SPRINGFIELD, Mo. — It is 7 a.m. when Shilo Cook clocks in at St. John’s Regional Medical Center, the start of a 12-hour nursing shift that begins ordinarily enough on this Sunday morning — taking vitals, drawing blood, tending to a patient with stroke-like symptoms who needs an EKG.

The one thing that Cook, a registered nurse who is four-months pregnant, is not paying attention to is the weather. A few co-workers pick up on a tornado watch broadcast by The Weather Channel, but no one is alarmed. It’s routine for the Four States this time of year.

***

Like Cook, Rod Pace also isn’t supposed to be at St. John’s this day.

But an out-of-state death of a relative means a funeral in a few days so the MedFlight director stops by the hospital to do payroll; later, he wants to meet up with his son for a workout at Powerhouse Gym.

At 5 p.m., as he’s wrapping up, he notices the darkening sky, rain beginning to fall.

Weather is critical for Pace and his flight crew. Their safety and the safety of the patients being transported depends on knowing the weather in their 75-mile service radius.

Pace decides to wait it out at the hospital — no use getting wet. Besides, he isn’t in a hurry. Pilots Jack Ball and Bob Dutton also are watching the weather.

The forecast indicates the worst of the storm will pass north of Joplin, near the airport, which is where they normally shelter MedFlight’s BK117 helicopter if storms are expected near the hospital. It’s a five-minute flight.

“There’s going to be hail at the airport, and we don’t fly into hail,” Pace says to his pilots, who agree.

The rule book and common sense tells them to stay put.

***

During his rounds this day, Dr. Alan Buchele has seen some 30 to 35 patients at St. John’s. Nearly half of the 367 beds are full.

Ready for a break, the trauma surgeon decides to head home to Carl Junction to see his family for a few hours, with plans to return to the hospital after supper.

He and his wife are eager to see a video of their eldest daughter’s school play. They settle down in front of the television.

***

ER Manager Sandy Woods is at home with her husband, a Joplin paramedic. It’s Sunday in Southwest Missouri. They fire up the grill.

They live on the south side of the county, two miles from St. John’s. Their barbecue is called off, however, when the weather radio advises that severe storms are rolling into Jasper County.

II.

Like Shilo Cook, Dr. Frank Veer, an emergency room physician at Freeman Health System, has been on duty all day. Around 5 p.m. — after a 10-hour shift — he is wrapping up.

His wife is driving home from her parents’ house, and they are going to head to a barbecue planned by his resident physicians.

Veer decides to wait for her at the hospital.

***

It has been a perfect day so far, thinks Del Camp, vice president for clinical operations at Freeman’s Ozark Center in Joplin. He has the day off. After his wife makes a run to Home Depot at 4 p.m., they take their kids to the banks of Shoal Creek for a picnic.

As the weather takes a turn for the worse, they decide to head home.

***

Kelli Perigo, too, is noticing the weather.

She is out in the yard of her Neosho home, watering plants, when her husband steps outside.

“You probably need to come inside,” he tells Perigo, the director of retail and contract pharmacy services at Freeman. “There’s a storm coming.”

***

Leslie Allen, a charge nurse in the emergency department at Freeman, is nearing the end of a 12-hour shift.

Her job usually consists of troubleshooting, coordinating staffing and patient care. It is a busy day for her and others at the hospital, with 259 of Freeman’s 288 beds occupied, not counting 38 of the 41 patient beds in her department.

In fact, it has been a busy week.

Only days before, Freeman staff participated in a mock disaster drill.

In the scenario, St. John’s hospital in Springfield was damaged by an earthquake. Not wiped out — that would be inconceivable — but sustaining enough damage that Joplin hospitals must take on some of the load.

As always, there had been grumbling because some believe taking time to go through the drill takes time and talent away from real patients who need care.

But every department in the health system participated; the drill was considered a success.

At 5:11 p.m., an announcement alerts Allen and others at Freeman that a tornado warning has been issued for the region.

Even warnings are nothing to get excited about, typical for the Four-State Area this time of year.

She methodically follows hospital procedure in such a situation. Waiting rooms are cleared, people are moved to interior hallways and doors to each of the patient rooms are shut.

“This is going to last a few minutes, then we’ll let you go out,” she tells people.

In her 25 years as a nurse, one might think that she’s seen it all.

She hasn’t.

III.

Back at St. John’s, Pace and his MedFlight pilots look out the large glass windows.

Trees at 32nd Street and McClelland Boulevard are swirling and a dark wall of water is heading toward them.

At 5:31, the hospital announces “Condition Gray.” It’s a hospital emergency code used to alert staff to severe weather. They’ve trained for it many times, as recently as the previous Sunday.

Pace hears no sirens — only a distant roar.

He thinks of his position near the windows, reasoning: “I can’t stand here any longer.”

He and the pilots scramble for flight-crew quarters.

***

Danielle Stammer and her family are driving near the two hospitals, on their way to visit friends. They turn unknowingly into the storm’s path as warning sirens go off in Joplin.

