Pretending to die isn't typically part of a correctional officer's job. But when the court issues a death warrant, there's often a team that has to rehearse the execution of the prisoner. In Nevada, one of the people they practiced on was officer Catarino Escobar.

Escobar wasn't nervous when his colleagues handcuffed him and escorted him out of the holding cell. But then the officers took him into the gas chamber. About the size of a bathroom stall, the room is framed with large bay windows so people can watch from outside as prisoners take their last breaths. It was inside that space that something strange started to happen to him.

As the officers strapped Escobar down to the gurney, his vision narrowed. He yearned for his mother, then his brother. Escobar wanted his family with him, he said, because for what felt like 20 minutes, he was absolutely certain his life was over.

"I wasn't acting or playing," said Escobar. "I believed that I was being executed."

During the past 50 years, more than 1,550 death sentences have been carried out across the U.S. Hundreds of people like Escobar played a role in each of those executions, and again, hundreds of others are getting to work. Five states scheduled seven executions over the last two months of 2022 alone.

There are legal restrictions to revealing the identities of many of the workers while they're employed, and a culture of secrecy tends to keep them quiet long after they leave their posts. But NPR's investigations team spoke with 26 current and former workers who were collectively involved with more than 200 executions across 17 states and the federal death chamber. They were executioners, lawyers, correctional officers, prison spokespeople, wardens, corrections leaders, a researcher, a doctor, an engineer, a journalist and a nurse. Many are sharing their names and stories publicly for the first time.

"Nobody talked about it," said Escobar, who has never even told his family about what he did in the death chamber. "We all knew to keep it silent."

The answers the workers gave about how their jobs affected them weren't all the same — and neither were their circumstances. A few said they volunteered for the task and that it didn't bother them much. Many more of the people NPR spoke with had little choice in their involvement. Execution work was often a required part of their jobs, and it took a toll.

Most of the workers NPR interviewed reported suffering serious mental and physical repercussions. But only one person said they received any psychological support from the government to help them cope. The experience was enough to shift many of their perspectives on capital punishment. No one who NPR spoke with whose work required them to witness executions in Virginia, Nevada, Florida, California, Ohio, South Carolina, Arizona, Nebraska, Texas, Alabama, Oregon, South Dakota or Indiana expressed support for the death penalty afterward, NPR found.

It wasn't always because the workers felt the process was unfair to the prisoner. It was often because they realized it was too hard on them.

"There was more than one casualty," said Perrin Damon, a spokeswoman who helped coordinate two executions for the Oregon Department of Corrections. "More people are involved than anyone understands."

Out of sight, not mind

Ten of the people NPR interviewed never saw prisoners die in the chamber. Some didn't work behind bars at all. They were still closely involved with capital punishment.

As a public defender who advocates for people charged with murder in Florida, Allison Miller is constantly thinking about the death penalty. It looms over her and her clients as their worst case scenario. When that scenario came true last year for a man named Markeith Loyd, Miller couldn't stop blaming herself. To this day, she can't forget how her toddler wished her luck before she left home to speak with his jury.

"She said, 'I hope you save Mr. Markeith,'" Miller recalled, her voice breaking. "And then I just remember thinking, I didn't. I failed him. I failed her. I failed in this godly task that I was given."

Loyd probably won't be executed anytime soon. He was sentenced to death in March, and it typically takes people around 20 years to exhaust all their appeals and face the death chamber. But Miller is already seeing her own consequences. She recounted a range of symptoms that she attributes to trying cases like Loyd's: hair loss, insomnia, irritability, anxiety and dissociation from the world around her.

"I cannot underscore what it feels like to stand there and ask 12 people to not kill somebody," Miller said. "It broke me a lot."

Laura Briggs' job started further down the execution timeline. As a law clerk on a federal death penalty case, she had to monitor documents filed just weeks before a man was scheduled to die in Indiana. If evidence had been submitted that could have paused the process, it was her job to tell the prison in time to save his life.

During the last few days before the execution, Briggs didn't do anything that could distract her. She barely slept. She rarely ate. She didn't devote a single thought to anything but worrying that she was going to miss something, she said.

"It was just beyond acute anxiety," Briggs remembered. "It felt like being suspended in burning oil."

The anxiety was so extreme that she sensed her blood pressure rising and heard a constant, high pitched noise in her head. Before doing the work, Briggs didn't have a strong opinion about capital punishment. Now, she's firmly against it.

"It creates a situation where someone innocent could be executed," Briggs said. "There's no chance for peace with that."

