Murder and Mayhem (19 page)

If these two entities occur together, not only does the heart muscle have less blood flowing to it from the obstructed arteries but also the blood it does get has less oxygen—a dangerous combination. We see this a lot. A patient with CAD and mild angina may become very unstable and even suffer a heart attack or die if he develops anemia from a bleeding ulcer or from some other cause.

As the anemia progresses, his angina would get worse, and since he's an abusive jerk, he might not go to his doctor. He would develop progressive and frequent angina attacks, any one of which could blossom into a full MI and kill him.

His M.D. might sign the death certificate since the wife would say her husband had had worsening of his angina, wouldn't go to the doctor, and finally clutched his chest and fell over dead. This way no autopsy would be done, his anemia and his irritated glass-filled GI tract would never be seen by the M.E., and her life would go on.

So the ground glass could work in your story, just not directly.

How Long Does It Take to Smother Someone with a Pillow?

Q: My victim is killed by suffocation—a pillow over the face. How long would this take? She is an elderly woman and not especially strong. She is in a nursing home because of two broken legs suffered in a car accident. I've written this with the assumption that it would be a quick means of killing her. Then I saw somewhere that it can take as long as ten minutes to kill someone this way. So what's the story? Do I have to start over?

A: No, you don't have to start over. An elderly lady would die in two to five minutes and probably toward the lower end of this range. A younger, stronger victim might be able to put up a good fight so that the suffocation would be intermittent; that is, he or she might knock or push the pillow away several times and be able to grab a gulp of air. He would be able to continue this until the oxygen level in his blood dropped sufficiently and he became weak, lost consciousness, and died. Your elderly lady would struggle but probably wouldn't be strong enough to dislodge the pillow, even for a gasp of air. This is particularly true since she has two broken legs and thus would not be able to get much leverage.

Her struggles, as well as the fact that she would be extremely frightened, would lead to rapid consumption of the oxygen in her bloodstream so that death would occur more quickly. Also, an elderly victim such as yours would likely have at least some degree of heart and lung disease, and these would make her tolerance for lack of oxygen even less. Two to three minutes would probably be it.

She would die from cardiopulmonary arrest (the heart stops). If she showed no signs of external injury, her death could be judged to have been natural by her family M.D., since elderly persons frequently die in their sleep—especially in nursing homes after auto

accidents. Her private M.D. might assume she had a fatal heart attack or a pulmonary embolism (PE). A PE is a blood clot that travels from the legs or pelvis to the lungs. This is a common cause of death in bedridden patients and in those who have suffered injuries to their lower extremities. Your elderly lady would have both of these risk factors for PE. Her M.D. might sign the death certificate, and that would be the end of it.

But if the M.E. performed an autopsy, he would likely see the characteristic petechial hemorrhages (red dots and small splotches from broken microscopic capillary vessels) in the conjunctivae of the eyes (the pink part). These are found in smotherings and in both manual and ligature strangulations. If he did, a homicide would be suspected.

How Does an Ice Pick to the Back of the Neck Kill?

Q: In my story, a killer shoves an ice pick into the back of a guy's neck, right under the skull, and kills him instantly. Does this work? How?

A: Since life depends on an intact communication between the brain and the body, any injury to the spinal cord in the cervical area is potentially lethal. If an ice pick or knife blade is forced between two of the neck bones (cervical vertebrae) and slices or macerates (chews up) the spinal cord, death is fairly well assured. The cervical portion of the spinal cord is divided into eight levels, which correspond to the eight cervical vertebrae. They are designated C1 through C8.

Though damage to any level of the cervical cord could do the trick, the higher the better. Why? The levels between C3 and C5 control respiration, so any injury at or above this level would shut down breathing and lead to death.

Your killer could best accomplish his deed by insinuating his

weapon between the second and third cervical vertebrae (Figure 12). The entry point would correspond with the small hollow depression in the back of the neck that is just below where the skull joins the neck. A cut here would anatomically and functionally separate the brain from the spinal cord and, thus, the body. Think of it as a localized guillotine, a cutting of the spinal cord without completely removing the head. The effect is the same.

With a transection (cutting) of the spinal cord, all the body's muscles would immediately become flaccid (limp), and the victim would drop to the floor. He would be unable to speak or breathe because the nerves to the diaphragm, which arise from C3 through C5, would be interrupted. Also, with the loss of enervation to the

body, the blood vessels would rapidly dilate (open up), causing the blood pressure to drop, and shock, unconsciousness, and death would follow.

