Iraq war veteran Tom Moran wasn't at the El Paso Walmart when a gunman attacked but he understands the emotional pain that will haunt survivors.
Nightmares replaying like a video stuck in a loop. Sleeplessness. Questioning yourself if you could have done more.
The wounds — physical and mental — suffered by survivors and others impacted by the mass shooting could last long after the carnage, medical and mental health professionals said.
It's been a year since a shooter with an AK-47-type rifle killed 23 people, wounded two dozen others and shattered an untold number of lives.
The pain is not only from physical injuries but an emotional trauma that rippled through the El Paso-Juárez community, including people with no direct link to the tragedy.
'It affects the whole community'
The damage inflicted in the Aug. 3 domestic terrorism attack targeting Latinos could reverberate for a lifetime, medical experts said.
“It’s not only the people that were direct victims or the ones close to them. As you’ve probably gathered, it affects the whole community," said Dr. Marcelo Rodriguez-Chevres, a psychiatrist and chief medical officer for Emergence Health Network.
Emergence Health Network, the mental health authority for El Paso, saw the number of calls to its crisis line triple in the days following the Walmart attack.
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Survivors, relatives, witnesses, first responders, medical staff, people running from the scene and even people with no direct link were traumatized, Rodriguez-Chevres said.
"When something of this magnitude happens, the trauma becomes more collective," Rodriguez-Chevres said. "... I have seen patients that were not even there and they’re still having symptoms."
The response to emotional trauma, symptoms and severity can very widely for each individual, mental health professionals said.
The severity is determined by how it affects a person's ability to carry on with everyday life.
Pain and memory
It can be a long, difficult road to recover from a traumatic event even after wounds heal.
Survivors of the Walmart shooting struggling with emotional trauma will be changed but can get better, said Moran, who uses his experience with post-traumatic stress disorder to help other veterans.
“Obviously, there always will be residue. It will never completely go away but you can learn how to cope with it," said Moran, explaining that everybody deals with traumatic stress differently.
Moran was the military veteran peer network coordinator for El Paso County under Emergence Health Network at the time of the Walmart shooting. He is no longer with Emergence.
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Moran was infantry in the U.S. Marine Corps and served three tours of duty in Iraq, the first with the 2nd Battalion, 5th Marine Regiment during harsh fighting in Ramadi in 2004.
In his second deployment, Moran was wounded, earning two Purple Hearts in Fallujah in 2006-07. He served a third deployment working detainee operations in Baghdad with the Texas Army National Guard in 2009.
“I’d say 2004 was probably the most intense deployment," he said, remembering a best friend killed by a rocket-propelled grenade.
"We had a lot of casualties, a lot of KIAs (Killed in Action), a lot of wounded in action."
'Why did I make it?'
During combat and other life-threatening situations there is no time to think, the emotional and mental blows can strike later, Moran said.
Moran described initially being jumpy, an anxiety of always being on alert, which can wear a person down.
"After the incident has happened, you start replaying it. You replay it and then you start questioning yourself," Moran said. “Why didn’t I have the courage to go out and save my friend? Why didn’t I go out? You get that survivor’s guilt. Why did I make it? You start questioning yourself. Could I have done more?”
Things worsened after leaving the military, said Moran, who is originally from Woodville in eastern Texas. He was going to school in Houston on the G.I. Bill, taking the minimum number of classes to keep food on the table and a roof over his head.
"When I first got out and everything hit me all at once," he said. "We are talking about repeated just like a video. I replayed almost every firefight. I replayed every time we lost a brother in arms.”
Sleeping was the hardest symptom, he said. "You’re attacked by intrusive memories, nightmares. I mean these nightmares can be torture. You’re literally getting tortured at night when you wake up physically in pain.”
He added: "I never abused any substances before I joined the Marine Corps and now I found myself trying to numb out whatever I was going through. So, I found myself being an addict. It didn’t matter what it was — whether it was alcohol, nicotine or any other drugs. You do anything to go to sleep, to numb yourself out and you fall into this quicksand.”
'A quicksand in an endless bottom'
Moran said he self-created a "solitary confinement" lasting five years, distancing himself from classmates and family, staying in his room, avoiding all other people.
It was "a quicksand in an endless bottom," he said. He would tell himself that he would get sober next week. One year slipped into the next and then the next. He had become numb.
"The more isolated you find yourself that’s when suicidal ideations start coming into play," Moran said. "You look for the meaning of life. You start entertaining a way to end the pain and those are the dangerous thoughts that can invade your mind.”
