Doctor, with the Court's permission could you step down. You were describing for us--and if both owe both of us will slow down when we are talking about what is contained on these charts, I think the reporters will find it helpful to getting a fully accurate record. Doctor, you were describing or beginning to describe in lay terms the substance of what Dr. Golden has described in this area of the protocol concerning that fatal stab wound no. 1. Would you pick up where you were, please.
The stab wound entered the right side of the chest, went through the right seventh rib, went through the lung, the right lower part of the lung, and then the stab wound ended in the back of the right fourth rib. You have twelve ribs on each side, and the fourth rib--on the back of the fourth rib the stab wound ended and the stab wound traveled from back to front, right to left, causing injury to the lung and that caused also bleeding. So this is a fatal stab wound and the total length of the track from the skin to the back of the right fourth rib is about four inches.
In your knowledge of anatomy is a wound path of approximately four inches consistent with the anatomy between the point of entry and where Dr. Golden describes the wound as ending?
That will be a fair distance of which would fall within the parameters of the anatomy.
If you will keep your voice up, please, doctor. Let me underline, if I could, the last sentence of the third paragraph under item 1 which gives the direction "Right to left and back to front with no other angulation measurable."
Doctor, again giving you the ruler, and I believe you indicated that there are alternatives, depending on whether the knife is being held in the right hand or in the left hand, about the thigh injury. Would the same apply with respect to injury no. 1?
Assuming, hypothetically, that the perpetrator is holding this knife in the right hand, again using me as Mr. Goldman and yourself as the perpetrator, can you demonstrate for us how that wound could have been inflicted?
Yes. The perpetrator has to be in the back of Mr. Goldman and the stab wound entry is in the front of the right side of the chest. As I told you earlier, the dull end of the knife is in the lower part, the sharp end of the knife is in the upper part, so if I'm holding the knife in this manner, it would be into the chest in this manner, (indicating), causing fracture of the seventh rib going into the chest cavity and ending in the fourth rib. It is likely vertically oriented also, so the blunt end is here and the sharp end is here, somewhat like this, (indicating).
Doctor, if you will fix that position so we can describe it for the record. You are holding with your right hand the ruler to represent the knife. You have positioned yourself behind me. You have the knife angled such that the part in contact with me is closer to the front of my body, than the back end of the ruler which is toward the back of my body.
And the angle appears to be about a thirty-degree angle from the horizontal, doctor?
Doctor, I want you to, if you could, please, reposition yourself as you did for the demonstration when you described how the two superficial incise wounds had been inflicted or at least in a fashion consistent with that?
Doctor, in this position could that fatal stab wound no. 1 have been inflicted on Mr. Goldman?
In this position where the perpetrator is holding Mr. Goldman in the fashion you are holding me?
Because the location of the perpetrator is in a position where this kind of wound is possible like the demonstration I just--I did.
So in essence does putting your arm--your left arm around my chest to restrain me affect in any way the ability of the right-handed perpetrator from behind to inflict that chest wound?
Yeah. The only thing is the victim's hand had to be a little bit on the--lifted for the wound to be in that area when the stab wound took place.
Or the victim could be trying to move. As I told you, all these stab wounds and sharp force injuries are dynamic process. It is not a stationary process where a wound takes place, so it is obvious that the arm must have been raised, because the location of the wounds are to the right side of the right chest area, which if the arm is on this side here, (indicating), it will be difficult to do the stab wound, so the arm must have been raised at some point to cause the stab wound in that region. So I really can't tell what exactly took place at that time, but the scenario we enacted is one possible scenario how this stab wound could have been inflicted.
Let's talk about if the knife is held in the left hand to see how that circumstance arises.
Then again the blunt edge should be in the lower part and the sharp edge of the knife should be in the upper part because that is how the wound configuration of the body surface is surfaces, so it would be something like this, (indicating).
But the only problem--but it has to be a little more--it is going from the back to front direction, but if I was in front of you, it would be more in a front to back direction, so the direction also should be more in a back to front right to left direction because that is the direction in the body, so the direction in the body doesn't change. So if you are going to enact a scenario, the scenario should match the path in the body.
