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Healthcare professionals working in a hospital setting must respond to a variety of stressful situations while on the job. Aside from patient care, they must be ready to respond to emergency situations and act in the best interests of the hospital and their patients. Employed healthcare workers have the benefit of undergoing regular training to prepare for such events. However, healthcare students on internships, who undergo months of clinical training in hospital environments, do not have the benefit of repeated training prior to emergency situations. Even if students learn hospital procedures during emergencies as part of an onboarding process, their level of understanding and ability to act on those procedures may be limited as it is likely their first exposure to those concepts. As a result, healthcare students may be uncertain of how to best execute their assigned roles during hospital emergencies.

Typical hospital emergencies that demand rapid action include a fire, a missing infant or child, an environmental danger, a combative patient, or an external disaster. One type of external disaster that has an increasing frequency is a mass casualty situation caused by an active shooter.

While different definitions exist, The Federal Bureau of Investigation defines an active shooter situation as any event in which one or more individuals actively engage in killing or attempting to kill people in a populated area. Both the number of mass shootings and the number of people shot in active shooter situations have increased steadily since 2015, with an increase of almost 50% between 2020 and 2021 alone.¹ Each of these tragedies have a deeply traumatizing effect on the victims, families, and potentially the healthcare workers who receive the victims as patients.

A recent mass shooting in Uvalde, Texas on May 24th, 2022, left 19 children and 2 teachers dead. Dominique Galvan, PT, DPT, a physical therapy student at the time, was undergoing her first clinical internship at the small, regional hospital that received the victims and their families on that terrible day along with another student from her class. Her story can inform other healthcare students about what they may expect during the chaotic aftermath of a mass shooting. The frequency of mass casualty situations as the result of active shooters does not appear to be slowing; it behooves future healthcare providers to prepare themselves, clinically as well as emotionally, for such emergencies to happen at their place of work.

What follows is Dominique’s accounting of her experience, guided by questions from Nathaniel Brown, PT, DPT. He is the Director of Professional Practice Education (DPPE) for the Doctor of Physical Therapy Program at The University of the Incarnate Word and worked closely with Dominique after her ordeal.

Tell us a little about your background: where you are from, your family culture, etc.

My name is Dominique Galvan and I am from San Antonio, Texas. I grew up in a Hispanic household on the west side of town. I grew up with my mother, father, older sister, and grandparents.

Where were you assigned to do your first rotation? Why did you request a rotation in Uvalde?

When it came time to choose the location for our first clinical rotation, I was unsure of where I wanted to go. I had never been away from my family, nor had I ever lived on my own before, but I viewed this as an opportunity to grow and spread my wings. As the time drew near, I remember getting an email from Dr. Brown, our DPPE, stating that there was an opportunity to do a clinical rotation in an underserved location. That location was Uvalde, Texas.

I was excited to receive the email and saw it as an opportunity to become more independent while still being close to home. After talking to my family about it, we agreed that it would be a good experience for me.

How did you feel about being assigned to Uvalde, Texas? Did you have any hopes, fears, or apprehensions about doing the rotation there?

I was excited to be assigned to Uvalde! This was going to be my first time away from home. I was very nervous, especially during the weeks leading up to the big move. I was afraid that I would not be able to make it on my own. I was also nervous to live with someone new. My hopes for this rotation were to not only grow as a clinician but as an individual as well. I aspired to be as open-minded as I could to learn new information from this clinical experience. I also hoped to expand my sense of independence and start to grow into the person I am meant to be: a person who is strong, kind, caring, confident, independent, and brave.

How did you feel when you moved there? 

Getting the logistics figured out and finding a place to live was challenging. Thankfully, the clinical site coordinator was able to find my classmate and me a place to live on a ranch for the duration of the rotation. Thankfully, the move itself went smoothly. However, being a girl who grew up in the city, living in a small town was a change. Having lived in the city, I was used to hearing the train, busy streets, and traffic, but in the country, there is silence. Absolute silence, with the occasional ranch animal noises. Along with the silence came the darkness. Out on the ranch, there are no streetlights to light up your surroundings. That took some time to get used to. The insects were also different. Living in the city I did not have to worry about scorpions, but I did out there.

