Charlene’s brain CT scan showed reduced white matter in most parts of the brain, including the frontal and temporal lobes and the midbrain.1 At this stage George Downward thought this would be caused either by a brain infection (encephalitis) or from lack of oxygen (hypoxia).2 The CT scan also showed infections in both middle ears (otitis media), sinuses (sinusitis) and inside the mastoid bone cavities (mastoiditis). Downward continued to treat her as ‘for a severe bacterial or viral infection’. At 11 am Maud Meates-Dennis came to ICU to check on Charlene, and she also noted these CT findings. Desmond O’Regan inserted a drip called a central line into a vein in the right side of Charlene’s neck (internal jugular vein). This had three tubes, allowing the central venous pressure to be monitored and drugs to be given.
Charlene’s family were in the ICU waiting room; Tafadzwa had now also arrived. At about 11.30 am an ICU nurse, Kathryn Crocker, explained to them that they could go in to be with Charlene, but only two at a time; this was the usual ICU protocol.3 The family visited her in pairs over the next hour.
At about 12.30 pm Meates-Dennis told them that the Starship team would be arriving at 1.30 pm. Lilian told Crocker they were going home to tidy the house and pack a small bag for Sifiso. She left her phone number in case they were needed. She drove Sifiso home to pack, and Tafadzwa went back to Lilian and Irvine’s house to prepare his things for the stay in Auckland. George also drove home, stopping at the supermarket to pick up some washing powder on the way.
George Junior and Charmaine were at home. George Junior was a student of civil engineering; he also had ambitions of becoming a professional tennis player.4 He had woken up with the commotion just after 6 am. Nothando had wanted to use the phone to call Lilian, and she asked her brother George to disconnect the dial-up internet on the family computer. George had seen Charlene being carried downstairs and the pool of diarrhoea in the bedroom, but he had not appreciated the gravity of the situation. Charlene had previously had diarrhoea as a young child and been rushed to the doctor. He assumed this was another of those events.
Once they were home, Sifiso and Lilian leapt into action. Sifiso wanted to wash all the soiled clothes and bedding.5 Charlene had been lying on a blue and white fitted sheet, under which was an electric blanket. She had been covered with two woollen blankets and a floral duvet. Lilian took the blankets and put them on the line to air. Sifiso bundled up the sheet, electric blanket and Charlene’s soiled clothes (pink and white striped long-sleeve top, white skirt, pink underpants, the multicoloured skirt she had put on her briefly) and took them to an outside tap. There she sluiced off the faecal matter in buckets of water, going inside to empty the dirty water into the toilet. After the soiled electric blanket was spot-washed, it was hung on the clothesline.
When Sifiso got to Charlene’s underpants, she found a huge stool squashed in them and had to scrape it off. She estimated its size as extending from the tip of her index finger to the middle of her palm, about 11 cm. Both she and Lilian were astounded at how big it was.6
About this time Meates-Dennis phoned: she asked if there was any blood on the clothes or the bedding. Sifiso checked and also asked Lilian to go upstairs and look at the bed and other underpants belonging to Charlene. Both reported that they did not see any blood-stained clothing or bedding.
There was a load of dirty clothes already in the washing machine, which had not been washed as the household had run out of washing powder. Lilian took out this load and put it on the laundry floor. Sifiso put the rinsed sheet and clothing in the machine. By now George had arrived home with the soap powder. Sifiso added to the washing machine anything that might have diarrhoea on it; this included the sarong she had been wearing when she found Charlene, and the orange and green towel from the back seat of the car. She also washed two small polar-fleece blankets that had been in the girls’ room that they used to wrap themselves in while watching TV, in case these blankets had also been soiled with diarrhoea.
Nothando arrived home. She was studying law and economics at Canterbury University, and also had a part-time job as a caregiver with a nursing bureau.7 After she had helped carry Charlene downstairs she had dressed and gone to work at 7 am. Throughout the morning she had been trying to find out what was happening to Charlene. She had rung her sister Maggie in Auckland and tried to reach her father. At midday she rang her brother Tafadzwa, who told her that Charlene was to be flown up to Auckland. Nothando finished work early and arrived home at 1 pm. Her mother and sister had just finishing organising the washing, and Lilian was washing the kitchen floor.