And so the relative position, if you could retake that position, doctor, the relative position for the left-handed infliction of injury no. 1 has my body turned at a diagonal with my right shoulder closest to you and you then standing at this angle to me so that your left hand is around the back portion of my body to inflict the stab wound; is that accurate?
Also your arm should be raised because there is no cuts to the arm, you see, so the arm has--cannot be obstructing this entry of this wound in the right chest area, so that also is a factor which must be kept in mind, so when these wounds were inflicted, very likely that the hand of Mr. Goldman was not opposing his body. It was probably up trying to wrestle away from the wound.
And doctor, if, in your opinion, Mr. Goldman had his right arm raised to wrestle away, would that suggest to you that the perpetrator is behind Mr. Goldman, rather than in front of Mr. Goldman?
Now, doctor, as long we are--we have the ruler in your hand, let's see if we could get you back here for injury no 2. Would the same scenarios that you've just demonstrated for the ladies and gentlemen of the jury apply with respect to injury no. 2, the second fatal stab wound seen in photograph G-10?
Yes. That stab wound, the--it is likely diagonally-oriented, just like the injury no. 1, and here the blunt end is in the back and the sharp end is in the front. You can clearly see it, the blunt end of it.
The dull end of the wound is on the back here, and the sharp end is in the front here, (indicating), and it is diagonally-oriented, so this also is caused by a single-edged knife, and this wound path direction is I think right to left going in a similar fashion as in injury no. 1, but more just in a right to left direction.
And if we can hold up or flip over to page 9, this is a paragraph just above the opinion paragraph for that particular wound. Is that a description by Dr. Golden of the direction of the wound?
Yes. It goes straight right to left with no other angulation or deviation determined.
Yes. The only issue here is he couldn't give more directions because what you have here is a stab wound which enters a cavity and you don't have an end point to it. It went through the right lung. Unlike the injury no. 1, where the stab wound entered in the back of the right fourth rib, there you have a reference point where the stab wound ended where you can be more definitive about the direction. All you can say here is it went from right to left because it entered a cavity.
Doctor, in your opinion is there anything in the form of a mistake by Dr. Golden for his inability to provide a specific measurement for the depth of the wound?
It will be difficult to give a full depth of the wound because the stab wound is entering a cavity. That is why he give a minimum total depth of penetration, which is correct thing to do in this situation.
Doctor, from your knowledge of anatomy is that minimum depth of penetration consistent with the description of the injury provided by Dr. Golden?
Let me just outline this area first in blue that was talking about the direction. I will outline the entire part of page 9 of the protocol and write "G-10, inj. no. 2," and let me finish off on the previous page with the outline of the beginning description of "G-10, inj. no. 2."
Now, doctor again can you, using the ruler, demonstrate first a right-handed perpetrator and then a left-handed perpetrator to create a direction such as described by Dr. Golden for stab wound no. 2.
This particular stab wound, the blunt edge is in the back and the sharp edge of the knife is in the front, and it is obliquely oriented, so the stab wound is located somewhere here, (indicating), in the right side the chest right here.
Let me turn just so the jurors can see that area where you are pointing and then I will turn back.
Somewhere here, (indicating), and all we could say was that it entered the chest cavity. It entered in an area of the chest wall which is called the eighth space which is just below the eighth rib, and it entered in that space, went through the right lung also, perforated the lung, that is, went through and through in the lung causing bleeding. And the direction given is just right to left. It didn't have an end point in the chest cavity.
Doctor, if you could hold that position one more time. Is that the accurate direction, using the ruler to reflect the knife itself, that correlates with this wound description?
And your Honor, for the record, Dr. Lakshmanan being behind me, is holding the knife--the ruler to represent the knife in his right hand. It has its end touching me. It appears to be slightly above the end opposite--
And it also has the back end closer to the back of my body than the end touching me.
