Both sides agree on the fact that the killings were horrific, but the defense told jurors the evidence will show Robert Stewart's actions were not murder.
Stewart, 47, has admitted he was the shooter who went on a killing spree March 29, 2009 at the Pinelake Health and Rehabilitation Center in Carthage.
Stewart is facing eight counts of first degree murder - one for each of the seven elderly patients and the nurse he gunned down at the home.
On Monday, prosecutors focused on the victims, residents Tessie Garner, 75; Lillian Dunn, 89; Jesse Musser, 88; Bessie Hedrick, 78; John Goldston, 78; Margaret Johnson, 89; Louise DeKler, 98; and nurse Jerry Avant, 39. All were shot in close range - most sitting in their wheelchairs.
Prosecutors believe Stewart was a man on a mission, fully aware of his actions. They say he came to the nursing home looking for his estranged wife Wanda Luck. She managed to hide in a bathroom in a locked area for Alzheimer's patients and was not injured in the attack.
The defense didn't dispute what happened, instead choosing to focus on what was going on in Stewart's mind during the shootings.
They told the jury that the evidence will show Stewart had been taking Ambien for two years and 48 hours prior to the shootings, a nurse practitioner had prescribed Stewart an anti-depressant and Xanax - a dangerous combination of drugs that the defense says caused what happened that day.
Stewart was eventually stopped by Carthage police officer Justin Garner who was wounded by shotgun pellets in the leg during an exchange of gunfire. Garner shot Stewart in the chest.
Prosecutors plan to seek the death penalty if Stewart is convicted.
Before the start of the trial Monday, it took nearly two weeks to select the jury of 10 men and 6 women. The dozen jurors and four alternates have to be bused 60 miles to Carthage every day for the trial. The jury was selected in Stanly County because of publicity about the shooting in Moore County.
Authorities are blocking off streets as jurors arrive and depart.