Roger Chui first learned about the mass shooting that killed 12 people in a packed bar Wednesday night in Thousand Oaks, Calif., when he woke up the morning after and turned on his phone.

“And I was like ‘Oh, that seems really soon after Pittsburgh and Louisville,’ ” says the software developer in Lexington, Ky. “I thought we’d get more of a break.”

Chui feels like these kinds of shootings happen in the U.S. so often now that when he hears about them all he can think about is, “Oh well, it happened again I guess.”

He’s not alone.

Ginger Ellenbecker, a high school biology teacher in Lawrence, Kan., has similar feelings.

“My immediate reaction was, ‘Another one. Here’s another one. This is terrible!’ But I’m not incredibly surprised,” she says.

Both Ellenbecker and Chui say they feel bad about their immediate reactions, but science suggests that their feelings are quite normal.

It’s a natural response called compassion fatigue, says Charles Figley, a psychologist and director of the Tulane University Traumatology Institute.

He says thinking too much about traumatic events, whether it’s a refugee crisis on the other side of the world or a school shooting in our own country, can make people too anxious or depressed to function in their daily lives.

“We of course think about ourselves being in such a place, in which someone would suddenly burst in and shoot things up,” says Figley. “But if we think about that too much, then it deteriorates our sense of confidence and our sense of trust and our sense of safety.”

Numerous studies have shown that human service providers — doctors, nurses, case workers, counselors — can experience compassion fatigue because of having to constantly address, deal with and think through tragedy. Figley says people in these professions have what’s called secondary trauma, which can build up and lead to compassion fatigue.

“Human service providers are wanting to help — that’s one of the reasons why we go into the field — but we recognize we can only do so much,” says Figley. “But if they’re not able to process that then they gradually begin to shut down in order to protect themselves.”

Another reason why people might find themselves feeling desensitized in the face of the latest tragedy is something called psychic numbing, which happens when the emotional response to a tragedy doesn’t increase when the number of victims does.

“The statistics of large-scale killing don’t convey emotion,” says to University of Oregon psychologist Paul Slovic, a leading researcher of psychic numbing. He and his colleagues demonstrated the phenomena in a recent study that found people are much more willing to donate aid to an identified individual than to an unidentified group of people.

Slovic says this is because the emotional circuitry in our brains is bad with numbers. “It can’t add and it can’t multiply, it reacts very strongly to one person or a small number of people that we can connect with and empathize with and we become emotionally connected,” he says.

But when more people are added attention and emotion get diffused, response starts to diminish, says Slovic.

For Audrey Cho, a teenager living in Grosse Pointe Woods, Mich., reports of school shootings really worry her. She says it’s hard not to think it could happen to her, but Cho consciously tries to not let it take over her life.

“This is very serious,” she says. “But you can’t allow it to be so detrimental that you can’t leave the house or something, because that’s impossible.”

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A ballot initiative that would have continued funding Montana’s Medicaid expansion beyond June 2019 has failed. But advocates say they’ll continue to push for money to keep the expansion going after that financial sunset.

“We now turn our attention to the legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” said a concession statement Wednesday from Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure.

The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren’t in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That’s more than twice as much cash as supporters were able to muster.

Most of the money in favor of I-185 came from the Montana Hospital Association. “I’m definitely disappointed that big money can have such an outsized influence on our political process,” said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish.

The ballot measure would have tacked an additional $2 per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren’t currently taxed in Montana.

Part of that $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana.

Unless state lawmakers vote to continue funding the Medicaid expansion, it’s set to expire. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act.

In September, Gov. Steve Bullock, a Democrat, told the Montana Association of Counties that if the Medicaid initiative failed, “we’re going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.”

Republican State Rep. Nancy Ballance opposed I-185 and disagrees with Bullock’s position. “I think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.”

Ballance, who didn’t receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products.

“No one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,” she said. “I think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.”

Ballance says conservatives in the Legislature want recipients of expansion benefits to face a tougher work requirement, and for means testing, so those with low incomes who also have significant assets like real estate won’t qualify.

In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge.

North Valley Hospital’s Cohen said he hopes Montana will pass a tobacco tax someday. “We all know how devastating tobacco is to our families, our friends and our communities,” Cohen said. “And I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.”

This story is part of NPR’s reporting partnership with Montana Public Radio and Kaiser Health News. Montana Public Radio’s Edward O’Brien contributed to the story.

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