Though this was a significant adjustment, I found myself loving the quietness and calmness in the nature around me. I loved the stillness and the beauty there was in the landscape. I fell in love with the sunsets and sunrises that painted beautiful pictures in the sky. I had never seen the sky so beautiful before without any buildings or towers getting in the way. This new place that I had never been to somehow also felt like home. To me, home is a place of peace, beauty, and love. This small ranch embodied that. The scenery, the animals, and the community of Uvalde made this new place and small town feel like home. The town of Uvalde itself also had a comforting atmosphere to it, and the people I encountered were all very kind, humble, and lighthearted.

What was the hospital like? What was it like interacting with your clinical instructor? 

My first day at the hospital, working in the outpatient rehab clinic, I was filled with a multitude of emotions. It was a busy morning. I remember my roommate and I decided to carpool in case parking was limited. As we walked into the new facility, we were greeted with the typical hospital atmosphere. I saw administrative workers walking and discussing renovation plans, front-desk personnel assisting patients, and patients conversing with their family members. The hospital staff were very welcoming, and I was always greeted with friendly smiles and polite welcomes.

The hospital itself had a new, fresh, and welcoming atmosphere. The patients were amazing. I was worried they would reject me for being a student, but on the contrary, they welcomed me with open arms. They were excited and eager to work with me and I felt they had so much faith and confidence in me from the very beginning. They would give me feedback in regard to the treatment and manual therapy I would provide. One patient I remember would say, “It’s okay to push harder, you will not hurt me. Don’t worry, I will let you know if you are doing too much.” Another patient said, “I can tell you are nervous but the pressure you are giving is really good and I can feel the relief.” They would ask me about the move and how I was adjusting to the area, and they genuinely cared for my well-being. They would give me food recommendations for restaurants around the area. These patients were very kind and were a pleasure to work with. The patients made me feel as though I was a part of their community. Their confidence and trust in me, along with their kindness and encouragement, made working with this community such a pleasure.

At first, I was anxious to meet my clinical instructor (CI) because I was nervous that we wouldn’t get along or that they wouldn’t understand my learning style, but all those nerves were put to rest on the first day. She welcomed me with a sweet smile and a kind hello. We talked about my learning style very early on along with my experience in the clinic. She reassured me that in the first week or so I would mostly be observing her, seeing how she treats patients with certain diagnoses and how she documents. I would also be allowed to become familiar with the environment. She created an atmosphere in which I felt safe to ask any and every question I had. We established great communication from the start, which I believe made us work well together. She also gave me the opportunity to work with other clinicians in the clinic, which I appreciated very much.

I learned so much not only from her but from the other physical therapists and the physical therapy assistants (PTA). They would push me out of my comfort zone and challenge me in the best ways and, as a result, I felt confident in myself. In situations where I felt I lacked knowledge or experience, my CI would take the lead, or she would talk me through it. My CI and I were able to establish patient rapport and create a learning environment for the three of us to work collaboratively.

What were the things you enjoyed about the rotation? What were the things that you found stressful? 

I enjoyed the opportunity to work with and learn from the different clinicians in the hospital. I was able to see how different clinicians treat the same diagnosis. I learned new and innovative ways to address different impairments. I enjoyed being able to learn from the PTAs in our clinic as well. I also enjoyed the sense of family that the team created and how they made me feel a part of their family. All of these interactions put me at ease and contributed to the feeling of home.

Trying to create a good study plan for the National Physical Therapy Examination was the most stressful thing about this rotation. I found it difficult to come home after a long day at the clinic and study. I felt very drained. I also found it overwhelming to make time to cook dinner, prepare for the next day, and study, while trying to incorporate some time for self-care. Another thing was performing manual therapy on patients post-op. I had limited experience with manual therapy prior to this rotation and I was nervous to hurt the patient. However, with the help of my CI and feedback from my patients, these nerves and worries went away fairly quickly. 

What was happening on the morning of the shooting?

Tuesday, May 24, 2022, started out like a normal day. I woke up, got dressed, had a bowl of cereal and I was out the door. I walked into the hospital a little early just like I had the days before. I greeted the front desk staff and those who I encountered on my walk from the car to the clinic. I walked into the gym, put my things away, and started to look over the schedule for the day while I waited for my CI. We had three or four patients scheduled for the morning, but our last patient of the morning canceled. My CI and I decided to work on any hands-on techniques I wanted to practice, while we waited for our next patient.

