Her heart muscles were starved for oxygen, or, a blood clot blocked blood from being oxygenated in the lungs. She felt agonal cardiac pain in her chest or was asphyxiated while gasping for air. She was crying, and felt intense pain with a sense of impending doom. She could not yell for help, she could not speak. The fear and pain were unimaginable to her. She died alone knowing she was dying with her parents who did nothing to help her in the next room. She suffered. Sean Casten did to his daughter.