A phone call from a relative alerts them to a storm cell moving into town and leads to a decision to head to nearby Freeman West to seek shelter. As they approach St. John’s, they see transformers explode, notice the dark sky and realize they won’t make it to Freeman.

“Pull over, pull over,” Danielle tells her husband, Andrew. He parks their van under an awning at the east entrance to St. John’s. They grab their children — Emily, who has just turned 3, and Ethan, 17 months — from their car seats.

They fight against the wind as they make their way to the door.

Andrew hunches over, clutching Emily to his chest, and they realize once inside the entryway that they are surrounded by glass windows. When the hospital begins a Condition Gray, doors automatically lock.

The family can’t go any further.

***

Shilo Cook, the registered nurse who has been on duty since 7 a.m., joins other nursing staff rushing to shut doors, as Condition Gray requires, and prepares to move patients in outside rooms to the hallways.

She doesn’t get the chance.

Lights go out, glass shatters, and she crouches under a desk in the doctor’s lounge for shelter.

The air is sucked out of her.

She can’t breathe. The pressure on her head makes her think it will explode. Ceiling tiles hit her legs.

Cook, who is pregnant, decides she and her unborn baby are likely to die, and tries to come to terms with it. She prays for her husband and daughter, who are on the road home after visiting a relative.

***

Trapped between doors in the entryway, Andrew Stammer begins throwing himself against the locked door leading to the hospital’s lower level. Danielle tries to help. Knocking it slightly off its lower track, they are able to wedge a corner out and slip under with the children just as the tornado hits full force.

The electricity goes off and Danielle is thrown toward the elevator with Ethan under her.

Andrew and Emily are tossed about, somehow winding up tucked under the stairwell. He’s clutching his daughter and holding onto a railing.

“I am still alive, I have to move,” Danielle thinks.

She heads to the stairwell and crouches there with the rest of her family.

***

In MedFlight’s crew quarters, Pace and Ball, his pilot, struggle to keep the thick wooden door shut. They can feel debris pounding against it.

The whole room seems to move beneath them.

“It is like the building is breathing,” thinks Pace.

The sound is ear-splitting and seems to last forever. It stops for a moment as the eye of the tornado passes, then starts again with the arrival of the storm’s back wall.

The twister grinds through St. John’s. It sucks pediatric crash carts out of ER hallways and deposits them in Cunningham Park. It twists the MedFlight helicopter — the one Pace and his pilots had talked about moving not long ago — into scrap metal, and leaves it lying on its side. It lifts the roof off the emergency room and throws it down on a raised bed garden by the north entrance to the hospital, trapping a young girl underneath.

***

At her home, two miles from St. John’s, Sandy Woods and her family are huddled in their underground storm shelter. After a demonic roar passes overhead, voices on their portable radio announce that the tornado has hit St. John’s.

Woods, a 21-year employee of the hospital, begins to cry.

“It’s my second home,” she thinks. “What has happened to my co-workers?”

She instinctively grabs her employee name tag required for hospital admittance and drives east on 26th Street, getting as far as St. Paul’s United Methodist Church.

It is there, unable to go any further, that she realizes the extent of what lies before her.

A swath of destruction stretches as far as she can see.

She abandons her vehicle and continues on foot toward St. John’s.

***

After the tornado passes, Cook emerges from under the desk and pries her way out of the lounge. She hears screaming and wonders, “Is this real?”

After tending to a few bleeding but walking wounded, she and a co-worker go up one floor to the cardiovascular holding area and break a door in to access supplies. They fill a linen bag with gauze and anything else they can find and drag it and some portable supply cabinets back downstairs.

***

Pace, Ball and Dutton make their way out of the flight-crew quarters.

They realize they can’t get through the jammed ER doors, and are forced to leave the hospital through a window and across a roof. As the three arrive at the north entrance, they hear the screams of the girl trapped by the roof. Her mother and father approach, begging for help.

Ball and Pace are able to lift a section of the roof just enough to allow Dutton to reach under and feel around. The girl crawls out; she is OK.

“Your job stays out here,” Pace then tells Ball and Dutton. “Check the aircraft, walk the perimeter of the hospital and check for those who need help.”

He returns to the building to help with evacuation. A 13-year veteran of St. John’s, he knows the hospital’s plan for emergency response. He also is no stranger to disaster: Ten years prior, an EF-4 ripped through his hometown of Hoisington, Kan., where his mother served as director of the ambulance service. His military training also prepared him to make sense out of chaos.

He begins to systematically approach the situation, assessing along the way what personnel and resources are available. The first priority is getting patients out of the wrecked hospital.

***

Buchele, the trauma surgeon who has ridden out the storm sirens with his family in his Carl Junction basement, receives a text from a friend in Haiti. Buchele had been there twice after the 2010 earthquake.

“Heard St. John’s has been hit,” the friend says. “Are you OK?” A call from his dad in Coffeyville, Kan., reports the same news.