It was then that one of our co-workers mentioned that they heard there was a man with a gun in town and that the police were after him. At this point, everyone pulled out their phones and took to the news outlets and social media to figure out what was going on. People started reading that the suspect had shot an officer and ran to a nearby school. I remember everyone trying to figure out who the suspect was and what school was involved.

What was the first thing that happened that told you something was going on in the hospital? How did the mood change?

It wasn’t until I heard a code grey being called over the intercom that it hit me that something was going on. I looked to my CI and asked what a code grey was. I remember her telling me that it meant we were on lockdown. We were not allowed to leave the hospital nor was anyone allowed in, as a precaution. My CI and the other clinicians around me started to get text notifications from the hospital. Every time I heard a phone chime, I would look to her and to those around the room to try to understand what was happening. I remember we all sat in the office discussing the situation and keeping up with all the information via social media and the local news.

We were then instructed by our Director of Rehabilitation (DOR) to call our patients and let them know we would not be able to see them due to the active code grey. As a team, we then discussed how we were going to help the inpatient physical therapy staff tend to their patients since we were on lockdown. I remember it was at this time, around 12:30, that I tried to send a message to my parents explaining the situation. The first text didn’t go through, and I remember becoming worried when this happened. I then sent the text again and this time it went through.

Soon after I sent the message, the mood in the office changed when we got word that the suspect had opened fire on the students and teachers at the school. The atmosphere became heavy and uncertain. One of our coworkers had a child in the school at the time, and as any parent would, she began to cry. She tried to leave the facility but was not able to due to the code. She was calling her loved ones to head to the school. I remember the co-worker stepped out of the room and everything went silent. You could hear a pin drop in the office. Then, like rapid fire, phone chimes went off one after another. The DOR walked in and said, “They are bringing the injured victims to the hospital. We are going to go help if you all would like to come.” As a team, without hesitation, we went. It was once we stepped out of the gym into the main hallway of the hospital that things started to become fuzzy and blur together.

How did your CI guide you at first? 

When we were asked to help, she did not hesitate to lend a helping hand and I followed. I don’t remember if we ever had a conversation about what to do or not to do, but somehow I felt a sense of direction from her that I should follow and help where I felt comfortable. There was less talking in that moment and more action, and I followed her lead. We were a team.

How did you first know it was a very serious situation and how did that make you feel? How did your CI guide you at this point? What did you see in your peers and supervisors that indicated the situation was getting worse?

I knew it was a serious situation when our DOR told us that they were bringing the victims to our hospital. I think it was then that it dawned on me that we were the only hospital in this town. I felt a rush of emotions, but I strangely also felt numb. I remember as soon as I stepped out of the rehab gym, my brain went silent. The only thought I had was remembering why I had always told my family I could never be a nurse: I never thought I could emotionally and spiritually handle situations like these, and I kept replaying this conversation in my head. I heard an internal voice saying, “Dom, don’t freeze, don’t panic, just do.” I felt the anxiety rush over my body like a heat wave as we walked to the entrance of the hospital.

I was met with the sight of all different kinds of employees standing ready to help. As a unit, people talked about getting water from the cafeteria and bringing chairs. Office personnel opened the adjacent doors that connected the main hospital to the ER. It was then that someone came and informed us that parents and family members were being told to come to the hospital. We decided to set up a team of people at the doors to hand out water and to direct family members. There we stood with water bottles in hand at the front of the hospital waiting to help direct people. We were advised to direct the families upstairs to the cafeteria. The other hospital personnel would oversee taking their information in order to help get them answers.

People were standing in place ready and then I saw an officer and border patrol agent walk into the building. It was then that I knew the situation was getting worse. Agents were stationed out front with their weapons, some at the adjacent doors connecting the hospital entrance to the ER and some upstairs monitoring the suspect’s social media and whereabouts. Several therapists in our department and I were standing in front of the doors handing out water to the families as they came in. My classmate was across the way from me doing the same. My CI was speaking to the police and monitoring the situation.

I looked around and saw worry, fear, and blank stares on everyone’s face. As I looked around, the only thing I could think about was that this felt like I was in a movie. I saw officers with large military-grade weapons, vests, and sunglasses. I looked over to the ER side of the building and nurses were ready, discussing a game plan. At this time the ER staff was instructed to get the back entrance ready. They were going to bring in the victims there to avoid any civilians who might be watching at the main entrance.

