Sunday, June 5, 2011

First Response Mode: May 22, 2011, Joplin Tornado

The first smells to sand blast their way into my car as I opened my door against the northerly winds was that of gasoline, kerosene, and swamp gas. The tornado lurked very close by, the unmistakable roar of wind, rain, hail, and debris gnashed about the road less than a mile or so away from us, and the sky roiled in avocado green. I couldn’t see it, but I could feel it and hear it inside my skull. Some insulation from a house or business floated down next to my foot, which was now soaked from the horizontal winds about the rear flank downdraft. Off to my right, a sole power flash as the tornado moved on. A resonant bass, deeper than sound, signaled the proximity of the tornado, but in its wake it left wind, rain, and a remarkably intense staccato lightning and thunder, like a strobe light stuck in irregular leaping beats.

I had forecast this target almost 24 hours before, but just about 30 miles west of Joplin near a town called Coffeyville, KS. I liked the winds at the surface, the hint of a dryline, the ridiculous amounts of potential energy waiting to unleash itself on the atmosphere, and the way the satellite and morning radar showed a boundary just draped over the area, waiting to stir up storms. My chase partner, Robert Balogh, MD, and I headed from Wichita, KS, to the area near Coffeyville, arriving before storms initiated around 3pm. The storms looked beautiful, but mostly were rain bags mixed with hail. Severe, yes, but definitely not tornadic. But then they began to mutate and darken, red blobs turning to purple and white on my radar image. The storms were growing larger than Mt. Everest by over a mile or two and they began to turn right. One storm, the one northwest of Joplin, began to rotate, slowly at first, and then more intensely to 100 knots, then 110 knots.

We met up with Cloud 9, a chase tour company run by Charles Edwards and co-opted by George Karounis and Mike Ratliffe. We all agreed the storm near Joplin looked good on radar, and was the best bet by far to target. With limited road options, we were forced onto I-44 to take us over a reservoir inlet at the Kansas/Missouri border. Only now, days after the fact, did I find that the road we left in order to pursue this storm was named “Bagdad Road”. So we left Bagdad on Highway 400 into Missouri and onto I-44.

We knew we’d need to punch through the rear flank rain (and possibly hail) to get within visual range of the tornado that seemed increasingly likely to form. But the set-up felt good, our timing seemed right, and we agreed to proceed.

The sky heaved curtains of rain powerful enough to etch paint off signs. The winds picked up strongly out of the north as we approached the storm’s RFD. Radio traffic filled with sightings of a multivortex tornado. Sitting in the RFD, we could see nothing going on from as little as a half a mile away. Our storm had been tornado warned for about 20 minutes before this, and I noted this fact as I glanced at the latest radar scan and cringed in horror that the scan showed a very well-defined hook: the radar findings suggestive of a tornado. But in addition, the tornado bore the sign of a debris ball in the lowest levels: evidence of probable debris kicked up by the tornado, high enough to be spotted on radar.

Later, I’d watch YouTube and find video that showed the evolution of this tornado. From the first wisps and tendrils of the tornado touching down, to the point where it became a ¾ mile wide wedge of destruction took <30 seconds, something I’d never seen in my chase experience. The tornado grew in size in a way that was faster than its ground speed. Experienced chasers I knew could not move out of the way fast enough and some nearly found their lives forfeit. Sadly, so did many in the path who had become so used to hearing tornado sirens and had learned to tune them out as false alarms.

As we crossed over the Joplin town line, the tornado was busy spinning wildly at over 200 miles per hour, leaving behind a landscape that looked mowed down to its nubbins with humans tossed like batter smashed against debris. My patients would come from here and soon. I had not met them yet, but I would know them and see them for the next 12 hours, and I’ll never stop seeing them in my mind, ever.

We passed mile marker 9. At first we saw the occasional blown-over sign, or a knocked over tractor trailer. I felt hope that Joplin itself was left unperturbed except for some nuisance damage. But then we moved forward and discovered smattering of cars and tossed 18-wheelers, thrown well off the interstate in ways not typical of non-tornadic winds.

