Two and half years after a massive oil tanker cleaved the side of the USS John S. McCain, leaving a gaping hole and killing 10 sailors, hospital corpsman Mike Collins is still haunted by the aftermath.

That morning in August 2017, awoken by the thunderous shaking, the 23-year-old was thrust into round-the-clock motion: Tending to the chemical burns of the sailors whose sleeping area flooded, their flesh raw from the fuel that spilled in with the seawater. Collecting the heavy stack of the dead’s medical records. Staying up late trying to purge the stink of diesel that clung to their uniforms, so the clothes could be returned to grieving families.

Then came the hand. Delivered in a red biohazard bag and left casually on the cot in the McCain’s medical quarters for Collins to process was what seemed to be a perfectly formed hand, except the muscles, tendons and bones had been stripped out. It was a glove of translucent skin.

Even as the months turned to years after the accident, that image, down to the whorls and ridges on the dead man’s fingers, intruded into Collins’ life. It popped up when he saw water wash over his own hand or when he just leaned back on the couch to relax.

That gruesome image would spin into unanswerable questions about all the dead men: “How long of the process were they alive for?”

“What were their final moments like?”

In August 2018, Collins was finally diagnosed with post-traumatic stress disorder, anxiety and depression, and he began routine therapy.

The McCain crash was one of two deadly Navy collisions in the summer of 2017. Two months before the McCain, another destroyer, the USS Fitzgerald, also collided with a civilian ship in the Pacific, drowning seven sailors in their sleeping quarters. In all, 17 sailors died in the worst maritime mishaps since the 1970s.

The fallout for Collins and many other survivors is still acute.

But the Navy’s efforts with the crews of the McCain and the Fitzgerald — some 550 enlisted sailors and officers — have been uneven, resulting in prompt, thoughtful treatment for some and leaving others mired in depression and anxiety, unable to access care for weeks, even months, according to documents and interviews with dozens of sailors, officers and their families. Some affected sailors and officers have even left, or been forced out of, the service.

The Navy’s efforts have been complicated by some of the very causes that led to the crashes: chronically undermanned ships in desperate need of sailors — even those fresh from a deadly crash — and a relentless push for missions, both compounded by the sudden loss of two key destroyers.

“Treatment decisions are always subordinated to those demands,” said M. David Rudd, a psychologist specializing in military PTSD and scientific director for the National Center for Veterans Studies. In the military’s warrior culture, relying on sailors to take the initiative to ask for help, Rudd said, is “profoundly ineffective.”

That and the sheer number of sailors and officers potentially affected by the deadly collisions posed challenges for the Navy in how to properly respond.

The Navy sent a team of mental health specialists to help the crews in the immediate aftermath of each collision and launched a long-term pilot program, Project ORION, to track them. The project called or emailed each sailor at six months and one year after the crashes to ascertain how they were doing and whether they needed mental health services.

The Navy provided a written statement about its mental health response to the two accidents. Ed Gulick, a Navy Medicine spokesman, said Project ORION proved to be an important “safety net” and that sailors across all ranks “appeared to greatly benefit from ORION’s proactive, nonmedical approach of long-term outreach.” The Navy plans on making the pilot a permanent program, he said.

The program was able to reach about two-thirds of the sailors, the Navy reported, and about 20% of those requested mental health help.

Experts said that number is consistent with the percentage of service members who served in Iraq and Afghanistan who developed PTSD symptoms, and that a similar percentage of the sailors who did not respond to ORION likely also experienced PTSD symptoms.

In interviews, sailors described vastly different experiences depending on what ship they were on and when in the process they were assessed, if at all. McCain Senior Chief Petty Officer Ben Chester said the Navy response was extraordinary, with a team of doctors awaiting the crew in Singapore and readily available follow-up care.

The Navy also set up a 24-hour help line at the base at Yokosuka, Japan, and chaplains arranged for a resilience retreat at a military resort in the country for Fitzgerald and McCain sailors.

The sailors’ trauma also led to some impromptu treatment. A Navy doctor started a special group therapy session, attended by upward of 70 Fitzgerald sailors, after so many of them sought mental health services. That group has continued in smaller iterations at different bases in the United States as sailors left Japan for new Navy posts.

Still, some sailors were missed. Collins, for example, who started having acute symptoms about four months after the collision, would go a year without a diagnosis, in spite of having regular contact with mental health professionals. Collins said although he was suffering from nightmares and other symptoms, he may not have been presenting as severe enough.

It was not until the 7th Fleet commander required all remaining McCain sailors to be screened for fitness of duty in August 2018 that Collins was flagged as having PTSD. He went on limited duty.

Another former McCain sailor said two mental health screenings over a year and a half determined he was fine. It wasn’t until he transferred back to Japan in the spring of 2018 that he started to feel irritable, anxious and unable to sleep, with “almost no ability to feel happiness.” On his third screening, he was diagnosed with PTSD and depression and started therapy.