Sifiso packed a small bag and then she, George, Lilian, Nothando and Charmaine rushed back to the hospital. They left the washing machine running.
George Junior went to play a game of tennis he had organised for 1 pm.
Meantime there had been some developments at the hospital. When Charlene had first arrived, she had a high fever (over 40° Celsius). While she was in the emergency room her temperature had dropped, and it was noted that her arms and legs were cool. By 9.15 am her temperature was recorded as 35.1°C, which was well below normal;8 this was because of the several litres of cool fluid that had been dripped into her bloodstream. Also, her body’s ability to maintain her body temperature was failing. Once in ICU it was decided to measure her temperature using a thermometer inserted into her rectum (a rectal probe), which is more accurate than in the ear. ICU nurses Kathryn Crocker9 and Nicola Ferguson10 set about inserting the rectal probe just before 1 pm.
Because Charlene was lying on her back with lots of tubes and wires attached, Ferguson tried to insert the probe without being able to see the anus. However, she ‘had difficulty distinguishing between vagina and anus because they both felt quite loose’. She noticed a small amount of blood on her gloved fingers after doing this and ‘was not sure whether it was from her vagina or rectum’.
The nurses decided that they would have to roll Charlene over. Crocker turned her onto her left side. Both nurses then noticed what they described as a tear to Charlene’s anus. Ferguson described this as ‘a meaty open wound’ about 5 cm in diameter. Crocker said it was a fresh red tear to the anus, about 3–4 cm in length, which was oozing watery fluid. The nurses decided to insert the probe into Charlene’s nose instead to monitor her temperature. They reported their finding to Downward. Meates-Dennis and Dr Melanie England, a paediatric registrar, were also called. England had been one of the doctors who had looked after Charlene in the emergency room.11 Charlene was rolled over again. Downward saw an injury that ‘was not the result of any disease or medical condition … It could only have been caused by the application of external force or insertion of an object into Charlene’s anus.’ Meates-Dennis said she saw a large 7-cm tear that involved both the surface skin and the deep tissues. England described it as a gaping slash with clear fluid and pus coming out of it.
The horrified doctors decided that Charlene must have been sexually abused. They thought that her septic condition might be due to a tear through the wall of her bowel leading to the spread of infection and blood poisoning.
Meates-Dennis called Sifiso to ask about blood on the clothing or bed. She also rang the 24 Hour Surgery. Carpenter was now off duty but the doctor there checked the notes. She reported that there was no mention of rectal bleeding but a nurse had commented about blood on her finger after inserting suppositories. Meates-Dennis then asked another paediatric registrar, Dr John Garrett, to examine Charlene.12 He inspected her abdomen, which showed no sign of inflammation, and looked at her anal region. He said he found what looked like a rectal tear. Garrett rang the paediatric surgeon, Professor Spencer Beasley, and the Doctors for Sexual Abuse Care (DSAC) doctor on call, Clare Doocey. Beasley suggested an X-ray of Charlene’s abdomen, and Garrett arranged this. The X-ray was taken at 1.13 pm, along with a repeat chest X-ray.13 The X-ray of her abdomen was normal: this ruled out any tear to her bowel lining. The chest X-ray showed some worsening of the pneumonia in the right lower lobe of her lung as well as both upper lobes.
By 1.30 pm the family had arrived back in the hospital and were in the ICU waiting room. The pathology registrar on call, Dr David Hammer, had advised that Charlene be tested for HIV. The blood for this was taken at 12.40 pm and at 2 pm Meates-Dennis received the result that Charlene was positive for HIV.14 At the same time, Beasley arrived. He said that Garrett had rung him to ask him to examine Charlene, ‘who was desperately ill and suffering from rectal bleeding’. There had been no mention to him of the profuse diarrhoea with which Charlene had originally presented.