I remember hearing fast-paced moving, footsteps running, the cart that brought the water, people asking questions like, “What is happening now?” and saying “I can’t believe this. It’s about to get serious, we need to be ready,” and then a silence. Everything went silent. The voice in my head kept repeating, “You can’t freeze. You can’t freeze.”

I felt like I was not in my own body. I was not aware of myself or what my body was doing. It was then I felt a tap on my shoulder. It was one of the women who volunteered in the gift shop. She noticed that I was shaking, physically shaking, as I stood there in the silence. I didn’t even realize I was shaking. She grabbed my hand and said, “Open.” I opened my hand and she put a few gummy bears in my hand. She gave me the most sincere, loving, caring, and comforting look as she instructed me to eat them. I still remember her sweet voice saying to me, “The sugar will help with the nerves.” She held my hand closed and looked at me and gave a grin. The amount of comfort that small gesture gave me in that moment is indescribable and I will never forget it.

I remember coming back to earth once she did that. I had quickly thrown the gummy bears into my mouth, and I remembered I had my Invisalign retainers in my mouth. I couldn’t chew, so I ended up swallowing them whole. I finally felt somewhat present and in my own body again. As we waited, some started to talk around me, and I felt present. I looked over to see my roommate and classmate and he came and gave me the biggest hug. He asked if I was okay, and I said yes. I think a part of him knew I really wasn’t okay, because he stayed by my side holding my hand for a few moments. Still, my CI and I never spoke about what to do or what not to do. We stood there waiting.

What were you directed to do as the situation unfolded? How did you feel about the role you were asked to fill? Where did your CI go?

Just like in a storm, the calmness and the silence were torn apart by screams, shouts, heavy footsteps and running. The parents and family members of the victims started to arrive. I could see the look of utter despair and fear on their faces. I could see the hurt and worry. As they came in, I was instructed to hand water bottles to those who wanted them and to direct the people upstairs to the cafeteria. I was numb. I felt anxious. I could feel my stomach in my throat. I remember telling myself, “Just do. Don’t think. Just do.” I handed out the water along with other staff and my CI, and we directed the family members upstairs.

Then, we all got quiet again as a child walked in with blood on his shirt. His mother or grandmother was crying saying, “Help! Please help!” I remember saying in my head, “This isn’t real. This can’t be real.” Then I saw my CI go to the family and ask the little boy if he was okay. She then took him and his family upstairs and quickly got a nurse to tend to him to see if he was injured or hurt. As I followed her and looked at this little boy, I saw a face I had never seen on a child. I saw pure, real fear. He had the look of a deer caught in headlights. He was so disoriented. After my CI got him help, she ran to a corner and knelt down for a second and cried. Her friend and I put our hands on her shoulder and she put her hand on top of mine. I remember her asking, “How could someone do this? He is just a kid.” Then, within what felt like seconds, she composed herself and went back downstairs.

It was then that the first ambulance arrived. I remember our DOR ran back into the ER to help and after some time had passed, he ran back asking for help from those who wanted to or felt as if they could. I remember my CI gave me a look and ran to go help. Even though this entire time we really didn’t speak much, that look she gave me was all I needed. The look said, “It’s okay. Stay here, don’t follow me.” So I stayed. As soon as she left, the inpatient rehab therapist asked for help bringing down more chairs for the family members from upstairs, so I ran to help her with that. Then, I came back downstairs, placed the chairs in different locations around the main lobby and hallways, and came back to help direct people.

I could hear someone giving instructions to the parents upstairs, I could hear the loud voices of the parents asking for answers about their children. “Where is my daughter? Where is my son? Why doesn’t anyone know what is happening or where they are?” I could hear the fear and trembling in their voices.

I could also hear personnel getting the helipad ready. I could hear and see the blades of the helicopter turning and noticed how it moved the greenery around it.

Then, silence again. I could hear the sniffling from upstairs and I could hear the heaved breathing from those who ran in, but again there was the silence. Someone from the ER came and told us to ask the parents if their child was wearing green Converse. The infamous green sneakers. Someone ran upstairs and started asking. At the same time, a list was being passed around for parents to write down their names. I remember seeing someone from the ER walk upstairs and the next thing I heard was a sound that I sometimes still hear. It was a blood curdling scream. A scream that you only hear in movies. A scream of utter despair and heartbreak. One by one I could hear those screams echo in the hospital—screams that sent chills down my spine.