Other sailors from both ships didn’t draw notice until their coping mechanisms, such as excessive drinking, landed them in trouble.

Some Fitzgerald sailors began suffering symptoms after the Navy ordered many of them onto other short-staffed destroyers in the Japan-based 7th Fleet soon after the collision. The Fitzgerald was so badly damaged that it had to be loaded on a ship and taken back to the U.S. for several years of repairs.

It was a smart logistical move, “but they didn’t take the human aspect into account,” said Will Marquis, a petty officer on the Fitzgerald who was moved to another warship. Marquis escaped the flooded berthing compartment in which some of his shipmates drowned.

Some Navy leaders believed that quickly shifting the sailors to a new posting would also help them return to normalcy — and reinforce a sense of mission and purpose.

But in interviews, some sailors said that the return to sea, often with unsympathetic leaders, was retraumatizing for many of them. They were often assigned back to the same kinds of destroyers, sleeping in the identical bunks, from which some of them had barely escaped with their lives.

One sailor who escaped the flooding on the McCain said that for years after the crash he would have nightmares whenever he was in a berthing compartment on another ship. One day, as the two-year anniversary of the collision approached, the ship he was on made an unexpected sharp turn, sending a chair scraping across the floor.

“That instantly took me back,” he said. “That sound.”

He peed himself.

Rudd, the PTSD expert, said for those sailors who were symptomatic, quickly returning to duty “exacerbates the problem and can potentially fuel a chronic problem of PTSD.” Symptoms like anxiety and nightmares could become entrenched and more resistant to treatment, he said.

Thrusting important tasks on sailors who are still recovering and may not be able to fully focus on their work also “elevates the risk that something else will happen down the road,” Rudd said.

When Marquis first stepped on the USS McCampbell, another destroyer, a few months after the Fitzgerald crashed, he was excited because “I wanted to get back to doing what I do.”

But despite his decade and half of service, Marquis, 35, found himself working harder to simply focus and being unmotivated in a way he’d never been before. He started smoking half a pack of cigarettes a day, years after he’d quit, ate nothing but junk food and retreated from any social life.

During that time the McCampbell didn’t leave port, but every five nights sailors had to do an overnight on the ship. Marquis said he couldn’t handle sleeping in his assigned berthing compartment “because I almost died in there.” So he brought in a sleeping pad and bag to crash on the floor in his office, which was above the water line. “That’s just where I felt more comfortable,” he said.

Marquis said he knew of two sailors who were sent to another destroyer and strung up hammocks among the guns in the cold armory and slept there the entire time they were on deployment.

About 10 Fitzgerald sailors were reassigned with him to the McCampbell, he said. For months, sometimes several times a day, there’d be a knock on his door and a former Fitzgerald sailor would break down in his office, Marquis said. One young sailor told him she couldn’t handle being on a ship but was afraid she’d ruin her career if she asked for help.

As part of the Navy’s post-collision reckoning, the McCampbell and other destroyers started doing damage control drills that were the exact scenario of the Fitzgerald crash. Marquis said he had to talk to those in charge: “‘Dude, you got like 10 people from the Fitzgerald here.’” He said he heard other ships actually called the scenario the “Fitzgerald” drill.

One day, Marquis said, a senior enlisted leader cornered him. The leader said that he’d heard good things about Marquis, but that the petty officer wasn’t living up to his reputation. Marquis said that when he explained that he was trying, but was struggling mentally, the leader essentially told him to suck it up. “Basically trying to come at me like I was weak,” he said.

Marquis said he knew something was wrong and it was getting worse but he didn’t want to abandon the other Fitzgerald sailors on the McCampbell, many of whom were junior. The sailor he was replacing on the McCampbell saw him struggling and pushed him to get help, Marquis said, telling him, “You’re not right.”

After about two to three months on the McCampbell, he said, he finally sought mental health counseling. In just 20 minutes, he said, a mental health specialist said he needed to leave his duties on the ship.

Marquis transferred to the Washington, D.C., area, where he was able to get help at Walter Reed National Military Medical Center in Bethesda, Maryland. He has been diagnosed with PTSD, major depressive disorder and a traumatic brain injury and has since medically retired, along with at least nine other Fitzgerald sailors, Marquis said.

“We were all OK when we were a crew still,” Marquis said. “It was when they separated us that we started either noticing these underlying issues or we actually started developing them.”

On their new ships, some sailors said the fact that they had been aboard a ship that crashed made them instant outcasts. Several former Fitzgerald officers said sailors told them that they were made fun of by their new shipmates. “Don’t let the Fitzgerald sailor drive!” their shipmates would joke. It made the separation from the Fitzgerald crew even more isolating.

