Wednesday morning, Sept. 28, 2022, we had emptied the emergency department out in anticipation of hurricane Ian. The slow trickle of patients seeking care seemed to come to a halt.  Plant-ops had a small team of men outside the ED entry barricading the front doors with hurricane shutters. I was in the ED vestibule watching Wayne and his crew quickly fit the shutters to the glass entry and bolt them into place. Piece by piece less and less of the outside was visible and as the last shutter went up I could see nothing. This should have provided me a feeling of comfort and safety but I felt trapped and anxious that my vision was obstructed. Wind and rain were picking up and we were already on generator power. Staff began to shut off all unnecessary lights to conserve power. Slowly each light was switched off and the department began to darken until the only light remaining was from emergency lights. Our small department felt much bigger in the dimness. I walked to each room assessing the condition, itemizing equipment and closing the doors. I don’t know if this was what I should have been doing at that time or if I was just trying to keep my mind off the reality of the situation. The halls were eerily quiet and resembled nothing of the normal day-to-day bustle. As I shut each door it was almost like I was affording myself the privilege to take one last look, etching the picture into my memory as if I would never see it again.

I approached the nurses’ station and a small group of staff was huddled around a computer monitor that was streaming live news coverage. I briefly looked at the screen and saw what we all feared, the storm had shifted again and appeared it would make direct impact very close to us. I could tell by their body language that the staff were getting nervous. It was becoming more real that we were not going to escape the impact that Ian had in store for us. I studied the faces of the staff as they listened to the news reporter’s tone of voice change to concern. Their eyes were wide but had a blankness to them. I am sure I held the same expression. I could hear what he was saying but my mind was trying to process what his words looked like, what I should expect. I was brought back to the present when the screen flashed and started to show live footage of Naples and Fort Myers beach. Surge waters had engulfed both areas and was rising quickly. I ran over to the EMS entrance, which is the only area we could still see out of. I searched the area for any signs of water. In my mind, I was praying that we were far enough away that the surge water would not affect us but I knew in my gut that we were bound to see some degree of water. As I scanned the EMS drive and parking lot, I was relieved to see that there was minimal standing water despite the hours and hours of whipping rain. I stepped away for a minute to try to connect with my family but my cell phone would not connect. My house is a two-minute drive to HealthPark and you can see the red lights on the roof of the hospital from my driveway. It was frustrating to know that my family was so close but without contact I felt like they were in another world.

I shifted my energy to start preparing for possible evacuation. The storm surge was just updated to 12-18 feet. Earlier in the day I had searched a topography map of HealthPark’s elevation so that I could picture in my mind how the surge predictions measured up to our facility. Best case scenario we were looking at 2 feet of water, worst case, 8 feet. I went to my office and began to unplug all my electronics and move everything I could off the floor. I was headed back out to the department when I felt the buzz of my watch. I looked down and saw the text “evacuate now, it’s coming!” I quickly walked to the ED. I called the team over and told them the evacuation plan. Despite the urgency in my voice, the staff kept their composure and waited patiently for their next order. I split the team into two and assigned a team lead for each area we were evacuating to. Each team member grabbed the assigned equipment and lined up the back hall of the ED like floats in a parade. Once all team members were accounted for the team leader lead the way out of the department. I was keeping a list of all the equipment that was leaving and where it was going to. Once the last cart was pushed out and the ED doors closed, I ran to the EMS doors. My stomach sank at what I saw. The EMS drive that minutes before looked normal was now filled with water. I could no longer see the curbing coming down the drive as the water was encompassing every available space. I ran to room one to call my family, I didn’t want anyone that may have made it back down to the department to grab their belongings hear the panic in my voice. I tried several times, calling my husband and oldest two children. I placed my final call to my son. When I heard him say hello, I began to speak clearly but fast knowing the cell phone connection was terrible. I told him to get his dad and take everyone upstairs in the house and bring food and water in case they became trapped. I instantly felt guilty for saying this to my baby boy. I didn’t want him to worry but I couldn’t risk waiting for his dad to get the phone and losing service. He very calmly said “OK, I love you mom” and then the connection was lost. I wanted to cry, I wanted to panic but I know that I had to keep it together for my team. I knew they were relying on me to set the tone. I took a deep breath exited the room and regrouped with team. All the essential equipment was relocated so we all began grabbing our belongings to head to our new area. I stayed behind to make sure everyone got everything. I couldn’t help but look back out the EMS doors to see that everything was under water and the water was approaching the EMS turnaround. I quickly glanced around the department to see if I had missed anything. Once I was sure everything was accounted for I scanned the department one last time. I felt like I was saying good-bye to a best friend; I did not want to leave but I knew I could not stay. I grabbed my bag and made my way down the back hall towards the elevators. When I heard the ED doors click shut I shuddered at the thought of what I might see when they opened back up.

Early the next morning, after locating back to the ED, I woke to the sound of someone calling my name. I felt like I had just laid down and I could not distinguish if I was dreaming or someone was really calling me. I heard my name again and I opened my eyes to see Christina, my supervisor, standing over me. “Sabrina, I am so sorry but we just had a boat full of people show up.” I jumped up and threw on clothes as fast as I could. I walked outside to see a pick-up with a boat behind it filled with people. The driver was panicked and was shouting a report “I found these people clinging to a roof, they are cold and wet.” I looked at Christina, reading each other’s eyes. We called for help and I ran over to the boat to start assessing for injuries. Thankfully, no one appeared to be seriously injured. There were 15 people on that boat. They were soaked and their skin was water-logged. They were weak from clinging to their roof tops for hours. They were exhausted and could barely move. As soon as we got them all off the boat, another truck pulled up with a lady he found floating in the water. He was frantic and reported he didn’t know if she was alive. I jumped in the back of the truck, she was alive. She was naked and her skin was pale and cold. It didn’t stop there, truck after truck continued to pull up with people that were found in need of help. I stayed outside all day caring for the people that now flanked our entrance. They had nowhere to go. Their cell phones were washed away or dead. They were desperate. My heart physically hurt for them. I couldn’t imagine feeling so hopeless and lost. My team and I did or best to get them dry clothes, food and water. Once their basic needs were met we began to listen as they recounted the night and what they went through. I have always been really good at dealing with stress and trauma but this was overwhelming. I had learned that the lady I helped pull out of the back of the truck that was found floating in her house was floating beside her dead husband for 8 hours. I could not mentally listen to another story without knowing if my family was ok. At that second, I saw my husband’s car pull up and I saw my children’s faces pushed against the window. I ran to the car and opened the doors and just squeezed my kids.  I was so relieved to see them and know that they are ok. I couldn’t hold back the tears and they just started to flow out faster than I could wipe them away. I was blessed. I didn’t even ask about our house because I didn’t care. In that moment everything that was important to me was right in front of me. Seeing their faces was all I needed to keep going. I regained my composure, kissed them all good bye, and went back to work.

This is something I will never forget in my lifetime. Charles and I were reflecting recently and he turned to me and said “look at everything you have been exposed to and what you have been a part of in your short time as a leader.” I stopped and thought, wow, I have been a nurse manager for 2.5 years and I have led through a global pandemic, the great resignation, unprecedented nursing shortages, and now a devastating natural disaster. I have experienced more in my short time than some leaders experienced their whole careers. I have only been able to persevere because I have the best mentors in this leadership team. Although none of them are formal mentors, I listen and I watch and I am always learning. Between Charles, Eric and them, I have never felt more supported.

Sabrina Gorton, MSN, RN, CEN, is a Nurse Manager, Adult Emergency Services, at HealthPark Medical Center in Fort Myers, FL.