Feature
The Long Road
Two School of Medicine alumni stick together in the aftermath of the Joplin, Missouri tornado
Tornado sirens wailed, and winds whistled through the Emergency Room at a similar pitch. The wind increased to jet-engine levels and tore through the ER — first one direction, then the other — for more than three minutes. It sucked up the ceiling, and then spat it to the floor. Tim O’Keefe, M.D., one of the physicians working that Sunday evening, hurried patients to safety. He took shelter under a desk. “A large hallway light came down and hit my shin, and I thought that was God's way of saying, ‘Move it.’ ”
Dr. O’Keefe and his medical partner, Bill Kessler, M.D., both alumni of the Class of 1984, are residents of Joplin, Mo., the town torn apart by an EF5 tornado that struck through the center of the city of 50,000 residents on Sunday, May 22. The multiple-vortex tornado steadily churned east through the center of town at a
deliberate, 12-mile-per-hour pace. Nearly a mile wide and about 17 miles long, the tornado razed everything in its path from 5:34 p.m. to 6:12 p.m. Winds were estimated at more than 250 mph. It ranks as one of the deadliest tornadoes to hit Missouri and the United States. Damage is currently estimated at up to $2.4 billion.
The tornado destroyed the office of Drs. O’Keefe and Kessler, who have been close friends since medical school. The Illinois natives found their careers in Joplin after their residencies and built a successful private practice together at 2601 Cunningham St. The storm also destroyed Dr. Kessler’s house and the peace of daily life for them and everyone in Joplin.
“It hit with little warning,” Dr. O’Keefe says. He was working a second shift at the ER at St. John’s Regional Medical Center that evening, and it was a little busier than usual. “The nine-story building shook. The doors at both ends of the ER were blown out, and an area of roof over the waiting area was peeled off.” Then the power went out, including two backup diesel generators — an unprecedented occurrence. “The ceiling and lights crashed to the floor, and water lines broke,” Dr. O’Keefe recalls. The tornado broke nearly every window in the hospital, impacted all parts of the hospital and tore portions of the roof off multiple areas, sometimes including the supporting beams.
Dr. Kessler and his family were safely away from the tornado’s route, attending his son’s high school graduation, which was held at Missouri Southern State University, located about 10 miles east of their Joplin home. The ceremony ended, and Dr. Kessler’s son left for home shortly before the tornado hit. Unknowingly, he drove straight into the tornado’s path. He eventually joined others who had found shelter in a church.
Dr. Kessler desperately tried to make contact to see if his son had survived. Dr. Kessler recalls the debris-covered streets caused traffic jams, and it took an hour to drive just three miles to the ruins of their home. Several family members were in town for his daughter’s wedding the day before. They were badly shaken, but unhurt. “They weren’t expecting this,” Dr. Kessler says.
Indeed, nobody was expecting a storm of this magnitude. Once the tornado passed, rain and hail poured down for hours as the residents surveyed the damage: Three nursing homes — destroyed. Churches — flattened. Miles of homes, stores, offices, nearly one fourth of the public schools and one-third of the catholic school system — crushed. As of September 2011, 162 people were killed in the storm.
At the wounded hospital, Dr. O’Keefe and the two other physicians working in the now-wrecked department immediately began triaging the wounded ER patients, and the newly-injured visitors, co-workers and others who arrived for help. “When we didn’t hear any ambulances or fire trucks, we had a sense that this was big,” Dr. O’Keefe says.
Newly injured people began swarming the ER, and salvageable supplies were scarce. A massive gas leak forced everyone to evacuate the hospital. Medical staff did triage in a parking lot across the street in the rain, hail and wind, until they were told to move back another block.
“We knew we weren’t going to get much outside help initially,” says Dr. O’Keefe. “So we gathered the resources we could. It came back to old-fashioned, basic training from medical school,” he says. “I hadn’t done trauma evaluation since residency, but it all came back that night. There wasn’t much we could do but clean and cover the wounds.” Despite the uncertainty of the hospital’s safety, a few brave medical staffers ventured back into the hospital to recover supplies such as surgical trays, medications, gauze and dressings. “Crash carts were found to be a good source of supplies,” says Dr. O’Keefe. Critical patients were sent to Freeman Hospital, the other hospital in town. Non-critical patients were sent to Memorial Hall, a nearby civic center that was set up as an emergency triage center.
“With all the debris, it was impossible to get around,” Dr. O’Keefe says. Downed phone lines and cellular towers meant communication was futile. “It was chaotic, but everyone did a good job of keeping things moving,” Dr. O’Keefe recalls. “You get very focused on what is right where you are — with so much around you, that’s all we can really do.”
The hospital is one of the few structures left along the 14-mile stretch of destruction. Uninhabitable, it will be torn down and rebuilt. The cost to rebuild the hospital and clinics is estimated at $500 million.
