April 27th-Five Year Reflection
APRIL 27, 2016 · PUBLIC
I am always reminded of this day....April 27th is stuck in my brain. (This is a reflection of my personal experience and does not depict the opinion of anyone else besides myself. There may be more details that I don’t recall and did not elaborate on.) Read more about the damage survey from this historic day at http://www.srh.noaa.gov/bmx/?n=event_04272011 Note: Marshall County and the number of tornados in, ended, started in the county. There were at least 1998 injuries reported and 140 people lost their lives in one day.
Early on the morning of April 27th, 2011 I woke up and I was aware from our local weather station that the risk of bad weather this day was high, we were already under a tornado watch and it was one of those warm, sultry spring mornings in North Alabama. Not feeling confident with my skills in National Incident Management System training, my first thought was to text Greg who was assigned as Incident Commander for our hospital to make sure he was bringing his laptop and an aircard for internet service, just.in.case. “Bring your laptop today! Just in case!!” He immediately responded, “Already in the truck.” We had gone way back, Greg and I. Night shift, fun times, I knew I could always count on him. He and I felt the same about Incident Command and unsure of how to implement it. This day was our real life test.
My bigger concern now was TJC. I would be in meetings most of the day with the dreaded ‘Joint Commission’. A necessary, but grueling, anxiety producing entity that wreaked havoc on hospital personnel to know every single policy or know where to find them, do everything exactly right, say everything exactly right. We were on day 2 of a 3 or 4 day survey. I informed Greg that he would have to help out the charge nurse in the ED to watch the weather because I was sure we would be tied up the TJC most of the day.
I clicked on the tv in the living room to find some weather...nothing on yet. I would leave it on and start getting ready for work. A bit later I overheard the low mumbling from the tv in the other room that the news station was delaying schools for a few hours until the worst of the weather passed through. I plopped down on the couch with my cup of coffee and animals not too far away-fearful already, sure enough, my kids would get to sleep in today! As I watched the weatherman immediately following, I saw there was a lot of 'weather' coming our way. Blobs of green and lots of red and yellow tracking east. I hated driving in the rain...I would go ahead and head on to work before it got bad. I hesitated before I left...should I wake JD, Madison, Bronson or Joe? No...let them sleep in, they will be so excited when they find out they didn’t have to get up for school!
At that moment, I heard the urgency in the forecasters voice, ‘forming’ ‘stay alert’ ‘storm moving towards Cullman/Marshall county line. Time to go, it was 6:35 am.
I never understood my obsession with the weather. Maybe it was because I didn’t understand tornados or because there is such loss of control for people in the path of such a storm. I liked being in control. I had always loved thunderstorms as a kid, standing in my parents garage, my brothers daring me to step out onto the driveway while the thunder and lighting were crashing. I am slightly obsessive about it, I had at least 3 apps on my phone for the weather at that time, now I have 5.
As I got in my car the rain had already started, I searched the radio for the station that carried the local news station during bad weather so I could listen to it on my way in. As I drove, the changed the ‘stay alert’ to a Tornado Warning. I panicked. Did I have time to keep driving to work? I was approaching the causeway at Warrenton across the lake, it was raining hard. Yes. I had time...it was crossing the Marshall County line headed toward Grassy. I picked up my phone and called work. The nurse who answered the phone was aware of the weather, but unaware of the warning. I asked if they had paged a weather alert in the hospital yet, not yet....yes, do it, do it now. It was raining sheets sideways by now. I was close to the bottom of the mountain, one or two cars pulled off to the side of the road, I sped up. The radio announcer/weather man was talking about how much time until the storm got to certain locations. I was calculating in my head if I should stop or continue on. Trees started blowing in different directions, my heart felt like it was beating out of my chest. Go for it. The voice in my head was on survival mode. I cranked up the radio, stepped on the gas and sped up the mountain, at 80 mph.
As I reached the crest of the first part of the mountain, the rain slacked off a bit, the announcer had moved on to talk about another storm and I had no idea about the one I just drove under to get to work. I parked illegally in the MD parking spaces, got out, and walked in to find Greg already set up in the ER break room with his laptop and the TV on. The charge nurse finds me, “Should we call an all-clear?” I’m thinking to myself I wasn’t sure...let me go out the back door and look at the clouds, the weatherman was still diverted to another warning and not talking about us, frustrating. I headed out to the ambulance bay to find one of our physicians getting out of his car, “What the F*ck!! A tornado just ripped apart Guntersvile!! There are power poles lying in the lake, trees down everywhere!!”
I went into mom mode. Where?? How far did it go?? Panic and fear overcame me. I got my phone out and tried to call everyone in my house. The phones were not working, it wouldn’t even ring. I called over and over, I have no idea how many times. I was screaming at myself in my head, “you left them in the bed and didn’t tell anyone about the bad weather, you idiot!” I went storming into the ER and tried to call several other people, my boss for one. She urgently asked her daughter to text my daughter to see if she would answer. Thank God. They were fine.
