They go with the territory for first responders.
What often comes later, unexpectedly, are mental health issues.
“You’re dealing with traumatic stuff and the worst days of people’s lives over and over and over again,” says Detective Jack Schaeffer, vice president of the San Diego Police Officers Assn. “And you feel it.”
Do first responders come forward with their troubling memories? Do enough get help? Or do they just keep to themselves, rather than be thought of as weak?
Public safety jobs can take quite a toll on people -- mentally as well as physically.
Sometimes the mental toll really doesn't get accounted for.
For police officers and sheriff's deputies, lifeguards, medics and nurses, there's no shortage of events that can leave impressions that are hard on the heart and mind.
There's a risk to letting them fester.
"I think that a lot of us just learn how to compartmentalize things, put things away,” Schaeffer told NBC 7 in an interview Wednesday. “You have to deal with things in the moment. You have to react and respond to crises and stuff."
But down the road, what can't be compartmentalized -- or hasn't been -- may get in the way of long-term coping.
In a just-released, nationwide Harris Poll survey of more than 2,000 first responders, crafted by the University of Phoenix, 85 percent reported mental health symptoms.
One-third reported actual diagnoses of depression or PTSD.
Seven out of ten said mental health services are "seldom or never utilized" by their organizations.
Four out of ten cited "repercussions for seeking help at work".
That's hard to imagine among big-city law enforcement departments, where "wellness" programs are common -- and confidential.
But it's not hard to imagine that some first responders don't want it widely known that they have gone into counseling.
Mental health professionals see that as plainly unhealthy.
They prescribe treatment before problems lead to deep depression or destructive behavior.
“It's really to be expected that you're going to need some kind of intervention,” says psychologist Barbara Burt, social sciences director at the University of Phoenix’s San Diego campus.
“After all, when somebody has ongoing physical trauma, you send them to a physical therapist or a physician, and they get some help."
San Diego's police and fire departments are praised for doing more with fewer people than other big cities put in the field.
But the rank-and-file first responders who have spoken with NBC 7 over the years say understaffing adds to stress levels -- and the number of traumatic incidents they deal with.