Shared Grief : Coping: After helping disaster victims, many trauma counselors face tears, nightmares and sleeplessness as they confront their own feelings of acute sorrow.

The nightmares continued for weeks after Judith Tuohey returned home to Lake Forest from Oklahoma City. During the day, the smallest things can bring on a rush of emotion: when someone walks by her who’s just eaten a Lifesaver, it triggers her memory of the rescue workers and the masks they had to wear--soaked in wintergreen to conceal odors at the site.

Tuohey did not witness the horrific blast at the federal building two months ago, nor was she among those who sorted through its rubble looking for survivors.

She was among those whose task it was to help others deal with their emotions.

Tuohey is a registered nurse and trauma counselor; she has volunteered at 22 disaster sites, including two weeks in Oklahoma City.

While it is the scent of wintergreen that brings back memories from Oklahoma, it is the smell of gasoline that takes her back to two previous disasters: the crash of a small jet near John Wayne Airport last year that killed a planeload of business executives and the 1986 Aeromexico crash in Cerritos.

To help prevent burnout, mental heath workers generally stay only 10 to 14 days at a disaster site. But the effects linger. How trauma workers are affected by disasters has become a growing issue in the disaster relief community. There has been increased realization that those who are helping absorb the impact of a trauma must also have an outlet for their own feelings.

“I’ve got a great husband and family I can talk to,” Tuohey 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.”

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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.

Often, trauma counselors arrive on the scene very quickly, as quickly as police and firefighters. In Oklahoma City, they began working within 10 minutes of the bombing.

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.

But, after a 15-hour day, the counselors often 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.

“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 Tuohey. “Of course, while you’re talking the clock is ticking and you don’t get much sleep. That’s just part of the job.”

Judy Albert of Huntington Beach is a marriage, family and child counselor as well as certified trauma counselor. She says it can be hard for trauma workers to assess how they are handling things.

“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,” Albert says.

“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.”

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.”

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“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.”

Some find the work overwhelming from the very beginning.

In Mexico City after the 1985 earthquake, Caroline Graham 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. Today, when she hears a baby cry out, she still gets a chill.

Graham 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.”

She works in marketing today, but 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.”

Although some trauma counselors are paid by businesses to give comfort to employees after a crisis, most are volunteers who are ready to drop everything and rush to a disaster site if called.

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. Also, I’ve found that people who respond best to trauma cases are those who’ve had a major trauma in their own lives.”

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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.

“Most of us recognize the need to take care of ourselves and watch out for each other. If another counselor is irritable and fatigued, we’ll talk to them and give them a chance to grieve and share their experience.”

The long days and restless nights of trauma work take their toll, though.

“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.”

When forming a team of trauma counselors to go to a site, Williams relies on their individual strengths and works around their weaknesses. “I have one very good counselor who was involved in the sniper attack in the tower at the University of Texas nearly 30 years ago. She does very well at most disaster sites, except those where a shooting has occurred, so she doesn’t go to those.”

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.”

While trauma counselors have been expected to set aside their own needs and concerns when working and listen to patients with a clinical detachment, it’s not always possible, Williams says.

“When you have to deal with the death of a child, that becomes overwhelming. It’s very hard to be detached,” he says. “You could get your bell rung and it could bother you the rest of your life.”

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Coming to terms with 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.”