While Beasley was examining Charlene, the team from the Starship arrived. They watched his examination. After looking at her abdomen and establishing that it was soft with no signs of tears to her bowel, Beasley asked Garrett to fetch a proctoscope, an instrument used to look inside the anus and rectum.15 He asked for ICU staff to take photographs of his examination. Beasley noted some bruising and swelling of the area around the anus. He saw some fluid coming from the anus and seeping between the buttocks, which he described as sloughing of the gut lining (‘the surface layer of the rectum is falling apart and collapsing into the bowel’). He also saw some small deficits in the lining of the anus. These were ‘little cuts in the skin on a number of places around the perimeter’. These were about 2–3 mm or less, and at the very most 1 cm. Inside the rectum he noted patchy pinprick-size spots of red from broken capillary blood vessels. There were no visible cuts. He concluded that it appeared Charlene had suffered some trauma to her anus, that there was no sign of a tear to her rectum, and that ‘the presumed trauma to the anal region would be unlikely to account “per se” for how sick she was’. An anal swab was taken, which grew a small amount of thrush.16 The report also noted that there were much fewer bacteria than would normally be found in the bowel and grown from anal swabs.
After Beasley had left, Meates-Dennis and Downward were still worried about the rectal tear they had seen. They still thought that blood poisoning ‘from rectal penetration could not be excluded’.17 They were convinced that:
we were dealing with a non-accidental injury and the overall presentation of Charlene could be attributed to a total body hypoxic insult secondary to suffocation, based on speculation that she would need to have been kept quiet for such injuries to have been inflicted.
It was here the diagnosis changed. Charlene had presented with her organs and tissues in a state of severe hypoxia: this was thought to be due to overwhelming infection. The profuse diarrhoea had caused such a loss of fluid that her blood volume was reduced; and the infection in her lungs was limiting the amount of oxygen that could reach her blood. She was suffering from septic and possibly toxic shock. However, the doctors now speculated that her body had been deprived of oxygen not as a consequence of overwhelming infection, but due to suffocation by someone who was sexually assaulting her.
At 2.45 pm Meates-Dennis spoke with Sifiso and George, who were still in the waiting room with other family members and were not permitted to see Charlene. She told them that Charlene was HIV positive, but she was not sure how relevant this was to her current illness. She wrote in the clinical notes ‘I did not mention the rectal tear at this stage.’
At 3 pm Meates-Dennis wrote in the clinical notes that Charlene had ‘blunt trauma to the rectum’, and that the police and Child, Youth and Family (CYF) needed to be informed. The trauma to Charlene’s rectum and possibly the vaginal discharge indicated sexual abuse. She considered that it was likely that Charlene had the HIV transmitted from her mother at birth. However, she did not believe that HIV was likely to be a significant factor in Charlene’s current critical illness.
The blows to the waiting family were coming thick and fast. At 4.15 pm Meates-Dennis wrote in the clinical notes that she had spoken to George and Sifiso, accompanied by hospital social worker Michael Moss.18 She told them that they had found a rectal tear which looked like trauma and that an investigation would involve the police, who would want to interview them and other family members. Moss collected the names and cellphone numbers of all the family members. Both George and Sifiso were at a loss to know how this injury might have happened. Sifiso buried her face in her hands. George went in to see Charlene and spoke to her. He lifted one eyelid and saw that her pupil was fixed and dilated.
Charlene was now being examined by Daniel Dallimore and Brian Prendergast from Starship. Dallimore said that he had seen a rectal tear several centimetres long, with some bleeding, pus and faeces around the anus, when Professor Beasley had conducted his examination.19 Prendergast also reported having seen the rectal tear.20 Dallimore tried to stabilise Charlene by adjusting her ventilator settings and her medications. He discussed the case with Meates-Dennis and by phone with his boss, Dr Elizabeth Segedin, the consultant in charge of PICU at Starship.
It was decided that Charlene had multiple organ failure, fixed dilated pupils and a poor neurological state, indicating that she was effectively brain dead. Her death was inevitable. There was no treatment they could offer her, therefore there was no point in transferring her to PICU in Auckland. The Starship team left at 6 pm. When he went past the ICU waiting room George Gwaze asked Dallimore whether Charlene was going to Auckland. Dallimore replied ‘No,’ but nothing else was said.