Buchele dresses in work clothes and loads his truck with a chain saw, shovels, gloves and other tools. He makes it as far as 20th Street and Maiden Lane.

“Wow,” is all he can say when he gets out of his truck. “Wow.”

He grabs his gloves and a headlamp and starts running toward St. John’s through a deathly silence that smells of freshly-split green wood and burning metal.

“This is the smell of destruction,” he thinks.

He makes his way through Cunningham Park and comes across a man who tells him a woman in the park is dead.

“Are you sure?” asks Buchele, who receives a nod of confirmation.

“I’m sorry,” he tells him. “I’m here to help the living.”

Arriving at the hospital minutes after the evacuation starts, Buchele expects to find dead staff members.

Instead, he sees the living and injured. The first entrance he tries is jammed so he breaks down a door into the pitch-black basement and begins working his way upstairs, going first to the ICU to check on a critically ill patient from earlier in the day.

The man is dead; when the tornado took the hospital’s power, the patient’s oxygen supply was cut off.

Buchele recalls the Condition Gray training held at St. John’s the previous Sunday; it never could have prepared anyone for this, he thinks.

He helps evacuate an ICU patient recently paralyzed in a car wreck and on ventilation. Her boyfriend is with her, and she must be “bagged,” or manually ventilated, on the way down the stairs. Another patient is instructed by staff how to bag himself as they haul him down flight after flight on blankets and a backboard.

“Count to five and squeeze,” they tell him. He does.

Buchele silently wishes for people who have battlefield experience.

“All I can do,” he realizes, “is look at each problem and say, ‘How do we fix this?’”

IV.

Just after 5:41 p.m., power at Freeman goes out and the emergency generators kick in.

Allen, the charge nurse in the emergency room, is standing in the hall when she hears a triage nurse call her name.

She turns to see a young man in his early 30s being wheeled toward her. He’s holding something in his lap, but she can’t tell what it is until he gets closer.

Clutched in his arms are his own intestines.

“My gosh, what happened to you?” Allen asks him.

“It’s the tornado,” he says. “It’s devastated everything.”

Allen is stunned and wonders which outlying community has been struck by a tornado.

“Where are you from?” she asks.

“I’m from here,” he tells her.

“Dr. Veer!” she yells, seeing him nearby.

The physician hears the urgency in Allen’s voice and knows something serious has happened. He sees that the patient has been eviscerated and immediately wheels him toward the operating room.

On the way, he hears the same story about a tornado hitting Joplin.

“Get a hold of my mom,” the man tells Veer.

Veer is encouraging toward his patient, but he senses that the young man believes that he is going to die.

Not long after, he does.

When Veer returns to the ER, it’s a different place than when he left.

It had been clean and sparsely populated, but now there are people — wet, bedraggled and wearing shocked expressions — everywhere.

Some later will describe it as a “wave” of patients making their way into the hospital. What Veer sees strikes him as more of a “tsunami” — a giant wave that just keeps coming and coming.

The department’s lobby and hallways soon are filled with the injured.

***

Those on duty in the emergency department won’t know the full extent of what has happened to Joplin for hours.

The department is like a box with no windows. They can’t see the devastation left in the tornado’s wake; only its impact on people.

Every so often, an emergency responder will come in and say something difficult to comprehend: “Home Depot is gone!” or “The high school has been hit!”

Allen clutches her clipboard tightly to her chest, navigating through the mass of wounded filling the hallways, which make a loop around the department. There’s little room for a person to walk, and staff members have to step carefully over people.

The clipboard is her constant companion this evening. Hours later, when she’s ready to head home, she’ll discover that she hasn’t written a single thing on it.

Freeman’s chief medical officer, Dr. Richard Schooler, is working side by side with his staff, and Allen stops for a moment to talk to him.

“Dr. Schooler, do you think it is going to be OK?” she asks.

Yes, he tells her, it is.

She breathes a sigh of relief — “the big guy” offering her some much needed reassurance — and gets back to work.

***

Renee Denton, director for medical oncology and pediatrics at Freeman, arrives and checks on her staff, then reports to the command center that has been set up in the hospital’s executive conference room.

She’s directed to set up a 40-cot treatment area in the hospital’s downstairs conference centers. Thinking that it will be a quick job, Denton grabs a few of the newer members on her nursing staff.

The area is set up to treat the walking wounded, but after being open for about 30 minutes, Denton begins seeing patients with gruesome injuries ... much more severe than she had expected.

***

Camp, the vice president for clinical operations at Freeman’s Ozark Center who was returning from Shoal Creek with his family, has ridden out the storm at the Petro truck stop. They watch as a meteorologist on The Weather Channel goes live from Joplin, the ruins of a building that appears to be St. John’s visible behind him.

Camp heads for Freeman — the operating wisdom being that if you think they need help, they probably need help.

It’s getting dark by the time he makes it to the hospital, having followed a bulldozer down Maiden Lane as it pushed debris aside. Joplin, he thinks to himself, suddenly looks like the post-apocalyptic set of a “Mad Max” movie.