There is one more component to the wound. This wound, if you see, it is much larger, so just like the thigh wound, there has been movement of the body or the knife because there is a cutting component to this particular wound either during penetration or during withdrawal of the knife, which would indicate either the subject moved or the knife moved. It doesn't have just a--it has got a larger appearing gaping wound which would signify that there is a cutting component to the stabbing component.
Doctor, if we asked you again to reenact the position that you did several days ago regarding the superficial incise wound and your left arm around my upper chest and the one you just did for injury no. 1, would the same apply for injury no. 2, that in that position of the perpetrator being behind and restraining Mr. Goldman with his left hand across Mr. Goldman's chest, that injury no. 2 could have been inflicted with the knife held in the right hand?
It will be similar to what we just discussed earlier. The hand has to be elevated a little bit and in this manner, (indicating), which could be one possible scenario how this could have happened with the knife being obliquely oriented to conform--conform to the appearance of the wound on the body's surface.
Your Honor, I cannot see that because of my raised right arm. Would the Court help me out a bit?
Yes. Dr. Lakshmanan has the ruler in his left hand. He is pointing it towards the back of the chest area underneath your right arm, approximately five inches below your right armpit.
Now, doctor, with respect to these two fatal stab wounds, what would be the body's reaction to each them?
Well, they are fatal wounds. They caused injury to the lung, and you have bleeding, and you also have, compromising the ability to breathe, you have bleeding and you also have compromising of the bleeding--I'm sorry, breathing because blood accumulation in the chest cavity will compromise your breathing.
What kind of bleeding volume wise would you expect from the individual wounds and then the combination of the two stab wounds?
You will have a significant amount of bleeding because the lung is very vascular structure, and actually the total blood volume of the body can circulate in the lung in a minute's time, but generally these wounds bleed and you can have death--I mean you can lose blood pressure rapidly. If there is an accumulation of blood and air in the chest cavity, so you can expect death in a very short time after the injury.
Assuming no other injuries have been received by Mr. Goldman, do you have an opinion as to the approximate minimum length of time the combination of those two fatal stab wounds would require before Mr. Goldman died?
Well, it could--because bleeding is a significant component, it could be within a few minutes without medical treatment.
Now, doctor, would the blood from either/or both of those fatal stab wounds go in any particular area, internally, externally or both?
Because it is a fractured rib in the right, injury no. 1, you could have some external bleeding also, but generally these kind of injuries bleed more internally than externally.
Because, first of all, because of the muscle arrangement in the chest wall and also the muscle arrangement between the ribs, the plane which you get may not necessarily be like a defect in a--it won't be a defect which will just open up to the outside because of the varying and amounts of the muscle arrangements in that area, because even though there is a defect in the skin, the defect inside the structures underlying the skin may not have the same plane as the injury itself.
Now, doctor, did Dr. Golden describe in any fashion a volume of blood found inside this area of the body during the course of the autopsy?
Umm, it is described 100 to 200 cc in the right chest here under injury no. 1, and he described the same amount--
Before you flip the page, let me just underline that. And for the record, I have underlined in blue in the third pull paragraph of item 1 of page 8 of the protocol.
I think he described it--this is only one hemothorax belonging to both the wounds, 100 to 200 cc.
So there is no additional quantification by Dr. Golden of the blood found in this area?
That's correct. He said the total amount present in the right chest cavity was 100 to 200 cc.
Doctor, how would you characterize a volume of 100 to 200 cc's in that chest cavity?
Given the nature of the volume described, assuming that it has been accurately quantified, what significance, if any, does that have to you in evaluating when, in relationship to the whole assault, Mr. Goldman received those two fatal stab wounds?
Before I answer the question I would like to point out also that he has been lying on--
Doctor, let's go back then as you were about to point to exhibit 43-E, the copy of the photograph with that exhibit designation that we have on our board, is there something of significance on this issue of how much blood is found at autopsy in the chest cavity from the position that Mr. Goldman's body is in in that photograph?
He is found on his right side, lying on the right side when he was found initially, and also if you look at the clothing, the right side of the shirt and other areas are pretty densely stained with blood, so one of the factors one must keep in mind is the dependent drainage of blood from the chest cavity, blood from the stab wound, because one lies on the right side.
