Standing in his office suite in the Murrah Building on the morning of April 19, 1995, psychologist Paul Heath, EdD, heard three sounds in 14.5 seconds: the dynamite that set the bomb off, the bomb blast, and the building coming apart.

Instantly encased in debris up to his armpits, choking on dirt and smoke, he looked over his shoulder to see that the building had fallen away eight feet behind him. From the pit that remained, a great black and orange fireball raged toward the sky.

His first thought, expressed without words and repressed for weeks, was classic bargaining with God: "I don't want to die, not today and not in this building, so if it is alright with you, I'll die later."

The Murrah Building, destroyed by terrorist Timothy McVeigh, had been Heath's workplace for 17 of the 27 years he had held "one of the rarest psychology positions that you could ever hope for"--working for the Department of Veterans' Affairs (VA) with practically unlimited resources to help disabled veterans move to suitable employment.

Heath, who for years had led popular programs for Murrah Building employees on smoking cessation, weight reduction and stress reduction, knew more than half of those killed. That ill-fated day taught him new lessons about psychology and, Heath believes, changed his very brain chemistry. "I thought I knew what post-traumatic stress disorder [PTSD] was until I got my real training on April 19," he says. "I know what it is now."

The shock, emotional turmoil and devastation that Heath has experienced since that day is so familiar to the thousands of victims, emergency workers and families whose lives were forever changed on Sept. 11 with the bombing of the World Trade Center and the Pentagon. Heath's story of survival and recovery offers a glint of hope.

Thoughts that remain

After the blast, Heath extricated himself from the rubble, scrambling over desks and computers to reach co-workers who were screaming for help. He led two injured colleagues down a stairwell and then returned to help take another out on a stretcher.

He spent the next several hours on the building periphery doing what he could: sweeping away the layers of glass that rescue workers were slipping on, hugging a young woman who was forbidden to go into the daycare center to search for her baby, comforting an older man who had been forced to leave the side of a woman trapped in the building, and yelling to people who could not get out from the upper floors to stay where they were. Images from the aftermath were seared into his memory: detached arms and legs, the body of a man that hung in a third floor window all day, and the lawn area used as a temporary morgue.

As he worked into the afternoon, he traded information with longtime acquaintances in that community where he grew up. Later he was to learn that a high school classmate whose romances he can chronicle back to the 11th grade died in the HUD office. A former client died in the Social Security office, as did the daughter of the manager of investment property he owned.

Heath's long day ended at 2:30 a.m. after he had checked on hospitalized colleagues. He was up at 5 a.m. to report to temporary offices. The VA appointed him its official spokesperson on the bombing and at times he gave multiple interviews a day. He was also the building's medical safety officer and the only survivor allowed back in after the first day. He returned to the bombed-out building twice a day for 17 days to get veterans' files and other things. He often spent evenings at co-workers' bedsides.

One particular aftershock a few days after the bombing haunted him. Heath realized something about a young veteran who had come into his offices six days before the bombing, whom he had talked to about employment for 15 to 20 minutes. The man was Timothy McVeigh.

"He was just as gentle to talk to, just a pleasant young man. I described him to the FBI as 'vanilla,'" says Heath.

"But I had horrible, horrible survivor guilt when I realized and had to report it: that I talked to him and then he came back and blew the building up."

Learning about PTSD

All employees in the building during the bombing were given an automatic diagnosis of PTSD from the federal government so they could have as much therapy as they needed over the course of their lives. Heath himself had two-and-a-half years of supportive therapy.

Heath defines PTSD as a "chemical change that takes place in the brain when you are faced with your own death or the death of somebody you care about...in an environment where you feel totally and completely helpless to prevent the death....Your brain immediately changes into a survivor mode as surely as adrenalin is pumped into your body when you are frightened."

Part of that survivor mode is the brain's constant replaying of the event to remind the person, Heath says. "Starting at the moment that the bomb went off, I had a mental video and audio of that day's experiences that played 24-hours-a-day, along with everything else I was doing."

He asserts therapists often don't recognize that for patients with PTSD, "the new experiences you have become a part of that video loop and are woven into it." Since the incident, several of Heath's friends and relatives, including two half-brothers, have died. But in terms of emotional impact, he says, "not one of those deaths came close to the deaths of the people that I witnessed the day of the bombing."

When Heath's offices were moved back downtown close to where the Murrah Building had been, the phantoms remained. "I could still smell the nitrate." It took about a week for him not to smell those odors.

He is convinced that PTSD, although it's treatable, "is not something that you get over." He points to research on Oklahoma City survivors, including himself, that showed physiological changes occur when individuals just talk about the experience.

"It is an anxiety disorder that you learn to live with in ways that don't interfere with your everyday reality in significant ways."

But he also notes that a number of the survivors, including two of the three men he rescued, have developed health problems and died.

Heath and his family have been surprised and at times disappointed that he is not the same person as before the bombing. As he threw himself into activities related to the tragedy and continued with his job at the VA, he became less family-oriented--for almost six years, he says.

He describes his need to help and to tell the story as a "channeling" of the hypervigilence that comes from anxiety related to PTSD. He has done hundreds of media interviews. He consulted on a state project for counseling survivors and on various efforts on international terrorism and eventually served on the state mental health board. He founded and helped lead the Oklahoma City Survivors Association and was on the jury that selected the architecture of the memorial.

He has also attended all the trials on behalf of the survivors. As the McVeigh execution neared, he hired an attorney and got the order for the closed-circuit television feed so survivors who wanted to could watch. Heath himself opposes the death penalty and had no desire to watch. He then arranged for the Bureau of Prisons to counsel the witnesses about what they would see.

But these days, in addition to work relating to the bombing, Heath spends more time with his family, having left the VA two years ago, after 31 years.

"I am now changed into the now me," he says. "I hasten to say that the now me is, in some respects, an improved, but changed me. But I would treasure a brief visit from the former me any day or night."