Dr. Keith Kocis, who specializes in critically ill children, was the attending physician at UNC's intensive care unit for children when the 4-year-old Johnston County girl was brought to the hospital in July 2010.
"Startling is not the right word, ah certainly deeply disturbing is again is is not how I truly felt, ah it was a very visceral response like I was going to vomit," said Kocis.
Jonathan Richardson is accused of beating and sexually assaulting his girlfriend's daughter over a 10-day period while her mother, Helen Roxanne Reyes, was out-of-state for Army Reserves training.
The then-21-year-old Richardson had originally taken Skiba to Johnston Medical Center -- she was later transferred to UNC-- claiming the girl had fallen off the bed. However, doctors found she had cuts, bruises, a head wound, and bite marks on her body.
Skiba died days later from her injuries.
On Friday, Kocis said he had never seen injuries like that on any child in his 25 years as a doctor.
"We saw this small frail girl who you know from her status she was pale, she was poorly perfused, in shock, those parts ... don't portray how beaten this child was when she ... I had a first look at her," Kocis said. "These scars, these whip marks, these injuries to her skin that were all over her body, I mean there was essentially no part of her body that was spared."
His testimony got pretty graphic at times when he began to detail the extent of the girl's injuries.
At one point, the jury was asked to leave the room while the prosecutor went over some evidence with the doctor and discussed showing the jury video and photos of the injuries.
Kocis said Skiba could have been violently shaken, because she had brain injuries similar to other cases. He said he was only able tell she had brain function by poking a needle in her foot. He said her foot responded little, but said the girl had very little brain function.
"We knew that there was a significant, ah, inter-cranial, ah, brain injury, bleeding in the brain on the left side and it was so severe in impacting the brain it was swelling," said Kocis.
The doctor testified that Skiba was one step away from being brain dead.
"Her basic, very basic, ah, functions of the brain - what we call the brain stem functions that keep you alive - ah, were - thinking about it type of activities - were deranged and failing," he explained.
He also said the girl had a lot of acid in her blood from possibly poor circulation of air and that Skiba was barely hanging on when she arrived to UNC.
Authorities have said the 4 year old was tortured inside an air conditioned barn behind Richardson's grandparents home, where she was living with her mother and Richardson. There was no running water, no bathroom, and just a single air mattress on the floor to sleep on.
On Wednesday, a crime scene investigator described to the jury every single piece of evidence that she uncovered in the shed, which was littered with trash.
"I observed the interior of the shed to be cluttered with what appeared to be an odor of urine and/or feces," Former CSI Investigator Charlotte Fournier said. "There was an air mattress on the floor in the south east corner of the room with a few pillows on top of it. Located on the floor between the chair and treadmill, there was a laptop and a brown extension cord with exposed ends."
Fournier also said she found underwear - size 14 - with suspected blood, and a piece of tissue inside with suspect blood on it.
Richardson has been charged with first-degree murder, and felony child abuse inflicting serious bodily injury.
Prosecutors are seeking the death penalty against him.