A Moment of Epiphany in the Wake of Catastrophe

As far as 24-hour call goes, it had been a fairly ordinary shift for Larry Epps, CRNA, MS, on March 2-3, 2020. He had just finished a routine C-section and was anxious to get to his call room in hopes of catching a couple hours of sleep.

Larry’s head had barely hit the pillow when all hell broke loose at the 200-bed Cookeville Regional Medical Center (CRMC) in Cookeville, TN, a tranquil “micropolitan” with a population of nearly 35,000 not far from Nashville.

The unmistakable sound of his pager going off jarred Larry awake. It was the emergency room calling a Code Yellow. “Code Yellow?” Larry thought. That was a first for him.

He slipped into his Crocs and started hustling for the ER. His pager went off again, so he picked up his pace. Obviously, something big was happening.

Larry had no idea how big.

“It was pandemonium when I walked into the ER—absolute agony and misery,” he recalled. “Fear on faces. Gurneys everywhere. I’d never seen anything like it.” Larry estimated there might have been as many as 100 injured people in the ER when he arrived, with more coming. Many, their clothing tattered, were suffering from blast wounds—lacerations, scratches, bruises, broken bones. And those were the people who were doing “OK.”

Around 1:48 a.m., nearly the same time that a tornado warning was being issued for the area, a violent EF4 tornado had touched down in Putnam County near Baxter. Moving fast, the monster proceeded to rip through the western part of Cookeville, causing catastrophic damage to neighborhoods along its 8.4-mile path and leaving misery and death in its wake. Mercifully, it abruptly dissipated just before reaching downtown Cookeville. The tornado was the seventh, and most deadly, of 15 tornados spawned by a supercell that night, taking the lives of 19 people and severely injuring 87 more.

Born and raised in Oklahoma, in the heart of Tornado Alley, Larry knew all about twisters. He always chuckled at his Tennessee colleagues on the rare occasion when they would say, “Did you see where a tornado touched down yesterday?” telling them “You ain’t seen no real tornados.” But even Larry hadn’t seen anything like the mayhem in the ER at CRMC that night, not up close and personal anyway.

Instantly, his adrenalin started to pump and his caregiver mentality and anesthesia instincts took over. He was the only anesthesia provider on staff that night, and he quickly learned that roads all over town were strewn with uprooted trees, overturned cars, and what was left of people’s homes and possessions, making access to the hospital a slow, arduous affair. Even though an APB had been sent out to hospital employees to come in pronto, Larry knew it could be a while before help arrived. Meanwhile, the injured, some catastrophically, kept coming, dropped off by family, friends or neighbors with pick-up trucks and SUVs—big vehicles that could get through the debris. They would leave their precious cargo with whoever could help them in the moment, then head back out to find more survivors.

A cardiologist came over and grabbed Larry by the arm. At that moment, the only healthcare professionals in the ER were the cardiologist, a surgeon, the ER team, and Larry, the lone anesthesia provider. “I remember him yelling ‘Larry, I’m a cardiologist. I’ve never triaged before!” Larry said. “I shouted back, ‘Point me to the people who need help with their airways.’”

The first two hours were complete mayhem. Larry was part of a dedicated team of providers who worked tirelessly to perform five resuscitations; each of the victims initially had a chance of survival, but two of them wound up dying. Shouts of “come over here, we need you over here” were constant, as if being played on a loop over the intercom.

As he related his story, Larry’s voice filled with emotion, the words tumbling out in a rush:

“There was a young boy, maybe 8-11 years old, unconscious, being resuscitated. Everyone is working in tandem, calling out this and that. You just function instinctively at that point, letting your education, training and experience take over.

“I got the tube into that boy and was called to help a little girl—a toddler, just 1-2 years old, with a devastated airway and brain injury. I worked so hard to get that tube in through all the blood and damaged tissue—it was just ‘hamburger,’ as we call it—but I was absolutely determined to secure her airway. I was so focused on the child that I had to detach for a moment. So I looked around the room at all the carnage and terror and saw her father sitting against a wall with his head in his hands.