“First responder mode” was the last radio transmission I received before I snapped out of reverie and shock. I put my car in brake and took one last look forward; I wouldn’t be wearing dry clothes again until dawn the next day. The tornado was audibly moving off to the east (off to my right and away from me, I-44 bearing slightly north of east at this point).

Soul-piercing thunder charged the air as I got out of my car. Courtesy of the dark skies and pounding northerly winds, I could only see to the underpass directly in front of me. One truck was overturned on the off-ramp to my right: whether it had started heading east or west was not clear. Multiple cars, shards of glass, and scoured earth were just east of the overpass.

I took charge of the scene rapidly, asking my chase partner to attend to 3 vehicles in the westbound lanes. I worked with Mike Ratliffe to secure the scene on the eastbound trucks and the one tossed like a toy onto the on-ramp. I remember trying to emanate calm, I remember trying to pretend the lightning didn’t scare me, but internally I wanted to be anywhere but walking down the middle of an interstate watching a victorious forecast manifest in hideous destruction. Every rationale part of me knew I needed to take cover, the threat of death by electrocution or falling debris still loomed imminent. Still, I also felt the reflexive need to take charge and take back the earth from the sky. I felt this was on September 11 when I reached to the television screen and tried to right Tower 2 from falling using nothing but my mental will and my desire to turn back time. It didn’t work then. It wouldn’t work now. But at least this time I was in a position to act.

I grabbed my orange trauma kit from the back and began to attend to the trucker on the off-ramp. The rain had been torrential and the roadside was a mass of water. I took one step toward the truck and sunk my shoe into muck and swamp water. I could barely walk through the morass at the side of the road, let alone make progress up the incline and yet, seemingly 100 feet away at an angle that felt close to 45 degrees, loomed a truck on its side. I couldn’t propel myself up the incline, but wind had no problem taking a truck weighing tons up the same incline.

The driver was shaken up, but was much more worried about his cat and dog—both of whom were in the cab, he thought. He was unrestrained, he had been tossed as easily as his truck. Glass had shattered throughout his cab and now the exhaust port of his truck was coughing up large amounts of black smoke as the engine revved. I shouted for him to cut the power and began to consider the unholy paradox that in this driving rain I may be dealing soon with a raging fire. Other rescuers attempted to find the dog while I escorted the driver back to Mike Ratliffe’s truck. His wounds were superficial: a severe laceration about his left elbow that was far too complicated to be sewn in the field coupled with a laceration on his forehead.

Whereas I had thought I was gaining traction mentally on the situation I was working in, I began to feel a telescoping effect: I was through the Looking Glass and was getting smaller and smaller in relation to the true scope of the disaster. It had taken me several minutes to care for a single person, and increasingly I knew he was one of many. I was only just beginning to appreciate it how helpless I was. I had no radio to communicate with EMS, there was no formal command structure, my cell phone was not receiving any signal (despite being in Joplin’s city limit), and just where had the debris raining intermittently from the sky come from exactly?

The first police officer arrived on scene. I ran up to him to establish that I was a physician, had a background in EMS, and wanted to check in at incident command to help. He asked which hospital I worked at. Not being sure how to answer, I just stated I was traveling through. He looked at me and said, “Better not go to St. John’s then: it’s been destroyed.”

That took a moment for both of us to process. A whole hospital was destroyed? A whole hospital? “Where’s the next closest hospital?” I asked. “The only other one,” he said, “is Freeman—do you know how to get there?” I became smaller and smaller as the rabbit hole grew larger. He gave me harried directions: head back on the interstate and take the 2nd exit to the right and follow the signs.

I radioed to my friends on the Ham radio my intent, I got Robert back in his truck, and we began to head eastbound on I-44 since the only way back was literally to go forward a fraction of a mile and then turn around. As I pulled out under the overpass, I felt like a football player clearing the atrium of the locker room: each step exposes a dizzying sense of vertigo as the full scope of the stadium manifests visually from shadow and murk to vivacious color and size.

