This case is interesting because Luigi doesn't fit the normal profile of a shooter - he had almost everything going for him. He graduated from a private high school as valedictorian. He went to an Ivy League college to major in Computer Science with a minor in mathematics. He worked as a digital nomad doing data science and surfing. He was attractive, flaunting his abs in photos taken in Hawaii. From most of his online presence, he seems pretty normal.
It seems like this back injury completely derailed his life, leading him down this path towards confrontation with the American healthcare system.