Then silence. Another wave of silence befell the hospital.

I saw my CI come out of the ER and some of the other therapists and I walked to her. We stood at the main doors to the ER now discussing everything that happened. We stayed there as one of the officers instructed us to man the doors and only let staff or police personnel into the ER through those doors. We were to direct families to the main hospital entrance. At this time things were calming down. We stood there for what now seemed like hours. Then we got word that there would be a bus coming with victims. We (my CI, another PT, a fellow SPT, and an OT) stayed standing at the entrance of the ER.

I remember feeling a rush of nerves flood over my body. I felt my heartbeat in my ears. My heart was racing and the only thing I could think was, “Am I really about to see the aftermath of this tragedy? Can I handle seeing that?” As we saw the bus approach a sort of eerie stillness fell upon me. As soon as the bus got closer, a part of me knew and a part of me felt who was in that bus. Somehow, I felt the coldness of death and the cloud of sadness and emptiness as the driver drove the bus around back. We all stood there in such silence as the bus came and left.

A calmness had fallen upon the hospital. Families were instructed to go to the Civic Center to be reunited with their children. The families that stayed were the ones who had been told their child was in the ER. We continued to man the ER doors, and a doctor who had come in from a nearby town told us the statuses of some of the victims. I remember he said, there were some that could not even be identified. I remember he used the word “shredded”—the bullets shredded the body. When he said this, I felt myself become a little lightheaded. And then it dawned on me: those green sneakers were the only way to identify the victim.

Then I remember a nurse came and asked us to look out for family members coming in because they were releasing some of the patients. A little light of hope sparked in all of us, and in a few minutes, children were being rolled out of the hospital and reunited with their families. Some still had that mile-long stare in their eyes. Some still had that confused emotionless look, but the relief that was on the family’s faces was incredible. The look of love. You could feel the warmth from the embrace of a mother and her son, a father and his daughter, a child reunited with their family.

Soon after we released four children to their parents, our DOR came from the ER. He called the rehab team over to the main hospital lobby. There we gathered and talked about how we had all pitched in to help, and he told us that we were allowed to leave for the day.

Did you have any previous experience that helped you perform your role in this situation? 

Prior to this, I don’t think I had any experience in handling a stressful situation like that. However, I have experienced tending to those in need and being there for others, and that I can do. I think I relied on my faith a lot during those moments. I just tried to do my best and be whatever it was anyone needed me to be.

What thoughts went through your mind as you performed your role? What emotions did you feel?

As far as emotions go, I was very numb. I felt as though I was living someone else’s life. It all felt like a dream or an out-of-body experience. I experienced many emotions: fear, anxiousness, sadness, and worry. But during the time I was performing my role, the emotions I felt were not mine. During those moments I personally was numb; however, I could feel the emotions of those around me. I could feel the sadness, fear, anguish, and despair. All of this felt like a thick and heavy cloak of darkness. The atmosphere felt heavy and empty. It reminded me of the dark and invisible sense of a storm. So much uncertainty and so much heartbreak.

How did the night end for you?

I remember walking out of the main entrance and walking to my car. I honestly felt like a zombie. I called my dad as soon as I got into the car and told him I was going back to the ranch in Uvalde, then I called my mom. I remember asking my parents if I should drive back to San Antonio or stay there in Uvalde. I wasn’t sure what to do. I remember getting home, petting the ranch dog, and then walking inside to an empty house. As I sat alone at the kitchen table waiting for my roommate to get home, I felt this overwhelming sense of fear and anxiety. When my roommate arrived, we gave each other the biggest, warmest hug. I think we both needed it. I remember closing my eyes and just falling into his embrace. In that moment there was so much love and understanding and I think a lot of gratitude for having one another there.

We spoke a little about what happened, and he asked me if I wanted to drive to San Antonio. I told him a part of me did, but I did not want him to be alone. He reassured me that his girlfriend was already on the way to see him. He hugged me and he told me, “Don’t worry about me. Go home and be somewhere you feel safe.” I hugged him even tighter back and I packed a bag for the night and started my drive back to San Antonio. I remember I drove with the windows down, but it started to rain. As the rain droplets hit my windshield, my first thought was that those sweet angels had made it home.