Meates-Dennis discussed further investigation with her colleagues. These were focused on finding out the cause of Charlene’s condition, because at this stage nothing could be done to save her life. Beasley suggested a CT scan of the abdomen: he would decide whether or not to have a look inside her using a laparoscope based on the findings from the scan. Downward suggested a special CT scan of the head, using contrast media, to clarify the condition of her brain.
The family were all tired and hungry. George, Sifiso and Lilian had left home before breakfast and had not eaten all day. They asked George to go and get takeaway food for them all. He left just after 6 pm. Soon after, Meates-Dennis spoke to Sifiso.21 She explained that the Starship team had departed; Charlene was brain dead, her kidneys and lungs were badly damaged and she was not going to the Starship because there was nothing else they could do for her. However, according to Sifiso, Meates-Dennis then said that ‘miracles can happen’ and asked permission to do more tests. These would involve disconnecting Charlene’s life support to move her to radiology and back. Sifiso agreed, in the hope that something could be done to save Charlene’s life.
Charlene was taken to radiology for CT scans. An injection of contrast medium was used to improve the images taken in the scan. This procedure is not usually done in someone whose kidneys are not functioning normally; however, because it was clear Charlene would not survive, it was decided to proceed with it to further explore the possibility of traumatic injury. O’Regan was called back to the hospital to help transport Charlene. At 7.30 pm he disconnected her ventilator, connected her to a transport ventilator and wheeled her to the CT scan, accompanied by ICU registrar Dr Veronica Gin22 and ICU nurse Fiona Blythe.23 She was moved onto the CT scan bed then back to the ICU bed and returned to ICU. Once she was back in the unit, Blythe and another nurse, Lesley Whyte, cleaned Charlene.24 They washed her face, because she had yellowish discharge from her right ear and blood trickling from her nose. They rolled her over on her side and cleaned her bottom: ‘There was a clear to brown liquid discharge which had leaked onto the bed and Charlene was lying in it. It was around her buttocks and lower back area’. After cleaning her up they changed the sheets.
Meanwhile Dr Clare Doocey from DSAC had become involved.25 Garrett had rung her at 3 pm; he told her that Beasley had examined Charlene and that she had a rectal injury. Garrett wanted to know whether they should do the forensic medical examination of Charlene’s genital area in Christchurch or wait until she was transferred to Auckland. At 3.13 pm Meates-Dennis also rang Doocey. She told her that Charlene might not be well enough to be flown to Starship and asked for the forensic assessment to be done in Christchurch. Doocey arrived at the hospital at 3.30 pm and met with Meates-Dennis. She was shown the photographs of Beasley’s examination taken on the ICU digital camera. At 4 pm Doocey decided that she might need to do the forensic examination. She contacted Jocelyn Thomson, the DSAC nurse on call, whose role was to help DSAC doctors during medical examinations following allegations of sexual assault. Doocey told her that she would need her help if Charlene was not going to be transferred.26
Doocey was not actively involved in Charlene’s care. She waited in ICU while Charlene’s medical condition was further assessed by the Starship staff and Meates-Dennis. Doocey and Meates-Dennis had informal discussions about the possible causes of Charlene’s condition ‘in the nature of bouncing ideas off each other’. Doocey rang Dr Martin Sage, forensic pathologist, to let him know that it was likely he would soon be called on to conduct a post mortem in a sexual assault and homicide case. Detective Sergeant Craig Farrant of the Christchurch CIB also rang Sage to alert him about Charlene’s imminent death.
The police arrived at the hospital at 6.45 pm. Senior Constable Olds and Detective Lisa Harrington met with Michael Moss and then with Doocey.27 Doocey explained that she was planning to conduct the forensic examination and asked for a police photographer to be present. She told the police that she had already contacted Sage. Olds discovered that there were ‘a number of family members who live with the victim’ present at the hospital. He liaised with the officer in charge of the case, Detective Inspector Malcolm Johnston, and arranged for more police officers to come to the hospital to interview these witnesses.
There was a police officer in the visitors’ room with the family; and another sat outside Charlene’s room. Friends of the Gwaze family, including members of their church, had arrived to support the family. When George failed to return with food, Nothando rang him. He explained that he was being detained by the police and could not bring any.
