Destroyed Joplin hospital, workers find a way back

JOPLIN, Mo. -- The hospital had always been there for the victims of calamity. It had saved lives, healed the desperately sick, patched up the bruised and bloodied and made them whole again.

It was always a haven -- never a victim, itself. Until one spring afternoon when that all changed.

On that day in late May, a monster swooped in, its shoulders nearly a mile wide, its savagery unimaginable. One of America's worst tornadoes in half a century took dead aim at St. John's Regional Medical Center, barreling through halls and ripping open ceilings. Concrete crumbled. Pipes burst. Windows exploded.

And when it was over, this hospital whose roots here date back to the 1890s was wounded -- mortally, it seemed.

But this was not the end.

Not for the doctors who toiled in dust and darkness in the building's final hours, scrambling to remove glass from the wounded, insert IVs and carry the sick to safety.

Not for the nurses who shielded patients with their own bodies, pumped air into the lungs of those struggling to breathe, and jumped into pickup trucks to keep people alive.

Their building would crumble around them, but their hospital would survive.

Surgical aide Terry Burns greets volunteer Laurel Gaut on July 20 in the cafeteria at the temporary tents housing St. John's Regional Medical Center. (Charlie Riedel ~ Associated Press)

'Do you feel that?'

There was tension in the woman's voice.

"Execute Condition Gray," she announced on the public address system. Tracy Hernandez had heard plenty of tornado warnings in 30 years of nursing. On May 22, it sounded more ominous.

The lights went out. A generator kicked in, but just for a second. A trainlike roar rumbled through the building. Hernandez felt all the air being sucked out of the emergency room. Her ears popped.

"Do you feel that?" she asked another nurse. "It's coming."

The two nurses covered their elderly stroke patient with a sheet and draped their bodies over her while the woman's daughter watched in fear. "She kept looking at me like, 'Are we going to be OK?'" Hernandez recalls.

Terry Burns, a surgical technician, had the same question.

He wondered if that eerie creaking signaled the building's collapse. He, too, had used his 190-pound frame as armor, covering two nurses protecting a patient in the surgery recovery room one floor above.

"Keep your head down!" he yelled, clutching a rattling cart.

When the wind seemed to subside, Burns grabbed a flashlight and moved into the hallway. The back end of 200 mph gusts sucked him closer and closer to a shattered second-floor window. He gripped the ragged metal frame tightly with his left hand and pressed his right hand and feet against a wall.

There was chaos throughout the building.

Patients screaming. Insulation falling, kicking up blinding dust. Water from broken pipes gushing. With no power, staff resorted to flashlights or the illumination from cellphones to guide them to patients screaming for help.

Within moments, the bloodied and dazed stumbled into the emergency room.

It reminded Hernandez of a zombie movie. Two wet, terrified teens who'd been celebrating high school graduation arrived in fancy dresses. One had wood and glass wedged in her head and back. Another young woman's scalp had been peeled back. Hernandez stopped the bleeding and sent her to another hospital.

"There were several people that we knew weren't going to make it," she said. "You have to go on to the next person that you know you can help."

Dr. Kevin Kitka treated a man gasping for air. He pulled a large piece of glass from his back and diagnosed a collapsed lung. Knowing the injury was life-threatening and time was short, the doctor inserted a tube into the man's chest -- but had no anesthetic to dull the pain. The patient never complained. Soon, he was breathing normally.

Outside, a man had been impaled by a street sign. Another was crushed under his mangled SUV, which was buried under a peeled-off emergency room roof.

Inside, dogs and cats, lost and scared, had scurried into the emergency room.

Pete Anastosopolos, the hospital's materials coordinator, was evacuating patients when two men volunteered to help. "Sure," he said. "Go, get a patient."

"As God is my witness, later I see them, they were trying to steal the ATM out of the main hallway," he recalled. "Part of me was like, 'Stop them.' Part of me was like, 'The hell with it. I've got to get these people out of here.'" (The ATM remained.)

One of the first patients Anastosopolos encountered was dead; the body was purple and so bruised, he couldn't tell if it was a man or woman. Six people would die at St. John's.

In 90 minutes, the hospital evacuated 183 patients.

The makeshift hospital moved a few miles away to Memorial Hall, the town's community center. The injured arrived by school bus, ambulance, emergency crews and pickups driven by good Samaritans.

Soon, there were people on tables, stretchers, chairs, everywhere.

Dr. Sean Smith treated one woman whose heart stopped after arriving. He had no oxygen, no cardiac monitors. He put a tube in her trachea, used a bag to push air into her lungs and inserted IVs for heart and blood pressure medication.

Her pulse was restored and she was transferred.

To this day, Smith doesn't know if she survived.

Starting from scratch

On the day after, St. John's faced one question: What's next?

"Our immediate response was our building was destroyed. What do we have to do to get it back up and running?" said Smith, president of Mercy's clinic group in Joplin and Kansas.

With its 367 beds, St. John's had served Missouri, Kansas, Arkansas and Oklahoma. It was essential.

