CARTHAGE, N.C. — Some of the seven residents of Pinelake Health and Rehabilitation Center killed during a rampage at the nursing home were shot from a very close range, the former state medical examiner said Wednesday.

Forensic pathologist Dr. Thomas Clark took the stand in the trial of Robert Kenneth Stewart, who is charged with eight counts of murder in the March 29, 2009, shootings. In addition to the patients, a nurse was killed and three other people were wounded when Stewart opened fire a the Moore County facility. He could be sentenced to death if convicted.

Clark performed autopsies on three of those who died. During testimony, he held up photos of the victims' wounds.

John Goldston, 78, was shot by a shotgun from about two feet away or less, Clark said. He held up a tattered and bloody shirt Goldston was wearing when he was shot.

“He could not have survived following the injury. He would have been unconscious within a few minutes and would have been brain dead within a few minutes of that," Clark said.

Seventy-eight year old Bessie Hedrick, another patient, was hit by a shotgun shell from at least six feet away, Clark said. 

Clark said the shots fired from a few feet away completely destroyed 88-year-old Jesse Musser's heart. "It was shattered," he said. 

During Clark's testimony, family members of the victims cried in the courtroom. One man covered his eyes to avoid looking at the photos. 

Medical examiner Dr. Marion Gaffney-Kraft testified that nurse Jerry Avant, Jr., suffered about a half-hour of extreme pain before he lost consciousness from multiple gunshot wounds. 

Prosecutors have argued that Stewart went to Pinelake, where his then-wife, Wanda Neal, worked, to track her down and was so heavily armed that nothing was going to stop him.

Defense attorney Jonathan Megerian said at the start of the trial that Stewart overdosed on the sleep aid Ambien the night before the shootings, which put him in a hypnotic state that left him powerless over his actions. Stewart doesn't recall what happened the day of the shooting and can't be held legally responsible, Megerian has argued.

Dr. LaVonne Fox, a clinical psychologist at the Central Region Psychiatric Hospital, also testified Wednesday about a personality and emotional test given to Stewart this Spring. She said the results showed "symptom exaggeration" and she deemed the test invalid.

Fox did not administer the test, but said she met with Stewart three times in June and gave him a battery of other tests, including tests to check his memory. 

Fox said tests to check Stewart's memory recall had good results.

On other tests, she said Stewart appeared to be trying to do well and did not appear to be faking.