Now the family members were taken off to individual rooms to be interviewed by the arriving detectives: these included Sifiso, Nothando, Tafadzwa and Lilian. The family were not permitted to see Charlene. Charmaine had arrived in the hospital at 1.30 pm, but she never had the opportunity to see her little sister. She remained in the waiting room with other visitors, including the church elder, Musa Masenda. George Junior never made it to the hospital. Using the cellphone number given to the social worker, the police called him at his tennis club, picked him up and took him straight back to the police station for questioning: as one of the two males living with Charlene, he was a prime suspect. He was still being interviewed when Charlene died.
At about 8 pm the family were advised they could see Charlene. They could come in two at a time, wearing gowns. Sifiso and Tafadzwa visited her briefly, Sifiso in tears. However, by this stage most of the family were sequestered in private rooms being interviewed by police.
Soon after 8 pm Beasley returned to view the CT scan results with Meates-Dennis and Doocey.28 The head scan showed significant deterioration since the previous scan 9 hours earlier at 10.30 am. There was much more loss of white matter throughout the brain. The report concluded that the pattern was not typical of global oxygen deprivation, but some of the findings might be explained by ongoing damage from the HIV infection plus effects on the brain tissue from small clots lodging in the blood vessels (the result of her coagulation disorder DIC).
The scan of the abdomen showed patches of tissue death in the spleen and kidneys due to insufficient oxygen (from clots lodging in the blood vessels, bleeding, or from insufficient oxygenated blood reaching the tissues). There was a ‘diffuse “shock bowel” appearance in the large and small bowel, consistent with changes from hypovolaemic septic shock’. There was no sign of free gas in the abdomen, nor any specific injuries to the rectum. The doctors agreed that the scan result ruled out any possibility of a major rectal injury or bowel perforation.
Soon after 9 pm Meates-Dennis spoke with Sifiso and Tafadzwa again. She explained that the abdominal scan had not found any treatable problem. There was damage from lack of oxygen to Charlene’s bowel, lungs, kidneys and gut, but she did not really know why. The head scan showed lack of oxygen to the brain. She told Sifiso that Doocey was going to do a formal forensic examination of the injuries. Sifiso asked if she could be present. Meates-Dennis did not agree to this. However, at 9.40 pm she discussed Sifiso’s request with Detective Harrington. It was agreed that they would allow Sifiso to view the injury in the presence of police, after the forensic examination had been completed. At 10 o’clock the family asked if Charmaine, who was still ill with chickenpox, could leave, and Detective Paul Johannsen gave permission for her to go home with Musa Masenda so she could get some sleep.29
Having obtained Sifiso’s signed consent, Doocey started her examination at about 10 pm. She was assisted by Beasley and Thomson. Also present were Meates-Dennis, Clarke, England and another paediatric doctor, Heste Henning, as well as a number of intensive care nursing staff. Doocey first examined Charlene with her lying on her back with her knees bent and her legs held against her stomach by medical staff. She looked at the genital area using the light and magnification from a colposcope (a vaginal microscope). She noted that the tissues around the anus were grossly swollen and ‘progressive since seen initially’.
Charlene was then rolled onto her left side and Beasley repeated his examination using a proctoscope. Doocey recorded generalised bruising and haemorrhage of the lining of the rectum up to a depth of 8 cm. Lastly Charlene was returned to lying on her back with her legs placed in frog-leg position while Doocey examined her genital area using the colposcope. She reported that the outer vaginal lips were swollen, with broken outer skin on both sides. There were areas of haemorrhage on the hymen and at the area where the vaginal lips join. She reported a tear to the hymen at 9 o’clock and discharge from the vagina. The tissues around the anus were also swollen and disrupted, and there was an offensive green discharge coming from the anus. She noted multiple splits extending from the skin around the anus into the anal canal. Police photographer John Trenchard was present and took photographs as directed by the doctors.
Doocey took a series of specimens for the forensic examination, including swabs of the mouth, vagina and rectum, hair and fingernail scrapings, and blood to test for alcohol and drugs. These were handed to Thomson and processed using the usual medical protocol in cases of assault.