When I’d gotten out of the car the first time, I was convinced we were in the tornado’s wake, tending to the tornado’s victims. I was wrong. We moved forward into a battlefield of staggering dimensions where the tornado had crossed the interstate. Where I had only seen a few trucks and few passenger vehicles near the overpass now, just east of there, was a quarter to half-mile wide cacophony of vehicles mangled, overturned, tossed, and littered with mud, tree limbs, glass, and utility parts. People staggered in between vehicles checking on passengers. Navigating this debris I had an awful moment to see a Barbie doll lying on the dashed center line. “Holy shit, holy shit, holy shit,” I kept muttering. A hospital destroyed, an interstate littered with debris and vehicles, what the hell did I just drive into?

I exited the interstate and then got to replay the whole thing again as I went back west to get to Freeman. This time I was navigating traffic that had been forced to a stop due to the destruction I’d just cleared. I hit the 4-wheel drive button and began to navigate the shoulder trying not to hit debris or another car or a body. Somehow I eked my vehicle between two 18 wheelers. I ended up getting flagged by the same cop I had seen earlier. When I rolled down my window he flagged us through the road block.

The world became bigger and bigger as I tried to reach Freeman. No matter how hard I pressed the accelerator, my car simply could not travel the distance fast enough. I felt that horrible dream feeling of being on a treadmill, spinning in place while my destination drifts further away. Finally, Robert radioed me to slow down: “Nobody’s going to be helped if we become victims ourselves…don’t hydroplane, Jason.” I acquiesced and actually followed the speed limit. The blue sign with the H approached on my right. Finally, the exit was here.

Coming off the exit we re-entered the damage path. Tree limbs, stalled cars, and damage began to show up just north of our exit. Ambulances crossed the intersection to our north. Follow them, I thought. Beyond all reason, this sole intersection in the town had power. I brought the car up to the red light and stopped. The dichotomy of urgency and law abiding, the ego and the id.

Straight ahead there was a raucous of flashing lights and a solitary building I’d later learn was the other hospital. For now, I was just waiting at 32nd and Main St for the light to turn green. Finding an emergency room during an emergency proves to be decidedly difficult. Signs point up or left or right where roads seem to dash and turn. Somehow we made it to the ER parking lot during a loll in the ambulance activity.

I used my stethoscope as identification and made my way to the ER entrance with Robert. In the dying gray, the city was preternaturally dark. The hospital itself had experienced a total power failure transiently. The emergency lighting strobe lights could be seen from outside the hospital: given the window tinting, these strobe lights beat in asynchrony from all the floors and all the windows and somehow terrified me worse than any event that day.

By now I was steeling myself and preparing to help in any way I could. It felt reassuring to re-enter a hospital setting. I remember checking in with the triage nurse whose name eludes me: she was incredible. She ushered in a sense of calm and order to what had been nothing short of chaos up until that point. Through her cues I was able to search out a comfortable and familiar work rhythm.

I’d worked multicasualty simulations in my old EMS life, but in most of these scenarios patients numbered in the teens to twenties. Suddenly I was shoulder-to-shoulder with care providers seeing many tens of patients at a time. I eventually migrated into the center of the highest level trauma: patients who were unconscious and gravely wounded.

Head trauma was ubiquitous with scalp lacerations nearly uniform and often the scalp wound appeared more dramatic than the actual life-threatening injury. One particular incident involved a person whose lower leg was severely injured. The patient was conscious and state that her leg hurt, but nothing else was affecting her. She had a head laceration that was bleeding vigorously, soaking the head of the bed. Meanwhile, her mangled leg was not bleeding at all. Her toes of both feet pointed forward, but on inspection, it became clear that her left leg had spun 360 degrees about the shattered tibia and fibula and was essentially auto-amputated. The leg had clots, but no active hemorrhage. While I inspected the twisted sinews, I was shocked to find my glove had snagged and torn open on a large nail that was embedded in the tissue near her calf. Her head wound was minor, but it was the cause of incredible bloodshed. She stabilized enough to undergo surgical amputation less than an hour later; her scalp wound continued to ooze after she came out of anesthesia.

As an internist and a father, I had no training or stomach to deal with the critically injured children, some who died. I take some comfort in knowing the ones I saw looked like sleeping children, and did not look like they were suffering.

