by Peche, Alec
Chocolate Diamonds
By Alec Peche
Copyright May 2014 Alec Peche
Published by GBSW Publishing
Reprinted June 2015
Discover Vials, A Breck Death, Death On A Green, and A Taxing Death also by Alec Peche
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Chocolate Diamonds
Chapter 1
Dr. Jill Quint was walking through the large terminal in Brussels, Belgium looking for her three friends, Jo, Angela, and Marie had flown out from Wisconsin, while Jill had departed California, for blissful days of eating, drinking, shopping, and sightseeing in Belgium and the Netherlands. It was early fall and the color of the trees was starting to change outside the airport. She couldn’t wait to get outside and explore this part of the world.
Jill was a vintner growing the Muscat grape. Her first crop had hit the market a few weeks before and was doing well in sales. To supplement her income, she also maintained a forensic pathologist consulting business that provided second opinions for cause of death. She’d had her toughest case in the spring of this year.
It had been her first case in five years in which she had become a target after providing the San Francisco medical examiner with evidence that the case was a homicide rather than death by natural causes.
On occasion, her three friends assisted Jill with her investigations. They had full-time jobs, but she generally needed ten to twenty hours in research, which they could do at night or on the weekend. This last case was so complex it had required many hours from all of them, and now they could afford fancier hotels than they normally booked.
Jill had taken a break from consulting over the summer and concentrated on producing her first crop of Moscato wine. Once she returned from vacation, she planned to resume consulting.
She spied her three friends in the baggage area at the other end of the baggage carousel and headed their way. After hugs, stories, and each retrieving their own piece of luggage, they departed the arrivals hall looking for their transport to the hotel in Antwerp.
They spotted a driver holding a sign with Jo’s last name and were soon settled in the van and heading toward Antwerp, which was an hour’s drive in normal conditions. Ongoing construction made the trip a little longer, but nothing could spoil the sunshine and promise of a new city, and indeed, a new country to explore.
The women had a list of museums, churches, and libraries to visit. Of course, they also planned to eat chocolate, drink lots of beer, and celebrate having the time together to enjoy a country that none of them had explored before. They were also studying the facial features of passer-bys, looking for Jo’s heritage in the people around them. Her ancestry was in this city.
It was midday when they settled into their hotel rooms. Although they were tired from the long flight to Brussels, they really wanted to stretch their legs, so headed out into the city. Using their travel guide, they followed a walking tour of the historical center of the city.
After gazing up at the beautiful Gothic Cathedral of Our Lady, they found their first Belgian beer pub. Belgians served beer in glasses specially designed for each beer brand. Spending the next hour comparing the size and the shape of the glasses, the alcohol content of the beer and the taste passed the afternoon in a most pleasurable way.
They strolled around the Grote Market, walking off the beer, window shopping, casually looking for a place to dine. In the end they decided to try a restaurant recommended by several Belgians.
They settled in at their table and were handed menus that were printed in Dutch but fortunately had English subtitles. The noise level was moderate as tables were fairly close together. It was fairly easy for Jill and her friends to listen in on the conversations around them. Jill was looking forward to trying Flemish stew. Angela had the vegetarian pasta, Marie also went with the Flemish stew, and Jo ordered a seafood stew. Another round of beer was a fine pairing with the dishes they'd chosen. Between the beer and the heavy meal, they knew they'd sleep well that night.
“Let's toast,” said Jo
“Cheers, and here's to a great vacation,” the other three said in unison with a laugh.
Just then there was a commotion at the next table. The four women looked over towards the sound. There was a lone diner at the next table looking panicked and clawing at her throat.
Jill stood up and quickly went to the diner's aid.
“I'm a doctor. What's wrong?”
Now was not the time to mention that she was a doctor to the dead – a pathologist.
“Nut allergy,” said the woman in a very distressed manner.
“Do you have an EpiPen or some kind of injection in case of an emergency? What's your name?” asked Jill, with her eyes on the woman's purse.
“I’m Laura Peeters.”
Jill was peripherally aware that Marie, Angela, Jo, and half of the diners and restaurant staff were gathered around her and the woman. There was near silence; everyone was concerned about Laura. Jill looked over her shoulder.
“Call for an ambulance. She needs to get to a hospital right away.”
Jill looked back at the woman, whose condition was rapidly deteriorating. She had reached for her purse, but seemed to have forgotten what she was looking for. Jill knew people with severe allergies could become confused quickly if their blood pressure dropped drastically due to the allergic reaction.
In most cases people with bad allergies puffed up in the lips and eyes. Laura seemed to be that rare 5 to 10 percent who experience some difficulty breathing, but whose biggest problem was a large and possibly fatal blood pressure drop. If Laura hadn’t said nut allergy, Jill would not have guessed that she was someone heading for anaphylactic shock.
“You seem to be having trouble finding your allergy medication in your purse. Let me help.”
Jill quickly looked through the purse, but didn't see any medication to treat the allergic reaction. She did locate the woman’s identification and saved that for the ambulance crew.
“How soon will the ambulance be here? She desperately needs medication!”
The woman was slumped over, with labored breathing. Jill didn’t carry a medical bag with her in California, let alone in a foreign country. She could start CPR if the woman needed that, but that was about all she could do for her.
“The ambulance will arrive in five minutes,” shouted a restaurant employee.
“Is there any medical help nearby? A doctor’s office or anything?” asked Jill.
“No, madam, this is a tourist area. We have police but no doctors or emergency personnel. Five minutes is a good response time. It generally takes ten minutes.”
