Weathering the Storm

From the middle of the emergency department, I can hear sirens ringing faintly in the distance. Second-by-second, the ringing grows louder. As I step away from my workstation and look out of the back doors, I see lights flash in the distance. At that moment, I know those lights and sirens are heading this way. Within what feels like mere seconds, a Chattanooga Police Officer rushes through the ambulance bay with a young patient in his arms. I can tell by the look on the officer’s face, full of both fear and fight, this person needs my help immediately.

As I rush the patient to a room, leaving the officer standing at the door he shouts, “Others are heading this way!” Right now, my focus is on the patient in front of me. I am doing whatever it takes to stabilize the individual. Minutes feel like seconds when another officer walks through the front door with another patient. As we rush the patient to room 11, a third officer appears, and I overhear the officer request a box of gloves and a lot of gauze.

At this point, it is me and a few nurses on shift and all I can think is there is no telling how many other patients we will get tonight. As we prepare to intubate the patient, I quickly pull out my phone, lay it on the patient’s chest and turn on speakerphone to call Juan.

“Juan, I need you to come in, can you head here now?” asks Dr. Rob Hamilton, Emergency Medicine Medical Direct at Erlanger East Hospital. Without hesitation, Juan responds, “I am on my way.”

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The drive from Juan’s house to the Erlanger East ED is about 14 miles, which on a normal day, should take 25 to 30-minutes. This was not a normal day. A tornado ripped through town destroying anything and everything in its path. Cars were crushed by trees, homes were ripped to pieces, power outages were almost everywhere. The town was hurting and there was no telling how many of its people were too.

“I hung up with Dr. Hamilton, I hopped in my jeep and headed to the ED,” said Juan Class, NP, Lead Advanced Practice Clinician for Erlanger Health System. “After about a mile, I came to the first area of notable damage. Neighbors were working feverishly to clear downed trees from the roadways so cars could get through. Every so often I hopped out to help and continued to inch my way through town.”

With every impassable road, Juan grew anxious. There was no end of this mass destruction in sight. Many of the downed trees were too big to maneuver alone.

“In my head, I was thinking about my first and only experience working clinically during a tornadic event. The number of patients I saw and transferred to the OR during the night was astounding,” recalled Juan. “This memory could quickly become the night’s reality. Knowing Dr. Hamilton was the only physician left on shift and with the potential of an overwhelming number of patients, I had to make a decision. If I wanted to get there anytime soon, I needed to walk.”

With his flashlight in hand, stethoscope around his neck and former Army Medic training kicking in, Juan started the rest of the way on foot. He navigated his way through water-filled embankments, over and under trees and around people walking aimlessly down the street. After a mile or two, his phone rang. It was Dr. Guzman.

“Hey, I am headed to East to help out. Dr. Hamilton said you were too. Which route did you take?” Dr. Jocelyn Guzman, an emergency medicine physician at Erlanger East Hospital, asked Juan.

Juan let her know his route was completely impassable by vehicle so he was walking, but he was safe and should be there soon. Before he hung up, he asked her to not tell Dr. Hamilton.

“I knew if Dr. Hamilton found out he would tell me to turn around. At this point, I could only think about all of the people who lived in these demolished homes and if they needed help. It motivated me to keep going.”

Finally, after about five miles he made it to Gunbarrel Road. A truck was driving slowly toward Juan so he started to wave his hands in an attempt to flag down the driver. To his surprise, the truck pulled over. Juan told the father and son inside he works at the ED and was trying to get there to help take care of patients. The driver did not hesitate or ask any questions and told him to hop in.

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Almost an hour and a half passed since Dr. Hamilton’s phone call to Juan. Patients continued to stagger into the department. Dr. Guzman was already at the ED, and she had left after Juan.

“Suddenly, how much time passed since I spoke with Juan registered with me. I knew if he couldn’t get through, he would call. I knew he would call. I started to worry,” said Dr. Hamilton. “I took out my phone and just as I was about to call him, he walked around the corner.”

Juan was soaking wet. His clothes were covered in mud and leaves from head to toe. Before any questions were asked, Juan said, “Sorry it took me a while to get here, I had to walk.”

For a split second, I just looked at him. I knew my face said it all. I was glad he was there and okay but I just stared at him blankly struggling to find words. We did not talk about it further and Juan headed to change. I told him, “Once you get done, patients are waiting in rooms two and three.”

The rest of the night into early morning was a waiting game. Waiting for the waves of patients as the tornado ripped through the next town over, then the next.

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“After I cared for several walking wounded, I had a minute to sit and almost decompress. What I saw firsthand on my walk was devastating and there was nothing I could do,” said Juan. “I could not fix the homes or the destruction, but I could provide care for those in need and be there for my team. I am thankful in such an unpredictable situation I was able to do something as small as this.”

What started as a slow night in the ED quickly turned into one Dr. Rob Hamilton, Juan Class, and the rest of the Erlanger ED team on shift will never forget.

“Low census as a result of COVID-19 required our teams to make different strategic scheduling decisions in the last several weeks,” said Dr. Hamilton. “This night was no different. For several hours the ED was empty. I felt comfortable and it was necessary to proceed with single physician coverage for the remainder of the shift. Then, the tornado hit.”

Dr. Hamilton and the nursing team were not aware of the severity of storms predicted for the night. In the ED, especially one with few windows, it’s easy to forget about everything happening outside. Even with an unknown, unpredictable surge, the response from Dr. Hamilton and the East nursing team was incredible. Fortunately, the high-volume of severely injured patients never came. Patients trickled in but it was manageable with the help of Dr. Guzman and Juan coming in too.

Around 7:30 a.m., it was time to change shifts. The team debriefed, packed up and headed home. One of the nurses offered to take Juan to his car. Roads were still blocked and the devastation was more visible at sunrise. She drove him as close as she could. Then, he started another walk.

“I did what I had to do to help my team. It was nothing extraordinary,” said Juan. “I did what I think any other clinician would do if they were able.”

After the story got out about Juan, people were surprised he walked through the tail end of the storm and some questioned why he never called to say he could not get there.

“This is who Juan is. He truly defines the call to serve in every aspect of his life,” said Dr. Sudave Mendiratta, Chief of Emergency Medicine, Erlanger Health System & Emergency Medicine Department Chair, University of Tennessee College of Medicine Chattanooga. “Honestly, this is probably just one of the many examples of the things he does for his team and our patients. We could not be more thankful for his willingness to always go the extra mile – literally.”

People who know Juan describe him as a dedicated clinician, a strong leader, an incredible friend and a thoughtful mentor, including Dr. Hamilton who has a front row seat to witness it all. The two have worked together for more than a decade and during this time Dr. Hamilton has watched Juan’s growth in many different roles as a clinician, a husband and a father. In the moment, Dr. Hamilton had no words for Juan. Like the others, initially he was shocked but knew Juan well enough to know why he was determined to get to the ED that night.

“He is full of heart and treats every patient like he would his own family,” said Dr. Hamilton. “I am proud to know him, serve with him at the bedside and work with him as a leader. He truly embodies what we are all about.”

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