A “very distraught” Oscar Pistorius was kneeling beside the body of his model girlfriend Reeva Steenkamp when a neighbour, Dr Johan Stipp, arrived at his house shortly after the fatal shooting.

“He was crying, he was praying, he was talking to God, he was telling God to let her live, please don’t let her die,” Dr Stipp told the Pretoria High Court on Thursday.

“He was making promises to God, he was trying, I don’t know, to get atonement.”

It was a dramatic fourth day in the Blade Runner’s murder trial, with graphic evidence leading Pistorius to appear as though he was going to be sick in the dock.

A supporter handed him a plastic bag as he sat doubled over, clutching rosary beads, shoulders heaving and head in hands, as the court heard graphic details from Dr Stipp about Ms Steenkamp’s injuries.

The day was doubly emotional for the Olympian, being the 12th anniversary of his mother Sheila Pistorius’s death.

She died from drug complications from a hysterectomy when the double-amputee was 15. He has her dates of birth and death tattooed on the inside of his right arm.

As the court adjourned for the day, Pistorius sat sobbing with his sister Aimee, who wrapped her arms around him. He left the court on Thursday looking very pale.

But while his evidence was descriptive and emotive, it also went some way to bolstering the state’s case for murder.

Dr Stipp, a radiologist and formerly of the military, was the first person on the scene after the shooting, having woken to the sound of “three loud bangs”.

Thinking they were gunshots, he got out of bed and went to his balcony, when he heard what he thought was a female screaming three or four times.
He went back inside and called security, but there was no answer. He then rang police and got a strange dial tone. While he was trying again, he heard another three loud bangs.

Dr Stipp said he thought perhaps the person who had shot the first time was shooting again, so told his wife to get away from the window.

But thinking someone may need help, he went in the direction of Pistorius’ house.

“As I approached, there was a man on his knees on (her) left side,” he told the court.

The man who he now knows to be Pistorius had one hand on the body of the woman, the other trying to open her mouth as Mr Stipp took over, he said.

“I tried to open her airway, she had no pulse in her neck, she had no breathing movements that she made, (her mouth) was clenching down on Oscar’s fingers as he was trying to open her airway,” he said.

“I tried to do it too … It was very difficult with the clenching down. All during that time there was no signs of life that I could see.”

He said he opened Ms Steekamp’s right eyelid, and saw “her pupil was fixed and dilated, and her cornea was milky – in other words it was already drying out.”

“To me it was obvious she was mortally wounded,” he said.

“I looked at the rest of her body and I noticed she had a wound in her right thigh, also a wound in her right arm.

“Further, I saw there was blood in her hair and what looked like brain tissue mingled with that in the right area of her skull.

He said Pistorius, who was “emotionally very, very upset” repeatedly said: “Please, she must live, she must not die.”

He recalled Pistorius in a prayer-like state, saying “he would dedicate his life and her life to God, if she will only live and not die that night”.

When Dr Stipp realised he could not do anything for Ms Steenkamp, he went outside and spoke to a security guard, who had just arrived, and after discovering no ambulance had yet been called he phoned the hospital.

“Oscar stayed by her side most of the time,” he said.

A short time later he saw Pistorius walk back inside, and he asked the security guard if he knew where the gun was. He didn’t.

“I didn’t know the situation … I thought maybe he was going to hurt himself,” Dr Stipp remarked.

In other testimony, Dr Stipp said after he had gone out onto his balcony – from which he could clearly see the Pistorius house’s bathroom windows – he saw lights on.

He said around the time he heard the screams and what he believes were gunshots, he noticed the bathroom light was on. This is in contradiction to the version provided by Pistorius, who says the only light on was in the toilet, where Ms Steenkamp was.

“When the lady screamed initially, that’s when I saw that there was a light on in the bathroom,” he said under cross-examination.

After the gunshots, he then heard someone scream "help, help, help" – and there was “no change” to the lights in the Pistorius house.

Pistorius’ barrister, Barry Roux SC, had tried to suggest to Dr Stipp that the second set of noises he had heard were the sound of the cricket bat Pistorius says he used after the shooting to bash down the toilet door and rescue Ms Steenkamp.

However, Dr Stipp said the two noises sounded the same.

“I don’t know, maybe the cricket bat (was used) first, then the shots?” he replied to Mr Roux.

He also rejected the defence’s repeated claim the screaming may actually have been Pistorius whose voice pitched high when he was anxious.

“The screams I heard they sounded female to me,” Dr Stipp said.

Earlier, a witness who claimed he heard Pistorius fire up to six bullets the night he killed his girlfriend has rejected claims his evidence was designed to “sideline and incriminate” the athlete.

Charl Johnson, the husband of the case’s first witness, Michelle Burger, said he had heard screams and gunshots in the early hours of Valentines Day, 2013.

While his wife clearly said she heard four shots – the number fired by Mr Pistorius – Mr Johnson has said he heard “five or six”.

He told the court he heard two separate voices and screams: “I could hear she was in trouble. They were clearly distress calls.”

But Mr Roux accused the couple of colluding on their evidence, suggesting they simply could not have heard what they say they did.

However, he was also forced to apologise to the witness, who had told the court on Wednesday he had received threatening phone calls after his phone number was read out in court.

Mr Pistorius has pleaded not guilty to a charge that he murdered his girlfriend, Reeva Steenkamp, after an argument escalated and she locked herself in a toilet cubicle of his house.

He claims the shooting was a terrible accident after he was woken in the night and believed an intruder was posing an imminent threat to them both.