When it was over, eight people were dead and three others hurt.
A year later, Carthage residents find it hard to believe a full 12 months has passed since the rampage inside the Pinelake Health and Rehabilitation Center. The name of the center has been changed, but the memories live on.
"Once we look down and see those scars and see people that are hurting then we're reminded," said Pastor Thomas Herndon of the First Baptist Church.
Herndon remembers the crowd of two or three hundred outside his church desperately waiting for word about their loved ones.
"They needed to have a chair to set in. They needed to have some drink and some food. And, it was at this place they were first told which one had died in this tragedy," he recalled.
Carthage police officer Justin Garner was one of three people wounded that day. He was allegedly shot by gunman Robert Stewart in the nursing home, but Garner was able to shoot Stewart in the chest - stopping him from killing more elderly residents.
"Very, very emotional," said Garner of the one year anniversary. "Brings back a lot of memories. I was working yesterday and it was hard to believe that it's been a year and not a day goes by that you don't remember it."
At Monday morning's memorial service at the home, the flag was only raised to half staff. While many are trying to put the tragedy behind them, it's not been easy for some.
"The majority of the people are still remembering, are still affected. Especially when we see family members that's lost loved ones. It brings it all back," said Herndon.
A public memorial service was also held Monday night at the First Baptist Church.
The town paused to honor Garner along with Jerry Avant, a nurse who was killed protecting a patient.
"Being able to put it behind them one year anniversary, to get over with move on and move forward is probably where everybody needs to get to at this point, " resident Lance Mitchell said.
"This is known as sweet Carthage and we hope it will always be sweet Carthage and we hope we are getting back to being sweet Carthage," Carthage Mayor Tom Stewart said.
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