ASHEVILLE, N.C. − Dr. Matt Riester and his wife were about to head out of town to celebrate their 10th wedding anniversary when Tropical Storm Helene pummeled western North Carolina last week.

Floodwaters were raging and Riester's house went dark, so the medical director of the emergency department at Asheville's Mission Hospital had a new plan to fight his way through the chaos and get to work.

"I looked at my wife, who's also an emergency room physician, and she knew that I needed to get to the hospital," he said.

It normally takes Riester 30 minutes to drive from his home in Mills River south to Asheville. This trip took him two hours.

He maneuvered around downed power lines and bumped over tree limbs. He saw the surging French Broad River, typically 20 feet below the bridge, nearly level with the road.

"It was a very difficult and terrifying experience going over a bridge and you're not sure if it's going to get washed away," he said.

When he walked into the hospital, it was a hectic sight.

Patients at the hospital, owned by Nashville-based HCA Healthcare, kept pouring in through the emergency room entrance, some with make-shift bandages and slings. One person had caution tape wrapped around an injury as a tourniquet. The hospital, which typically treats 275 patients on a typical day, attended to 600, and many of them were very ill, the doctor said.

About 300 of those patients rushed in during a six-hour period on Sept. 27.

Nurses triaged patients, writing names on a whiteboard and lining up 12 clusters of beds so doctors could move quickly from patient to patient. Some of the patients didn't make it, but the hospital system hasn't yet given a number of those who died there from storm-related injuries.

"Obviously, it was very loud and seemed very chaotic," Riester said.

Patients cried out in pain with broken limbs, head gashes and other injuries. Adding to the frenzy, men and women rushed in to search for loved ones and check on their conditions.

Riester helped treat patients injured from the storm as well as patients already at the hospital for other conditions.

The hospital lost power, including access to electronic medical records, but the backup generator soon kicked on. The western North Carolina region lost cell phone service, and many remain without it.

Unable to reach his wife, Mission Hospital's Dr. Alexa Riester, and kids, Riester headed back home through the mess at about 4 a.m.

"A lot of the emergency room staff, nurses, the doctors, respiratory therapists and techs, everybody, we're all in the same boat," the medical director said during an interview Thursday with a USA TODAY Network reporter. "We all have families. We all have houses. Many people had damage to their houses and a lot of people who were here when it initially hit, they didn't leave the hospital for days.

"Some people who have been here voluntarily haven't left the hospital yet," Riester said. "Obviously, they've taken some walks outside for sanity, but they've been here through the entire time."

Many doctors and nurses are sleeping on mats and air mattresses.

Hospital aid arriving in Asheville

Within a couple of days, HCA Healthcare sent 300 nurses from Nashville and other cities to Mission Hospital. Asheville area nurses and doctors who were off duty hurried to the ER.

One doctor on her way home to Maine after a trip to Florida showed up and helped treat patients, one of 150 medical professionals, along with the Federal Emergency Management Agency.

Due to the influx of patients, Mission Hospital is only accepting certain patients brought in from other facilities, such as trauma and stroke patients.

Riester and other ER staff are part of the Southeast group for TeamHealth, a nationwide physician-founded and led provider network. He said he was thankful when TeamHealth chartered private planes to fly in relief clinicians from Florida to Asheville.

The network, based in Knoxville, Tennessee, also is using commercial airlines to fly in more doctors and nurses with advanced training and physician assistants from across the country to Asheville and other ravaged areas of western North Carolina, said Dr. Michael Corvini, president of TeamHealth's Southeast group.

Critical access hospitals across the region were isolated.

Days after the storm hit, Dr. Ashley Eville learned about exhausted doctors at a sister hospital and hurried in at 6 a.m. and volunteered to be flown by helicopter to Marion, typically a 35-mile drive rendered impossible due to flooding. She went not knowing when she'd be able to return home.

"She's one of the true heroes," Riester said.

He also praised his co-medical director, Dr. David Mullins, who was hunkered down for days helping an onslaught of patients at Transylvania Regional Hosptial, 33 miles southwest of Asheville in the town of Brevard.

HCA has brought in relief medical personnel, food, supplies and water to all of its six regional hospitals. The hospital system also brought in gasoline tankers and is donating $1 million toward disaster relief efforts.

Residents have brought in food and are leaving it in the ambulance bay. Volunteers manned the grill to feed doctors, nurses and other staff hotdogs and hamburgers.

As Riester drove from his home to the hospital Thursday, he saw fire trucks from Los Angeles bringing in Zodiac boats, Sea-Doo watercraft and other equipment to assist with the emergency response.

"I honestly started crying, just knowing everyone from across the country is supporting us," the medical director said. "That's been fantastic."

Nurses describe difficult conditions treating patients

Kelly Coward, a nurse in the cardiovascular intensive care unit at Mission Hospital, left her home in Canton at about 5 a.m. Friday, Sept. 27. As Tropical Storm Helene pounded western North Carolina, her normally 30-minute drive to work took three times as long.

When she finally arrived, the hospital already had lost power and was relying on its generators, she said. Around mid-day, the hospital’s electronic charting system went down, which sent nurses scrambling to organize and print out information with patients’ vital information.

Some nurses, Coward said, had never used paper charts, which often require at least five pieces of paper, along with multiple copies, per patient.

“So, there was a learning curve for them, and it really slowed down the process of patient care,” she said.

Adding to the challenge, according to Coward, was that some of the hospital’s printers weren’t functioning, causing even more delays.

By the time patients’ charts were organized, Coward and other ICU nurses were shuffling about 30 pages of information, she said.

Nurses were so busy, she added, they really didn’t understand the magnitude of the disaster unfolding outside. But they knew it was bad and they were worried about their families, who they were unable to contact after cell service across the region went out Friday morning.

Coward said it was difficult to stem the sense of inner panic from not being able to reach her parents or 25-year-old daughter in Canton, which experienced severe flooding and destruction from Tropical Storm Fred a little more than three years ago.

“It was very chaotic, very scary, because you couldn’t talk to your family, but you still have to take care of these patients that are in need,” she said.

The hospital had already lost access to water, she said, so nurses dumped buckets of water in toilets so they could flush them.

On Saturday, food was scarce, she said, and staff relied on MREs – meals ready to eat – and whatever supplies community members dropped off, like chips, drinks and granola bars.

Kerri Wilson, a registered nurse at Mission Hospital, was supposed to work Sunday, Sept. 29. But trapped in Henderson County, where she lives 45 minutes away, she couldn’t make it in, she told the Citizen Times.

By the time Wilson arrived for her shift Monday morning, the electronic charting system was back up and “a lot of the kinks of the chaos had been worked through,” she said. But the hospital was running low on supplies, and some of her coworkers hadn’t left the hospital for days, relying only on the little food the hospital had left – and with no running water, sponging off their bodies however best they could.

“It was really weird not to just be able to go to the sink and wash my hands, especially after I was helping flush and clean 40 toilets,” Wilson said.

Many of her coworkers were not only stuck at the hospital, where they had to sleep over, but cut off from the outside world, disconnected from their loved ones, worried if they were OK.

“Trying to balance taking care of your patients and also being to take care of yourself and your family, that adds a lot of mental anguish and anxiety when you feel the need and the pressure to be there and sleep there knowing that you’re leaving your family behind, especially when communications are down,” Wilson said. “That was really hard.”