Dave, it is a somewhat more difficult route from Strasburg, PA to Bellevue than the route out of Roanoke.
The NS routing would likely be Leaman Place (pronounced "lemon" like the fruit) - Harrisburg - Altoona - Pittsburgh - Alliance - Bucyrus - Bellevue.
The Leaman Place to Alliance portion of that route is NS busiest main line (the former PRR) with somewhere around 80 trains per day on it. Freight train speeds are as high as 60 mph, plus Amtrak runs that route at 79 mph. Sticking a 25 mph hospital train out on that line will seriously disrupt traffic for several days and hundreds of miles behind it.
The Roanoke to Columbus route does not have those problems. A lot of it is 40 mph due to the curvature in the mountains. It is not as busy as the other route, nor does Amtrak run on it. Moving a 25 mph train over that route was not too big a deal.