Trying to keep my cool and make sure we were ready for the day ahead, Greg and I decided that we probably needed to set up Incident Command. We also had TJC to deal with....what the heck. The next two hours were a whirlwind. Where do we set up IC, where do we put TJC, should we get out all the supplies for disasters, should we have a briefing now and continue to watch the weather as an Incident Command team? In this time span there were 3 tornados that touched down in Marshall County. 6:20, 6:24 and 6:30am.
We rearranged rooms for TJC and IC and other administrators were assuring their arrival and set up in the alternate space. I was standing at the charge nurse desk and someone says, Kathleen, Mr. Gore is on the phone. Hmmm...Ok? Mr. Gore is the CEO of the hospital system. Calm, cool, very diplomatic, business minded, easy to talk to and I had a lot of respect for him. “Hello?”
“Just checking in. We have some trees down in my front yard and I can’t get my car out and I won’t be there for a while, is everything ok there?” I assured him it was fine, filled him in on what we were doing. He continued, “I am sure that Joint Commission people may cancel today.” He said without a wary note in his voice that his home may have almost gotten hit by a huge falling tree or 10!
“No, sir. They are here already”
“Really??!!” I could hear his complete disbelief that they drove through a battered town to continue the survey. I assured him that there were enough managers here to assist them in day 2 of our survey. As I hung up I realized that there were probably many more who not could get to work because of trees fallen or tornado damage.
The surveyors had no power at the hotel but arrived non-the-less ready to continue to work. I think we were given the option to re-schedule our survey for another time but the decision was made that if they were comfortable staying, we already had one day down, we would get it finished. Didn’t really make sense to me at the time, I was now more worried about the staff. School was cancelled in several counties, parents worried about their kids being at home in such bad weather, arrangements to be made to assure people could get kids somewhere and come to work. Should we cancel the OR schedule and piss some surgeons off? All these things at the forefront of our minds.
At a hospital there is a lot of time and effort that goes into Emergency Management. Lots of time, training, preparing. You really have no idea how to prepare for the ‘unexpected’. Look at Hurricane Katrina, Hurricane Sandy, and the Joplin, MO tornado. Preparedness has improved over the years but there are so many things to think and worry about when you are ‘preparing’ that you never think of it all. Even with all the preparation in the world and no way to be ready for them all. I did not feel prepared. How could I be the ‘head’ of Emergency Management and be prepared to talk about the ‘drills’ that we called drills but were really not drills at all. They were every day ‘mini-disasters’ that we had in the ER and the hospital. Be prepared for anything. That’s what I knew. Make decisions quickly, delegate, assure people knew you were calm but inside your head doubting everything that came out of your mouth. I took all the NIMS tests....ridiculousness. No human would ever use all that knowledge in a hospital scenario. I went to a class at the University of South Alabama. I had training from the State. I still know that I was not prepared, how could my staff be?
The day went about as usual, I hung out in the ER, frantic most of the day because the warnings seemed endless and no one else seemed to think that we needed to watch the weather continuously and keep Incident Command up and running. Maybe I was a little overcautious. I think the nurses upstairs would cringe every time we came over the overhead paging system to call a weather alert....I wanted to be sure that our patients were safe and if that meant moving them into the hallways 10 times that day....we did. I know they didn’t get any actual work done or actual charting. Most of us were on edge listening to the weather. 62 tornados that day, 15 in Marshall County alone.
Dr. Zahn was finishing up his shift...he was trying to decide if he needed to go home or sleep for a while. I urged him to call his wife. I heard that there was tornado damage near the state park. KT lost her home to trees falling into it. Buck Island had huge amount of damage, no one could get in or out, was Dr. Greg Driskill and Mrs. Cheryl Marcum Hays OK?
There was a lul of activity and weather alerts for us for a bit. I was trying to decide what I should do? Should I prepare for my Emergency Management session with TJC for the next day or try to wing it? I think my brain was on overload. I felt the tug of responsibility to my kids who ended up staying home alone while my husband went on to work at Walmart..funny, they let him go just a few weeks after this... and he felt so obligated to go. The commitment to my staff and the hospital staff and our patients to assure everyone was safe. There was terrible internet connections, hardly anyone had access to Facebook and it certainly didn’t have that fancy new feature to let others know you were ok.
Around 2:30pm another warning for a big storm with a tornado in it. Attentive to what had happened earlier, we were all on edge but excited at the same time. Dr. (Victor) Tammy L. Sparks and I kept running back and forth outside, and the team, to look at the sky. I had been to storm spotter class, but again, felt inadequate to say anything about the clouds or storms that I saw. Again, needed to page a weather alert. Move the patients again. As I was standing outside watching the large black cloud move from Arab to Guntersville, there was a little red car came speeding up the back entrance to the hospital. A young man and a girl yelled out, “can we come inside???!!! That is a tornado coming this way!!” I have no idea who these two were but told them to park and come in, I badged them in and directed the to the interior hall in the hospital. We were already on the generator from the morning and I knew that it would be dark in the hallway, but as I directed the around to the interior hall, so many people were sitting on the floor in the halls. Patients, staff, a dog, the Joint Commission surveyors. I asked briefly if everyone was ok, they all said yes and there was quiet chatter, low and serious.