Moran sought help but didn't have the patience to deal with bureaucracy and he wasn't ready. The will to fight kept him going, he said.
“For me personally, it was recognizing that something was trying to kill me, recognizing that something wasn’t right," Moran said.
Recovery was a series of small steps. It began when Moran ran into a friend at school who was in the Wounded Warrior Project who got him to come out of the house: a walk, a visit to the gym, small things. He returned to Woodville and reconnected with his family.
He sought help through his fellow veterans, finding treatment that worked for him. He got sober, began exercising, eating right and turning off the TV to help him sleep.
Moran, who met his wife in El Paso, encourages people not to turn away from family and support systems.
"A lot of my friends have isolated themselves," he said. "Any kind of support from your family, from your friends, from your significant other, is priceless.”
When a person is "in that cloud, in that storm, it may not seem recovery is possible," Moran said. "It is possible. It can be treated."
Survivors face lifelong challenges
The damage caused to the body as a high-powered rifle slug rips through flesh and bone can leave permanent injury, said surgeons who helped save the survivors.
For the most part, physical injuries are addressed before a patient is released from the hospital. But there are lifelong impacts that the person will live with due to gunshot wounds.
Pieces of organs removed during surgery will be gone permanently and scars are left from surgeries, doctors said.
"That Saturday, UMC saw injuries consistent to what the military sees in Iraq and Afghanistan," said Dr. Alan Tyroch, general surgeon at University Medical Center of El Paso and chairman of the Department of Surgery at Texas Tech's Paul L. Foster School of Medicine.
“Those kinds of weapons are meant to kill," Tyroch said. "The bullets deform tissue. I took a slug out of a tibia and it was the size of a quarter."
Some patients had major "high energy wounds" that will have severe, lifelong impact, said Dr. Stephen Flaherty, trauma medical director at Del Sol Medical Center.
Some patients will have physical changes in parts of the body because some things don’t regenerate, in some cases intestines may have had to be taken out due to surgery, Flaherty explained.
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Doctors said that many patients will suffer the mental cost of the trauma and pain of being shot.
Anniversary dates can be a difficult for survivors, families and others impacted by the mass shooting, victim advocates and mental health experts said.
The COVID-19 lockdown has had negative repercussions by reinforcing avoidance, isolation and making it more difficult for people to get needed support, Rodriguez-Chevres said. But for others, the pandemic helped divert their attention and allowed them to transfer fears in a different direction.
“I think, especially, this past spring the conversation has kind of shifted from recovery from Aug. 3 to recovery from COVID,” said Christina Lamour, vice-president of community impact for the United Way of El Paso County.
The one-year mark “will creep up on people as these dates approach,” Lamour said. “They can be triggering for people who were affected a year ago. It can be triggering for people with differing kinds of trauma.”
In December, the United Way opened the El Paso United Family Resiliency Center, which provides resources for healing, counseling, financial advice and other help to people affected by the Walmart shooting.
“We are of the mindset that the entire El Paso community was affected one way or another whether they were present at the site or not,” Lamour said. “If the need is tied to Aug. 3 in some way, we can serve them.”
The center currently assists 99 clients, but the number is expected to grow as the Aug. 3 anniversary arrives and awareness of the center spreads.
Mental health counseling is sought by a quarter of the people assisted at the center, Lamour said. There are various types of programs for adults and children.
The center has also helped survivors with rent, utility assistance and help finding a new job due to the COVID-19 pandemic’s economic downturn, Lamour said.
Information on the El Paso United Resiliency Center can be found online at www.elpasounited.org
“The types of needs are constantly changing as our community as a whole goes through this healing process,” she said.
Signs of healing
Not everyone in a traumatic event will develop anxiety, depression or PTSD because mental trauma can vary greatly, Rodriguez-Chevres, the psychiatrist, said.
An individual's coping mechanisms, support system and even genetics play a role on how they are affected, Rodriguez-Chevres said. Sometimes some people just need someone to talk to.
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But some effects may not surface for years.
“There is a such a thing as a delayed type of onset," Rodriguez-Chevres said. "We see that a lot with victims of trauma, such as rape or victims of trauma such as war, especially males. It seems like initially it didn’t even touch them but years later — time can be irrelevant — you see symptom information."
People should not be shy about seeking help, he said, adding that there are signals that the El Paso community is recovering.
“We’ve seen people reach out, getting help and supporting each other — a sign of a community that is healing," he said.
Daniel Borunda may be reached at 915-546-6102; firstname.lastname@example.org; @BorundaDaniel on Twitter. Former reporter Aaron Montes contributed to this report.