin the two previous days, and was debriefed on what I could expect to see during the drive to Joplin from Springfield.

I can tell you that all of those things mentioned above had occurred. I felt that I was ready to go and see the wake of the EF 5 tornado that hit the city of Joplin, cutting a 6 mile swath through her heart. I know how to compartmentalize, and deal with seeing traumatic events. I have done that before. I am used to dealing with seeing traumatic events. Some of them were horrific, multiple vehicle accidents, shootings, even a tornado that had destroyed homes and taken lives. I had dealt with those types of situations before. I knew I was ready.

I would have been lying to you.

I had definitely lied to myself. Looking back, I do not feel that anyone can be prepared to see some of the things that I saw. The sheer magnitude of the damage is unreal. It is on a scale that seems impossible to me. I saw things that I do not care if I ever see again. I saw things that looked physically and scientifically impossible, and probably were due to the laws of physics and gravity.

I saw a Burger King that was reduced to rubble, yet I could tell it was a Burger King based on the kids play area that was still intact. Brick building decimated but plastic slides and tubes not the least disheveled. I saw a two story house in which the bottom floor was semi-intact. On the second floor 3 of the 4 walls were gone. They simply were no longer, but on the one wall that was left standing a flat screen television was still mounted on it.

Now I know what they mean when they ask, "Why does it take this one and not the one next to it?" I saw buildings with everything including windows intact, and the building next to it not be recognizable. The winds in an EF 5 tornado are unreal. I had heard that x-rays and medical records had been discovered as far as 70 miles away. On our way into town we passed people on 4 wheelers and horseback that were about 10 miles outside of Joplin. They were looking for the bodies of those missing......10 miles from the affected area.

The magnitude of this tornado did not dawn on me until I drove down the areas that were directly hit by the massive tornado. The drama that has enfolded for the lives of those who live in Joplin became real when I saw people with tents pitched picking through the remains of what was once their houses, just hoping to find one Christmas ornament that their children had made them, or a photo of their husband who blew away in the tornado and is still missing. I saw truly broken people that had lost everything: family members, their job, their home, their friends, their vehicles and their wallets. They literally had nothing and no way to get anything.There were people with plastic boxes and garbage bags sifting through the remains of their house, at times somewhat standing and at other times a three foot high pile of wood and bricks..

Do not get me wrong, I also saw people turn out in droves to help. I saw the United Way, Convoy of Hope, more church vans than I could count, the Red Cross, etc. Restaurants were giving out free food and people were handing out free water. The drivers license bureau was waving the fee for replacement licenses. People came out to volunteer in such numbers that they had to turn them away. I saw hope and compassion. I saw people who knew that they mattered because people were there to help them, and they were going to make it through it. I saw people that were resilient, who could still smile and laugh and see the positives to come out of the ashes and mayhem.

But I also saw us, and that brought reality home to me. I looked in the rearview mirror as we drove through the carnage, and I saw 2 sets of eyes struggling to hold back the tears. That is when I let my tears, the ones that I had not realized I was holding back, fall. I knew that my heart was broken and that my life was forever changed by what I had experienced over the course of my first day of many, counseling and supporting people in Joplin.

There was one emotion that was nagging me as I drove through Joplin. I could not quite put my finger on what I was feeling. As I was driving back to Springfield I realized what that emotion was. It was Empathy. What I realized was that I felt hopeless and desolate even though I knew I got to go home. How must they feel? They don't get to leave, they are home.

45 Seconds: Memoirs of an ER Doctor from May 22, 2011

Emergency Department
after May 22 tornado
View more photos from our Flickr

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

Joplin tornado and psychological first aid

Last night Joplin Missouri was hit with an F4 possibly an F5 tornado.The devastation appears to be prolific. The trauma that many in Joplin are experiencing will only be worse based on the weather report. There has been nonstop rain and thunder since the original tornado struck. To make matters worse, they are predicting weather patterns that are indicative of producing more tornadoes all day and into the evening tomorrow and Wednesday.

