GREENSBURG — Right after the tornado wiped out his town, 11-year-old J.D. Colclazier heard screams over his father's emergency radio. It was another father yelling into his emergency radio: "My kids are pinned! I need help now!"
When the screaming stopped, J.D. asked, "Does that mean they're dead?"
"No, that means there's help on the way," John Colclazier said, partly to reassure his son.
John doesn't know whether J.D. suffered psychological trauma when he heard the cries for help, but he is certain his son will never forget it.
Five weeks after the tornado hit, the psychological fallout has only reached the early stages. It will take several months or longer for the most severe cases -- including post-traumatic stress disorder -- to manifest themselves, mental health officials say.
One official expects that the number of PTSD cases could be higher than normal because the tornado uprooted a community whose residents were so deeply rooted.
Around Greensburg, tornado stress is showing, residents and health professionals say.
There's the 3-year-old, so terrified that it took three hours of coaxing to get her to leave her sanctuary under a bed when a storm blew through days after the tornado.
There's the elderly, vibrant woman whose short-term memory is so diminished, she wonders whether she is now suffering from Alzheimer's.
There's the 32-year-old sheriff's deputy who helped save lives but now feels survivor guilt.
There's the woman who worries because her husband is drinking more than ever.
There's the dispatcher -- who stayed so calm as she handled emergency communications the night of the tornado -- who has had three anxiety attacks at home, triggered by storms.
And there's 6-year-old Bailey Burns, son of Kiowa County Undersheriff Tom Burns, who won't let go of two donated toys because he fears they will blow away, as all of his other toys did the night of tornado.
In the short term, some people have taken advantage of free crisis counseling, provided through state and federal agencies.
But some health officials and professionals worry that months from now there might not be enough government assistance, insurance coverage or money in tornado victims' bank accounts to treat the most severe cases, which could require costly inpatient treatment and years of therapy. As with many small towns, incomes are limited, and even a $75 co-payment for outpatient care can be an obstacle.
In a recent interview, an Eagle reporter asked Greensburg's new mayor, John Janssen, what kind of assistance the town still needs.
"I think some of them need counseling, and that's not a popular thing in a small, rural community," Janssen said. "They don't want to share their feelings.
"It's post-traumatic stress... that's what it is for a lot of these folks."
The night of May 4, Bill Odle, a Kiowa County deputy sheriff and storm-spotter, used his fire radio frequency to call in one of the first warnings, which helped lead to tornado sirens being set off in Greensburg.
After the storm hit, Odle felt desperate to get to his children and check on them. He would later learn they were OK. But before he could reach them, he had to stop and assist others. He heard people screaming and saw dazed people creeping out of the rubble.
"It was just like a zombie movie," he said. "People didn't know what to do. They were lost."
He saw a puddle of blood.
He saw a body.
During the house-to-house search-and-rescue, he heard a rumor that a 2-year-old was missing. As he spotted children's toys scattered and soaked, he wanted to cry.
Although he had helped warn people, he felt what experts call survivor guilt. He second-guessed himself.
"What more did I need to do to protect these people?" he asked himself.
He went 36 hours without sleep.
He tried to prepare people at the shelter in Haviland for what they would see when they drove back into town the first time after being evacuated.
"Prepare yourself for the worst you can ever imagine," he told them.
Later, he went to shop in Pratt but felt out of place.
The abnormal state in Greensburg had started to seem normal to him.
For two weeks after the storm, his memory was shot. He would see people he had known for years, but he couldn't remember their names.
One night he bolted awake, thinking he was hearing a tornado siren.
But it was only the whine of an oscillating fan.
Help close to home
Greensburg is fortunate because one of the state's community mental health centers -- Iroquois Center for Human Development -- is located in town, and the four-year-old building is one of the few that survived the tornado.
Still, the center suffered heavy losses: Three of the 10 people killed by the storm were center clients, and 30 staff members lost homes.
Partly because the center is still recovering, community mental health counselors from around the state have been sent to Greensburg. Residents can contact them at a tent outside the damaged courthouse.
In coming months, Iroquois Center expects to see patients with serious mental health problems, said executive director Sheldon Carpenter.
"There's going to be plenty of PTSD... and you're not going to see that for three to six months," he said. "For some, it's going to be later than that."
Although with some disasters only 2 to 3 percent of the victims develop full-blown PTSD, Carpenter expects double that rate -- 4 to 6 percent, or 60 to 90 people from Greensburg or surrounding farms. He expects the incidence to be higher because so many affected by the tornado have deep ties to their community, ties that have been severed by the destruction.
Part of the challenge for mental health professionals is getting people to realize that they are not crazy or weak because they feel stressed, Carpenter said.
"Mental health services are no different than going to the doctor because... you have a heart condition," he said.
"You need to treat it just like you have any physical condition." And the sooner, the better, he said.
Even people whose job it is to manage stressful situations are having a tough time. Alicia Daniels, a Kiowa County dispatcher who handled the urgent emergency communications the night of the tornado, who activated warning sirens that saved lives, said she has had three anxiety attacks at her home in Mullinville.
"Just a little bit of wind scares me now," said Daniels, 22.
"I seriously thought I would have no problem with it."
When she feels anxious, she tries to calm herself. "I tell myself it will get better the next day."
The cost of care
Treating people's mental health conditions won't be cheap.
Some victims could end up with dual diagnoses of PTSD and substance abuse that are triggered by the tornado, Carpenter said. Those kinds of cases could involve inpatient treatment costing roughly $20,000 a person, he said.