Doctor, you examined, I think you've testified, the shirt Mr. Goldman was wearing at the time his body was found?
And you have also examined the body both on the 13th and the 14th; is that correct?
Did you find, in examining the shirt, that the shirt appeared more blood stained on the right side than on the left?
Now, doctor, does this draining of blood when Mr. Goldman is in the position as seen in the photograph that we've marked 43-E, does that staining--does that external blood flow continue even if Mr. Goldman's heart has stopped pumping?
Because it is liquid blood in a cavity which can just ooze out through the defect in the chest wall.
Is the blood staining you see in the right side of Mr. Goldman's shirt consistent with that kind of action, that is, drainage out of the wound itself?
Doctor, is there any other wound that you have identified in this area of Mr. Goldman's body covered by the right portion of his shirt that has the blood staining that you see in photograph G-1, other than the ones that are shown in the photograph G-10?
Is there any other source that you can think of, from your examination of the information and the photographs, which could be the source for the blood staining to the right side of the shirt, other than the two fatal stab wounds and the third sharp force injury you've identified but haven't described in much detail yet, in photograph G-10?
The shirt is also stained in the shoulder area and in the side area, so some of the blood of the shoulder area could be from the neck wounds, but as far as the chest goes, these are the only two wounds there which can account for this kind of staining.
Doctor, given that finding, does that serve as any basis for you to determine whether in fact the volume of blood that originally was in the chest cavity, after these wounds were inflicted, was greater than what was recorded at autopsy by Dr. Golden?
And doctor, if that were the case, that some of this blood flowed out due to the effects of gravity, would that affect your ability to assess when in relationship to the attack those two fatal stab wounds were inflicted?
It would favor that it occurred during the earlier part of the attack rather than latter part of the attack, but again, I want to emphasize that there are other significant injuries on Mr. Goldman, including the aortic injury and the internal jugular vein injury. And if, as I opined earlier, that they could have all been sustained within a minute's time you may not have much accumulation in the chest cavity, too, if they occurred rapidly after each other.
KEY QUOTEBecause you have the aortic wound which would bleed more than the chest wound at that point.
Doctor, I want to correlate, if a correlation is appropriate, the two fatal stab wounds to the chest and the thigh wound that you described as one which Mr. Goldman must have been in an upright position to have received based upon the blood staining pattern of the left leg. Is there anything medically inconsistent, doctor, with those two fatal stab wounds to the chest having been inflicted by the perpetrator holding the knife in the right hand and restraining Mr. Goldman, with the left hand being behind Mr. Goldman, and thereafter Mr. Goldman, in his effort to break free, breaking free in a position so that he is now face-to-face with the perpetrator and the perpetrator stabbing Mr. Goldman with his right hand still holding the knife in the area of the left thigh as you demonstrated earlier this afternoon?
So let me understand your question. The stab wound to the chest takes place while the perpetrator is in the back and the victim turns and then the stab wound to the thigh is inflicted in rapid succession?
Medically there is nothing inconsistent with that, but I would like to add that I also examined the clothing of Mr. Goldman wherein we have defects in the clothing. The larger defect in the clothing corresponds to the smaller wound here.
The one in the right front of the chest. And the smaller defect in the clothing corresponds to the larger wound, which would indicate to me that probably the clothing was not in the same position as the wound when those wounds were inflicted. Again this is only a possibility.
Doctor, from what you observed in the shirt, were the wounds in a position--I'm sorry--the defects in the shirt in a position which would be consistent with the perpetrator holding the shirt upright so as to twist the shirt from its normal position on the body?
Would this location of the defects in the shirt be consistent with somebody trying to pull the shirt over Mr. Goldman's head?
No. It would be more like the shirt moving around the body rather than in a top/down direction.
And in the movement would that be consistent with Mr. Goldman trying to twist and turn to break free of any restraint that is being imposed on him?
That would be more likely a possibility than the former possibility you brought up.