Behind bars — macabre meetings and revelations

Inside the prison, workers experienced a different set of stressors as they got ready for execution day.

"People think that it would be so easy to go up and execute someone who had committed such heinous acts," said Jeanne Woodford, a warden who oversaw four executions in California's San Quentin State Prison. "But the truth is, killing a human being is hard. It should be hard."

Woodford had to speak with the person slated to die, then talk with his family to receive instructions for what to later do with his body. Afterward, she had to speak with the other family involved, too — the family of the victim.

"You just don't know what to say to people who are in so much pain," Woodford said. "And no one is sensitive to the fact that you as the warden are sitting there thinking, in 30 days, I'm going to have to go in and give the order to carry out an execution of a human being."

With that on her mind, Woodford still had to brief security personnel to prepare for protests, select officers to carry out the execution and process permissions for outsiders who wanted to attend. Then, at around midnight on the date of the execution, she gave the signal for the executioner to go ahead.

Woodford felt the effect inside her brain. She tried to be present with her family and rarely missed her children's sports games. But the memories of what she had done kept her distant and caused persistent insomnia.

"You're there, but you're not really there," she said. "You realize that you're suffering from post-traumatic stress."

Farther north, in Oregon, Corrections Superintendent Frank Thompson watched staff suffer similar consequences as the state prepared to carry out its first two executions in more than 30 years.

Shortly after the U.S. Supreme Court banned the death penalty across the country in 1972, the court changed its mind. In 1976, it decided to leave it up to the states to decide whether and when they'd bring capital punishment back. Some states never did. Others, like Oregon, waited decades to do it. That meant many workers who started their jobs in prison when executions were off the table suddenly found themselves required to perform tasks they never expected.

It also meant employees in Oregon had to make much of what they needed to execute someone from scratch. They sourced the cart the gurney rolled on from a hospital and the arm and leg straps they attached to it from another state. Then they tried to anticipate every edge case of what could go wrong. Damon, the spokeswoman, said she even flew above the prison in a plane to spot security vulnerabilities from a bird's eye view.

The pressure of trying to ensure there would be no mistakes despite the staff's inexperience affected the psyches of everyone involved, Thompson remembered. Those at the highest levels of power — like the governor, who later issued a moratorium forbidding more executions during his term — were not exempt.

"We had to get the 'OK' directly from him before I gave the instruction to proceed with the execution, so he's very much a part of it," the superintendent said. "All of us had negative results."

Like the law clerk, that changed his opinion on the death penalty. Thompson grew up in the segregated South and remembers when two white men tortured and lynched 14-year-old Emmett Till in Mississippi. He used to believe that people who did things like that could deserve to die. But after seeing how preparing to carry out executions took a toll on staff, Thompson came to believe the workers didn't deserve to have to be the ones to do it.

"All of that was on our shoulders," he said. "My shoulders."

All of that, and the workers still hadn't seen the execution itself. Those that did told NPR their jobs were just as challenging.

Inside the death chamber

Nobody in the death chamber had expected Pedro Medina's head to catch fire. Like the electrician at Florida State Prison had done dozens of times before, on that day in 1997, he had soaked a sponge with saline before applying it to the top of Medina's scalp, to help conduct electricity and avoid a spark. But after the flames started rising around Medina's face, something had to be decided. Behind the secret curtain that hid the staff from view, the electrician looked to the warden, Ron McAndrew, for instruction: Should he stop the machine of the electric chair, or not?

"Once the smoke and the fire came out of the helmet, of course, there was no turning back," McAndrew said. "It was awful."

McAndrew said the stress of witnessing that execution and seven others caused his fingers and heels to crack and drove him to drink a bottle of scotch a day. It's been 25 years since the death chamber filled with the smell of a man burning. Though he couldn't stop Medina's execution after it started, he still feels responsible for what happened.

Bill Breeden felt a similar kind of guilt. In 2021, Breeden traveled to the federal chamber in Indiana to pray before Corey Johnson's execution, as his religious minister. Seven minutes after Johnson was injected with the drug that was supposed to kill him, the minister heard Johnson speak up from the gurney.

"He said, 'I feel my mouth and my hands are on fire,'" Breeden said. The prisoner was still alive.

For months afterward, Breeden became claustrophobic and would start crying randomly in the middle of conversations. He was haunted by nightmares that took him back to the moment when he heard Johnson's voice. Breeden didn't work for the government, but he still felt complicit in the death he hadn't been able to prevent.

"You kind of get this feeling of 'well, I'm validating this process,'" he said.