Although Medicaid and other government assistance will help, it likely won't cover the full cost. Some of the victims can expect to pay for their treatment based on a sliding scale. Relatively few residents have job benefits covering extensive treatment, Carpenter said.
The state sought an intermediate mental health grant of $237,000 from the Federal Emergency Management Agency, said Abbie Hodgson, spokeswoman with the state Department of Social and Rehabilitation Services. The state agency expects the federal government to provide about $200,000.
Although the expected funding will be less than requested, she said, "I think we feel at the present time that's a workable number.... I think we feel strongly that FEMA has been available and responsive to our needs and requests."
A long-term grant proposal, not yet submitted, would seek free counseling for up to nine months. After that, the state could seek extended federal aid.
Hodgson didn't think that federal aid would cover intensive care like long-term therapy or inpatient care. State programs could cover some substance-abuse treatment or inpatient care, depending on the person's income, she said.
Early signs of stress
Some signs of tornado stress are appearing at a tent hospital in Greensburg providing temporary quarters for Kiowa County Memorial Hospital; the tornado destroyed the building.
"We're seeing people who haven't slept in a number of days," said Nancy Kisner, a physician assistant who works at the hospital.
Some patients feel angry or anxious but aren't sure why, Kisner said.
Even those who have good insurance coverage and feel fortunate in many ways "still feel insecure in general," she said.
The hospital has dispensed sleep aids and anti-depressants and steered people to counseling, although some patients "want to think they can cope without any help," Kisner said.
She's concerned that some people could be abusing narcotics or alcohol as they try to cope. She heard from a woman who said her husband is drinking "a lot more than he ever has."
"I'm also hearing of a lot of people who are going to counselors, who have never been to a counselor before in their lives," Kisner said.
But she worries that there might not be enough assistance to treat mental health in the long term. She's hoping some psychologists might volunteer their services.
The hospital staff tries to check on people's medical health with subtle questions like, "How are you sleeping?" and, "How's your appetite?"
Some children have become hypersensitive to storm activity. One patient told her that her daughter crawled under a bed during a recent storm. The girl was crying, shaking.
"They couldn't rationalize with her," Kisner said. "She was terrified."
Although children can be resilient, Kisner said, "the people least equipped to cope... are the children."
Before the storm hit Greensburg, about 250 children lived there.
How parents respond to the stress will determine how their children fare mentally, said Briana Nelson Goff, an associate professor of marriage and family therapy at Kansas State University who directs a program providing counselors for major disasters, including the Greensburg tornado.
Parents can't effectively help their children, Goff said, unless they keep themselves mentally healthy and seek help if they need it.
The scope of the mental stress shouldn't be underestimated, Goff said. Some victims could be dealing with the mental trauma for the rest of their lives, but in many cases it won't be debilitating.
Still, she said, "It's going to be a memory forever."
And the tornado affects many more people indirectly. Relatives and friends who have taken in displaced residents and aid workers dispatched to Greensburg also can be affected by the stress, Goff said. She calls it "compassion fatigue or secondary trauma."
A child's perspective
John Colclazier, the 57-year-old Greensburg volunteer firefighter and former emergency medical technician, agreed to let his children talk with a reporter about their experiences after the tornado so people would understand what the children of Greensburg are enduring.
At a picnic table, with his father listening, J.D., the 11-year-old, said he still has a hard time fathoming what happened.
"I'm thinking, 'How could a tornado that big hit Greensburg?' "
When he peered at the smashed remains of his school, he looked for the hallway where he might have gone during a drill, or during the real thing. The hall was full of debris.
"It kind of spooked me," J.D. said.
"If school was in session, I can't even imagine how many kids would have died."
He has a hard time accepting that he can't return to his house, a ranch-style built in the early 1960s. It sustained so much damage it can't be salvaged.
"I've been living in that house my entire life -- that's where I grew up," J.D. said.
Part of his security now is his half-beagle, half-pug puppy named Sophie.
His parents will seek counseling for J.D. if they think it's necessary.
"There should be no stigma to counseling," his father said.
From family lore, J.D. knows that his ties to Greensburg run deep. His great-great-grandfather, another John Colclazier, settled in Kiowa County and on Christmas Day 1885 plowed a "fire guard" to protect his sod house from prairie fires. That same ancestor used mules to haul rock that would line the Big Well, Greensburg's tourist attraction.
Separated from friends
The night the tornado hit, J.D.' s 15-year-old sister, Maci, was in Salina with her school's forensics team, staying at a hotel for the state tournament. She's a straight-A student who plays the clarinet.
She called her father at 9:47 p.m., but he couldn't talk long. He was busy taking shelter.
In the next few hours, she and the other students learned much about the tornado from TV news reports. She remembers seeing three words running across the bottom of the TV screen: "Greensburg" and "direct hit."
Early that morning, she heard that 60 percent of the town was damaged. The destruction would later be put at 95 percent.
As the teens found out, long-distance, how wide the damage was, they began to cry and hug one another. It didn't matter that some of them had fought with each other in the past.
Maci fell asleep about 5 a.m. and slept only two hours. That night and morning is "kind of a big blur," she said.
"It was kind of overwhelming being there at the hotel, knowing that might be the last time everybody's together," she said, choking up.
She again tried to suppress tears as she explained how her friends are now scattered to temporary homes in Mullinville, Kinsley, Bucklin, Pratt and Coldwater. She's staying near Mullinville.
She maintains contact with friends through text-messaging.
This summer before her sophomore year, she worries that some of her friends might attend other schools next fall.
She's not sure whether she will seek professional counseling. In many ways, she said, her friends are her counselors because they can relate to one another.
"People just need to be around people," Maci said.