A gentleman with an open skull fracture presented needing to be intubated. The ER resident at the time and I performed a quick exam and noted that his left eye was deviated medially and his respirations were agonal. In this mode, there was no choice but to allocate resources to those with less severe injuries. I suggested we give him intramuscular morphine and allow him to die of his injuries so that more patients could come in. The ER attending nearby concurred and we did this. Several other patients were already dead.

Physical diagnosis became a minefield. Almost all patients were covered in some form of debris which tended to accumulate in skin folds or in the ears or mouth. On more than one occasion, shards of glass cut my gloves (but thankfully, never me). The floor was covered in so much blood in places, that it was a matter of throwing down towels to minimize the risk of slipping and falling. All my career I’d been trained about fluid precautions to avoid transmission of disease, yet in Joplin that night, the ER was a fine mist of all kinds of fluids—infectious and non—and the only thing that mattered was forward motion.

I saw things I’d never treated before, such as flail chests, impailments, and traumatic aortic dissections. There was a paucity of shouting, only the occasional cry or moan broke rapid clinical discussions and movement.

I learned humility beyond words at the reality a city’s worth of people were facing. I can’t emphasize how perfectly coordinated everyone was in spite of the destruction, a seeming hive mind borne of chaos. People moved like delicate samurai, cutting through the trees with grace and elegance. Even the patients seemed resigned to help by offering focused answers and trying to bravely absorb their plight without distracting anyone from moving to the next patient.

Here I was working with care providers in the middle of an ocean of darkness: cell phone service was down, the internet was offline, and the hospital’s landlines were not available. The nurses, techs, and physicians were triangulating whether their families were okay based solely on the location where the victims had been found. They could not know their own spouses’ safety or their childrens’. And yet they worked focused and without hesitation. No time for tears, no time to mourn.

The dead were treated respectfully, and were ushered from this life to the care of the morticians. The custodial staff rushed around cleaning the floors, the walls, the equipment, and occasionally the ceilings. The dance continued gaining increasing organization over time. The surgeons arrived, the CT scan reopened.

Staple evaluations, such as taking a manual blood pressure, or getting basic labs, were waylaid for more fundamental physical diagnoses consisting of analyzing a pulse or symmetry of breath sounds. Documentation consisted of plain paper taped onto the patient or Sharpee written on skin. For many reasons, this was the pinnacle of medicine to me: there was no note, no review of systems, no legal posturing, only me and my patients and their care. The irony of the disaster was that I was more of a physician then than I often internally feel I am in the wake of stability. And I was fluid in my care, moving effortlessly around nurses and techs whose care was equally as focused on treating the patient.

I had long ago foregone my surgical gown and was back to wearing just my shorts and short sleeves, my clothes reeking like a swamp. I kept changing my gloves, but still ended up with blood, sand, and gore on my forearms or legs. I would rush to rinse these off when I could, but the emphasis was on doing and moving.

It was shocking the things that didn’t run out: gloves, IV fluids, foley catheters, central line kits, EKG leads, pain medication, anxiety medication, and chest tubes. It was equally surprising what couldn’t be found: ABG kits, surgical gowns, suction kits, and manual blood pressure cuffs. The Freeman radiology department had an issue with getting their digital radiographs from their server to computers elsewhere in the ER likely stemming from the power outage, so most patients were treated without knowledge of their chest radiograph. If a patient had asymmetric breath sounds and were short of breath, they got a chest tube. If they were pale, they got blood.

At some point in time, the power went completely out transiently in this very busy ER. One patient cried out, “Not again!” The power was only out for a fleeting few seconds, but the pitch black exam room added to the surreality. Of course Joplin hadn’t been hit again, but for a moment there was a very pregnant pause while everyone braced for something else to happen.

Eventually I’d made my way into the main hall, all major trauma patients had been transiently stabilized. A charge nurse asked me if I was a doctor, and if so to follow him. I followed him around a maze of rooms and finally began to see just how big the disaster was. The trauma bays I had been in were numbered 36 to 40. Each of those bays had about 4 beds in them, so overall I was involved in caring for about 12-16 “slots” that each contained a patient.