For Craig Baxley, that feeling was inescapable. Baxley executed 10 people for the state of South Carolina. Although at least two executioners were supposed to share the task of pushing the drugs into people's veins, because of frequent staffing shortages, he was often the only one left with the job, he said. Until recently, he thought about suicide.

"Every single one of the death certificates says state-assisted homicide," Baxley said. "And the state was me."

Dr. Joseph Currier is a psychology professor at the University of South Alabama who studies military trauma. He said that having to take someone else's life is the highest predictor of most mental health problems among veterans.

"They think about it again and again and again, and then over time there's this profound sense of shame or guilt that begins to emerge for people," he said.

But there's a difference between servicemen who kill for the government in warzones and execution workers who do it at home. Veterans have access to free, lifelong health care through the Department of Veterans Affairs. Execution workers have no comparable support system. Although his job and his suffering were serious, Baxley never received counseling to discuss what he was going through while he was executing people for the state of South Carolina. He wasn't alone. Only one of the 26 people NPR interviewed across the country said they received psychological support from the government to help them through the process of working on executions.

Dr. Caterina Spinaris, a psychologist whose practice in Colorado focuses on correctional officers, believes that's dangerous. The kind of trauma that can result from taking another human being's life is an occupational hazard that can cause serious damage if workers aren't protected, she said.

"Think of radiation," Spinaris said. "You wouldn't send people to deal with radiation without the appropriate suits on."

But of the five states that scheduled executions before the end of 2022 — Alabama, Oklahoma, Arizona, Missouri and Texas — none have the kind of support system in place that psychologists and former workers recommend, NPR found.

Quick fixes for long-term problems

What each of the states confirmed they do have are basic Employee Assistance Programs, or EAPs. Those programs provide workers with a handful of free counseling sessions before referring people to pay out of pocket if they want more.

They serve a need, Spinaris indicated, just not this one. Because they're only available to staff, the EAPs do not provide help to execution workers who aren't state employees, like religious ministers. And they're not designed to treat complex problems such as the trauma involved with execution work, she said.

"If somebody has a serious issue like post-traumatic issues, they say, yep, doesn't cover that because EAP cannot fix it," Spinaris said. "They don't run very deep."

Representatives from Missouri, Texas and Arizona said their corrections departments also have trained teams of counselors that can help workers during some crises in prisons, like riots or hostage situations. But when NPR asked whether the team in Texas attends to staff during executions, a spokeswoman for the Department of Criminal Justice confirmed it does not. And like the EAP programs, the services are mostly optional.

That's part of the problem, former execution workers said. Because any assistance offered to them while they were working on executions was also overwhelmingly optional, many of them avoided asking for it so as not to seem weak. Not much seems to have changed. A current execution worker in Missouri told NPR that though he knows about the trauma-trained team there, he's choosing not to seek the help.

Spinaris recommended that basic support be mandatory for everyone involved with executions. At the very least, workers should be prepared in advance for the tasks ahead, provided with immediate assistance following the execution itself and then required to attend counseling for some time afterward, she said. Currier, the psychologist from Alabama who studies veterans, agreed that execution work could be considered an occupational hazard and that the government has a responsibility to make sure that workers who participate are cared for.

But like others NPR spoke with, Holly Sox believes the right solution is to do away with the death penalty. Sox understands why people support the policy. She used to be one of its advocates too, until her father, a prison nurse, worked on his first execution in South Carolina.

That night, after the electric chair was turned on, it was he who had to place his stethoscope over his patient's heart and listen until it stopped beating. Afterward, it was Sox's mother who struggled to communicate with him when he grew withdrawn and unrecognizable at home. And it was Sox and her sister who could only watch as their father chose to do the job again and again during the state's next executions, in order to protect another employee from also having to suffer, he told them.

The idea of capital punishment looks good on paper, Sox said, but in practice, the damage it causes families like hers isn't worth it.

"Nobody stops to think, somebody has to carry it out," she said. "Somebody has to be the one."

The audio for this story was produced by Meg Anderson and Monika Evstatieva; edited by Barrie Hardymon and Robert Little; photo editing by Emily Bogle; and graphic editing by Nick Underwood.

Were you involved in any way with preparing for executions scheduled this year, like those in Arizona, Alabama, Texas or Oklahoma? Are you involved with any executions soon to happen, like those in Missouri or Idaho, or know anyone who might be? We want to hear about your experience. Your name will not be used without your consent, and you can remain anonymous. Please consider reaching out to NPR by clicking this link.