His initial thought is to put his skills to work: “There are plenty of people who are traumatized who need someone to visit with them.”

Checking in at the command center, he learns there is a more pressing need.

“We need you in housekeeping,” he’s told.

***

It’s late in the evening by the time Perigo, who rode out the storm at her Neosho home, makes it to Freeman, and her heart begins beating faster as she sees the spotlights set up, and the fleet of ambulances and school buses lined up outside.

“This can’t be happening,” she thinks to herself.

The first thing she sees upon coming through the doors is a line of blood, smeared through the usually pristine lobby. People are everywhere.

But it’s quiet, she notices.

Many people are injured and bleeding, but there’s no yelling. No screaming. No panic.

With the help of her support staff, Perigo is able to get the hospital’s pharmacy up and running.

***

Veer, the emergency room physician, has always been somewhat put off by TV shows set in hospital emergency rooms, especially that cliched moment in which a doctor rushes through the trauma area yelling: “I need this, stat!”

Those kind of staged, dramatic moments have no resemblance to the crisis unfolding at Freeman. The situation is overwhelming, for the staff and patients, but the inherent drama in what is happening is enough. No one needs to create any more.

On a normal day, a patient passing a kidney stone might be heard screaming in agony throughout the department.

But tonight, with hundreds of patients suffering what Veer likens to “battlefield injuries,” things are eerily quiet ... even among the staff members.

It’s a strange sensation, as the doctors and nurses are a tight-knit group that talk often of their families.

Not this night.

Veer and others realize that something horrific could have happened to anyone outside of the hospital, and nobody wants to mention it. But anytime a member of the emergency staff is able to get a signal to send a text, there’s a rush by others to ask to help get word to their loved ones.

Veer then sees a woman lying on the floor by the main entrance to the emergency department.

She is suffering from a severe facial laceration, one side of her face flapped open to the ear. She has been there for several hours.

Typically, injuries such as this or open fractures get the immediate attention of a team of doctors of nurses. Today, they have become minor in the face of the other, more devastating injuries.

As he passes her again, Veer stops for a moment to apologize to her.

“Oh, honey, it’s OK,” she tells him. “I see what else you’re getting.”

From her vantage point, Veer realizes, the woman can see the seriousness of injuries pouring into the hospital through the main ambulance bay.

***

Allen spies a woman who looks to be in her late 40s holding hands with a man in his early 20s. They’re sitting side by side in wheelchairs, blankets draped over their legs, and holding hands.

Lifting the blankets, Allen sees that they both are suffering from leg fractures; one is an open fracture — the broken bone protruding through the skin. Yet both are surprisingly calm.

“Are you mother and son?” she asks.

The two share a startled glance before telling Allen that they are not related. In fact, before arriving at Freeman with similar injuries, they had never met.

V.

Unaware of what has happened to the hospital, many of the injured in Joplin also are showing up at St. John’s.

Shilo Cook turns around to see a father clutching his child to his chest, a gaping wound running the length of the child’s neck.

“Oh my God,” Cook thinks to herself. “I can see his C-spine. I can see his vertebrae.”

Gone is the usual sanitary environment: The hospital is filled with ankle-deep dirty water and a coating of dirt and debris blown in from who knows where. Animals blown in and deposited by the tornado are everywhere. Dogs walk in circles, dazed and confused. A deer nearly sliced in half is on the helipad.

Another St. John’s employee calmly picks up a towel and tells the father to hold it tight, compressing the child’s wound to stop the bleeding.

“Don’t let go,” she says.

Cook is used to seeing horrific injuries in the ER. It’s part of business. But not 40 people all at once, with more arriving every minute.

She gets in an ambulance with six injured survivors to care for them during transport to Freeman, and is grateful for the chance to sit down.

After helping to get her patients settled there, she learns there is no return transportation. She must walk back to St. John’s, and arrives soaking wet and chilled.

She is starting to feel contractions.

***

A triage has been set up outside St. John’s, under HazMat tents provided by the fire department. Staff have brought out what crash carts and beds they were able to wrestle from the debris.

Woods, the ER manager, hears a physician yell that drugs are needed at Freeman, less than a mile from St. John’s but unscathed by the tornado. Freeman is running on emergency generators and already is inundated with wounded.

St. John’s staff use axes to break into locked medicine supply cabinets, pausing only a moment to second-guess doing such a thing that violates all training and protocol.

“It’s OK,” Woods tells herself. “These are not normal circumstances.”

Volunteers begin arriving in trucks, cars, SUVs — strangers who offer to help evacuate patients and supplies from the shell of St. John’s.

It is a blessing, Woods says, since none of the staffs’ cars survived the storm.

But they face a new problem: How to get bedridden patients — many of whom are connected to monitors, IVs and oxygen — down several flights of stairs? A 2006 disaster drill designed to prepare hospital staff for an EF-5 tornado illustrated the necessity of stair chairs, which the hospital then purchased. But they are blocked by debris. It’s dark. The generators that might have provided electricity to remaining connections were sucked away.

