Junosuke Oikawa, a 71-year-old firefighter, recalls the harrowing moments during the 2011 Tōhoku earthquake and tsunami, where he felt the heavy burden of survivor's guilt after losing nine colleagues in the disaster. Oikawa, who was asked to head an earthquake memorial center in Kesennuma, continues to live with the memories of those he could not save, evoking feelings of regret and responsibility for the lives lost while first responders sought to protect their community. In the wake of the tsunami, which struck just minutes after the initial earthquake, Oikawa and his colleagues were trained to respond quickly, but chaos ensued as the tsunami warnings escalated. As Oikawa navigated through the chaos, directing civilians away from the danger, he experienced a deep psychological conflict between his role as a rescuer and the pain of knowing that many did not survive despite their best efforts. As part of a series reflecting on the lessons learned from the disaster, Oikawa’s story emphasizes the importance of mental health support for first responders dealing with the trauma of such catastrophic events. The article highlights the necessity of addressing the emotional impact on those who put their lives on the line to save others, a reality that remains in the fabric of Japan's ongoing recovery and remembrance efforts following the 2011 earthquake and tsunami.