Albert dealt with her anguish the day she left for home. "I went out to the site, and looked around at all the flowers and poems people had left and just wept. It was my catharsis."
Just as some disasters are worse than others, some also have more impact on the trauma counselors.
"With the Northridge earthquake, although many people were upset, there wasn't a great loss of life, just property," says Dusty Bowencamp, a disaster health services supervisor for the American Red Cross in Los Angeles. "The counselor would spend 15 to 20 minutes with the average client and get them going in the right direction and move on, working a 12- to 14-hour shift.
"In Oklahoma City, there was a tremendous loss of life and a feeling that this was a senseless tragedy. The victims needed much more emotional first aid, with counselors spending one to two hours with them. Because of the effect on the counselors, they only worked four-hour shifts."
When a disaster occurs, local trauma counselors can respond quickly, sometimes getting to the site just as the police and firefighters arrive. In Oklahoma City, they began working within 10 minutes of the bombing. But local counselors are not always the best people to have treating victims.
"At the Loma Prieta earthquake in 1989 and at Hurricane Andrew in 1992, there were many counselors working who were worried about their own families and property," Williams says.
"Once the local mental health people have leveled off and found their footing, they provide excellent insight into the community for the rest of us," Tuohey says.
The long days and restless nights of trauma work can be brutal, whether the counselor is local or from out of town. "When you're putting in a lot of hours and not paying attention to needs like food, sleep and relaxation, you're not in the best shape to work," Williams says. "The counselor needs to sit back and take a break, otherwise, they're not much help to the victims they're working with."
Recognizing one's own humanity appears to be a prerequisite to becoming a successful trauma counselor.
"You try to be brave and you read all the books, take the classes, get the degrees, but if you can't cry at something terribly bad, something's wrong," Tuohey says. "You have to recognize that the same sights that can make someone else sick, can make you sick. You can't deny your own humanity."