As we marched through the ER, it became clear that every bed (1-35) was filled with moderately injured patients, and then we hit the waiting room. There were hundreds of people, blood on every surface, bandages outnumbered clothes, and here there was wailing and human suffering. If for only a moment I reflected on an amazing irony: it was better to have been moderately-to-severely injured by the tornado. To be one of the walking wounded meant misery—no doctor, no pain medication, no expected time until treatment rendered…it left me unsettled. Also, I had a moment of panic, fearing that the charge nurse was escorting me into this room—filled to standing room only—to care for this mass of patients with nothing but my heart to care for them. Instead, he directed me to a room that was used in better times to care for patients who had been discharged from the hospital but were awaiting pick up by friends or family.

This “discharge lounge” had been unexpectedly filled with patients from the stricken hospital, St. Johns. These patients had been on the top floors and had been admitted to St. Johns for routine medical treatments: hip fractures, cancer surgeries, pain control, etc. They would relay to me throughout the evening that they were all mobilized at some point into the hallway when the tornado warning was issued, but the tornado had destroyed the roof and all of the windows of their floor. Once the lead windows were shattered, the floors acted like wind tunnels, accelerating the winds, focusing them on objects in the rooms such as chairs, end tables, and in one case a Coke machine. All of this was sent aloft emerging out the far side’s windows, in some cases crashing to the ground below.

One patient told me how her room was several rooms away from the nurse’s station, but when the tornado ripped the roof off, she “flew” (per her) past the nurse’s station, colliding eventually with the far end of the hallway as she bounced into other patients and beds. One patient relayed making it to a stairwell which “fell apart” as the tornado hit, and he thought he saw staff and patients fly out from above his vantage point. To date, only 4 patients were known to have died directly from the tornadic winds; 1 visitor likewise succumbed, but no staff.

When the tornado hit, these people still needed medical treatment, but now the hospital they depended on had become a disaster zone. Some of the patients had chest tubes that now were no longer hooked up to suction, ditto with nasogastric tubes. Pain medication, IV fluids, and other accoutrements of care were suddenly not working, broken, or absent. That they had been rescued from the top floors by EMS was a true tribute to the emergency response in Joplin. That they now were sitting in a room with one doctor and three nurses hoping to get their care back on track was overwhelming.

For the remainder of the night I would be their doctor, their healer, and their confessor. In this room, I began to organize a hospital floor with the nurses. The staff I worked with down to every single one was impeccable, appreciative, effective, and efficient. We began to round on these patients and began to piece together their medical care. In some cases, patients were demented and had no idea how they got there or why they were there. One lady sweetly referred to herself repeatedly in the third person, but laughed and chuckled at the end of each of her statements.

One patient was summarily “pissed off” because he had been scheduled to be discharged from the hospital earlier that morning, but his doctor never made it in before the tornado. He also wondered whether I’d seen his medical records (I’m sure they were in the sludge miles away from there). He asked me to discharge him on his new “white pills”. I could not comply, sadly, not only for not knowing which pills these were, but because I had no way to coordinate his care safely. And for his part, he didn’t press the point since he had no home to which to be discharged; his wife confirmed that their house and vehicles had been hit by the tornado too.

I recognized that while the care that was required was infinite, my energies were not, and now, almost 10 hours since the tornado hit, I was running out of adrenaline. I hadn’t eaten or drank anything since lunch. I had seen about 25 trauma patients earlier in the day, but now had equally that number that required “routine” hospital care in addition to tornado-related aid for bumps, bruises, and cuts. It was a jarring realization, but we needed to return from the world of disaster to one of written orders, standardized handoffs, and resumption of basic medical protocols. I had written for what felt like gallons of opiate pain medications, and bottles of benzodiazepines. Accountability needed to return, and care needed to reflect a broader scope again, rather than just the here and now.