As I came back around to the ER, I found the team outside again....I walked out unsure if we should really be out there. And there it was. A huge black cloud with crap swirling around the base of it. Dr. Sparks was filming...yelling...”that is debris!! That thing is on the ground!!”
It felt like it was close...really close but not heading toward us. We all stood out there with giddy excitement and anticipation and fear. At some point, I realized we needed all hands on deck and with a tornado that big, that close, we were sure to have casualties.
The next several hours are a blur to me. I know we had 10 or so MD’s lined up in the hallway. Emergency, Internal Medicine, Surgeons, Pediatricians. Nurses from other floors were sent to the ER to wait. Nurses who used to work at the hospital showed up, ready to work. A manager walking around with a cooler with bottled water for people to drink. The reports coming in were few and far between. The first few patients came in by private vehicle. The ambulances couldn’t drive around...there were too many trees down. Communications were spotty anyway that day. Cell towers were knocked down. No internet or cable TV most of the day. The whine of the weather radio over and over and over and over...but you have to listen to the entire computer generated message to figure out what was going on and where the warning was “ATTENTION. TORNADO WARNING FOR MARSHALL COUNTY”. I couldn’t pull up the radar on my phone. Less than 20 patients came in that day after that tornado. We heard of an entire family that was found, they had all huddled together for their lives, as we watched the debris swirl around we had no idea it was taking those lives of people so close in the community and known to many at our hospital.
I was on high alert, high anxiety the entire day....I checked in on my kids when I could. They were playing board games, together. My step-son made it there from his house to keep them company. I felt like there was more to come. I heard of a bad tornado in Tuscaloosa at the University of Alabama but had no idea the devastation there.
At some point in time during the day the CEO arrived wearing jeans and just walking around checking on folks. I realized my gas tank was on E before I left that morning. There was no power to get gas at the gas station near the hospital now. I was torn on whether I should stay to help the staff, I think at the time I felt like they couldn’t manage without me, but I know they could. Reflecting back, I don’t think I did hardly anything that day. Just worried, with high anxiety of what ‘might’ happen.
Our TJC surveyors left, people were sent home who needed to go home to check on homes and families. Some staff weren’t able to get there at all, we made do because that is what is expected. Night fell and I think someone urged me to go home. Hm...what if I ran out of gas? No cell service, no power....Mr. Gore offered to try to syphon gas from his car into mine. Literally...tried to suck gas out of a tube from his gas tank to put into mine so I could go home. After a mouthful of gas, I told him not to worry, I should have enough to get there and we had lawnmower gas at home to put in it. The charge nurse assured me they would be fine that night.
As I left the ER at whatever time it was...it was dark. Darkest I’d ever seen. No lights, anywhere. Coming down the mountain, it was erie. As I arrived home, everyone had candles out and were planning on going to bed early. I had no phone battery left. No way to charge it. I can’t even remember if anyone had eaten that day at work, including me. I went to bed and couldn’t sleep.
You’ve never heard no noise like this before, no cars driving in the distance, no lights, no anything...except for the quiet humm of someones generator in the distance. I walked outside and went and laid down on the driveway to look at the stars. The driveway was warm and hard on my aching back. There were millions of stars. My son came out and sat down next to me and I started crying. I told him about my day and how stressed I was about leaving them in bed. He comforted me...held his arm around my shoulders and we just sat in the dark quiet of the night.
I slept only 3 hours or so and drove back to work for day 3 of our TJC survey. I was exhausted mentally. We had our Emergency Management session early in the day. I was not mentally able to spew out policies...but I showed up. We had our morning briefing. As I sat at the table with my peers and the surveyors. I heard the story of TJC getting to watch Emergency Management in action. We had all the notebooks lined up and ready to go. Every policy. Every drill. They did not think it was appropriate. They spent most of the day in the hall with our visitors, patients and a dog, they didn’t need to look at the policies now or discuss what if situations and how we would respond. I was so relieved, I have no idea what I said but I know I cried biting my tongue, trying not to. I was too tired to care what my peers thought about me crying.
I found that this day helped me steer my life in a different direction. Several other traumatic things happened shortly there after at work and at home, death of a co-worker, several pediatric codes, Joe’s ending work at the retail giant and his heart attack. I knew that I needed to get out of Emergency Medicine that year. I made a plan with my husband and continued to work but focus more on what I had forgotten that was so important. I spent a lot of time dedicated to that ER, worrying, trying to cover shifts, working from home, on call 24 hours a day for years. It was a hard job, one that taught me many valuable lessons. I had high blood pressure (self diagnosed and then verified by my one primary care doc visit in my adult life). I didn’t take care of me. I knew I could always count on my team to treat me when I was sick. I would drag myself there..and say, ‘Hey doc, I’m not feeling great...can you...?”
This was my own fault. There is no one else to blame but me for not caring for myself. Now, retrospectively, I have found me again. I lost many years to the ER that I missed with my kids and husband but was able to be a big part of their lives. I prioritized things more now, with balance. Real balance.
My blood pressure is perfect now, without medication.
I appreciate and love every single person I had worked with at my hospital and only credit them with our teamwork that day, April 27th. You have helped me form who I am now and I thank you for that.