As soon as I got home, my mother was waiting at the door for me. She embraced me but I felt numb. We got dinner and while at the table she asked me about the events that unfolded that afternoon. I told her what I had experienced and opened up to her about what I felt. I told her how I felt the pain, the death, and the agony. I felt it all. I mainly spoke to her about the spiritual aspect of things. I disclosed to her how I could feel their emotions. I could feel the despair and sadness. I also told her how I felt the death in that bus that came. I also spoke to her about the screams—the screams that I could not get out of my head. She sat and listened with all the love in the world, and at the end she hugged me and told me she loved me and that I was safe.

I ended the night with a hot shower, and I decided to sleep with my mom that night. I felt safe being home and the talk with my mom helped a little, but I still didn’t feel better. When my dad got home in the middle of the night, he woke me and hugged me, and reassured me that I was okay. I tried to get a good night’s rest, but my mind would not stop racing with thoughts about the children, the teachers, their families, and how they must feel still waiting to hear or find their children. I also continued to play news images in my head of the families standing outside the Civic Center. I kept hearing the screams from earlier in the day in my head. I remember I cried myself to sleep that night.

How did you feel in the days that followed?   

To be completely honest, I don’t quite know or remember how I felt after. Looking back now, I felt empty. I felt numb. I felt like I was in a daze. I felt not like myself. I had this overwhelming feeling of guilt. I felt guilty for feeling anything. In my head I didn’t have the right to feel any way except okay because I did not lose a child. I wasn’t standing there with those kids. I did not lose a parent. I felt angry and guilty because I knew I wasn’t okay, but I didn’t feel that it was right that I didn’t feel okay. I didn’t witness what others did. I think a part of me felt ashamed along with the guilt, because in my mind I had no right to feel the way I did on that day, given everything others had to process and deal with.

Who did you speak to after the day was done? Did that help at all? How did you feel about speaking to others about it?

In addition to my mom and dad, I spoke to Dr. Brown, my school’s DPPE, who reached out to me and my roommate on the day that this all happened. A few of my close friends reached out to me that day as well. Speaking about the day was quite difficult for me. It was hard for me to process everything and speak about it, especially since I was feeling so numb and just not all there.

I already had a working relationship with a Licensed Professional Counselor, and once she heard about the incident, she reached out to me to move up my next appointment with her. I remember she started off our session by looking at me for a few seconds and saying, “Before we start our session today, I want you to take it off.” I looked at her confused and asked, “Take what off?” She proceeded to say, “Take off the mask that makes everyone think you are okay, because I know you are not.” I stayed quiet for a moment, and then I broke down crying over Zoom. I told her that I felt guilty. I had this overwhelming guilt in me. I told her I felt like I had no right to feel sad or afraid or just affected by the whole situation. I told her that the day after the tragedy felt like a trip into the Twilight Zone. I walked in and everything was just as it was, but quiet; no more people crying, no more chaos. It seemed like everyone just went about their day as if nothing had happened.

I felt so out of it that day. I felt like someone else was driving my body because my mind wasn’t there. We talked about the things I saw and the things I felt. She told me that on that day, and the days following, I was dissociating. She said that was my brain’s way of coping with everything. She also disclosed to me that my empathic nature was what made me susceptible to the energy and feelings around me. Most important of all, she told me I had every right to feel the way I did. She said that my hurt or my sadness was completely valid. She told me something else that has stuck with me to this day. She told me that my hurt, my emotions, do not take away from or invalidate the hurt and pain of others. My emotions and feelings are valid. Talking to her helped tremendously.

In the days that followed, Dr. Brown and the school’s chaplain, Josh Welker, came to meet with the rehab staff and me in Uvalde. I remember seeing them walk into the building and a comfort filled me. We were able to have a sit-down conversation about how I was feeling and how I was coping with everything. I don’t know how or why, but having them there made me feel so warm. It made me feel so cared for and so loved. That small act of kindness really meant more than I could have ever imagined.