So it was that I went from rescue mode into the heart of being a hospitalist. I fell back to writing out medications for constipation and for daily labs, not the things spawned from supercell thunderstorms. The emotional toll of what I’d been experiencing from without began to seep into me. I rinsed my hands off again as I looked around. There was blood on the carpet, the area was covered in a gravelly sand (a weird amalgam of concrete, glass, stucco, and wood that once was ostensibly St. Johns Hospital), and people were lying in chairs or on the floor. I received word that ambulances were on the way now to take my patients away from Freeman to surrounding areas, some as far away as Wichita and Kansas City. I began to triage who would go first, and who was too unstable to be transported. I formed incredibly fast friendships with my nursing staff. We worked together like I’d been in charge of this ward for years.

Violating any number of state and Federal laws, and hospital credentialing committees, by caring for my patients, I grudgingly recognized that we needed to begin keeping a tangible record of our endeavors. I signed every order with my Florida license (worthless in Missouri) and with my DEA. I left my phone number and address and I hoped that somehow all this would suffice. A nurse lent me her phone: cell service had been restored. I called my wife. With two words I conveyed an idea so transcendent from the town in which I was working, that I felt guilty even uttering them: “I’m okay.” Without much explanation, I told her I loved her deeply, and that I would call when I could.

By 4am, I was done though I had no sleep in me. I wandered into the hospital’s ER to check out my patients. I felt an incredible guilt: how selfish I felt to stop rendering care because I was tired. Surrounding me were all the players who’d been working from the start: the same triage nurse, the same ER doctors, and here I was walking away. Still one part of me knew that no matter how long I worked, this transition back to allowing Joplin to care for itself was inevitable. I longed for the energy and for the ability to do more, but I knew I had done all I could. Almost fifty patients and several fatalities packed into a short span of hours and a marathon of patient care.

While walking to the ER, I randomly bumped into Robert. It is difficult to explain just how unlikely that was. The hospital was still full of the injured and their families notwithstanding three shifts’ worth of staff. It was a central hotbed of activity and movement. Yet, here was Robert literally standing in my way. He was tired too, and he too had reached the conclusion that he had nothing further to offer. After checking out my patients we then made our way to our cars. I tearfully hugged most of my patients and their families. I said goodbye to my nurses. I left the ward I’d helped create for the last time.

Every chaser knows that the end of a chase day is complicated by hotel room availability. We didn’t even bother checking for a motel nearby, we already knew none would be found. We made our way back to I-44 and drove 100 miles into OK. Near dawn we found an EconoLodge with blazing-fast wireless internet service and very hot running water. This too fostered a sense of disbelief and a sense of being utterly removed from the real world of just hours before.

While driving, Robert was shocked to hear that I was going to chase storms again in just a few hours after a veritable nap as Central Oklahoma looked primed for severe weather within the next 12 hours. After what we'd seen, how could the reasonable person storm chase? I had to think about that, and then realized why. I didn't cause the storm by wishing for it, and had it not been there, Robert and I wouldn't have been there either to help. Karma.

I will forever remain captivated by severe storms and the incredible beauty they possess, though now I have a new appreciation and profound respect for just how exceptionally powerful the storms are. The destruction the tornado rent upon Joplin did so without antipathy, and in so doing seemed even more hurtful in its emotional neutrality. There was no one to blame, no one to hate, no forces against which revenge could be focused. It was a feeling of inevitability bearing witness to its destruction—an amplified sense of helplessness. I couldn’t right the World Trade Centers, and I could not stop the storm from destroying Joplin.

I threw my socks away because they were unsalvageable. I would need new shoes. I showered, and then I slept. And then, as unexpected as it was, the sun rose again…

Post-script: Joplin’s tornado was one of the deadliest in recorded history. Few tornadoes have caused this much death save some in Third World countries, such as a Bangladeshi tornado that hit several years ago killing 1300. As of this posting, more than 138 people are confirmed dead, and over 7000 structures in Joplin were deemed damaged or destroyed by the tornado. The National Weather Service has confirmed that the tornado was an EF-5 with estimated winds in excess of 200 miles per hour.

