Genco carefully described what he set about to do to pronounce the manner of Mrs. Quillian’s death, the legal classification that made it a homicide, rather than a natural event. The causation-the medical finding of the mechanism responsible for the death-was fairly obvious to anyone looking at the victim’s throat, but not able to be legally confirmed until autopsy.
This was not like the many cases in which the determination of the time of death played a critical role in the case, making measures of postmortem rigor, lividity, body temperature, and ocular changes significant. Here, instead, the parameters were tightly drawn by the hour and minute stamped on the digital photograph taken at the end of the ladies’ lunch, the phone records from Amanda Quillian’s cell as she was confronted by her killer, and the 911 call from Kate Meade.
So Dr. Genco moved his audience from the exquisitely appointed parlor in which he first saw the body of the deceased to the formaldehyde-scented room decorated only with a cold steel gurney in the basement of the morgue.
He described photographing his charge, undressing her, washing her body, and autopsying it. He didn’t need a receipt from the tony bistro where the friends had dined to assert that the victim’s last meal had been a Cobb salad with blue-cheese dressing. Stomach contents visible to the naked eye underscored that death had occurred within a short time after the ingestion of food. The two glasses of white wine she had sipped might have made it even more difficult for her to resist her attacker.
“Were you able to determine, Doctor, to a reasonable degree of medical certainty, what caused the death of Amanda Quillian?”
“Yes, Ms. Cooper, I was.”
“Would you please tell the jury about your conclusions?”
“Mrs. Quillian died as a result of asphyxia, and in particular in this matter, by compression of the neck-or strangulation.”
“What is asphyxia, Dr. Genco?”
“It’s actually a broad term referring to conditions that result in the failure of cells to receive or to utilize oxygen, along with the inability to eliminate carbon dioxide. Body tissues simply cannot function without oxygen. Most especially the brain, since it uses twenty percent of the body’s total available oxygen.”
“Is there more than one category of asphyxia?”
“Yes, in general there are three. One would be chemical asphyxia-things like carbon monoxide or cyanide poisoning, which operate by excluding oxygen from the brain. A second would be suffocation or obstruction of the airways.”
“Let me stop you here for a moment, Dr. Genco, at these first two categories. In the case of both chemical asphyxia and suffocation, is it correct to say that the resulting death might occur homicidally?”
“Yes, Ms. Cooper. You’re right-in some circumstances. But in both instances death might also be accidental. And in the case of suffocation, it’s frequently self-inflicted.” Genco went on to give examples of each to the jury. “One may have a choking fatality because of the unintentional inhalation of an object-a wine cork or the cap of a pen that someone puts in his or her mouth temporarily, but then it gets sucked in and occludes the airway. Same thing happens with a piece of food.”
Several jurors nodded their heads in understanding.
“Now, Doctor, what is the third form of asphyxial death?”
“Compression of the neck, Ms. Cooper-usually by strangulation.”
“Are there different methods of strangulation?”
“Yes, there are. Again, we usually break these down into three varieties. Those would be hanging, ligature strangulation, and manual strangulation.”
“Can you distinguish between accidental, intentional, and homicidal deaths in the case of asphyxia by strangulation?”
Genco spoke confidently to the jurors farthest from the stand. “Most of the time, of course. The overwhelming number of hangings are suicides-it’s not a method frequently used as a means of killing someone.”
The jury was following his analysis. “With ligature strangulation, although you do get a few accidents, virtually all the cases are homicides-probably the most common form of homicidal asphyxia.”
“And by ligature, tell us what you mean exactly.”
“Certainly, Ms. Cooper. I’m referring to a bond of some kind-electrical cord, rope, wire, necktie-an object used to encircle the neck horizontally, occluding blood and oxygen from reaching the brain.”
“That’s distinguished from manual strangulation, is it not?”
“Quite easily, in fact. Manual strangulation-death caused by using one’s hands to compress the neck of another-can never be anything but homicide.”
“Would you please tell the jury why, Dr. Genco?”
He straightened his glasses and looked earnestly at the people in the box. “It’s not possible to use your own hands to strangle yourself. Pressure on the neck is a very intentional, deliberate action. The first thing such excessive pressure causes is a loss of consciousness. So that if you were holding your own throat until the point at which you passed out, you couldn’t possibly continue to keep the grip on. You’d regain consciousness as soon as your hands dropped away.”
I wanted him to go through every second of Amanda Quillian’s final agony. I wanted them to understand that her last moments were spent face-to-face with her attacker, at less than arm’s length, while he purposefully squeezed the life out of her body.
“Can you estimate for us, with a reasonable degree of medical certainty, how long it was that Mrs. Quillian remained conscious while her neck was being compressed?”
Genco took his time with the answer, trying to explain the dynamic of this death mechanism without drawing an objection for any prejudicial statement. “Strangulation, you must understand, does not cause death as quickly, say, as a bullet to the brain or a stab wound to the heart. There is evidence here that despite her small stature and weight, the deceased put up a struggle-a fierce struggle-for her life.”
Several jurors began to wriggle in their seats as they followed his testimony. Genco paused, asking permission of Judge Gertz to step to the easel and refer to an enlargement of one of the autopsy photographs I had introduced through him half an hour earlier. I handed him a pointer and he got back to work.
“These marks on the neck of the deceased represent the force used by her assailant to subdue her, and then to cause her death.” He tapped at several large bruises on her throat as he spoke. “Repeated applications of force, actually, suggesting that she was struggling against him while he tried to fasten his grip more tightly. All of that fighting prolonged the process of the strangulation.”
The finger marks of the killer looked enormous to me, causing not only the external bruising but the hemorrhaging deep into the musculature that Genco’s dissection of the throat had revealed. I had studied the images for months, thinking constantly of someone with hands big enough, strong enough, to cause that damage. Someone with hands much larger than Brendan Quillian’s, which detectives had examined at the time of his arrest.
“Is there any other physical evidence to suggest that unconsciousness did not occur immediately after Mrs. Quillian was attacked?”
“Yes, Ms. Cooper. All the medical hallmarks of manual strangulation are present.”
“Would you identify those to the jury?”
Genco pointed to the small, crescent-shaped marks that bordered the larger discolorations. “Can you see these small semicircles?” he asked the jurors, most of whom were nodding. “These abrasions weren’t made by the killer. They were left there by the fingernails of the deceased herself.”
Brendan Quillian had assumed a posture of faux anguish. His shoulders were slumped and he held his head in one hand, shaking it from time to time as though incredulous that someone could have done these things to his wife.