Two months after the storm, the Joplin air was still punctuated by what the physicians term “the tornado smell,” which seems to be a mixture of dirt, creosote, mold and decomposition. “This is a damaged, grieving town,” Dr. O’Keefe says, calling everyone — from neighbors to colleagues — family.
Much like the air is still soaked in the smell, the shock, stress and frustration remain potent. Emotions are still raw, and thousands of tragic tales are quick on the community’s lips. Two men waited out what they thought was just a hailstorm eating pizza in the bed of their pickup, taking shelter in a car wash. The tornado rolled the truck multiple times, pulled the top off while the men hung on, texting their families goodbye. When the storm set them down four blocks away, the men didn’t recognize the shredded town. A man’s arm was pulled out of his socket as he engaged in a futile struggle to hold his son’s hand. The lifeless boy was found days later in a pond.
“We’re not in post-traumatic stress disorder,” Dr. O’Keefe says. “We’re still in acute stress disorder. It’s going to take years for the town — and the people — to recover. We have to be optimistic about the future. It’s going to be a long road.” He admits that he is much more impatient in the aftermath of the tragedy. “We don’t have control over so many things in life. All the plans you think you have … you just don’t know when it could all spin out of control. You can prepare, but if it’s big enough, it tears down all the systems you think are in place. What you learn in the process is that you have each other — that you can count on.”
With the destruction of their practice, the SIU School of Medicine alumni have lost the independence they enjoyed for nearly a quarter of a century. “The medical system is overloaded,” Dr. Kessler says. “We’ve lost huge resources.” While the physicians have insurance to cover income for one year, with the loss of the hospital revenue that represented nearly half of their income, they say they needed coverage for three years.
Patient care hasn’t stopped. No usable medical records were recovered from their office, but the hospital had “gone live” with electronic medical records just three weeks before the tornado hit. That system worked flawlessly, and a backup center retained the information to be sent to receiving facilities. “As for our practice,” says Dr. Kessler, “All patients are now new patients, and we are learning the office version of the computerized medical record.”
Within seven days of the tornado, St. John's had established a mobile medical hospital for emergency patients. Within two weeks, the units expanded to see inpatients, including intensive care. “Patients are squeezed in tight. There’s no privacy, and the big air conditioner is noisy,” Dr. Kessler says. “But all the patients are wonderful, taking the difficulties in stride. They are being 100 percent supportive. That really makes a difference.”
After making their rounds, Dr. O’Keefe and Dr. Kessler, now employees of St. John’s Mercy Physicians Clinic, see patients in two small beer tents erected at Joplin’s Memorial Hall, where the air conditioner keeps the hall a frosty 55 degrees. The family physicians work with 25 other physicians representing most specialties. Nurses and staff communicate via shaky cellular connections. “We can’t do some minor procedures, such as mammograms, and we’re limited in others, such as GI procedures. Routine things like locating surgeons and scheduling tests now take a lot of extra time,” Dr. Kessler says. “It’s frustrating.” Still treating injuries, the physicians say they are seeing cases of zygomycosis, a rare fungal infection that has resulted from storm-related wounds.
In its wake, the tornado has inflicted one diagnosis on all the residents, says Dr. O’Keefe: survivor guilt. “It’s not well recognized, but everybody has it. Some feel guilty for not being there; some feel guilty that their house survived while another's was destroyed; some lost family members, some lost businesses. Everybody has been affected in some way.”
Joplin’s is the seventh deadliest tornado in the history of the United States. A third of the city was destroyed. Nearly 1,000 were injured, according to the Missouri Emergency Management Agency. Approximately 8,000 homes and apartments were destroyed, with nearly 20,000 residents left homeless. About 450 families are living in FEMA housing parks.
The SIU graduates are natives of the Springfield area, but Joplin has been their home for more than two decades, and they are staying to help rebuild the community. “Support is a sprint; recovery a marathon,” Dr. O’Keefe says. “It’s sinking in that this is going to take 30 years to rebuild.” Although the media and many of the support crews have left, the community is pulling together. Several music festivals have helped raise funds for reconstruction. The Salvation Army and the Red Cross have established funds for Joplin. However, in August, federal recovery funds slated for Joplin were redirected to recovery efforts elsewhere following the East Coast hurricane.
By September, things were beginning to look a little brighter for this town undergoing resurrection. The children started school, and locations for a new hospital and medical clinic have been announced. The piles of debris are decreasing, and new homes are sprouting. Retailers are set to open by the end of the year.
Drs. O’Keefe and Kessler are seeing patients in a mobile medical office. “It’s very small, but at least we have walls,” Dr. O’Keefe says. “Don’t take your walls for granted. You might lose them someday.”