More than 100 sailors from the McCain were able to stay together after the crash because the destroyer could be repaired in Japan with some of the crew on it. That camaraderie, many sailors said, helped their recovery. But it also meant they had to walk down the pier every day to board a ship with a “massive puncture,” said Collins, the hospital corpsman who dealt with the dismembered hand. “Your heart kind of sinks every time you walk into work.”

The cafeteria where the sailors ate had served as a medical triage after the crash, filled with the injured. Every third day many of the sailors had overnight duty.

Collins said “every day was like trudging through mud.” His refuge in the aftermath of the collision was to just go numb. He remembered in early 2018 his wife giving him the welcome news that she was pregnant and he couldn’t even muster a smile. “OK,” was all he recalled saying.

To keep the image of the ghostly hand at bay, he learned to stay in constant motion. During most busy days he could outrun it, he said, but at night, vivid nightmares often jolted him upright.

About a year after the crash, the Navy offered the McCain sailors still assigned to the ship an option to transfer to a new job early. Almost 40 sailors took it, including Collins. He left Japan six months ahead of schedule and took a post in Jacksonville, Florida, where his parents live. He spent several months on limited duty there.

He was able to join a Fitzgerald therapy group already in place that met once a week. The group now meets once a month as sailors have progressed in their recovery.

A group of McCain sailors, including the estates of some of the sailors killed in the collision, has sued the owners of the civilian ship involved in the accident, the Alnic MC, in federal court in the Southern District of New York. The McCain sailors and the families contend that the Liberian-flagged Alnic was, at least in part, responsible for the collision because it failed to properly man its bridge and take appropriate action to avoid the collision. In the suit, at least 40 McCain sailors say that they have suffered debilitating psychological injuries as a result.

The owner of the Alnic, Energetic Tank Inc., contends in court documents that it was not liable because the collision was “solely the fault” of the McCain, which violated several maritime regulations. The case is slowly moving toward trial as both sides interview witnesses and experts around the globe.

A petty officer told the court in a letter asking to be admitted to the case that when the berthing “flooded with fuel, crewmates were screaming for help. As I helped one out of the hatch he repeatedly screamed, ‘Don’t leave me, I have a daughter.’”

A chief petty officer, who sustained a head injury and chemical burns on his hands in the crash and during rescue efforts, wrote that he now suffers from PTSD and depression as well as a “lack of confidence and a host of other associated psychological problems that makes it difficult to do things.”

Interviews and documents show that the Navy has struggled to provide a consistency of treatment over time. Collins said mental health services in Yokosuka, where both ships were based, had appointments set aside for Fitzgerald and McCain sailors. But the longer sailors took to ask for help the less likely they were to have a positive experience. The ORION project stopped reaching out after a year — and some sailors reported hearing from the coordinators only once.

After he waited weeks, the sailor who’d wet himself said he finally got his first mental health appointment. He related his story of flashbacks and nightmares, he said, hopeful he’d get help. But nobody ever followed up as promised. When he called the office, he said, he was told there was no record he’d ever been there.

Some sailors said once they transferred back to U.S. bases — sometimes specifically to receive treatment — they often faced similar delays, spending weeks, and even months, waiting for appointments.

One such sailor who’d gone to San Diego, Machinists Mate Third Class Eli Swantkoski, said he arrived in November and wasn’t seen until February.

“Why I wasn’t getting any help was drowning me in stress,” he said.

In part to ensure the sailors didn’t get lost in the shuffle as their careers moved on, the Navy assigned all Fitzgerald sailors a code, 0006, as well as one for all McCain sailors, 0007. It shows up on the sailors’ personnel records so that commanders, ship leaders, assignment managers, health care providers and others will be aware that they served on one of the ships.

One retired captain said he thought it was a great idea to alert commanders and other leaders so they could better guide the sailors. But Marquis, who worked in personnel, worried there might be unintended consequences.

For example, the Fitzgerald sailor who told him she was having trouble being on a ship did as the senior sailor had pushed him to do and “sucked it up.” But Marquis wondered if her career would suffer anyway. Would the next command reject her, deeming her damaged goods? Marquis worried it could end up being a red flag on sailors as they climbed the ranks.

Collins isn’t sure anyone noticed the 0007 on his personnel file when he returned to full duty in April last year. He was assigned to the Field Medical Training Battalion at Camp Lejeune in North Carolina. There he did intense training to be qualified to save Marines on the battlefield. The stressful scenarios, not unexpectedly, aggravated his PTSD. The Navy took months to transfer him out of that job back to Florida, he said.

Now, he’s training to be an assistant in ophthalmology at a naval hospital.

“It’s very, very low stress,” Collins said. “It’s just checking people’s eyes, then turning over that patient to a doctor. That’s pretty much my gig.”

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If you or someone you know needs help, here are a few resources:

• Call the National Suicide Prevention Lifeline: 800-273-8255

• Text the Crisis Text Line from anywhere in the U.S. to reach a crisis counselor: 741741

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