A boom from the speakers at church was all it took to send Paula Walker back to that moment of horror on the Deepwater Horizon oil rig.
"I freaked out," Walker said. "I huddled up on the pew and wouldn't put my feet down because the floor was blue and I thought it was the water."
Members of the congregation rushed to hers side and desperately tried to convince the 56-year-old laundry worker that she wasn't back on the rig. She says she had a similar flashback when a car backfired near her home.
The April 20 explosion and fire killed 11 co-workers. Walker got off the rig with just some bruises but, like several other survivors, says she's haunted by memories of that night. Although the environmental toll has dominated headlines, survivors say they suffer a more personal -- and private -- burden.
"When you go to sleep, you wake up crying. You wake up with nightmares, thinking the building is exploding," said Walker, who worked on the rig for three years and was in her room watching TV when the blowout occurred.
"It's hard coping with the situation I'm in, not going to work, thinking about the guys that lost their lives. It was like a family out there," she said.
The more than 100 survivors from the rig and the families of those killed suffer far from the public eye and TV cameras, which are more focused on the oil that has spewed from the blown well, fouling the Gulf of Mexico and its coastline. The flow was finally stopped, at least temporarily, last week, nearly three months after the blast.
"If (the leak) is fixed, it will help the rest of the world, but it doesn't bring my boy back," said L.D. Manuel of Eunice, La., whose son, Blair, was killed in the explosion.
"He was a great man, a great father. If you had a son, you'd want him to be just like him," Manuel said. "I don't want the world to forget my boy."
Blair Manuel, a 56-year-old engineer with three daughters, was engaged to be married, and the wedding was supposed to have been this month.
The loss of life and the emotional turmoil have been overshadowed by the spill, said Carl Taylor, a 62-year-old great-grandfather and retired Jackson, Miss., firefighter who survived the explosion.
"We still have to go on and live with what happened on that rig. It was devastating. I'm sure all of us are still having the memories of that night," he said. "It was so terrifying. You didn't know if you were going to live or die.
"Actually, I think it changed me to make me realize that I need to enjoy life more," Taylor said. "When I was young, I spent all my time working trying to support my family, but after this incident I realized it could have all been gone in just a second."
Taylor was a radio operator on the rig who says his hearing was damaged by the explosion. And, he said, it's hard to escape reminders of the spill. He owns an eighth-floor condominium in Gulf Shores, Ala., that now looks over beaches that have been hit by oil. At times, he's seen oil washing in with the waves. Like Walker, Taylor said he's been diagnosed with post traumatic stress disorder.
Numerous survivors say in the more than 260 lawsuits filed in 12 states that they suffer from PTSD. Walker's attorney did not immediately respond to a message about whether they intend to sue. Taylor didn't want to discuss his intentions about litigation.
Many survivors say they will never go back to the Gulf's deep waters. And, in a way, those suffering from PTSD or other mental health problems may find it hard to leave the disaster behind.
PTSD follows a traumatic event and can show itself in symptoms including nightmares, flashbacks and attempts to avoid reminders of the experience, said Matthew Tull, a clinical psychologist who teaches at the University of Mississippi Medical Center.
"It's going to be very hard to avoid reminders of this event, and that's one way PTSD can have a huge impact on someone's life," Tull said.
PTSD can vary in severity and duration based on many factors. It may stay with some for the rest of their lives, leaving them basically disabled, said Dr. Thomas Kosten, professor of psychiatry and behavioral sciences at Baylor College of Medicine. "There will be some that had a childhood trauma who made it OK until this happened, and now they may never recover."
Left untreated, PTSD could lead to substance abuse and even suicide.
"There's nothing we can do to take away the traumatic event, but we can take away the extent to which the symptoms associated with that event interfere with a person's life," Tull said.
It's not clear how many survivors have been diagnosed with PTSD.
Kosten, the psychiatry professor, said it's unlikely that more than about 30 percent of those on the rig would suffer from PTSD.
Still, some of the lawsuits describe frightful scenes, with survivors allegedly kept on boats near the blazing rig for hours, knowing their friends might not make it, or actually watching others get seriously injured or die.
Asked if BP has offered mental health care to its people who were on the rig, spokesman David Seldin said Tuesday the company doesn't disclose "health information about employees." Seldin had no immediate comment on pending litigation.
Transocean, which employed most of the people on the rig, sent a statement to The Associated Press saying the company "provided support and offers of counseling" to survivors and to the families of those who died. It also has extended full pay and benefits to the families of the Transocean employees who were killed and others who were on the rig, the statement said.
Transocean said it had no comment on litigation.
The owner of ART Catering Inc., Walker's employer, was out of the office Tuesday and did not immediately return a call seeking comment.
"There's not going to be a turning point for me. This has affected me for the rest of my life," said Doug Crawford, a 43-year-old laborer from Mendenhall, Miss. "It won't ever be over."
Crawford, who is suing BP and numerous other companies, said he escaped the rig with minimal injuries, but had a loss of appetite, changes in his sleeping habits and was seeing a psychiatrist.
Some who survived have returned to offshore work. Others plan to do so, but wonder what it will be like given what they've been through.
"I won't know how I'll feel until I'm back out there," said Jarod Oldham, a 24-year-old engineer from Peru, Maine, who was asleep when the rig exploded. "I just hope we learn from this and nothing like that ever happens again. ... It just changes the way you look at things and you have a new respect for things you can't control. You can't take things for granted."
William Terrell II of DeRidder, La., an electronics tech on the Deepwater Horizon, has signed on to work on another rig. The 31-year-old father of a 4-year-old boy said he's not concerned, but understands why many people would have second thoughts.
"I know it's harder for some people than others, depending on where they were on the rig and what they saw," Terrell said. "I was asleep when the accident happened and I just made my way to a lifeboat and got off the rig."
Terry Sellers, 61, from Urania, La., a motorman who works on engines, hurt his back in the explosion and doesn't know if he'll ever step back on a rig. He said the accident had a greater emotional impact on him than the action he saw in Vietnam. He's never been one to take medications to sleep, but he does now, saying he suffers from PTSD. Sellers is represented by a Texas lawyer who has eight other survivors as clients. The attorney did not immediately respond to questions Monday.
"The explosion was so tremendous. We had friends on the rig burning up and we couldn't do nothing about it," Sellers said. "I'm still doing counseling about it. I can't handle loud noises right now. I've been doing this (offshore work) over 30 years, but I don't think I'll ever go back."
He added, "If I can ever quit thinking about it, that's when I can move on."
Associated Press writer Jay Reeves in Gulf Shores, Ala., contributed to this report.