Talking to my parents, therapist, and professors about it was not difficult. Talking to other family members, friends, and other people was very difficult for me. One of the main things that made it so difficult was that a lot of people didn’t know I had worked so closely to everything. When someone thinks of a physical therapist, they think of a clinician who prescribes exercises and helps people move better. They would not think that a physical therapist, let alone a physical therapy student would have anything to do with an emergency situation like this. I know for sure that I never thought I’d be involved in a situation such as this. So, it was hard trying to explain what I did and what I saw. I felt like I had to explain why I was there and why I was so involved, and it was hard for them to understand. What also made it difficult to speak about it with others was the fact that it had affected me so much on a spiritual and emotional level. Physically I was fine, but spiritually and mentally I was not, and it was hard to convey that to others, especially when I am not the type of person to be vulnerable with just anyone.

What did you do and how did you feel as you returned to the hospital? What changes did you see in the hospital as well as in yourself?

The following day, everything felt surreal. I woke up around 5 am to make the drive from San Antonio to Uvalde. When I pulled into the parking lot of the hospital and walked to the entrance, everything was gone. Everything looked back to normal. That made me feel as if it was all a dream. There was one news van outside the front of the hospital, but that was it.

As I walked through the entrance, it was quieter than usual. The actual reclining chairs that I had helped fetch for the families were still in the lobby where we had left them. As I walked to the therapy department, it was as if nothing happened the day before. It was the same quiet hallway as it was two days before. When I walked into the gym, everything felt like it was a dream. Some of the staff talked about the events that unfolded the day before as we waited for everyone to arrive. We had a staff meeting that morning. The atmosphere as we all gathered around the treatment tables was a somber one.

Our DOR talked about how he was proud of all of us for stepping up and helping. He stated that he understood how devastating this was to all of us. He talked about how he could not sleep due to what he witnessed the day before. He reminded us that if we needed or wanted to talk, his office was open. He also made us aware of counseling services that were available to us if we needed them. After that he took out his rosary and said he would like to pray the rosary for everyone affected, so together, as a staff, we prayed the Hail Mary. Some of the staff grew emotional during the prayer and others just sat in silence respectfully.

After our meeting, we went about our day. My CI and I saw our patients and everyone else saw theirs. In all honesty, I was surprised by the number of patients that came in that day. Everyone went about their work as if it was just another day.

On the other hand, I felt very numb. I felt as if I was going through the motions the entire day. I physically was there, but mentally and emotionally I was somewhere else. I did all I could to keep my mind from thinking of the day before.

As the day went on there were more news crews outside interviewing families and some employees. As the week went on, the crews were gone, and everything went back to normal.

The next few days for me felt off, to say the least. I really couldn’t sleep. I felt aware and anxious, but I was not sure of what. I remember getting emails from our behavioral health department asking if I needed their services. At the time I already had a therapist, so I asked to be seen by her. My classmate/roommate and I did go to play basketball that Thursday to take our minds off of everything. We also went to get ice cream to just sit and be around each other. I think we just tried our best to go back to normal.

What actions did you take to care for yourself? Who has helped you and how? What has helped you cope?

To be quite honest, the only actions I took were talking to my therapist and going home the night of the incident. My parents really helped me by simply being by my side and being a place of comfort and safety. My professors such as Dr. Brown, Josh, and Dr. Bains (my school’s advisor) really helped me. They provided me with a safe space to speak freely and openly about what I was feeling and what I had experienced. My therapist helped me tremendously. She helped me validate my own feelings and allowed me to sit in them and process it all. I also found a lot of comfort in driving alone and being alone with my thoughts. Breathing and grounding techniques have been my means of coping.

During my third rotation, there were moments when I would mentally go back to that day. My third rotation was in a skilled nursing facility, and there were days when patients would scream, nurses and aids would be speaking and talking loudly at their station, and other personnel would be walking in and around the building. All of the noise would send me back, but more so the screams. I vividly remember one day when a patient was screaming down the hall and it was a very hectic day in the facility. I remember watching nurses move fast and other medical staff doing so as well. I started to feel this tightness in my chest, this worry, and I heard them again: I heard the screams of the parents and the families. I found myself rushing to the bathroom to breathe and calm myself. I had to practice breathing and grounding exercises to bring myself back into reality.

Are there other ways that this experience continues to stay with you?

On that day, I saw so many police officials (border patrol, DEA, Uvalde police officers) with weapons all around me. Being surrounded by all those weapons stuck with me. At that moment, I felt a sense of awe. Prior to this I had never seen a military grade weapon in real life. In fact, I don’t think I had ever seen a firearm of any kind up close until then. However, following the tragedy, I realized I had a different feeling towards firearms. A few weeks following the incident, I was shopping at a local store with my mom. Upon browsing the aisles, I noticed a firearm sitting on a folding table with no employee or anyone around. At that moment, I felt my stomach sink into my chest. I began to get hot, my hands became clammy, and my heart was beating out of my chest. I felt so anxious. I wish I could tell you specifically why I did, but I just felt like I was back in that hospital on that day. All the feelings and sounds flooded my mind.

