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Question about the ending. (Spoilers)

Please bear in mind that I could be extremely wrong in these views, but I don't understand how Miss Sneezy was killed by Saint and Nature. It mentions that Whittier and Sneezy walk out of the building hand in hand, but when the Saint and Nature get outside, Mr. Whittier is almost a city block away. Why did Sneezy linger so close to the door while he just walked so far away? Weren't they going to be..together?

Now this is where it gets a little hazy. In my mind, I see the Saint and Mother Nature as on the verge of starvation, barely crawling out into this alley, but somehow they manage to either HURL this knive across the alley and land it in her chest (skills!) or from ground level, reach up and stab her in the chest (super long arms!) How did they manage to kill her?

I loved the book and I completely understand the deeper meaning behind the ending, about pain, suffering, and dwelling on personal pain but logically I don't see how that knife entered her chest! Any help would be appreciated. Thank you.