And if in fact that was the circumstance of Mr. Goldman trying to twist and turn to break free of the person retraining them, who is behind him, holding knife in the right hand, is there anything medically inconsistent with those two fatal stab wounds being inflicted first followed by--when I say "First" I just mean relative to the thigh injury--being inflicted first and then as Mr. Goldman breaks free and is more in a face-to-face relationship with the perpetrator, to have the perpetrator with the knife still in the right hand moving that knife forward to get the area of the left thigh?
And even with the effects of those two fatal stab wounds to the right chest area, doctor, medically, could Mr. Goldman still have experienced the kind of bleeding from this left thigh stab wound which would be consistent with the blood flow seen on the bottom or down the length of the left pant leg, his jean?
Umm, it is possible that that happened, but given the amount of bleeding, I would favor the thigh wound occurred before the stab wounds to the chest.
Because the thigh wound didn't hit any major vessel and there is a significant amount of blood staining on the limb portion of the jean, and that could--that means without any major vessel injury there is significant bleeding, that means this occurred earlier in the altercation.
Does the type of injury to the right chest that you expect from those two fatal stab wounds impact directly on the volume of blood that flows to the lower half of the body?
I'm sorry, it does impact in a way, but not directly, because you have bleeding into the chest cavity, but not directly.
Let me contrast that for a moment and invite your attention to photograph G-8. You talked about the aortic wound, I believe?
Can you point out on your body, doctor, approximately where that is on the human anatomy?
It is around here on the left flank. I'm pointing to it right here, (indicating).
Your Honor, about the midline between the front and back of the body and about maybe three inches up from the belt line.
Now, doctor, from what you know of this fatal aortic stab wound, medically, would that stab wound affect the volume of blood that could flow to the lower parts of the legs of Mr. Goldman's body?
Yes, it would, because the flank wound hit the aorta about one and a quarter inches above the bifurcation. You see, the aorta is a large vessel in the abdominal portion and it divides into two branches which supply the lower extremities, which is your thighs and legs, and the--that is why I feel that the thigh wound occurred before the aortic wound, because if the aortic wound occurred earlier, you won't have that much bleeding in the thigh wound because the bleeding would be occurring inside the abdomen from the aortic wound.
Doctor, is that what you would describe as a direct impact between the aortic stab wound and the blood supply available to the lower limbs where the thigh wound is inflicted?
The chest wounds, the two fatal chest stab wounds, do they have that same direct impact on the volume of blood that flows to the lower extremities?
And how do they indirectly, if at all, affect the blood volume that flows to the lower extremity, the legs?
What exactly happens is there is only so much blood in the body, as I told you several times in this last few days. The total blood volume in the body is 5.5 liters, and if you have blood loss in one place, the body still tries to maintain blood pressure so that the rest of the key areas of the body get blood supply. So even though there is blood loss--there is blood loss, that wouldn't affect the total blood volume, the mechanism inside the body, which includes the sympathetic nervous system, helps to maintain the blood pressure, but whereas if you have an aortic injury, which would be a direct injury to the vessel, in relation to the thigh wound, it would definitely impair the blood supply to the thigh, because the aortic injury occurred earlier, and that is why it is a direct impact in contrast to this. It is a loss of blood to an area, but not a direct impact to the--umm, as far as the thigh wound goes.
As a result, doctor, is it, in your judgment, more plausible that you can have the thigh wound be incurred after the two fatal stab wounds to the chest and still end up with the blood flow that you see in the pant leg, the left pant leg, than it would be to have the aortic stab wound incurred before that same thigh wound?
Doctor, I don't think we've covered the diagramming, if there was any diagramming, of these two injuries 1 and 2, the fatal stab wounds, have we?
Doctor, we've covered--is there anything else you want to tell us just in general terms about injuries numbers 1 and 2 before we go to the diagram?
Nothing else. I have addressed the structures they caused injury to. I have addressed the clothing defects. I have addressed the--them being caused by a single-edged knife. I have discussed that they are fatal wounds. I don't think--I have nothing else to add.