“We’ll have to figure this out as we go along,” Woods thinks.

Ceiling tiles now littering the hallway are wet and almost impossible to move. Nearly every patient requires the ability to roll on wheels. They soon realize that bedside tables turned upside down can be used as makeshift scoop shovels to clear a path.

They get busy.

***

The Stammer family, who had arrived at St. John’s just as the storm hit, make their way upstairs, with no idea of the size and scope of what just bore down on them or the extent of damage. Someone — a hospital employee, maybe — approaches with a flashlight and beckons them to follow.

“I’ll take you to where we’re having a makeshift ER,” he tells them.

They slosh their way through debris, and Andrew hands Emily to Danielle so he can assist those who are injured.

But he becomes lightheaded, feels like passing out, and realizes that he is injured himself.

He has bruised ribs — thinks they might be broken — and glass embedded in his back, and needs medical attention. Danielle and the kids have only minor bruises and scrapes.

At the triage area, the injured and non-injured are divided, and the couple is separated. A woman Danielle has never met holds Emily for her, and firemen lead them out of the hospital.

Trucks take those who are not injured to the nearby Ozark Center. Then, because it is not deemed structurally sound, they are taken to Freeman. Danielle doesn’t know it, but Andrew, who is in a wheelchair on oxygen, is evacuated to Memorial Hall.

“Andrew will be here any minute,” she thinks as she worries over her children, who are strangely silent.

But he doesn’t come.

***

Cook’s contractions, meanwhile, have stopped.

Accompanied by a co-worker, she heads on foot to Memorial Hall — more than two miles away. It has been set up as an emergency shelter and triage center in accordance with the city’s emergency response plan.

To reach it, nurses climb through, around and over debris: Telephone poles, twisted cars, metal, wood and glass.

A woman shouts to them, “I think my mother died!” The two nurses confirm the death, but there is nothing they can do. They walk on — something that goes against every grain of their ER training.

A stranger pulls over in a truck, offers them a ride. Cook is able to rest again.

At Memorial Hall, she begins suturing, helping diabetics whose insulin was scattered to the winds, responding to survivors with chest pains and in need of EKGs.

***

Andrew Stammer is being unloaded at Memorial Hall when someone asks him his name and writes it on a sheet of blank paper. There is nothing else on it.

“This,” he thinks, “is my ID.”

There also are no pain medications, or IV poles to suspend bags of saline drip. Volunteers must hold them.

Someone removes the shards of glass from his back and puts him on a backboard to move him into a hallway. He’s in pain, looks at the ceiling, hears others moaning.

When more injured arrive, someone puts Andrew on a table outside of Memorial Hall, then onto an ambulance bound for Via Christi hospital in Pittsburg, Kan.

***

Helicopters from across the Four-State Area fly overhead, evacuating critically injured people to other hospitals.

Pace’s flight crew and the BK117 aren’t among them — the showpiece of the MedFlight program and the largest operating air ambulance in the area has been destroyed.

Pace joins four members of a Highway Patrol disaster response team in making one last sweep through the hospital to check for survivors.

The team walks every floor, looks in every room of the 750,000-square feet structure, from the top of the 162-foot tower to the lowest level.

They find no survivors. The victims include five patients and a visitor.

***

Outside St. John’s, Buchele sees a fleet of at least 20 ambulances arrive and begin loading up patients.

Walking in concentric circles until he finds his truck, he follows them.

“Wherever they are going, they’ll have patients to take care of,” he thinks.

The ambulances wind up at Freeman, and so does he.

VI.

Supplies in the emergency department at Freeman are running low.

Chest tubes, sutures and IV material, casting and tetanus shots ... they’re almost gone.

Veer breathes a sigh of relief when ambulances from outside of the region begin arriving. It’s a godsend, he thinks, when he learns that they’ve been loaded down with those much-needed items.

Thankfully, the red tape and paperwork that comes with transferring a patient to an outlying hospital have been suspended.

If a patient is deemed stable and can be better cared for elsewhere, he or she is put in an outgoing ambulance.

A call comes through from the Freeman East campus — the old Oak Hill Hospital — at 932 E. 34th St. It’s mainly used for long-term care and outpatient procedures. There is no emergency department, but injured people have begun arriving in search of help.

“We have about 50 people over here, and some of them are hurt pretty bad,” Veer overhears.

“Don’t you have someone down there?”

“No, you don’t understand. We have a psychiatrist.”

“Oh, s---,” Veer thinks to himself.

Vehicles are quickly deployed to Freeman East to bring those patients back to the main hospital. Luckily, the psychiatrist there has been joined by a Freeman emergency department nurse who stopped to help.

In the ambulance bay, Veer can see one of his emergency department colleagues working side-by-side with Buchele, from St. John’s, performing triage.

Veer is reminded of the fact that despite differences between the two hospitals, they have plenty in common.

Doctors are doctors. Nurses are nurses. Patients come first, period.

***

In the first-floor conference rooms at Freeman, dozens of procedures are taking place at once.