The examination ended at 11 pm. Meates-Dennis brought Sifiso into the room accompanied by Detective Lisa Harrington. Doocey showed her Charlene’s anal injury. Sifiso said that all she saw was a reddish area in Charlene’s bottom, not the great gash or wound that she was expecting to see. She asked why this had not been recorded at the 24 Hour Surgery. Meates-Dennis explained that ‘the injury would not have been seen unless Charlene’s buttocks were parted’.30 Meates-Dennis told Sifiso that Charlene was deteriorating and that she would not live for long.
Clarke had taken notes during the forensic examination, and afterwards Doocey used these to record her findings in the assault medical protocol booklet. Doocey met with Sifiso and Tafadzwa in the side room after the examination and obtained written consent to release the medical examination kit to the police. The report and labelled specimens were placed in the examination kit, sealed and signed, then given to the police. Constable Olds stayed in Charlene’s room. His role was to watch any family members who came to see Charlene.31
When George had gone to buy food for his family, he had called in at their home on the way. He wanted to ring his sister in Zimbabwe to tell her what had happened to Charlene. He also wanted to check that their house was secure. As he was about to leave, Constables Terrell and Lapslie arrived. They had been briefed to keep the occupants there ‘while a search warrant was obtained’.32 Their job sheet identified Charlene Makaza as the victim who had suffered ‘blunt force trauma inside of anal cavity. Brain injury possibly caused by being suffocated.’ Lapslie’s role was to ‘maintain a presence and keep any occupants there until a search warrant was obtained’.33
When they found George at home they asked him to wait with them there. They told him that their senior officer would be coming and wished to speak with him. George invited them in and was friendly and cooperative.34 George assumed it was about Charlene and the puzzling injury reported by the doctors, but at this stage he had no idea he was a suspect. When Nothando rang he explained that he could not come back with food for them because he was with the police. It started to rain and George went to bring in the electric blanket from the clothesline. Lapslie asked him to leave it there. The police placed a large tarpaulin over it to prevent it from getting wet.
The warrant was secured at 8.20 pm. Johannsen arrived and asked George to accompany him to the Christchurch Central Police Station. Lapslie asked George to give him the keys to the house, and George handed them over. He agreed to go to the station. Johannsen commenced a videotaped interview with him there at 8.40 pm.35
Johannsen was clearly considering the possibility of an intruder. He asked George if he was sure the house was locked up the previous night and still locked in the morning.36 George insisted that he was very particular about securing their house. He doubted very much that anyone could have come in while they were asleep.
Johannsen told George that Charlene has internal bruises ‘consistent with something being forcibly pushed up her bottom’; that she had a tear in her anus ‘which would be horrendously painful’, ‘it would be like taking a knife and cutting through layers and layers of skin’; and that she was brain dead, which was ‘consistent with someone trying to suffocate her or holding something over her head’.37 George was horrified.
Johannsen tried to get George to confess (‘If you had something to do with it, George, you can cleanse your soul’; ‘You can tell me’) but George repeatedly said no, he had done nothing and he had no idea how this could have happened. At 12.15 am Johannsen terminated the interview. George was then allowed to go to the hospital. He arrived under police escort at about 12.40 am and joined family and friends at Charlene’s bedside.
At midnight ICU nurses Fiona Blythe38 and Lesley Whyte39 had decided that Charlene was near death and advised the family in the waiting area, who were then allowed to be with her. Sifiso and a family friend sat with Charlene, talking softly to each other in Shona. Soon other family members joined them, including those still undergoing interviews with the police. Not Nothando, however: despite her pleading to be with her family and with Charlene, her interview continued. She was not present with the others when Charlene died. She says:
I was interviewed behind closed doors at the hospital with a Detective Barry Tinkler, he was the one who broke the news to me that Charlene had died and despite me asking him several times to go and be with my family, he refused and I was only let out about an hour later from when Charlene had died. There was a policeman in the room she lay in and as I bent towards Charlene to give her a kiss on her forehead, the policeman was watching; it really felt like I couldn’t have time alone with her.
Family and friends stood around the bed, and one man prayed in Shona. At 1.01 am on Sunday 7 January, Charlene died. The nurse called the ICU registrar Sarah Hughes, who certified her dead and all the monitors were switched off. Charlene’s short life was over.