KANSAS CITY — In Joplin, a wounded beautician had a request for the busy intensive care nurse.
Could someone wash her hair?
Could a little bit of time be found for a little bit of mental healing?
"Her scalp had been sandblasted by the tornado," said Dana Weber, a North Kansas City Hospital nurse who volunteered to go to the ripped-apart city. For nearly three hours, Weber picked out gravel and debris from the woman's hair and emptied buckets of muddied rinse water.
"She kept telling me, 'Oh! That feels so good!'"
It made Weber feel good, too.
It was a simple act of kindness, lifting them both, especially after so much sadness.
Most experiences of a disaster are not so positive and weigh heavily on first responders — police, firefighters and medical staff. Each encounter with a victim or survivor brings fresh doses of sorrow and horror. Unseen are the invisible wounds: "traumatic stress."
For nearly a week, working 12-hour shifts at Freeman Hospital West in Joplin, Weber and 11 other Kansas City nurses waded deep into the tornado's aftermath, trying to relieve Joplin ICU nurses struggling with personal losses. The volunteers cried nearly every day.
"How could you work there and be unscathed from it all?" Weber asked. "Any normal human being couldn't."
In the hospital gift shop, a stranger sobbed on her shoulder for several minutes: Her grandson was a patient in the intensive care unit, and rescuers still hadn't found her son. Another of Weber's patients survived a flying board that pierced her spine, but the patient worried for her caretakers because she had hepatitis C.
"I tried to give them all as much care and attention as I could," Weber said. But she knew the stress, like a cloud of dark, would crawl into her psyche, too.
She couldn't relax. She drank caffeinated drinks, talked fast. Her eyes were framed by dark circles. On a meal break, she noticed she inhaled a slice of banana cream pie — in two bites.
"I can sleep and eat later," she told herself.
But she knew to keep asking her colleagues whether they were OK. And they kept asking her. They were all aware how the stress was increasing. Every person would have a moment when it was "too much."
Weber's team was a dozen nurses from North Kansas City Hospital and St. Mary's Medical Center in Blue Springs.
Trained in critical incident stress management, they were better prepared than most to understand the stress of disasters.
"It helped a lot that we could share what we saw and felt, and that we all slept together in the same room, working the same hours," she said. "If you don't take care of yourself mentally, physically and spiritually, you can't take care of anyone else."
Several critical incident teams exist in Kansas City, said Chaplain Steve Smith from Liberty Memorial Hospital. Retiring last week, he had led its volunteer team since 2006.
"The idea, I believe, grew out of the Hyatt disaster," he said. "First responders suffered for years afterward, and something needed to be done."
A person's reaction to disaster can take many forms. One example happened after the 2005 Liberty school bus crash. Firefighters who worked the scene still can't tolerate the smell of bacon and eggs; the smell brings back the memories.
"Perkins Restaurant was making breakfast at the time," Smith explained, "and they kept smelling it during all the rescues. The human mind is an amazing thing."
Smith estimates he's made about 80 visits to area agencies that asked for the help of the team. Many of the smaller counties and cities, he said, have volunteer firefighters and first-aid responders. These responders don't have as much experience as the larger departments.
There is no vaccination, he tells them, no pill to block traumatic stress. But there are ways to help loosen its grip.
"I always encourage people to vomit the stories out as much as possible," he said. "The more they talk about what happened, the faster the stress will be released."
Avoid alcohol, especially beer, because "it interferes with rapid eye movement of deep sleep."
Eat healthy and get rest, but maintain a normal sleep schedule. "Up at the same time, to bed at the same time," said Smith, a big believer in the power of naps.
Although much of Smith's advice is common sense, the American Psychological Association, along with the American Red Cross, has only in the past 20 years begun studying disaster trauma, said Gerard Jacobs. He is the director of the Disaster Mental Health Institute at the University of South Dakota, the nation's only doctoral program in disaster psychology.
"The Hyatt Regency collapse was an isolated event," he said about the idea of disaster mental health. "But there were others that intrigued mental health experts."
A plane crash in California, a flood in Virginia, a dinner club fire in Kentucky.
"We were shocked at how little we knew in this field and how little was published."
A disaster mental health training program for first responders was created in 1991. Called critical incident stress management, or CISM, it's now practiced nationwide.
It's good but not perfect, psychologists have found.
Although Jacobs praises the pioneering work from CISM, "There is no one-size-fits-all," he said. "One problem with CISM is that the debriefing sessions are projected to a group, and not everyone might be ready to talk just then."
But reading is something that can help everyone, so Jacobs and his colleagues distribute fliers in disaster areas. In the past two weeks, his team has focused on the Missouri River flooding.
"We're in it here," he said. "We know it's coming your way."
Jacobs emphasizes the difference between traumatic stress — a common event — and the much deeper post-traumatic stress disorder, or PTSD, which requires extensive screening by a physician.
"People interchange the two, but they are two very separate topics," he said. "The lesser, typical traumatic stress, will resolve in 90 percent or more of the people within four to six weeks. It can be difficult, but most people can process it in that time frame.
"The biggest danger from the public is seeing a reaction as a sign of weakness. Traumatic stress is not a sign of being weak or unprepared; it's a sign of being human."
In Joplin, one of the ways Weber coped was to remind herself of the many blessings in her life. She thought of her family, safe at home in Kansas City. She was grateful she could volunteer. She tried to be selfless with her patients.
In Kansas City, she is trying to be gentle with herself.
"I was so needed. In Joplin, they needed hands. They needed skilled nurses. And I had been feeling burned out. The experience renewed my connection to others and why I believe I was put on Earth: to take care of people," she said.
After the team came home from Joplin, she said, "That first night I was so wired I couldn't sleep." Then she crashed, sleeping nearly 24 hours straight.
The nursing team reunited recently at North Kansas City Hospital for a debriefing session. It helped Weber. Still, when a Joplin family recently called to tell her one of her former patients died, she struggled.
"I broke down. I cried so hard. But I gave myself permission to cry. ... And you know what, I'm happy.
"I'm so glad I went."