Denton, who helped set up the cots, feels overwhelmed as the magnitude of what they are experiencing begins to set in.

She looks to her nurses, whose eyes are wide as they take in sights that even many seasoned medical professionals have never had to witness.

“Are you OK? Do you need to leave?” she asks them.

To a person, they tell her that as long as they can see their co-workers at their side, they’ll stay.

Denton struggles herself to keep her emotions in check, to keep from openly crying.

As she passes by, a patient looks at her to catch her eye.

“You’re doing an amazing job,” she tells Denton, coming over to embrace her.

“This is someone who has probably lost everything she has, and who knows if she lost any family members,” Denton thinks to herself.

She feels humbled beyond words.

***

Bins are overflowing with blood-soaked bandages and other items, towels are floating in the lobby’s water wall, and the floors are streaked with blood.

Camp, assigned to help with housekeeping, is shocked by what he sees but quickly gets to work helping to clean up.

As he does so, he has a chance to ask patients and family members if they are OK, or if they need anything. What he finds is that doing housekeeping has put him in a prime position to offer psychological first aid to those who are in need.

It’s not long before he has his own small staff working with him to help keep the area picked up and mopped. None of them, he realizes, are Freeman employees.

They are friends and family of patients who couldn’t just sit by ... they want to help.

He’ll remain on housekeeping duties for the entire night, finally heading home after 7 a.m.

***

Many people who have come to the hospital in the wake of the storm are doing whatever they can to assist.

Joplin resident Matt Keller has arrived at Freeman, searching for his girlfriend’s mother, Ellen Freeman.

Keller and his girlfriend, who rode out the tornado at home, climbed out of its ruins to check on family members. Unable to find her mother in the rubble of her home, they assume the worst. But a neighbor tells them that Ellen survived and has been taken to Freeman Hospital.

After searching the corridors of the emergency department, Keller and his brother, Jack, find Ellen. Her leg has been torn open and her head is badly wounded, but she’s coherent and not in too much pain.

Keller and his brother see that the staff is in need of help and begin assisting with the flood of people seeking treatment.

They meet a man in the parking lot whose leg is badly broken and they help him inside.

The halls of the emergency department are full and getting more crowded by the moment.

It seems to Keller that the hall is visibly constricting.

They step carefully, propping the man up between them, as they search for a place to put him down.

But he tells them that he’s not ready to find a place to rest.

“What I really need to do is go to the bathroom,” he says.

As they continue down the hall, they finally find an unoccupied bathroom. It’s seen some heavy use by people tending to wounds; it is a bloody mess. But the man is grateful for the chance to relieve himself, and then the Kellers are able to find a place for him to sit in the hall and prop up his injured leg.

Keller watches the hospital staff tend to the wounded. It’s chaos, he thinks, but there’s a control to it — an effort to create a sense of order. Everywhere, he sees people helping people — staff, patients, family members doing whatever they can.

***

Staples.

So many of the people coming through the Freeman pharmacy have staples closing their wounds.

It’s not something Perigo is used to seeing every day, and the severity of some of the injuries is startling.

A nurse — a woman not from Freeman whom Perigo doesn’t recognize — brings by prescription orders for two people.

“Do you have an address for them?” Perigo asks the nurse.

She gets a funny look in return from the woman.

“Did you really just ask that?”

And it hits Perigo in that instant that many of their standard protocols and regulations suddenly seem out of step with their current situation.

***

As he continues to triage patients, Buchele, the St. John’s doctor working at Freeman, sees that supplies such as ventilators are running short, and he’s concerned how far they will stretch. Who gets them? Who does not?

Years of trauma training tell him to tend to patients with less critical injuries as they are more likely to survive and will require less resources. That means deciding to give the last two ventilators to two children instead of an elderly woman with critical injuries.

Communication is problematic, and Buchele finds himself growing frustrated with a few on duty who find it difficult to break out of the medical profession’s standard mode of having everything authorized.

“We’re off the map of authorization!” he shouts at them.

VII.

At Memorial Hall, Cook, who began her day at 7 a.m. at St. John’s, still has no idea if her husband and daughter are OK. She pauses a moment to use her cellphone, but can’t get through. Finally, she gets reception and hears her husband’s voice. They are OK, but he is frantic.

“I pulled over by the side of the road and threw up when I heard St. John’s had been hit,” her husband tells her. “I thought you were dead.”

Grateful to have made contact with her husband, Cook refocuses on the tasks at hand. She’s a former college track standout and is used to pushing through pain. But her back and feet are beginning to ache with hours of abuse and the extra strain of carrying the baby.

Sometime after 1 a.m., Cook’s husband and father arrive at Memorial Hall to pick her up.

She is in need of sleep, food and the chance to rest and clear her mind.

***

Danielle Stammer, meanwhile, is sitting at Freeman, hoping Andrew will come.

Ethan is acting normal again, but Emily is not; she is very quiet, tucked into herself.

A nurse offers a juice box for the children to share, and Emily complains of a “hurt in her eye.”