Would the victim be conscious for a few seconds? Possibly, but he would be as flaccid as a scarecrow, unable to move, speak, breathe, or cry for help. Death would be as immediate as it could be.

What Are the Most Lethal Wounds That Can Be Made with a Knife?

Q: In my story, a right-handed murderer with a very sharp six-inch blade kills a man with one "slice." I know that it's possible for the victim to go into shock and die right away. What I don't know is what the knife has to cut in order to get that result. What would the coroner's report say was the cause of death?

A: I assume from your question that you want the victim to die fairly quickly. There are several possibilities.

A professional assassin can maneuver a blade between the cervical vertebrae (neck bones) and slice the spinal cord in one movement. Usually the attack comes from behind. The assassin slaps a hand over the victim's mouth and thrusts the blade into the back of the neck, slipping it between the bones. The victim goes limp, falls, and dies almost instantly.

From a similar position the killer can draw the blade across the victim's neck, cutting through the carotid arteries and the trachea (Figure 13). Since the carotid arteries supply blood to the brain, the victim dies quickly, and the cutting of the trachea below the vocal cords prevents the victim from crying out. This is what happened to Nicole Brown Simpson.

A thrusting stab wound to the heart is lethal most of the time and fairly quick. The same can be said for the lungs if a major

artery is severed. But people often survive stab wounds to the chest and even the heart, and would, of course, be able to call for help.

A slashing or stabbing wound to the abdomen might work if the aorta or vena cava was sliced. The problem is that both lie along the back of the abdomen, and a six-inch blade might not reach them. It could, though, if the attacker was strong, thrust the knife deeply, and then made a sweeping motion with the blade. Death would take several minutes since it would require the victim to bleed to death.

The cervical spinal cord cut, the throat slashing, or the stab to the heart are the most effective ways and have the highest likelihood of killing the victim.

The coroner or M.E. would be able to determine the cause of

death without difficulty. The cervical cut would be called "transection of the spinal cord at the cervical level." The throat slashing would be termed "transection of the carotid arteries." The stab to the heart would lead to blood filling the pericardium (the sac around the heart), which would compress the heart and interfere with its function. This would be called "death due to pericardial tamponade secondary to a penetrating knife wound." The abdominal stab would result in "death due to exsanguination secondary to a penetrating abdominal knife wound with perforation of the aorta" or vena cava or both.

Gruesome, huh?

What Stractures Must Be Injured to Make a Stab Wound to the Back Lethal?

Q: The scenario is for the sleuth to go into the office and find her boss dying with a letter opener lodged in his back.

Is there an artery in or near the lungs? If a victim is stabbed in the back and this artery is hit, would he then literally drown in his own blood? Would the victim be able to speak and give the sleuth the inevitable cryptic clue? If no artery is hit, would the stab wound in one lung be enough to kill him?

A: Let's review a little anatomy and physiology first. Our lungs are designed for gas exchange. This is simply the loading of oxygen into the blood and the removing of carbon dioxide and other toxins from the blood. To do this, the blood and the air must come into close contact with each another. The lungs allow this to happen by having billions of microscopic air sacs and billions of tiny blood vessels that surround these sacs.

The basic circulation system of the body is divided into the systemic and the pulmonary circuits (Figure 14). The systemic circuit is the left ventricle pumping blood out the aorta and into the various arteries of the body, ultimately reaching every organ and nook and cranny, and then the blood's return via the veins to the right side of the heart. The pulmonary circuit is the right ventricle pumping this blood into the pulmonary arteries, which continually divide into smaller and smaller vessels and spread to all parts of the lungs like a fan. After the blood collects oxygen, it flows through the pulmonary veins into the left side of the heart and the left ventricle.

This points out two facts important to your question: First, the entire volume of blood in the body flows through the pulmonary circuit continuously. This is necessary since the lungs are the only means available to load vital oxygen into the blood. Second, the lungs, like every other organ in the body, receive a portion of the systemic blood flow. This is the oxygenated arterial blood that keeps the lung tissue itself alive. Thus, the organs known as lungs are extremely vascular (loaded with blood vessels—arteries, veins, and capillaries) and bleed profusely when injured (Figure 15).

Now back to your question. A penetrating wound to the lung as occurs in stabbings and gunshots would result in bleeding into the lung and then out the mouth and nose. The blood coming from these orifices would be bright red and frothy since it is mixed with the air flowing in and out of the lungs as the victim struggles for breath. As the lungs fill with blood, the victim would literally drown in his own blood. The injured lung may or may not collapse, which would only add to the victim's struggle to breathe.