A Dark Night in Aurora

by Dr. William H. Reid

  As we talked over a year later about Holmes’s writings, it became clear that some were simply ways to pass the time; some were efforts to understand or express thoughts, much as an artist sometimes paints with realism and sometimes waxes abstract in the extreme. Not to compare Holmes with e. e. cummings or T. S. Eliot, but he has as much right as the next person to write abstractly without being called crazy. His musings about galactic colonization, for example, follow reasoning that exobiologists have employed for years.

  Nevertheless, many of the mental health professionals who read Holmes’s writings saw at least some of it as evidence of his mental illness. The fact that he wrote much less after starting antipsychotic medication, and his own comment that the impulse to write had slowed since he began treatment, suggest that they may have been right.

  Holmes was a model prisoner through that first July, August, September, October, and much of November. His dyed hair soon grew out to its normal color. He grew a beard. He never had altercations with anyone, and he cooperated with custody staff orders and requests. He kept to himself, whether by personality or due to mental illness—maybe both. There is no record of him striking up conversations with the deputies or expressing interest in anyone else.

  His parents, still in California, wrote to him often, but he never wrote back. He said his lack of corresponding was partly because he had to be careful about helping the prosecution—all of his correspondence was monitored by the jail and available to law enforcement and the prosecution—but that doesn’t wash completely, nor does it explain why his sister very rarely wrote. His family either couldn’t visit or weren’t allowed for months after Holmes’s arrest. They eventually met with Holmes in a jail visiting room with his lawyers and were his first outside visitors other than Dr. Woodcock. After that, he saw them only when they came to town for periodic court hearings.

  Early in his incarceration, Holmes would get a bit emotional, and occasionally a little tearful, when he thought about his family. That passed with time. After a few months, he said, he “kind of accepted the way things are.” His mother wrote often, his dad a little less, their letters brought to the jail by his lawyers. He looked forward to the letters; they made him happy. Sister Chris, on the other hand, didn’t write. At first he told me, “It doesn’t matter if she writes to me or not … I know she loves me anyway,” but he soon admitted that “if I had a choice, I would want to hear from her.”

  Holmes had an unrealistic, psychologically defensive view of his isolation and the reasons some people wrote or, more important, didn’t write to him. To protect himself from feeling hurt, he unconsciously “chose” to ignore any contradiction between getting thousands of cards and letters from strangers and the complete absence of communication from his sister and former friends. He took exception to any suggestion that Chris had abandoned him, or vice versa, but admitted that he probably wouldn’t write to her even if his lawyers said it was okay. “I don’t have much to talk about,” he said with a chuckle that seemed out of place. “There’s books I’m reading and TV I’m watching; that’s about it.” He would have written to his mom if the lawyers had allowed it, he said, “just ’cause she writes so often.”

  It hurts to be ignored or isolated from the people in our lives, but isolation was an old friend to Holmes, a tool for easing uncomfortable situations and keeping troublesome feelings at bay. He created explanations, plausible to him but transparently illogical to the rest of us, to assuage—no, to prevent—the pain.

  As late as the summer of 2014, two years after the shootings, Holmes still believed that his graduate school friends Ben, Tim, Gargi, and Hillary, though they had never written to him, thought of him as having been a good friend. “They knew me before I was … outright mentally ill…. They probably want to distance themselves from me so they don’t get lumped in as related to a killer. I think they’d care about me.” He didn’t think his friends would be angry at him “unless it interfered with their lives, or the press interfered with their lives…. I think they’d be supportive.”

  Holmes’s denial of the almost universal hatred of him expressed by society—to be fair, most vehemently expressed on social media and an Internet that he couldn’t see—was striking. When I asked what he thought the public felt about him, what people would say about him, he answered, “Um, dislike, they would say … misunderstood. They don’t have the full picture of my life and what’s happened.”