Danielle is hesitant at first to go to the pediatric ward for treatment, worried that if Andrew shows up, he won’t be able to find them. Once there, they flush Emily’s eye and she perks up.

Danielle notes it is past the kids’ normal bedtime, and someone leads her to a playroom at the end of the hall. She turns benches into a bed, lays the children down, and they fall asleep side by side.

At that moment, Danielle feels very, very alone.

“If you see a tall guy looking for his wife and two kids, that’s Andrew,” she tells a few nurses.

Her in-laws arrive at the pediatric ward to pick up Danielle and the children.

At the in-laws’ home, Danielle settles into a bed with Emily, but can’t sleep. Every time she closes her eyes, she replays the moments they sought shelter, fought the doors, held on against the wind. She keeps changing details, asking herself, “What if I hadn’t made it there in time? What if we had tried another entrance? What if we were a minute later getting out of the van?”

And then she tells herself, “Stop with the scenarios. I know the end of the story. We are alive. We are alive.”

***

It’s about midnight at St. John’s when Woods, the ER manager, pauses in her work to straighten for a minute, looking up at the wrecked hospital.

“After 21 years here, I’m going to have to go find a job,” she thinks. “I’ll have to move away. We’ll all have to move away.”

Staff members are weary. A few have had minor injuries themselves. They are cold, wet and hungry.

Woods notices a co-worker exhibiting signs of shock and decides to take her home. An hour and a half passes as they take detours around the massive stretch of debris to reach the woman’s home in Webb City.

Woods decides to go home, too. Her plan is to get cleaned up, eat something and try to rest. She knows she’ll be needed at daybreak.

She can’t sleep, though.

Thoughts flood her mind: “Did we do everything we could? Is there something we should have done differently? Is there something else I could do besides lay here in this bed?”

She doesn’t know what she’ll face tomorrow.

She finally drifts off.

***

Pace is cold, wet and hungry.

His son, a firefighter-EMT who at some point responded to St. John’s, sees his dad and offers him a ride home.

Pace is home long enough to change into dry clothes, eat and get an operational vehicle.

He heads back to the hospital, where he will spend the next four days.

VIII.

Near the Freeman pharmacy, a woman waiting in the lobby is informed that her husband’s injuries were fatal. She’s not alone, her mother is there, but both are in shock.

Perigo watches as Gary Duncan — Freeman’s chief executive officer — approaches the women and asks if there’s anything that he can do.

“Crackers,” they tell him. Something to eat.

Duncan leaves and returns a few minutes later with their request.

Perigo is struck by what she’s witnessing. “Out of everything he could be doing, he’s focused on the patients ... this is the best part of human nature.”

She will remain at the pharmacy until nearly 8:30 p.m. Monday.

***

Sometime after 1:30 a.m., Buchele is still doing triage.

A fellow physician, who suffered a minor head injury during the tornado, starts to show signs of exhaustion.

Buchele tells the doctor that he’s taking him home, then decides to head home himself.

Morning will come quick enough.

***

Nearly 24 hours after starting her shift, Leslie Allen, the Freeman nurse, is on her way home.

Home is in Carl Junction, but there is no easy way to get there. Block after block, she’s stopped by the National Guard.

“You can’t get through here,” they tell her.

She winds up on Range Line when she is stopped once more. She’s nearly in tears.

“Where do you live?” a guardsman asks.

“In Carl Junction,” Allen says. “I just got off work at the hospital and I want to go home.”

He radios ahead, and tells her that barriers will be moved so she can get through.

Allen is relieved, but as she drives she becomes disoriented because familiar landmarks are no longer there.

By the time she approaches Northpark Mall, she begins to get her bearings back. Passing through Webb City, she sees traffic backed up at McDonald’s.

“What’s wrong with these people?” she thinks. “They’re eating Egg McMuffins and there’s no Joplin left!”

***

Still in the emergency department, Veer is in a bit of a daze.

Since the first patient was brought in, there has not been a break.

Sometime after 4 a.m., someone brings in a box with little bags of chips and bottled water to drink, and he realizes that he hasn’t had anything to eat.

Dr. Alisha Wright arrives at the hospital. She tried to make it in earlier, but wasn’t able to get through. Now, rested and ready to go, she tells Veer that he needs to go home.

He doesn’t want to leave, but he is wiped out. Eleven patients have died of injuries they sustained during the tornado. Hundreds more survived.

In fact, within 48 hours of the tornado, Freeman will treat 1,000 people; in two weeks, that number will grow to 1,700.

Veer heads home, but it’s difficult to sleep.

In a few hours, he’ll be out with search and rescue teams, looking for survivors in need of care.

At the ruins of a shopping center at 20th Street and Range Line, it occurs to him that he used to live in the nearby neighborhood.

The landscape is alien to him now. He no longer recognizes any of it.

Joplin’s wounds run too deep.

IX.

A year has passed.

Woods’ worst fear — that St. John’s employees would have no jobs and would have to move — didn’t come true. The hospital, now called Mercy Hospital Joplin, kept almost everyone on the payroll and began rebuilding almost immediately.