I found out this evening that I will probably be going to Joplin. While there, I will be working with those who were impacted either directly or indirectly by the tornado. In order to do that, last night I read a field operations guide for psychological first aid. Psychological first aid intervention strategies will allow me to work with children, adolescents, parents, caretakers and families.

The guidebook discussed how to be nonintrusive and compassionate in making connections with those who were traumatized by the event. It also looked at providing emotional and physical comfort as well as how to remain calm as it orients emotionally overwhelmed survivors. Giving assistance and gaining information are important to allow us to assess people's needs in order to address their concerns and allow them to feel more comfortable.

In a disaster situation you attempt to take care of people's basic needs. To explain this, let's look at Maslow's hierarchy of needs. For those unfamiliar with Maslow, he developed a pyramid that represented a biopsychosocial perspective of the needs that humans have. He felt that we all had five basic needs. They needed to be met from top to bottom, because without the one below the one above was impossible to meet.


Let's look at each level of the pyramid from bottom to top:
1. Physiological needs – water, food, sleep
2. Safety needs – security, order, family
3. Belonging and love needs – friendship, family (psychological)
4. Esteem needs – self esteem, confidence, achievement
5. Self actualization – can only occur when the four lower levels are met

If we do not take care of the physiological needs such as water, food and sleep the safety needs are immaterial. They will not be met. So offer them water, something to eat or a blanket to insure that their physiological needs are taken are of. After the physiological needs are met we begin to look at their safety needs (calm them down by being calm and talking slowly and maintaining eye contact), and then they're belonging and love needs (also called their psychological needs) by listening to them if they want to talk and validating how they feel. Those are the main  things that we focus on in psychological first aid, the bottom three levels. The top two levels will seldom be reached over the first several days and weeks while we are on scene.

There are some things that need to be remembered when doing psychological first aid with disaster survivors and those who have experienced traumas. Never assume that you know what the person is experiencing, as everyone reacts differently to the same situation. Also never assume that the survivors want to talk about the trauma they have just survived. This can actually cause more harm than good.

Sometimes it is best just to be supportive and to remain calm. That allows you to be seen as a person who can give survivors the physical and emotional comfort that they need. Some of the survivors will simply want to be left alone, while others will need to talk. Be prepared to listen, as people will generally tell you how you can assist them and what they need if you listen without interrupting.

The most important goals of psychological first aid are to allow the survivor to function, assist them with their current needs and reduce their distress to the situation. We're not there to debrief the survivor. If we ask them to give details of the traumatic experience of loss they have experienced this could traumatize them even more. We are not there to help them work through their trauma. There are generally many survivors, and we do not have the time guide each of them through their grief. We're there to do psychological triage.

We should reassure them that how they feel is to be expected. We should let them know that they will be angry at times, sad at times and lonely at times. We also need to let them know that if they continue to feel depression, they should talk to a grief counselor.

Never tell them that you know how they feel, that they will feel better soon or that they need to grief. They already know that they need to grieve. Also do not discount how they feel, by saying things like it could be worse or they're better off where they are or everything happens for a reason. Instead allow them to grieve, show them compassion and empathy.

There are some things that will allow survivors to overcome their trauma. Having a strong religious belief, positive beliefs, remaining optimistic or seeing others acting altruistically to support them. We need to find ways to empower them by giving them hope and allowing them to have some dignity.

Finally treat people the way you would want to be treated. Don't talk down to people, don't spread rumors, if you don't know the answer admit it, don't label people and do not guess what people are thinking or feeling. When listening to someone lean in, make eye contact and give them your complete attention. Never forget to let them know you understand what they're saying by reframing questions/active listening and then validate how they feel.

Remember to try and stay calm. This may be difficult because you are in a disaster area. This can be very overwhelming for you. Realize that you may need to talk to somebody. Always use the buddy system. Rotate shifts with them, take breaks and always monitor your own level of stress. If you are stressed out, how can you possibly help someone else destress. Hope this helps anyone who is attempting to volunteer in disaster relief and traumatic situations.

My prayers go out to all of those who were impacted by the storms and tornados that swept across the United States over the past two days and today as well. I hope that you will join me in praying for those impacted as well as the volunteers who are rushing to help out either in person or by donating goods and giving blood.