When she hears a tiny baby cry out, Caroline Graham still gets a chill. In Mexico City after the 1985 earthquake, she was part of a mental health team sent to help the victims and spent some time there trying to comfort babies whose parents were dead, hospitalized or missing.
Graham, who at the time was working on a master's degree in psychology, returned to her Texas home feeling drained and powerless. After three weeks of sleepless nights, she sought help for herself.
"Each day I was there I listened to people's stories and tried to help them cope, but I didn't feel like I was helping enough. I realized I couldn't do this kind of work."
After earning her degree, Graham began working for a marketing firm, but she still takes an interest in relief efforts. "I'm one of those people who sends a check to the Red Cross right after a disaster. I feel even though I can't be there to help, I should be doing something."
Graham's experience reflects a growing issue in the disaster relief community. After an earthquake, flood, bombing or other crisis, trauma counselors are immediately dispatched by organizations such as the American Red Cross to help victims cope and to "debrief" rescue workers and emergency personnel who may be suffering mental anguish from spending hours searching for survivors.
These men and women are trained to look for telltale signs of trauma--the rescue worker who sits against the wall holding his knees up to his chest and staring into space; the woman who's lost her home and family yet sits in a shelter calmly doing needlepoint; the man who slaps other victims on the back and tells them to cheer up, laughing as though nothing is wrong.
They help people "process" their immediate trauma, listening as they recount the things they've seen, heard and felt. To those they help, counselors are seen as selfless, strong individuals who are there when needed. But after a 15-hour day, they return to empty motel rooms and have to deal with their own feelings about the disaster, sometimes with tears, sleepless nights or nightmares and vomiting.
"No matter how many disaster sites you've been to or how well trained you are, this stuff gets to you," says Tom Williams, president of the International Assn. of Trauma Counselors in Denver.
"Charles Figley, a psychologist at Florida State University and a leader in this field, coined the term compassion fatigue, and that sums it up perfectly. It's something you have to deal with or you won't be doing this kind of work very long."
Although some are paid by businesses to give comfort to employees after a crisis, most trauma counselors are volunteers who are ready to drop everything and rush to a disaster site if called.
"There's a real adrenaline rush; it's exciting to be at a disaster site at first," Williams says. "But it's not easy work."
Williams, who always keeps a packed suitcase in his closet and an eye on CNN, has found that certain people thrive on trauma work. "They're usually in their 30s and up. There's a certain maturity you need to handle the stress."
To keep his head while working a disaster, Williams gets together with his team every day. "We'll talk about what we've gone through and what we've heard. It's just a way to see how we're all doing as a team."
"There have been times when I'd hear a tap-tap-tap on my door in the middle of the night and it would be another counselor who needed to talk," says Judith Tuohey, a registered nurse and trauma counselor from Lake Forest who has volunteered at 22 disaster sites, including Oklahoma City for two weeks. "Of course, while you're talking the clock is ticking and you don't get much sleep. That's just part of the job."
Mental heath workers generally stay only 10 to 14 days at a disaster site to help prevent burnout, but the effects linger. Two weeks after she had arrived home from Oklahoma, Tuohey still had nightmares. When someone walks by her who's just eaten a Lifesaver, she remembers the masks rescue workers had to wear that had been soaked in wintergreen to conceal odors at the site.
The smell of gasoline when filling up her car takes her back to a small jet crash near John Wayne Airport last year that killed a planeload of business executives, as well as the 1986 Aeromexico crash in Cerritos.
"I've got a great husband and family I can talk to," she says. "And I can always talk to other counselors who have seen the same sights and heard the same things; that makes a big difference."
"When I'm at a site, people will come up and ask, 'How are you doing?' and I'll say, 'Fine.' Even when I know I'm not fine," says Judy Albert, a marriage, family and child counselor and certified trauma counselor in Huntington Beach.
"In Oklahoma City I was helping a chaplain who had been notifying families that their loved ones were confirmed dead in the bombing. He was having a hard time dealing with the job and he just described these horrifying scenes to me. I had tears in my eyes as he talked."