Saturday, July 21, 2012

The Case of Preston Hughes III: Exceptional

In The Big Sleep, I listed a number of precautionary statements (i.e. assumptions) before I listed the implications associated with Shandra dying soon after having her carotid was severed. One of these assumptions was that Shandra was not exceptional in her ability to survive a severed carotid.

Since that post, I learned from a professional pathologist that some people do, rarely, survive a severed carotid without immediate medical intervention. The pathologist cited this case summary from the April 1988 issue of Journal of Laryngology and Otology. I must have missed it when I scanned my home delivered copy.
The Case of the Missing Carotid -- A Well Aimed Knife 
A 20-year-old male presented with a small stab wound to the neck and with haemodynamic signs of significant haemorrhage, but no signs of local bleeding. On exploration, an intact vagus nerve and internal jugular vein were found, but the common carotid artery was not immediately apparent. Careful dissection confirmed a completely transected common carotid artery with the two ends contracted and retracted. A primary repair was performed and post-operatively the patient recovered completely and had no neurological deficit.
Carotid arteries are under tension in their normal state. When completely severed, the now exposed ends of the carotid retract. The lower portion pulls down towards the torso and it can be difficult to find. Through some combination of pressure from surrounding tissues, swelling, pseudoaneuysm, clotting, and other phenomenon of which I am clueless, the carotid may rarely self-seal, the patient may rarely not bleed out, and the patient may rarely survive without prompt medical intervention.

The point is that survival of a severed carotid is not an impossibility. It is a rare event, but it has happened. I don't know how frequently it happens, but I accept it happened at least in the one instance just cited.

To be thorough in our investigation of the case of Preston Hughes III, we must therefore consider whether or not Shandra Charles was one of those exceptional people who survived a severed carotid without immediate medical intervention.

The first characteristic of the exceptional person described above is that the person survived. Shandra did not. Still this does not completely rule out Shandra as being an exceptional case. She could have been even more exceptional. She could have been one of those cases not yet identified (as far as I know) whose carotid self-sealed long enough for her to make a dying declaration but then self-ruptured before receiving medical care.

A second characteristic of the exceptional person described above is that the physician found the self-sealing carotid so remarkable that he made note of it. The autopsy report made no note of Shandra's severed carotid being in any way unique or remarkable.

A third characteristic of the exceptional person described above is that he exhibited no external signs of local bleeding. Shandra not only had external signs of local bleeding, she spilled copious amounts of blood onto the dirt pathway. From Cook and Becker's report. The emphasis is mine.
Officers walked east along the path that Hunter eluded to and walked approx 30 yards when observing a black female laying face down in the path. She was positioned face west and feet east. There was blood along the neckline and she was breathing deep but was unconscious. Officers notified the west side dispatcher of the find. The blood appeared to be fresh ...
Here's some of that fresh blood.

There's no telling how deeply that blood soaked into the ground. It is obvious, though, that the stain did not form from blood merely dripping or oozing out of her neck. The blood spurted from her neck in an amount sufficiently copious to make that dark, elongated stain. That stain spans the trail and extends into the grass and weeds on each side.

That stain is compelling evidence of a severed carotid artery that did not self-seal.

There is no evidence that Shandra responded to a severed carotid in any exceptional fashion. Instead of surviving with no external evidence of a severed carotid, she spurted blood onto the trail, lost consciousness, and died.

Shandra was not exceptional, at least when it came to surviving a severed carotid artery.

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