  There’s no indication in the record that Holmes suffered significant mental discomfort for the first hundred days or so of jail. He was continuously monitored with video, day and night, but after saving the first few weeks of uneventful video recordings, custody staff began to record over the video every twenty-four hours. In October, he exercised a lot and sometimes didn’t eat supper, but he had lots of commissary snacks and was gaining weight. Sometimes he would “spin” during his exercising, but he had no complaints; “no distress noted,” the record said. He got books from the library cart. He kept himself and his cell clean, chatted briefly with staff from time to time, cracked an occasional smile. Daily medical unit notes and other records were unremarkable until mid-November.

  Then everything changed.

  At about 4:30 in the morning on November 11, 2012, jail surveillance video showed Holmes climbing into a standing position on his bunk and facing the near wall. He stood there for a moment, perhaps pensive, touched his bearded chin with his left hand, and reached out to the wall a couple of times. He crossed his arms on his chest, gripping his shoulders. He continued to stand, maybe gathering courage or just preparing himself. Thirty seconds later, he let himself fall stiffly, straight backward off the eighteen-inch-high bunk, reflexively putting out his arms and lifting his head just before his back and buttocks hit the hard floor. The jail deputies’ report, not entirely true to the video, was that he “jumped” backward off the bunk. His defense lawyers implied that Holmes made no attempt to catch himself. That’s not true, either.

  Whatever his purpose, Holmes let himself fall straight backward and at the last moment, consciously or not, put out his arms and kept his head from hitting the floor. In some interviews and clinical visits after that, Holmes said he was trying to get bad thoughts out of his head; at other times he didn’t remember, or never knew, exactly what he was thinking.

  Whatever his motivations at the time, it hurt. Holmes doubled up, clutched one hand between his knees, and writhed a bit before lying back and closing his eyes. Guards, at least three of them, were there within a couple of minutes. One can see everyone’s lips moving (the video lacks sound). The deputies talked to him; he talked to them. He remained on the floor, arms crossed, not apparently injured. The guards hovered a few feet away, and then Holmes stood up and left the cell with the officers. He was going to BC.

  BC means “behavior control.” A BC cell is the jail’s “safe” place. It’s where the staff puts inmates who are suicidal or violent. In Holmes’s case, they wrote that he was on suicide watch. It was “for his own good.”

  BC cells—there are more than one at the Arapahoe County jail—have other names among ACDF staff and inmates: “the Hole,” “the Rubber Room.” It’s not rubber as in soft and bouncy, but hard rubber, almost as hard as the brick walls it thinly covers. There’s no furniture. There are no fixtures except a metal drain in the middle of the floor. That’s the toilet. There’s a food slot in the door, commonly called the “pie hole.” Inmates in the Hole never get pie.

  Holmes was put in the Hole, no doubt physically safer than his cell at the time but extremely isolated, and continuously observed with live video. His clothes were removed, and he was given a “suicide gown” or smock and a “suicide blanket,” both made of materials that couldn’t be torn or used to hurt himself. For the first few hours, he walked about or slept wrapped in the blanket. At some point, he defecated on the floor. No one picked up the turds.

  Holmes remembered the BC cell as a time when he was quite psychotic. “I thought other people were r
eading my thoughts, so I tried to, like, hide them, so I would say a bunch of colors like red, blue, green, red. And then, like, point in my cell and stuff in random locations … to get them to stop listening to my thoughts … to hide them.”

  Some six hours after Holmes was put in BC, some members of the medical staff came to talk with him. He was sitting nude, facing the back wall. He told one of them, in disjointed terms, that he was trying to keep it together but was afraid of what he might do. He seemed very confused, staring intently but blankly at a staff person, doubting that he was “real” and asking to shake the person’s hand to be sure. That wasn’t allowed under the circumstances. A “safety mattress” was ordered but never came.

  A few hours after that, a jail deputy on video surveillance duty reported that Holmes had run headfirst into the cell wall. Guards and a nurse, Nancy Winegar, reacted at once and found him lying on the floor with the suicide blanket over his face. He had no open wounds, but there was a “red mark” on his forehead. Holmes seemed passive as they examined him from a distance, and then he grabbed for the nurse’s leg; she retreated through the cell door.

