Chuck Picone never expected it to hit him this hard. After all, he's seen death before. He's not a rookie. It's nothing new to him.
But Picone, 31, an emergency medical technician, is learning the hard way this week that his experiences working at the World Trade Center disaster are not going to fade away easily.
He hasn't been sleeping. His appetite is gone. And that's not the worst of it.
"The smell is burned into my head," said Picone. "It smelled like death -- death and chaos. Think of your worst nightmare and multiply it by 10."
Picone is not alone. Dozens of men and women from Western New York went to New York City to pitch in with rescue operations following the destruction of the World Trade Center -- and many say they are now having problems slipping back into normal, everyday life.
"Being a firefighter, you're kind of trained to expect it. But not to this scope," said Dale Bless, 31, a hazardous materials specialist with the Buffalo Fire Department who returned from duty in New York on Sunday.
What is the price local men and women paid for serving at the scene of mass devastation?
Peace of mind, they say. And that might not change for quite a while.
Experts say that Western New Yorkers who rushed to the scene of the World Trade Center to help with search-and-rescue efforts can expect to face a "post-trauma response" that could take a few weeks to fade. The symptoms could include:
Difficulty sleeping for more than a few hours at a time.
Nightmares about the scene of the tragedy.
Jitteriness and restlessness.
Loss of appetite.
The problems will likely fade away over the course of the next few weeks, said Dr. Gayle Beck, a clinical psychologist at the University at Buffalo. If they don't, she said, it's time to get help.
"It's important to realize that most of us are pretty resilient when it comes to traumatic events," said Beck, who works with victims of serious car crashes. "But the one hard and fast rule is, if this is continuing a month from now, they should not just think it's going to go away. It's time to get professional help."
For Stephanie Koren, 25, the worst experience of her career as a paramedic up to now had been working at the scene of the horrific car accident on the Kensington Expressway, at the interchange with the Scajaquada, where six people died. Koren responded to the scene and found that five of the victims were people she knew -- classmates of hers from Lancaster High School.
Now, Koren has an even more traumatic experience to deal with -- her "one continuous shift" of 20 hours at ground zero of the trade center disaster site.
"I'm either dreaming about it or I'm getting up every few hours because I'm frustrated about it," said Koren. "I'm not getting as much sleep as I should. I'm more short-fused, a little on edge."
Koren, who like Picone works for Rural/Metro Medical Services, said she is finding some relief in exercise.
"Running helps me. It helps me relieve my stress," she said.
Jack Regan, a Buffalo firefighter for 11 years, said he has nightmares about the disaster when he tries to sleep.
"I probably woke up six or seven times last night," said Regan, a hazardous materials specialist who spent three days digging through the rubble of the World Trade Center.
Regan said he feels better when he talks to his fellow firefighters about the experience.
"What helps a lot is, the guys we went down with, just talking with them," he said. "It helps a lot to get it out."
Bless, the Buffalo hazmat specialist, said he knew a few of the firefighters killed in the World Trade Center disaster -- New York City firefighters he met at training seminars. He said he tries not to think about that.
"I try to keep busy. I try to spend time with my girlfriend, my parents, my family," Bless said.
At Rural/Metro, paramedics and emergency medical personnel have access to a full range of stress debriefing and one-on-one counseling options, some on a 24-hour basis, said Michael Hughes, a spokesman for the medical service.
"It's a way to piece yourself together mentally," said Hughes.
Beck, the UB psychologist, said coping mechanisms like exercise, talking to others, and relaxing with family are generally good and might be effective, depending on the individual.
What also helps, she said, is turning off the television news.
"Turn off CNN, NBC, Fox News. Repeated exposure to visuals of the crash scenes is not going to be helpful," Beck said. "You saw enough."