“The essence of the entire experience—the triumphant part that I will never forget—was the vision I keep in my mind’s eye of a nurse who was helping us try to save this little girl. I feel just terrible that I can’t remember that nurse’s name! But we all had a role, and at that moment hers was holding the little girl’s hand and praying in her ear, ‘God will protect you.’

“We got the little girl stabilized and moved on to another victim—a gentleman I’d worked with, a friend. I tubed him, but he was unresponsive. Next we helped a woman who was not in good shape. And so it went…five resuscitations in all.”

Finally, Larry’s anesthesia colleagues, Robert and then Aaron, were able to get to the hospital. “They were a godsend,” Larry said. The two CRNAs immediately blended into the chaos, providing life-saving care wherever it was needed in the ER or OR.

“It was kind of like a MASH unit, to be honest,” Larry recollected. “There obviously wasn’t anyone checking people in—we had no names, ages, insurance cards—just damaged people who needed help urgently. Questions would come down from the OR about the patients being sent up to them, like, ‘What’s this person’s name? How old is he?’ But all we could tell them was we didn’t know and pretty soon they stopped asking.”

Larry recounted in hushed tones that “there were healthcare professionals that night who were fearlessly doing things they don’t normally do—surgeons putting in chest tubes, NPs sewing up lacerations and degloving injuries, cardiologists doing triage—just stepping right out of their comfort zones and doing heroic things. I realized afterward—because there was no time in the moment—how proud I was to be part of that team of providers. All we wanted to do was take care of people.”

Larry calls that early morning on March 3 his epiphany moment. “It was never more clear to me than that night exactly how we, as healthcare professionals, pull together to work as one. That night we truly were a ‘collective of heroes.’”

He candidly admits, though, that everyone is affected in a situation like what happened that night—even the heroes. No one comes out unscathed, victims and providers alike. It’s just a matter of varying degrees. For Larry, his struggle has been with post-traumatic stress disorder (PTSD). While therapy has helped, so has something else…something magical.

“The little girl I intubated that night? She survived!” he said triumphantly. “She spent a long time in Tennessee Children’s Hospital in Knoxville—the local media followed her amazing recovery closely. She’s 4-5 now and doing great, and believe it or not she lives in our neighborhood. The family has no idea it was me who was part of that incredible team of providers who worked to save her life that night, and they will never know it. But I’m blessed to be able to see her progress, and it heals my heart and fills it every time I see this beautiful, happy little girl.”

“If there’s one thing I’ve learned through my therapy sessions,” Larry said, “it is simply this: Every day is a gift.”

More about Larry Epps

Larry earned his Bachelor of Science in Nursing in 1984 and his Master of Science in Anesthesia in 1987, both from Kansas University Medical Center in Kansas City, KS. He and his wife Tracy, a nurse practitioner, moved to Cookeville in 1987 following Larry’s graduation. Throughout his 32 years at Cookeville Regional Medical Center Larry provided general anesthesia in all surgical areas including obstetrics, pediatrics, neurology, and cardiovascular. Now semi-retired, Larry works as a 1099 CRNA specializing in cataracts and plastic surgery.

An active member of the Cookeville community, Larry served as a Putnam County commissioner for 13.5 years and as the vice-mayor of Cookeville for 8.  He has also worked on numerous community boards and committees.

The Epps have two children and two grandchildren, with a third grandchild on the way. Their daughter is also an NP.

For Larry and so many of the other healthcare providers and hospital workers who experienced that awful night in March 2020, it took time to process what had occurred and what it meant for them and their community. “There’s healing that comes from being able to tell what happened,” Larry said. “I am grateful to TANA for providing the opportunity to share this story with my nurse anesthesia colleagues through Center Stage.”

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