After witnessing the havoc Hurricane Helene wreaked on Asheville, North Carolina, Shirley Rotolo, 55, died unexpectedly from a suspected heart attack in her home just north of the city that is still without power and water.

In the early morning on Sept. 28, Rotolo died in her son Ulisse’s arms after her family could not call for emergency medical services because they did not have cell service. The day before, she saw the destruction the storm left behind in her hometown when trying to find groceries. Her daughter Nausica described the last 10 days as a “nightmare” and “pure hell” as she attempts to plan a funeral from a Raleigh Airbnb.

“My mother loved Asheville. She always said it was the place where she had the most friends. She loved her job there. She was happy there and I think it was just overwhelming for her,” Nausica said. “I strongly believe that if this hurricane had not happened that my mother would still be here.” 

The Rotolos are one of many families grieving the loss of loved ones, homes, businesses and the natural landscape of the Appalachian Mountains that are considered sacred to the state’s residents and were forever changed by the hurricane.

Costs to repair damage from Helene, which first hit Florida as a Category 4 hurricane on Sept. 26, are estimated to surpass $30 billion. On Saturday, the USA TODAY Network analysis of Helene deaths increased to 228.

Live updates:Powerful Hurricane Milton hits Category 5 status on path to Florida

'I feel so guilty'

Shirley and Nausica worked together at Odyssey School in Asheville. Nausica teaches art and Shirley taught kindergarten. A children’s book author and a mother to “absolutely everyone,” Nausica said the school’s community is also grieving her mother, who many called the best teacher they ever had. 

“It’s just really overwhelming. When the full weight of this sets in, I’m not really sure how my family will be,” Nausica said. “A lot of parents are reaching out saying they don’t know what to do without her.”

Nausica’s friend Mariana Restrepo hasn’t stopped thinking about the Rotolos since she heard the news.  

“I feel so guilty,” Restrepo said. “I feel so horrible that happened. It's been on my mind 24/7.” 

Restrepo and her boyfriend Christian Carreno are grateful their apartment was left relatively unscathed by the storm. They left Asheville a few days after the hurricane hit to stay with their extended families whose homes in other parts of the state have water and gas.

“It’s normal to feel survivor’s guilt,” said Kelly Crosbie, director of the state Department of Health and Human Services’ mental health division. “People need to remember that they did not cause this crisis. The fact that they feel guilty means they are an empathetic and caring person which is wonderful, which is a strength, and they can use that to help and to volunteer.” 

Crosbie encouraged residents struggling with the mental and emotional toll from the hurricane to use the state’s 24/7 disaster helpline and suicide hotline. She added that the state is making mental health counselors available to first responders and caregivers.

“Everyone in North Carolina knows someone who has been impacted,” said Rebecca Feinglos, a certified grief support specialist living in Durham. “I am fine, but just because the storm tracked a little bit further west, they are decimated. That leaves me and so many of us in the rest of the state just kind of sitting here with the sense of ‘Whoa. Why not us?’ That, I would also label as grief.”

And that grief may linger.

"We tend not to think of the long-term feelings (like grief) that may accompany the loss of one's possessions, for example," said Maryanne Fisher, a psychology professor at St. Mary's University in Canada. "But years from now, when a past relative comes up in conversation with a grandchild, someone has lost the ability to show a photo, which can cause a recurrence of sadness."

David Kessler, founder of Grief.com, knows all about that as both a grief expert and as a person. He lost his home due to Hurricane Camille decades ago as a child.

"For me now, when I hear them talking about the storm surge, I understand how deadly it was," he said. "Losing a house is hugely traumatic and filled with grief. I don't think we fully understand when we all see the pictures on the news, what it's like to have your house ruined. I have no childhood pictures because of that."

More on grief:She lost 100-pounds but gained it back. The grief surprised her. Now, like others, she's sharing her story.

'There's no place like home'

Jessica Lynn Luffman, 33, is an independent contractor living in Elkin who picks up jobs in Boone, Banner Elk, and everywhere in between. 

She knows the mountains and their residents well. A week after Helene hit North Carolina, she was checking in on her past clients, offering people a ride down the mountain, and thinking about how the houses with full glass walls overlooking the landscape fared during the mudslides. 

While driving around in her truck she recognized creeks she’d never noticed before because they were flooded and said there are so many fallen trees the mountain smells like “Christmas” and “mud.” 

Luffman said after the hurricane hit the mountains, it felt like something bad happened to a family member. The land is important to her family. She, her mother and grandmother all want their ashes scattered at Wildcat Rock Trail when they die. 

About 150 miles away, Restrepo feels a similar connection to Asheville. She described the mountains as “other-worldly” and said people move there to get better because it is a healing place.

“There’s no place like Asheville. There’s no place like home,” said Restrepo who still dreams of buying a house in the city one day. “Now I’m even more attached.” 

They came to Asheville for healing.Now, all they see is destruction.

Feinglos emphasized that many people moved to Asheville, which is located in the western part of the state, because they thought it was protected from the effects of climate change. She said grief around climate change is real and the state’s residents are also grieving a sense of safety. 

It's a unique kind of grief – but one worth unpacking. "With so much loss, we can't gloss over the grief that will inevitably follow suit," said Gina Moffa, a licensed clinical social worker and author of "Moving On Doesn't Mean Letting Go." "We have to grieve. We have to acknowledge the losses, the secondary losses and the ripple effect that will continue to come with time."

Kevin Chapman, founder and director of the Kentucky Center for Anxiety and Related Disorders, adds: "Allow yourself to grieve by intentionally thinking through the emotional experiences."

Feinglos recalled memories spending time with her parents in the mountains, calling the terrain “an anchor to who we are as North Carolina.” 

“Asheville, the mountains, eastern Tennessee, Georgia, all of these places that have been physically impacted, they will rebuild. But we don’t forget what happened,” Feinglos said. “The hole doesn’t get just totally filled and we pretend like it never happened. We get to hold both. We get to move forward. We get to rebuild, and we honor the grief and the pain that persists.”