The city of Joplin was enclosed within a tornado watch box that had been issued over 2 hours before the storm crossed into Missouri. The storm that spawned the tornado was under an active tornado warning for up to 20 minutes before the tornado hit. In some parts of the city, no sirens wailed. Some chasers fleeing the tornado reported that people were out walking on the street as they rushed past, oblivious to their impending deaths, completely unaware of the severity of the storm on their doorstep. The high fatality count likely is due to the combination of EF-5 damage and many people not in proper shelter at the time the tornado hit. Had the tornado been ½ mile further south, both St. Johns and Freeman hospitals would have been destroyed simultaneously and the death count from such a hit would have easily exceeded 1000. As it was, accounts confirm that emergency preparations inside St. Johns and at least one nursing home in the tornado’s path were executed properly.

Still, the tornado and its wake have served as defining moments for me. I will use them as impetus to improve healthcare’s response to disaster preparedness and response. Ironically, less than 48 hours after clearing the scene at Joplin, I became the triage officer of a two county disaster area west of Oklahoma City on another destructive tornado that ultimately “only” caused EF-4 damage. Given my clinical experience, I felt very confident in rendering care at that scene. After decades of chasing, I’d never been present when a destructive tornado struck, and in 48 hours I had experienced two.

I have no images from these tornadoes, nor their aftermath, as once the transition from chaser to caregiver occurred, documenting what I witnessed was left to these words and my memory out of respect to the communities I served.

If the caregivers are any representation of the surrounding community, Joplin will rebuild and flourish. These are survivors. These are neighbors who care for one another. They are the best of humanity, and they affirmed the good that exists in all that day.


Anonymous said...

As someone who knows you personally, it does not surprise me that you were there and that you worked so hard to treat the wounded. You've always been a hero to the many nurses and doctors who have worked with you over the years. Kuddos, my friend.

Mike Smith said...

Thank you for a wonderful writeup.

Stormspottertodd / KB4MHH said...

(*sigh!*) (long pause) :(

Poetslife said...

I sent your blog content to Polly Wood of The American Civil Defense Association Journal of Civil Defense.
This is an incredible piece for lessons learned, and it deserves a much wider audience. I hope she agrees and we see this published in a future issue.
What is especially valuable is your reflections on how it is affecting you and the patients. As you know, it is difficult to get those involved in emergency management to open up or reflect that way.
You might enjoy the emergency management posts on my blog, Poetslife.

Tanja said...

Thank you Jason. An incredible account.

Tanja in MT

sknr31 said...

Such an awful situation, and this testimony is definitely a blessing in regards to this humbling experience. Another thing, your writing is really amazing, look forward to reading other blogposts in the future

Anonymous said...

Wow. This brings back so many memories of Port-au-Prince.

Good job, doctor.

Michelle said...

Thank you.

Angela said...

I have a cousin who was at work at St. John's and another cousin that died at St. John's that night. Thank you so much for being there to help! And thank you for blogging about it.

hga said...

As a native of Joplin who managed to avoid physical injury, but who's Mom was an RN and who spent a lot of time with doctors in the '70s, I can barely, vaguely, imagine what those 12 hours were like; it reminds me of an account of the aftermath of the Coconut Grove fire I heard from a physician who just recently passed away.

Thank you very much for the aid you rendered in our time of extreme need.

Taylor said...

Your story is so amazing. I cannot thank you enough for helping my city recover when we're at our worst. I'm sure if it wasn't for amazing people like you who are willing to help, the death toll would have soared past what it is today. Joplin is amazing and we're the type of city that is going to recover just as fast as the city was destroyed. Your story was amazing, I can't even imagine the heartbreak you felt while dealing with the people who passed away. Once again, Thank you so much for all that you did for our city. I only hope that one day we can all repay you for all that you did for us. A talent like that is truly amazing. Thank you so much!

blyoakam said...

Thank you dear one and all those that helped us in our time of need. I am the supervisor of the NICU/NBN at Freeman Health System, and unlike you I spared seeing what you did. I was located in another location in the city to treat the walking wounded. I am proud to say I am the cousin of Shawn Davies who is also a Storm Chaser. Thank you for what you did for us that night and Thank You for watching storms in an effort to keep us safe. Bobbie Yoakam RN BSN/Freeman Health System.

Crystal said...

