Irishman David Keohane was bashed and robbed because he was the only person walking down a Sydney street in the early hours of August 9, 2008.
In a recorded police interview played to a Sydney jury, his attacker admitted jogging towards the stranger, before he hit him on the side of his face and "he just dropped".
Earlier in the NSW District Court on Wednesday, Dr Vanessa Sammons said Mr Keohane's head injuries were so bad that doctors believed he would be lucky to survive.
Dr Sammons, the neurosurgeon registrar who treated him until he returned to Ireland, said his Glasgow Coma Score had been three, "akin to someone who is deceased".
Thomas Isaako, 21, of Bankstown, has pleaded not guilty to the attempted murder of Mr Keohane, 29, at Coogee.
The scaffolder has pleaded guilty to robbery in company and inflicting grievous bodily harm on Mr Keohane.
In his police interview, Isaako said that after drinking at the Coogee Bay Hotel, a companion suggested they "roll" someone, which he said meant "bash someone and take their stuff".
As they turned a corner, Mr Keohane was "the only person I could see. There was no one else."
Isaako said that after hitting Mr Keohane and seeing him fall to the ground, he punched him four more times before telling his companion to stop hitting him.
Asked what he thought was wrong with Mr Keohane when he left him lying on the ground, Isaako said: "I think he was, just like, hurt."
Asked if he thought of calling an ambulance, he replied: "After that I was just in my own world."
Dr Sammons told the jury Mr Keohane's whole face was fractured and she recalled looking at the CT scan and thinking "what could possibly have caused that extent of damage".
"To have the degree and number of fractures that David had, I cannot imagine that what happened was one or two blows," she said.
"It must have been multiple and from multiple directions."
She remembered conversations at the hospital when doctors agreed his prognosis had been very poor and "we thought he would do very poorly and he would be lucky to survive".
"In my first conversation with David's family, I said he could possibly live, but he would never be the person he was."
She said that on September 15, 2008, Mr Keohane went back to Ireland on a commercial flight with doctors and nurses in attendance, adding that he had to go on a stretcher.
Under cross-examination from Isaako's barrister, Nathan Steel, Dr Sammons said it was not possible certain injuries resulted from Mr Keohane having fallen backwards.
Mr Steel asked if some of the injuries could be from falling.
"It would have to be that he hit things with his head several times in the course of a single fall," she replied.
The trial is continuing before judge Ronald Solomon.
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