But a hospital is a finely tuned machine. It depends on medicines, modern equipment and hundreds of highly skilled people working together. How would St. John's, now badly broken and missing many of its parts, regroup -- and do it fast?

"We had to start from scratch," Smith said. "We could not use most of the medications. The bandages, the dressings, the IVs, everything was damaged from the water or the tornado."

St. John's had some salvageable beds. But what about heart monitors? Defibrillators? Oxygen containers?

St. John's had one big advantage. As part of a network of 28 Catholic hospitals founded by the Sisters of Mercy, "we were able to pick up the phone in the middle of the night and say, 'We need supplies,"' Smith said.

Within 12 hours, two semis packed with them arrived at Memorial Hall.

Help came from other states, too. Mobile operating rooms. MRI and CT scan machines. And volunteer doctors, nurses and paramedics from across the country.

Within days, there was a tentative plan: A tent hospital that had been set up about 75 miles away in Branson for an earthquake drill was dismantled and hauled to Joplin.

The Missouri National Guard's 117th Engineer Team quickly assembled the MASH-like tent, a network of white canvas tunnels. It had 60 beds, a pharmacy, an intensive care unit and emergency, waiting and operating rooms. Two helipads were created.

It was planted on a parking lot blacktop in the shadow of the old hospital.

At 7 a.m. May 29, the doors opened. Three minutes later, the first patient. That afternoon, the first surgery -- a minor skin abscess removed from a little boy. At 5:45 p.m., about the time the tornado struck seven days earlier, a Catholic bishop blessed the tent with holy water.

"It was our first big shot in the arm," Smith said. "It was pure elation. It was, 'OK. We're here to stay. We're back and running in seven days.'"

On day one, Dr. David Hagedorn, an emergency room doctor, was embraced by a woman whose leg he'd stitched up that night.

While he and others were grateful to be working, they quickly discovered practicing medicine in a tent had its downsides: Noisy, elbow-to-elbow quarters. Limited supplies. No windows or plumbing.

"It's very, very psychologically draining," Hagedorn said. "You basically have your fellow peers and staff right on top of you and the patient wards are just 20 feet away. ... Then there's the continuous hum and noise of the generators. It's almost mind-numbing."

During his first night shifts when Hagedorn stepped outside for a break, the darkness and devastation were jarring. But he willed himself to overcome his anxiety and move on.

That's been harder for more than 200 St. John's workers with severely damaged or lost homes.

Anastosopolos, the materials manager, had deemed himself "effectively wiped off the planet." His house was gone, his hospital in ruins.

He worked a month straight. "I wanted to keep the hospital going," he says. "And it took me away from thinking, 'poor me.' I didn't want that."

Burns, the surgical technician, found St. John's comforting. It didn't matter that it was a tent, and that he still was recovering from three cracked ribs -- the legacy of his near-death experience.

His house had been badly damaged, his church had been leveled, but the hospital provided routine in his discombobulated life. "This place is the only stable thing that I have," he said.

In mid-June, the staff had its first chance to swap stories when about 2,000 workers gathered for a reunion. Preliminary sketches of the new hospital were unveiled and a January groundbreaking was announced, evoking cheers.

It was a healing day for Tracy Hernandez, who'd wrestled with nightmares and tears.

"Every time you talk about it," she said, "it helps peel another layer away from the pain."

As summer set in, her heart still ached as she noticed how much was gone: The McDonald's where she'd sometimes have lunch. The bank where she'd do errands.

But she found solace, too, knowing she gave it her all in a storm that would eventually claim 162 lives.

"There's nothing in the last 30 years I had done that would have prepared me for this," she said. "You go home and you think, 'How can I make what I'm doing better and get through one more day?' ... You hope that soon you'll get in some place with walls ... and you thank God we have what we do have."

From sprint to marathon

The walls are up.

By the end of September, only a tiny part of the tent remained. St. John's new home -- a temporary insulated metal building -- has the feel of a regular hospital with floors, automatic doors, windows, water and toilets.

Next spring, a concrete version of St. John's will be erected a few hundred yards south.

By then, construction will have begun on the new permanent hospital. It will have a second medical campus and cost about $950 million. The opening date: 2014.

"It was a sprint the first six weeks," Smith said. "We're in a marathon now."

For now, the staff remains dispersed. About 1,500 workers are in the Joplin area, in the temporary quarters, offices or Mercy clinics. Nearly 400 are at hospitals in nearby communities or elsewhere in the Mercy network. Everyone has been paid without interruption.

Tragedy often transforms survivors. It already has changed Hernandez.

"You always hear the phrase, 'Don't sweat the small stuff,"' she said. "Well, it's all small stuff now."

Burns misses his beloved hometown. He's living temporarily with his family on a farm in a nearby community, remembering a day he hates talking about.

"It just brings it all back and you have to relive it -- the screams, the cries, the sirens," he said. "Will I ever get over this? I don't know."

EDITOR'S NOTE -- This story includes details from Dr. Kevin Kitka's first-person account, which was posted on the hospital website. Sharon Cohen is a Chicago-based national writer for The Associated Press. She can be reached at features@ap.org.