28/04/2016 6:30 AM AEST | Updated 23/11/2016 6:14 PM AEDT

Port Arthur Massacre: What We Can All Learn From 20 Years Of Intense Grief

Fairfax: Rick Stevens

The phone starts ringing as soon as Dr Stephen Wilkinson walks through the door. It's a Sunday afternoon, but not a slow one. He's just returned home from the fourth and final day of the hospital's new trauma protocol training program. He answers. Less than a minute later, he's at the wheel again.

But his mind is barely on the road. It's with the dozens of people about to come into the Royal Hobart Hospital, where he's the Head of Surgery. The dozens of faces, the dozens of names. The one face and name he's dreading coming across.

For five hours Wilkinson operates on the injured coming in from the Port Arthur Historic Site, where a lone gunman has just committed the worst mass killing in Australia's history. For five hours he waits to see the face he doesn't want to see, the name he can't bear to hear, as he continues tending to the operating table.

And then, finally, he gets the call. But this time, relief. His son's Sunday plans fell through; he never made the trip down to Port Arthur.

He is safe.

A sigh of relief, then his sterilised and now steady hands get back to work, operating for another 12 hours.

The brand new trauma protocol is a complete success. But no training, no matter how recent or revolutionary, could prepare Wilkinson for what came next: endlessly reflecting on the "mess" he'd cleaned up, and the wait he'd endured to hear from his son.

"Some people got over it and moved on, and some people sort of carry the scars," Wilkinson tells The Huffington Post Australia.

Burying himself deeper and deeper into the profession is Wilkinson's answer, but it doesn't really help, "it just hides it".

"I have this tendency to bury stuff. It'll all burst out of me one day," he says.

Then, almost as if on cue, as he sits in his office covered with so many certificates you can barely see the colour of the walls, the surgeon of 40 years crumples into a heap.

Between tears he apologises, because this tragedy nearly 20 years in hindsight isn't about him. This is about the victims, about their families; "it's best I was forgotten".

"Maybe I should have got the counselling," he says, with a laugh. And then, a guilty shift in his gaze.

"I'll just bury myself in work this afternoon."

Dr. Stephen Wilkinson in 1997 while he was still the Head of Surgery at The Royal Hobart Hospital.

Opposite the Royal Hobart Hospital is the local newspaper, The Mercury. Leigh Winburn followed his father into the business as a photographer.

It was a Sunday afternoon on April 28, 1996 and Winburn was collecting firewood with his brother. As they drove home, they saw a helicopter, then heard sirens, and then news of a shooting came across the radio waves. Soon Winburn arrived home to a full answering machine. He quickly rushed to the office.

He spent the next two weeks capturing the heartache of the massacre, from the little Mikac girls laying beside a tree -- where only a couple of blankets covered the lifelessness -- to Walter Mikac walking down the steps of St David's Cathedral at the memorial, held up by two grown men as he came to terms with a life without his babies, a life without his wife.

Winburn had too many tears in his eyes to see whether he had captured a good photo of Mikac. He just kept clicking. When he returned to the office, he couldn't bear to look at the negatives, hiding them in a drawer.

It wasn't until an editor demanded to see every negative that Winburn realised he got the shot. His best shot. It was splashed across the front page of every News Limited paper in the country the next day.

A little like the photo, he hid his pain from his family and kept the drawer shut for months.

It took him 12 months to break down.

"You tend just to work your way through it but not without some damage emotionally," Winburn told HuffPost Australia.

"The ones that you love can be the ones that carry the burden, and that's the painful lesson you hopefully don't have to learn again -- is to put them first and foremost. Thinking you're being brave is far from the right path to take.

"Nobody's bulletproof emotionally like that."

May 1, 1996: Walter Mikac leaves the memorial service at St David's Cathedral in Hobart.

The emotional scars of trauma usually manifest in four ways: avoidance, intrusion, hyperarousal and negative thoughts.

Avoidance, whether it be someone burying themselves in work, hiding a photo or shutting off completely is so common because it's often a necessary coping mechanism in the aftermath of a tragedy.

"Sometimes when we can't cope with something our brain will shut down for us, like a protective factor," said Dr Jill Crookes, a counselling psychologist specialising in grief.

"You'll often hear people say, 'There's something wrong with them. They're not grieving.' In the immediate aftermath it's not so strange. It's quite normal. But that can only last so long."

When the grief finally hits, the "singular most important factor" is the support network a person has.

"It's the response from people around you that determines your recovery," Crookes said.

The recovery from trauma differs from grief. It's often more severe, more prevalent, more long-lasting.

"The brain is a very logical, rational, organised thing. It loves to understand. But with Port Arthur there are so many unanswered questions and things that we'll never understand and we don't like that. Human beings don't like that," Crookes said.

"So you've got all of that layered upon the grief."

