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JOHN HENDREN
AP National Writer

AP World Wide Photos Cheryl English, an emergency room nurse at University of Colorado Medical Center in east Denver, stands outside the emergency room amid backboards lined up outside the door Sunday, April 25, 1999. Four students who were injured during the shooting spree at Columbine High School in the southwest Denver suburb of Littleton, Colo., were treated at University. (AP Photo/David Zalubowski)

LITTLETON, Colo. (AP) -- The usually chatty paramedic spoke to no one as he entered St. Anthony's Central Hospital, still dazed and white-faced two days after the Columbine High School massacre. He hadn't slept more than two hours at a stretch.

"It's time for me to make a career change," the veteran crisis worker, hands in his pockets, told emergency room nurse Jane Cole. He's already got a lead on a new career.

Death comes with the job, but the police, surgeons and other emergency workers who tended the dead and wounded are enduring trauma unlike anything they've ever experienced. For many, it was the sheer numbers -- 15 dead, 23 wounded -- and the tender ages of the victims.

"This is the hardest thing that I've had to deal with since being a nurse," said Cheryl English, a charge nurse at University of Colorado Health Sciences Center who has tended hundreds of patients disfigured by burns and gunfights over seven years. "These kids were helpless. They were innocent. They were not involved in any gang. They weren't in a shootout. They were in a library."

For many Jefferson County sheriff's deputies, Sunday was their first day off since the rampage. Most hadn't had time to seek the crisis counseling the department offers. They were tired and still shaken by the scene of a library and cafeteria littered with slain students.

"It was so difficult for me, walking into the library," Sheriff John Stone said. "It was devastating."

One officer from a county juvenile diversion program bears an especially heavy burden, District Attorney Dave Thomas said. When gunmen Eric Harris and Dylan Klebold finished a program for troubled teens in February after being caught breaking into a van, the unidentified officer said their trouble appeared over.

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In a report recommending early release from the program, the officer wrote that Klebold was a "bright young man who has a great deal of potential" and Harris was "likely to succeed in life." Those words have haunted him since Tuesday.

"I'm very concerned about him," Thomas said of the officer. "He did the best he could, I believe."

For health care workers, the trauma often came after the patients were stabilized or declared lost. Surgeon William Pfeifer didn't have time when the patients started coming in.

After 30 years of surgery, the stress was still with him.

"I hope that never goes away," he said. "I don't want to get casual about this."

Unpleasant duties add to the stress of surgery. After the March 1998 school shooting in Jonesboro, Ark., doctors anguished over a somber task: asking desperate parents in the waiting room for photos of their children so they could tell them if their children were among the dead.

"That's one of the most cruel forms of Russian roulette I could have ever conceived," Dr. Warren Skaug later told a conference of fellow pediatricians. "There were tortured faces and churning stomachs, including mine."

Grief counselors call the experience "compassion fatigue." It can be made worse when the victims are children, said Dr. Mark Stebnicki, an Arkansas State University psychologist who counseled workers and victims in Jonesboro.

"When we experience loss in children there's the feeling of injustice: How could this happen? Who's responsible?" he said. "A lot of times that's anger coming out."

A year and several school shootings later, St. Anthony's Cole took Wednesday off. She thought about the 15-year-old boy whose bullet-scarred face and leg will always bear witness to the shootings. The flowers and faxes sent by Oklahoma City and Arkansas nurses marked the kinship of grief that workers feel. But they are also a constant reminder, as is the talk amid the din of clinking plates and coffee cups in the staff lounge.

"I don't know that anyone's ever been involved with anything like this before," said Ms. Cole, an ER nurse for 19 years. "It's just been such a sensory overload."

RELATED LINKS

• Littleton Fire Department Home Page
  
• Inside Denver.Com Extensive Coverage
  
• Shooting Victims List
  
• CNN Coverage
  
• Expanded Associated Press Coverage w/photos
  
• Yahoo! News and Information related links
  
• Denver Post story
  
• Denver Post: Incident Chronology
  
• KMGH-TV Coverage (local TV)
  
• KUSA-TV Coverage (local TV)
  
• Columbine High School Home Page
  
• Washington Post Photo Gallery
  
• Washington Post Coverage
  
• Local Gov't High School Shooting Info Page
  
• Transcript of Police/Dispatcher Transmissions
  
• Transcripts of 911 Calls
  
• USA Today Coverage