Thank you so much for your accounts of what was witnessed that night, and thank you so much for helping. I work at Freeman in the ICU. I am so proud of how everyone came together during this horrific time. The heroism of all the people that came in to help at our hospital has not been recognized as much as deserved. Your writing gives a very vivid account of the horrors endured by patients and workers alike. It is a sight many will never forget...

djhagedon said...


Jason Persoff, MD (the StormDoctor) said...

I am so deeply touched by all of the comments people have left above. My story is but a pebble in the ocean of other stories of people who dropped everything to help. The people who deserve the most praise may never be known. I was very grateful to be in a position to help, but as I'd said above, I was intensely humbled by those who performed so nobly even when they themselves were experiencing true turmoil and uncertainty. Everyone from the janitorial services to the administrators of the hospital, from the people who used their own vehicles to bring patients to Freeman, to those who searched for their neighbors: these are the people I still stand in awe of. Truly, Joplin as a city was heroic. It was an honor to be there shoulder-to-shoulder with people of this caliber.

@Poetslife--feel free to share. I enjoyed reading your EM posts and really appreciate you writing about how these events have impacted you!

@Angela--I'm so sorry for your cousin's death. It must be very hard on your family right now, and I'll keep your family in my thoughts and prayers.

@blyoakam--I so admire NICU nurses. I didn't see any babies that night, and I'm very grateful of that, but know that your services watching over Joplin's wee ones was just as needed as for the big people I saw ;). I've heard your cousin's name several times, but never met him. But we chasers tend to be kindred spirits.

@Crystal--your ICU was incredible that evening. I've never seen so many sick patients, and I knew ultimately the ICU would bear the brunt of this. Their capacity for taking vented patients with myriad chest tubes was unprecedented. How they functioned that night, let alone the next few days, is chilling to think about.

@djhagedon--THANK YOU for letting me borrow your phone. My cell phone had gotten soaked when I was on I-44 and the battery shorted out shortly after I got to Freeman. The cell is working fine again, but man did my wife need to hear from me that night :).

Last: for those who haven't had a chance, you can view my photography (of all the storms other than Joplin and OKC) which is up on my main website at

Please feel free to continue linking to this story if you desire. To all those in Joplin, please share with any nurses or other care providers I worked with. I want them to know how appreciative I am.

My email is if you wish to contact me offline.

For those in Joplin, do keep me posted on your recovery. Next year, when I'm back on the Plains, we'll hit a restaurant and meet face-to-face :).

Shari said...

Thank you for putting your account into writing. It's so hard for those of us who are even a little distance away to even imagine the trials of being in a situation like this. Even though we think we feel empathy for the people who go through this, we don't really know what empathy is until we read articles like this. I came to your blog through It seems that there still are many great American heroes. Thank you for your part.

mandylynn80 said...

You are such a great man Dr. P. You have healing hands and such a WONDERFUL heart. Like I've said over and over again, I would like you by my side. I enjoy you by my side. Your are truely a special person. Love ya!

mandylynn80 said...

Oops..........I spelled truly wrong. He he

Anonymous said...

Thank you so very much for documenting your experience and for your help in such a trying time. What an amazing story. Your prose is beautiful and I look forward to reading more in the future. You are truly a hero and a godsend. Blessings to you and yours.

James said...

Will you please post a link to your Blog at The Storm Chasing Community? Our members will appreciate it.
Members include: Storm Chasers, Storm and Extreme Weather Enthusiasts, Storm Chasing Experts, Clubs.
It's easy to do, just cut and paste the link and it automatically links back to your website. You can also add Articles, Photos and Videos if you like.
Email me if you need any help or would like me to do it for you.
Please feel free to share as often and as much as you like.
The Storm Chasing Community:
I hope you consider sharing with us.
Thank you,
James Kaufman, Editor

roger singh said...

Buy Car In JoplinGreat Sometimes i see very nice and easy created blogs but in the most ways they are very usefull like your blog

Marcus Garcia said...

I am a Hospital Corpsman in the United States Navy and an aspiring storm chaser...someday. Reading your story was inspiring. Thank you for your tremendous courage.