Before the prosecution rested their case in the penalty phase of the case against Boston Marathon bomber Dzhokhar Tsarnaev, the jury heard from Dr. David King, a trauma surgeon who treated survivors of the attack and likened their injuries to what he’s witnessed as a military physician in Iraq and Afghanistan. King’s testimony gave insight into the litany of abuses the bodies of the injured suffered on the long road to recovery. In arguing their case for the death penalty, the prosecution needs to establish aggravating factors, which include the defendant acting in a depraved manner that caused torture to the victims.
Dr. King was unsure of exactly what had occurred when he was called into Massachusetts General Hospital’s emergency room just after having completed the marathon himself, but a quick look at the injuries made it abundantly clear. “I looked across the patients and I knew immediately without anyone really having to tell me exactly what the wounding mechanism was and what had happened,” he explained. “In just a few moments, the pattern of injuries was fairly predictable and stereotypical from injuries I’d seen hundreds of times from explosives.”
What quickly became evident to doctors was that the bombs caused such extensive trauma that treating it caused its own damage. “Taking care of trauma patients who are bleeding is not a one shot deal. Losing all your blood volume and them stopping the blood loss itself is its own set of additional injuries, physiological insult. Your body is not meant to do that,” King said, explaining that “the insults keep piling up,” making the body more susceptible to infection and organ failure. As he put it, in these situations “nothing is for free.”
The doctor’s testimony came right after survivors Heather Abbott and Marc Fucarile testified about their amputations and the process of recovery. Fucarile, whose lower body is riddled with remaining shrapnel, has been operated on more than 60 times, with further surgeries scheduled in the near future. Dr. King shed light on the factors that have made the cases of Fucarile and others so difficult to treat.
King discussed the process of limb salvage, where doctors operate in an attempt to save a very damaged appendage from amputation. He described it as a shell game, moving a vein from a less severely injured limb to a more injured one and gambling the better-off one is healthy enough to survive without it. He also explained the concept of visceral pain, which comes when an injury is internal in the body, calling it “excruciating pain that you can’t describe well … it’s not in one spot, it’s in an area and it’s always evolving.” That pain “connects to a part of your brain that’s more primal” and is extraordinarily difficult to treat. “We can’t take your pain away because doing so would require so much pain medication that you would be unconscious,” King said.
The prosecution asked King whether 8-year-old Martin Richard would have felt pain before he was killed. “Based on the anatomic injuries, I can say with an extraordinarily high degree of medical certainty that he did not die instantaneously,” he said. “Martin died from blood loss, yes, and he died from rapid blood loss, yes, but that is not instantaneous.” King continued that “without question” he would have felt pain from his grave injuries with “stretch, twist, and distention” of his organs activating the visceral reactors.
Richard’s small size, King said, put him at a much greater risk of injury. Because the blast came from the ground, adults standing nearby suffered damage primarily to their lower extremities, but being shorter, Martin’s vital organs were much closer to the path of shrapnel. They were also more easily damaged. “If your aorta is only half an inch and a half-inch fragment flies through it, suddenly the entire thing is disrupted or more so than it would be if it were an inch in diameter,” he explained.
That information spoke to Richard’s being a victim of particular vulnerability, one of the aggravating factors the prosecution is looking to establish in order to get a death sentence. When court picks up again on Monday morning, Tsarnaev’s four lawyers will begin presenting mitigating factors in their case for life in prison.