Today was day 6 of the George Huguely murder trial. My previous estimates of when the Commonwealth will be done are way optimistic. I had thought that the Commonwealth would finish today — at this rate, they’ll be lucky to finish tomorrow.
The morning was taken up with crime scene forensic folks, testifying about recovering blood stains from George Huguely’s room, recovering his clothes, recovering Yeardley Love’s computer, and going painstakingly through the photos and physical evidence. They are thorough.
This afternoon, attention turned to the cause of Love’s death. At the preliminary hearing last April 11, the Medical Examiner, Dr. William Gormley, testified that the cause of death was blunt force trauma to the head. (See the Daily Progress article on that hearing here.) In an earlier hearing, Dr. Jack Daniel (yup, that’s really his name), a pathologist hired by Huguely’s family, testified that he believes Love died when she suffered a cardiac arrhythmia that caused insufficient blood flow to her head.
As a matter of advocacy, “blunt force trauma to the head” is easy to understand. It means that she got hit hard on the head, and it usually means that she got hit hard enough to cause bleeding into the interior of the skull, causing brain damage and death. A cardiac arrhythmia, on the other hand, is much harder to figure out. Cardiac arrhythmias don’t show up on X-rays. Sometimes microscopic examination of tissues can reveal some very subtle signs, but in many cases such a diagnosis is a diagnosis of exclusion. That means, in essence, “we have ruled out everything else, and we can’t come up with anything.” Cardiac arrhythmias can be caused by pre-existing heart conditions, by blows to the heart, by by drug interactions, by damage to the electrical systems that regulate the heart, even by rock music played loudly (years ago doctors noted that cardiac arrhthymias increase among young people at Queen concerts, because the “stomp stomp clap” of the rhythm of “We Will Rock You” mimics the heartbeat).
But most distressing is that in a significant number of sudden deaths, the cause of death cannot be determined. A 1997 article in the Annals of Internal Medicine reported that among sudden deaths of new military recruits, no cause of death — no reason why the heart stopped beating — could be found in 35% of them.
An article in the May, 2006 edition of the magazine Cardiology discussed the fact that it is not uncommon in autopsies of young people to have what is called “SCD” — “Sudden Cardiac Death”. SCD is one of the most common causes of death, with many of the cardiac deaths attributable to cardiac/coronary abnormalities evident at autopsy — an enlarged heart, various structural defects in the heart, etc. A significant number of SCDs, however, particularly in young people, remain unexplained even after a full autopsy. These are referred to as “autopsy-negative sudden unexplained death (SUD).”
Recent advances in the cardiac pathology, though, have led to a new type of autopsy — a cardiac channel molecular autopsy. This new type of study may show a cause for SUD, and help establish cause and manner of death.
In the past 15 years, five different investigations of sudden death in young people have been conducted. The biggest study concluded that nearly 30% of SCDs in young people are autopsy-negative (i.e. SUD) and most likely secondary to cardiac channelopathies. A cardiac channelopathy is literally a disease or defect in the chemistry of the ion channels that regulate how metabolites get into and out of heart muscles. If these metabolic channels are not just right, a cardiac arrhythmia can result.
To detect a cardiac channelopathy, the heart muscle needs to be examined at a microscopic level, and perhaps a genetic level. There appear to be some genetic mutations that are typical of the conditions that lead to SUD. There had earlier been testimony that there was nothing wrong with Yeardley Love’s heart, but I don’t remember asking whether anyone had tested to rule out cardiac channelopathy. Dr. Danny Mistry — her primary care physician at UVA — testified last week that her EKGs were all normal, but as I understand the arrhythmia issue, an arrhythmia may not be detectable on EKG.
It would not surprise me if the defense effort, led by Dr. Daniel, backs up the idea that she died from cardiac arrhythmia. And under the circumstances, I am not sure that the prosecution will be able to rebut that kind of testimony effectively.
But I’ve gotten off on a tangent.
Dr. Gormley testified today about many bruises and contusions on Love’s body. One contusion that was mentioned prominently was a bruise under the jaw on the left side. This contusion, said Dr. Gormley, was over the carotid artery, at an area called the carotid sinus, or the carotid body. This is the only injury that Dr. Gormley linked to a possible cause of death.