Seven days after the tornado, the hospital erected a 60-bed field hospital in tents east of the wrecked building. By Aug. 18, a temporary building had been erected, followed by a “component” hospital that opened on April 15. Mercy also began operating McCune-Brooks Hospital in Carthage after an initial partnership formed in the weeks after the tornado.

Officials broke ground in January on the new, permanent Mercy Hospital Joplin, slated to be complete in 2015. The hospital, which has a construction budget of $335 million, initially will have 261 beds, to be expanded to 309.

For Woods, staffing the temporary hospital’s ER has been a challenge.

“Some resigned, some left for emotional reasons. I don’t blame them,” she says.

• Rod Pace is overseeing MedFlight from flight quarters in a modular building north of the new Mercy Hospital Joplin component hospital.

Within six days of the storm, MedFlight had a new helipad and a replacement helicopter on loan from Sullivan, Mo., followed by a permanent replacement: A BK117.

The pilots transferred, but Pace says the crew has adjusted.

“All in all we’re doing good,” he says. “Are we working with less? Yeah, everybody is. But less what? It’s just stuff.”

• Buchele was unsure what the future would bring for St. John’s.

Seeking stability for his family and career, he became a physician for Freeman Health System. He opened a surgical office on McIntosh Circle, but maintains surgical privileges at Mercy Hospital Joplin.

He is hopeful that a collaborative effort will take place between the two hospitals for future emergency preparedness plans.

• Andrew Stammer spent Sunday night at Via Christi, but his calls to Joplin couldn’t get through that night. The next day, he reached a sister who lives in Southeast Kansas and the two return to Joplin, reuniting Andrew with Danielle and the children. Their Joplin home was damaged beyond repair. After living with Danielle’s parents in Jefferson City for a year, they moved into their own Jefferson City home three weeks ago.

Andrew has found a job at University Hospital in Columbia, and Danielle has self-published a memoir, “Singing Over Me: A Joplin Tornado Survivor’s Story.”

The couple is expecting their third child in October.

• Cook was put on bed rest toward the end of her pregnancy, but on Sept. 29, she and her husband became the parents of a healthy baby girl, Aggie Jane, who was delivered at Freeman.

Cook sometimes suffers from nightmares and finds it hard to fall asleep. During thunderstorms, she puts her children to sleep in their basement.

“I am looking forward to getting past this spring,” she says.

X.

In March, Missouri Gov. Jay Nixon joined Freeman’s new Chief Executive Officer Paula Baker for a ribbon-cutting ceremony for the newly completed fifth floor of the Hall Tower.

The 24,000-square-foot space provides 29 private cardiology, medical and surgical beds and employs 52 new clinical staff members. A sixth floor is scheduled to be completed in October.

The additional space is welcomed by Freeman, which has seen increased patient loads since St. John’s was hit by the tornado.

• Allen says that for the emergency department staff, everything is different.

“Our whole way of practicing medicine has changed,” she says. “I don’t know that it will ever go back to what we once knew.

“We don’t walk into those calm days and have time to stand around and network with our friends. (Freeman) is a busy, busy place with a lot of sick people to care for.”

• Denton says that the effects of May 22 still are felt today.

“I have staff members who had to move out of the area because they were traumatized by the event,” she says. “I have staff members who still require ongoing counseling to deal with the magnitude of things.”

But there are positives as well.

“The response and the renewed faith in our community are a lesson that will never be forgotten,” she says. “I recognized that evening that people were needing stability ... they needed our hearts as much as the skills of our hands, someone to hug them and say that it’s going to be OK.

“It was truly an honor for me to be part of that evening.”

• From the pharmacy standpoint, everything has changed, says Perigo. The work volume is much higher, and they’ve had to hire more staff and expand services.

“Personally, I’ve finally had time to grieve,” she says. “All of my schools are gone ... the place where I got married is gone. Driving by 26th and Indiana and seeing a big pile of rubble hurts.

“It’s changed, but it’s getting better.”

• From Ozark Center’s perspective, the last year has seen many doors open in the area of behavioral health, says Camp.

“We now have connections with organizations that we never had in the past,” he says. “We now have therapists embedded in schools teaching resiliency and stress management.

“The relationships we’ve been able to build are incredible.”

• During the past 12 months, Veer has lectured around the country, sharing Joplin’s story and the important role that Freeman played that night.

It’s an important question for hospitals to consider, he says: What if 50 percent of your community’s health-care capabilities were to disappear in an instant?

Both Joplin hospitals have reason to be proud, he says.

“The people at St. John’s did an admirable job that night,” says Veer. “They were on the canvas. They were knocked out. But they were still able to move their patients, set up another facility and take care of who they could.”

Freeman’s response to the situation was equally impressive, he said.

“More than having the right disaster plan, we had the right people at the right spot at the right time,” he says.

“The health care in this community did an incredible job of putting politics and finances aside and taking care of (Joplin).”