  That night, Holmes paced in the BC cell continuously, stopped for a moment, and then fell straight back onto the floor. He lay there as deputies and two nurses came to examine him. His eyes were closed and “fluttering” as he moved about. He was difficult to examine—the nurses didn’t touch him because of what they described as “unpredictable behavior”—but appeared uninjured.

  The next morning, Holmes continued to behave oddly. Now lying naked on the floor. Now throwing his “suicide sack” breakfast (finger food with no utensils) onto the drain-toilet in the middle of the cell. Now licking the cell wall. Now trying to jump up and look out the small, high cell window. He was restless, seemed to ignore staff attempts to talk with him, and continued his blank but penetrating stare. Jail administration and medical services were aware that something was very wrong mentally and that his intake of food and fluids was very low. They monitored him. He continued to appear confused and responded oddly when staff asked how they could help. A deputy asked if he was thirsty. He said, “I don’t know where the water is.”

  At midday, he put his lunch meat between two flattened paper cups and ate everything. He did backward somersaults while trying to balance a paper cup on his penis. He remained naked in spite of the smock provided. Jail psychologist Dr. Sather came by that afternoon, but he refused to talk with her. He accepted supper and then mashed it into his blanket. Water was offered often, but he didn’t drink anything for at least thirty-six hours. They monitored him.

  During the early morning hours of Sunday, November 13, Holmes stood and again defecated onto the cell floor. They continued to monitor him.

  Around 9:00 that morning, nurse Sandy Paggen tried to examine Holmes. He resisted and sometimes required several guards to contain his agitation. He would not, or could not, stand. His eyes were “very bloodshot and tearful”; the nurse thought perhaps there was trauma from his contact lenses, but she couldn’t find them in his eyes. He was verbally unresponsive but moved his lips as if trying to speak. He resisted when others tried to move his limbs or open his eyes. He sometimes assumed “catatonic” postures (placing his limbs in unusual positions and holding them motionless indefinitely). Nurse Paggen noted his lack of eating or drinking in the record and that his feet were “covered in feces.”

  Dr. Jason Grope, the jail medical director, reviewed the records and tried to examine Holmes after Nurse Paggen’s efforts, with limited success. Holmes was lying on the cell floor, shaky and sometimes rigid. Dr. Grope ordered him taken to the emergency room at Denver Health Medical Center (DHMC) for tests to rule out head injury, dehydration, and other medical problems. Jail psychiatrist Dr. Mozer also wrote a note in the record that morning, perhaps after viewing Holmes on video but probably not seeing him in person. A little after 11:00 a.m., he was strapped to a gurney and sent to DHMC by ambulance.

  He was back at the jail, in another BC cell, just two hours later. There’s no record of his being seen in the emergency room; he simply had the CT scan and blood tests requested by Dr. Grope. He received half a liter of intravenous fluid on the way to the hospital.

  Upon his return, Holmes appeared about the same as when he had left the jail. EMS workers reported that he said a few words in the ambulance, but he didn’t seem to know what had transpired. Jail staff put him on a mat in the BC cell and continued monitoring him by video. He didn’t move. They occasionally offered water and other help. He sometimes mumbled quietly and incoherently. He lay there naked, not eating or drinking, for hours. They kept monitoring him.

  About 8:00 p.m., deputies entered the call and offered food and drink again. He drank the water and ate a little, then lay back down on the floor and stared at the ceiling.

  The next morning, now more than three days since falling backward from his bunk, Holmes was behaving even more bizarrely, standing naked, not responding, crying at times. He mindlessly tried to stuff his food back through the pie hole, like an automaton, mucus streaming from his nose, down his chin, onto the floor. His lawyers came to talk about a court hearing the next day. He didn’t respond to them, either.

  A nurse that morning, Carl Anderson, noticed the feces still caked between his toes. Anderson took the time to wash Holmes’s feet. He didn’t resist that kindness.