Here is a diagram that helps to understand the carotid body; it’s from Dorland’s online medical dictionary :
If you picture the carotid artery (there are two, one on each side) as a “Y”, the carotid body, also called in Latin the carotid glomus, is a small group of cells that lies in the cleft of the Y. It contains sensors that monitor oxygen and carbon dioxide flowing to the carotid artery (which provides blood to the brain). The carotid body sensors send signals to the heart to tell it to slow down, or speed up, depending on how it perceives the oxygen content of the blood in the carotid artery. If there is an injury to that small group of cells, the sensors may essentially shut down, and send signals to the heart to slow down, or even to stop. If the heart stops pumping blood, you will pass out in 15 to 30 seconds — that is all the oxygen that the brain has in reserve. If the carotid body injury causes the heart to stop, the heart may return to normal rhythm, it may resume beating but in an abnormal rhythm, or it may remain stopped. In this case, Yeardley Love had a contusion to the right side of her neck right at the point where the carotid body is found. Out of all of Dr. Gormley’s testimony so far, that is the only physical sign that he testified to that could be consistent with death; he said that if there had been an injury to the carotid body that caused a disruption in the electrical signals to the heart that are transmitted by the vagus nerve, the heart might stop, or go into an arrhythmia from which it might not recover.
Dr. Gormley’s testimony was also remarkable in other ways. Although there has been a lot of discussion about blood in Love’s room, I didn’t hear Dr. Gormley mention any wound to her body that seemed likely to bleed much. He mentioned some contusions — doctor-speak for an injury that doesn’t break the skin and therefore doesn’t bleed. He mentioned one incised wound — a wound made with a sharp edge — but it seems to have been a small one, on her finger. He mentioned some abrasions that seem to have NOT been made around the time of death, but beyond that he couldn’t age them any more precisely. The defense had suggested in opening statements that perhaps she suffered a nosebleed when she fell; Dr. Gormley said there was no injury to her nose.
The prosecution seemed to want to emphasize a large bruise on the right side of her head — 2 inches by 3 inches. The bruise itself indicated an injury to the head, but OUTSIDE the cranium. In other words, it could not have caused Yeardley Love’s death. Dave Chapman asked Dr. Gormley a slightly odd question — “Were there any other contusions that suggested to you the possibility of an injury that could have caused death?” And Dr. Gormley mentioned this 2″ x 3″ bruise, saying that such a bruise is an indication that there might be an underlying head injury of some seriousness. But it is clear that the 2″ x 3″ bruise, without a concussion inside the cranium, or a fractured skull, or evidence of bleeding in the brain, was not itself proof of a life-threatening blow to the head. Dr. Gormley testified that there was almost no bleeding in the cranium, except for some blood that had gathered at the base of the skull. Toward the end of Dr. Gormley’s direct testimony this afternoon, he was asked about that bleeding by the base of the brain. He went through about a five-minute answer that indicated that such bleeding could be an indication of a fatal injury — it could be caused by a ruptured brain aneurysm, or it could be left by some subarachnoid bleeding. Finally, we thought as we watched — something to explain this death! But, he said, there was no indication of either. Drat.
On cross-examination, the defense brought out that Dr. Gormley’s findings could all be explained by one impact; there did not have to be repeated impacts. There was no evidence that her body had been gripped tightly and shaken hard, so as to beat the head repeatedly against the wall. The contusions and bruises that he observed were consistent with a fall off the bed — as the defense had suggested in opening statements.
Tomorrow, the Commonwealth will call two other doctors who did a more detailed pathological examination of her brain. Then Dr. Gormley will be recalled to finish his testimony. Then, I understand, there will be more scientific witnesses — DNA, blood spatter perhaps. At this rate, they’ll be lucky to finish tomorrow afternoon.
I can recommend the WVIR coverage of the trial — particularly their online coverage available here — not just because they have a distinguished legal expert but because they include a very detailed and pretty accurate description of each witness’s testimony.