Martin Bryant opened fire at the Port Arthur Historic Site on April 28, 1996.

Only in the past couple of years has Anita Bingham been able to vacuum her house, or any house for that matter, without looking over her shoulder. As 20 people were gunned down in the Broad Arrow Café on April 28, 1996, Bingham was serving soup in the tea rooms next door. Just a 17-year-old working her part-time job. As the rampage continued, as people ducked and hid under the windows, she kept serving water and tea. Back and forth, back and forth. Because that's what she was told to do.

And when people were allowed to leave the café, traumatised and hydrated, Bingham cleaned up. Because that's what she was told to do. Like it was the end of a regular shift. A regular day.

"The vacuuming was quite traumatic for me that day because I had to go in and out of rooms and I didn't know where the gunman was at the time, and I was there by myself," Bingham told HuffPost Australia.

She was awarded a bravery medal by the Governor-General. She has a letter from the Queen. She keeps them hidden away in the drawer.

For a long time she jumped whenever a car backfired. Only now is she able to begin reading the stories of other people from that day. It's always been too hard for her to revisit.

While the trauma from the day fades as the years go by, the resentment towards the gunman remains. But for Peter Crosswell, not so much.

"I used to think that someone should get a gun and shoot Bryant in the head, now I couldn't care less. He doesn't exist in my world so I guess that's where the change has happened," Crosswell said.

When Bingham was serving soup that afternoon, Peter Crosswell jumped in front of the two women he took to the Broad Arrow Café that morning. All three survived the hailing bullets.

But Crosswell battled post-traumatic stress for at least three years, suffered a bitter marriage breakdown, and eventually found love again. That was his turning point.

His wife, Jane, was "the best thing to come out of Port Arthur". She suffered her own grief over the sudden death of her former husband and then, months later, a child with whom she worked at Camp Quality.

The late Queen Mother once said "grief doesn't get any easier, you just get better at it". It's a line Crookes likes to borrow.

"I think that's a really correct statement. You get better at it. When you think about parents who bury a child, you never ever recover from that, you just get better at living with the fact," Crookes said.

"Still 20 years on there are questions none of us will know the answer to. Eventually your brain says 'You need to stop asking that question because you're not getting an answer'. So mostly people do resolve it."

May 27, 1997: Melbourne sisters, Jessica and Tiffany Bass, pay tribute to the victims of the Port Arthur Massacre.

And to "resolve it" doesn't mean never asking the question again, but asking it less and less, until eventually it fades from an everyday occurrence to a sporadic reflection.

"Really, it's part of my life. I just change the way I think about it, the way I use it," Crosswell said.

Helping other people cope with their own loss has helped Crosswell. Whether that be the loss of a child with Camp Quality, preventing the loss of a life with Lifeline or helping the elderly cope with losing just part of the life they once knew.

The trauma has made Bingham want to live more. She has travelled and worked around the world, to eventually come full circle, back to Port Arthur. She's just purchased her first home there. It's quaint, the water's close and if the wind is still you can hear a pin drop from the balcony.

While Crosswell and Bingham both battled post-traumatic stress from Port Arthur, they came out of it with post-traumatic growth. It's not spoken about often, but sometimes "people build profoundly different and successful lives because of the grief," Crookes said.

Leigh Winburn went on to become a manager at The Mercury. After 12 months of bitterness, resentment and mood swings, the aftermath of Port Arthur only made him more compassionate. But now he's getting used to retirement in his home just outside of Hobart, where the sea almost runs up to his doorstep. And that photo has grown on him. He's proud of it.

Wilkinson feels like he owes another two decades to his profession. His grief is a set of ping pong balls lying beneath the surface. One pops up when he least expects it, but these days they're rising to the surface less frequently.

Crosswell said Port Arthur was the moment he began to see the world differently. Before, he was like a 16-year-old surfer trying to catch a 35-foot wave.

"He's not vulnerable, or he doesn't think he is. I think in our youth, we don't see ourselves as being vulnerable, but we are," Crosswell said.

"I think the impact of Port Arthur, of how it happened and what happened, that made me aware of how vulnerable we, as humans, really are. Because we rely so much on others doing the right thing, and being supportive of us. And this was tragically the opposite."

The Reflections Pool at the Port Arthur Historic Site commemorates those affected by the Port Arthur Massacre.

Grief touches everyone at some point in their lives. Despite this, we're still very much a society that denies grief. A 'fix it' society. But you can't bring someone's wife, husband or child back. You can't press rewind.

"We don't have the skills to know how to support someone who is grieving," Crookes said.

"We are stuck for words. What we don't realise is we don't need words. Just sitting with someone in silence is enough. It says 'I can be with you in that pain, that deep, horrific pain. It's not scaring me'.

"And that helps people, in a way, realise their pain is somehow tolerable."

Video by Emily Verdouw and Emily Brooks

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