A similar occurrence happened during my second rotation. During the last week of my second rotation, the clinic scheduled an active shooter training in-service. Prior to the actual in-service, I spoke with my CI, and we agreed that if I needed to skip it or not be present, that was completely okay. I thought about it for a few days and decided I would try to attend. During the drill, I felt a little nervous, but I was okay until the presenter played a 30-second clip of an AR-15 being shot. It was within the first 5-10 seconds of that audio that my friend and fellow classmate noticed tears streaming from my eyes and my chest rising and falling very rapidly. She walked me out of the room and into the back patio where I ultimately broke down. Again, I felt my stomach in my throat, I felt on edge, I felt anxious, hot, and not okay. My friend had to keep repeating the words, “You are okay” to me. After about 20 minutes, I finally came back to reality and was okay.

There are other, more hopeful images that stay with me as well. I saw nurses, office staff, volunteers, and all kinds of hospital personnel drop what they were doing that day to help in any way they could. I saw cafeteria staff hand out lunches to families and to the children. I saw hospital staff walking around checking on families. I saw strangers going up to other strangers and giving them an embrace. I saw people holding hands and praying. As the afternoon continued and patients were being released, I saw the happiness, joy and relief that was felt reuniting a child with their family. I saw the glimmer of hope.

Although it might be hard to fathom, on a day filled with so much darkness, there was still so much light. Seeing a stranger care for another, a child reunited with their family, and a hospital full of different people from different walks of life helping one another was the light in the darkness. But most of all, it was the outpouring of love that was seen and felt throughout the day along with the days and weeks that followed. I made this realization after the day had ended; however, I felt and saw that light during the day as well.

How did this experience change you and your idea of physical therapy? How will you be a different person in the future? 

Before this experience, I knew as a physical therapist I would be a movement specialist. I knew that I would have an enormous role in a patient’s ability to move and a huge role in the mental aspect that accompanies that. However, after this experience, I have realized physical therapy is so much more than that. Being a physical therapist to me now means doing everything and anything we can for the patient. It means working collectively with other health professionals to aid in patient care. In emergency situations like this, it’s about working as a team and as a unit, which I experienced firsthand.

As I sit here in the hospital parking lot almost a year after the tragedy writing this, I can honestly say this experience has changed me for the rest of my life. It has made me realize that no job is too little or too large. A small community, when it comes together, can be one of the largest and strongest forces. I never thought I’d fall in love with a small city on the southeast side of Texas. I never thought that after such a tragedy, I would find so much comfort there, but I did. Uvalde quickly became a home for me in the early weeks of my rotation, and it remains a home after the tragedy. After my time there I feel a part of the community, and I feel a sense of belonging. I have so much love for Uvalde Memorial Hospital, the staff, and the community of Uvalde.

My CI wrote me a note on the last day of my rotation and in it she said, “You are a part of Uvalde, and you are a part of #UvaldeStrong.” Uvalde will always have a very special place in my heart, and I see myself returning there in the future. I am proud to be a part of this amazing community, and I am proud to be a part of #UvaldeStrong.

Many thanks to the staff at Uvalde Memorial, including but not limited to Matt Hughes, Ashley Holt, and Cristy Yeager, for their heroic efforts during the above-mentioned events and for the strides they took to support UIW DPT students. Thanks to the administration within UIW’s DPT program, including but not limited to Dr. Steve Goffar, Dr. Lisa McDougal, and Dr. Chad Jackson, for allowing Dr. Brown the resources to support their students. Thanks to Josh Welker, Chaplain to our program during that time, for his healing presence to our students. Finally, thanks to all of Dominique’s friends, family, faculty, and classmates that supported her during the challenging months after the tragedy.

FBI Designates 61 Active Shooter Incidents in 2021. Federal Bureau of Investigation. Published May 23, 2022. Accessed August 9, 2023.

https://www.fbi.gov/news/press-releases/fbi-designates-61-active-shooter-incidents-in-2021