  They kept monitoring him.

  Early that afternoon, Holmes again ran headlong, literally, into the cell wall. Video shows him standing naked, blanket on the floor, facing the back wall. He seemed to ponder it for a moment, pressed on the wall with his fingers (perhaps checking its hardness), and then stepped back six or eight feet for the run. This time he kept his arms behind him and didn’t slow down until the crown of his head hit the wall. Holmes fell back and then sat up and rocked to and fro. It hurt. He stayed on the floor, sitting cross-legged and facing the wall, now putting his arm up, now turning gingerly as if to see if anything were injured.

  After five minutes he got up. He walked to the wall, looking dazed, touched it, turned slowly, and then went to the round grate in the middle of the floor. He stood directly on the drain and turned around several times, unsteady. It’s hard to interpret his actions, much less his thoughts. It took almost six minutes from the time of impact for the guards to arrive.

  Dr. Grope was called. Holmes yelled, “I see shadows! You’re a shadow!” At one point, nine custody and medical staff were in the BC cell as he was immobilized and strapped into a restraint chair, a “spit guard” cowl put over his head. An IV was started, and he was given lorazepam (Ativan). In addition to the head trauma, Dr. Grope diagnosed acute dehydration and ordered three liters of intravenous fluid (Ringer’s lactate). Three liters is about sixty percent of a normal adult’s entire blood volume.

  The fluids and medication helped. After a couple of hours, the IV was removed and Holmes was released from the restraint chair. He communicated a bit and followed commands. He finally began to urinate again, thanks to the massive IV fluid replenishment, but he still didn’t eat or drink on his own. As the lorazepam wore off, his bizarre movements and lack of responses returned. The staff notes often said “no distress noted,” a standard nursing note when a patient isn’t complaining. On the other hand, it was obvious that Holmes couldn’t express distress directly.

  They kept monitoring him.

  By Monday, November 15, Holmes had not taken any food or oral fluids for two days and was again lying on the floor, almost always naked, shivering and not communicating. Dr. Mozer sometimes watched him on video but didn’t see him in person. Jail staff prepared to implement a “starvation protocol” (efforts to force nutrition when an inmate repeatedly refuses to eat). Mozer made plans to transfer Holmes to the secure wing of the Colorado Mental Health Institute in Pueblo, 110 miles away, for more definitive medical and psychiatric care. Later that morning, as the starvation protocol procedures were being read to him, Holmes suddenly became agitated and was again strapped i
nto a restraint chair. That afternoon, rather than going to the state mental hospital, he was sent back to DHMC, this time for inpatient treatment.

  He was admitted to DHMC under an alias, though it wouldn’t have taken much imagination to figure out that “Brady Arkansas,” admitted November 15, was the same person as the James Holmes who received a CT scan November 13. After all, they were both from the jail, had the same medical record number, and shared a birthday.

  Holmes was very ill when he arrived at the hospital. In addition to acute delirium, his severe dehydration and starvation had caused a serious imbalance of electrolytes (vital elements in his blood). Psychiatrist Dr. Rachel Davis saw more than delirium in Holmes’s behavior. He sometimes exhibited catatonic posturing, suggesting psychosis associated with a schizophrenia-like disorder.

  Emergency nutrients and medications were administered at once, and he was admitted to the internal medicine service. Psychiatric consultation was quickly obtained. The various specialists tried to figure out what was wrong. Intravenous rehydration and nutrition stabilized his physical condition, antipsychotic medication began to calm his agitation, and Holmes slept.

  Over the next five days, he began to eat and drink on his own, slowly regaining a grasp on reality. He started to talk, albeit with the slow, oddly responding speech he had exhibited since his arrest. He spoke of hearing voices, being suspicious of the jail food, and ramming his head into the wall “to get the bad thoughts out,” thoughts that he was hungry and thirsty. While he was still delirious, he said he was in jail because “I pulled away from the people I knew … I drank their blood … I took the blood that wasn’t mine to take … I was selfish.”