One thought I just had pop into my head and I wanted to ask you about, did you examine the jean leg, the left leg and the defects that you described you observed in that left leg, with respect to the location of the left thigh wound injury?
He had a defect in the outer aspect of the jean and he had two additional defects in the pocket underlying the defect in the jean, which would indicate that the stab wound went through the outer garment layer, through the pocket layers and then entered the thigh.
Was there anything inappropriate about the location on the clothing of the defects with respect to the location on the body of the wound, such as you described you found with the defects in the shirt, in relationship to the two fatal chest stab wounds?
And what, if any, significance did that have to you in talking about the circumstances of Mr. Goldman receiving that fatal--I'm sorry, that thigh stab wound?
Nothing really much significant, because the--the--the limb portion of a jean is more fixed than a shirt on a trunk of a body.
Doctor, I have put on the board, this is board 3G of our collection 357, the 21 series. Is one of these forms used by Dr. Golden to describe in a diagrammatic fashion the stab wounds 1 and 2 of the photograph G-10?
Yes, it is in 21-II. It is injury number no. 1 is here and injury no. 2 is there, (indicating).
I'm sorry, doctor, if you will point and hold the pointer, where is injury no. 1?
It says, "Mid-axillary line" and he has just put the location on this diagram.
That is an imaginary line which passed through the middle of your armpit, if you raise your arm up. I'm sorry, I can't raise my left shoulder very well.
The armpit area is the axilla, medical term. Mid-axillary line is the imaginary line which runs in the mid-portion of your armpit and down the side of the body, so it is an imaginary line and any injury in that area is described as such.
All right, doctor. Now, I want to circle this area. Is this the appropriate area for fatal stab wound injury no. 1 of G-10?
All right. I will circle that area in red on the left side of 21, roman numeral II, and I will write "G-10 inj. no. 1."
And I will circle that area then in blue and to the side write "G-10 inj. no. 2."
Yes. There is a diagram of the--which also shows the skeletal area of the body with the outline of the body.
And this is the second page of that form 20H with schematic representations of the human order front and back with a skeleton outline, your Honor.
Yes. This part he refers to the injury no. 1, stab wound going to the right seventh rib, and in this area here, (indicating).
Let me--before you go on, let me circle that area and I will write "G-10 inj. no. 1."
And then it continues, "Right to left back to front, striking chest wall." The length of the stab wound is four inches, and then he continues that it ends in the back of the right fourth rib, and the--he has got two--two defects in the right lung, half an inch and 3/4 inch, and that covers the injury--this includes the pleural--
It says the pleural areas of the lung have these measurements, have an inch and 3/4 inch, so this would also correspond to that wound.
Yes, all this, (indicating), because that is where the fourth rib is on the front, but the knife cut the back of the fourth rib inside the chest cavity.
If we can slow down here so I can try and keep up with you, doctor, you pointed now to the left side of the diagram in some area?
The right side of the diagram--right side of the body, left side of the diagram.
Mid-clavicle line. That is another imaginary line. You have your collar bone here and an imaginary line which runs in the mid-portion of the line in front of the body is the mid-clavicle line.
Let me circle that area that you described on the left side of there, 28, and I will write again "G-10 inj. no. 1." And does the Court wish to take a break at this point?
Ladies and gentlemen, I need to take a 15-minute court reporter recess. Please remember all my admonitions to you. This will be a 15-recess. Let me see counsel with the court reporter, please.
The total blood volume in the body can circulate in the lung in a minute's time, but generally these wounds bleed and you can have death—I mean you can lose blood pressure rapidly.
It would favor that it occurred during the earlier part of the attack rather than latter part of the attack.
The aorta is a large vessel in the abdominal portion and it divides into two branches which supply the lower extremities... that is why I feel that the thigh wound occurred before the aortic wound, because if the aortic wound occurred earlier, you won't have that much bleeding in the thigh wound.
The larger defect in the clothing corresponds to the smaller wound here... which would indicate to me that probably the clothing was not in the same position as the wound when those wounds were inflicted.