Is that photo real but for the added balloon text?
Yes. Sadly, it is a real photograph (actually a single frame extracted from a video file) of the “cameraman” and “reporter” he was ostensibly “protecting”.
It was taken a few frames after the patriot hit the ground, dead, and instead of attending to the guy he just shot (as I believe Kyle Rittenhouse did before the mob began crying for his head) he looked directly at the camera as if to say one of two things:
“Did you get that on video like we wanted?”
or
“OMG. Am I for real on video murdering a person? Can we erase that and get out of here?”