In the aftermath of the Haiti earthquake, Howard Kessler boarded a plane with a group of volunteers offering medical assistance to earthquake survivors.

A week later, on the flight back home, Kessler got the first inkling of the emotional impact of his experience in Haiti as he was reading e-mails on his BlackBerry, and a message from an acquaintance praising him for his efforts made his eyes well with tears.

Later, unable to finish a telephone interview with a reporter because he kept being overwhelmed with emotions, Kessler said he realized he had some feelings he needed to deal with. He took a couple of days off with wife Anne Van Meter and they hiked in the woods and relaxed.

Kessler, of Panacea, is a retired orthopedic surgeon who has kept his medical license up-to-date. Thirty-five years ago, Kessler attended medical school in the Dominican Republic – on the other side of the island of Hispaniola.

Sitting in his office in the county commission complex after his trip, Kessler says that friend Tony Cartlidge contacted him and said he should have warned him of the emotional reaction to coming home. Cartlidge, a Vietnam vet, told Kessler that while you’re in that environment, you’re busy, you’re focusing on what you have to do.

It’s later, he said, that the emotions of what you’ve experienced start bubbling out.

Sitting at a Mac iBook, Kessler scrolls through some digital photos from his trip. He’s an inveterate photographer, snapping pictures all the time, and says he’s surprised at how few photos he took on the trip. He has some photographs of the injuries he treated – crushed legs and other injuries of people pulled from the rubble – but no faces. He could not bring himself to take pictures of their faces.

People suffered extreme injuries and had extreme infections: compound fractures with bones protruding through the skin. Kessler notes that, without treatment, these people faced osteomyelitis (bone infection) or overwhelming sepsis (where bacterial infection moves into the blood) – and ultimately death. For the surgeons, the response was to amputate.But that also required convincing the patients to go along with the surgery, Kessler said. The doctors and nurses tried to communicate with the patients through translators that they absolutely needed the surgery.

“I would have liked to have been in the operating room about 10 times more than I was,” Kessler says. But he recalled meeting with patients and their families, spending an hour trying to convince them to have the surgery, to have them agree to go ahead and them back out at the last moment.

Kessler shared a photo he took of a patient’s foot, and a picture of the man’s X-ray showing multiple fractures.

“He was a young fellow. Nice, and he was bright,” he says. “But he just couldn’t understand why he needed the surgery.” He could still wiggle his toes, Kessler said, and so couldn’t understand why the doctors wanted to cut off his foot.

“You can’t get them to understand that in 24 to 36 hours they’re going to be dead,” he says.

He stared at the photo on the computer screen for a moment and says in a moment of realization: “That man is probably dead now. If he didn’t get treatment, he’s dead.”

There’s the taxing experience of trying to convince a mother than her 2-year-old daughter needs her leg amputated.

The faces are etched in his mind, he says, such as the mother trying to make that decision for her child.

He was frustrated for the first couple of days with the team stuck at the airport at Port-au-Prince. Because of concerns about increasing unrest, the United Nations was unable to assure their security. They did eventually get an escort to get them to a hospital in the town of Saint Marc, about two hours from Port-au-Prince, and were able to spend four or five days there.

The surgical teams were performing basic guillotine amputations – that is, cutting limbs without leaving flaps of skin to cover the stump.

As he was leaving Haiti, other surgeons were coming in. One, a surgeon from San Francisco who was in Vietnam, asked Kessler: “Just guillotine amps, right?”

“It was military medicine, disaster medicine,” Kessler says. “Trying to save as many people as you can.”