Jill didn't think that Laura’s condition could wait five minutes.
“Help me get her out of her chair and flat on the floor,” Jill instructed to people that had gathered around the table.
She looked at Laura intently. “Laura, I know you’re having trouble breathing, but I want to make sure your heart gets plenty of blood. I am going to get you flat on your back and put your feet up.”
Jill knew this situation was heading in a bad direction. She looked over at Angela with the silent request for her to take control of the crowd while she tended to Laura.
“Let's give Jill and Laura some space,” said Angela to the crowd that had ga
thered around the resuscitation effort. “Will someone go outside and wait for the ambulance so that they can be directed inside to help as soon as possible?”
A couple volunteered to go outside and wait for the ambulance. Two men stepped forward to assist Jill in getting the woman flat on the ground. Jill had been monitoring her pulse as it slowed. She asked for something to prop the woman's legs up on in hopes of keeping blood available to her heart and brain.
“Does anyone else know cardiopulmonary resuscitation?”
Jill made the gesture of what CPR looks like in case her English words were not understood.
Fortunately, Marie knelt down beside Jill, ready to assist when Jill determined it was time to start CPR. Three other restaurant patrons knew CPR and were also ready to assist. Jill could no longer feel Laura’s pulse.
“One and two and three and four and five. . .” Jill started chest compressions.
Since Laura was suffering from an allergic reaction causing anaphylactic shock, Jill knew that performing CPR would be of little help. Laura needed a shot of epinephrine, quickly. Jill hoped that the ambulance carried medication for allergic reactions. She had no idea who staffed ambulances in Belgium, or what supplies they had.
CPR had been underway for three to four minutes when the ambulance arrived. The two responders carried a toolbox that thankfully had medication in it. One of the responders was a nurse. Marie took over for Jill doing chest compressions.
“I am Dr. Jill Quint, a physician licensed in the United States. I’ve been doing chest compressions for about four minutes. Before the patient lost consciousness, she indicated she was suffering from a nut allergy. Do you have epinephrine that you can give her now?”
With a quick assessment, they agreed with Jill's diagnosis and treatment recommendation. CPR continued. The nurse was in communication with the ambulance’s base station. Jill heard the nurse request the base station speak in English so that the American doctor could listen to the communication, or at least she thought that was the request as she didn’t speak Dutch and all of a sudden everyone began speaking in English.
“Giving the patient 0.5cc of epinephrine to the thigh muscle. Oxygen via mask running at six liters per minute was placed on her face. EKG monitoring being transmitted to base station. CPR has been underway for five to six minutes.”
Jill did a quick assessment of the situation.
“Look, we need to get her to a hospital now. There are two of you and I believe we need three to care for Laura -one to drive, one to administer medication, and someone else to continue with CPR. Let’s get her on a gurney, and I’ll accompany you to the hospital, continuing CPR.”
The nurse transmitted Jill’s request to the base station.
“This is base station at St Marie’s Hospital, we agree with your request. Please get her to the emergency unit as soon as possible. We will have a team awaiting your arrival.”
The driver had the gurney and was ready to load Laura onto it. CPR had to be stopped while they moved her.
“How long is the drive to the hospital?”
“Seven to ten minutes depending on traffic.”
“Let’s take one more person with us in case I tire out doing chest compressions. We need to remain strong on the compressions.”
Marie had resumed compressions after they loaded her on the gurney. She looked up.
“I’ll come with you and relieve you if necessary. We can share a ride back to the hotel,” she said.
The nurse nodded in agreement.
“We’ll see you back at the hotel,” said Jill to her friends as they hopped on board the ambulance.
It wasn’t easy to continue chest compressions in the moving ambulance. Jill had to straddle the gurney and Marie steadied her as they rounded street corners. The nurse tried to start an IV, but in a pulse-less patient in a moving ambulance, it was proving impossible.
Jill asked the nurse, “Should we give her another shot of epi?”
“I’m checking with the base station, Dr. Quint. I have treated severe allergic reactions before, but not one whose primary sign is low blood pressure. She doesn’t have the usual swelling.”
“This is the base station. What is your ETA?”
“Four minutes.”
“Let’s hold on the epi until she gets here. I am worried about giving her too much. Let’s get a read of her EKG without chest compressions. Can you stop compressions for ten seconds?”
Jill softly counted aloud the ten seconds and then she leaned forward to resume compressions.
“This is base station. We have a rhythm of sixty beats per minute. Stop chest compressions. The rhythm contains some abnormalities. What is your ETA?”
“Two minutes.”
“Continue to monitor her heart rhythm. We will meet you at the door of Emergency.”
Jill took a seat beside the gurney. It had been a wild ride. Her natural car sickness, the motion of the ambulance while doing CPR, the beer she had consumed earlier swaying in her stomach, and jet-lag combined to make her feel very queasy. She looked around the ambulance for an empty bag to puke in, if it came to that. She only needed to last another sixty seconds to avoid humiliating herself in front of everyone.
“Her heart rhythm is holding,” said Jill to the nurse.
“We are pulling into the hospital now. Laura will be met by a team that is excellent,” the nurse replied.
Jill could see the Emergency doors ahead and indeed, there was a team awaiting their arrival. The ambulance came to a stop and the doors were opened up.
The team looked upon Jill and Marie briefly with some curiosity. Laura's gurney slid out and she was taken inside. Jill glanced over at Marie.
“I'll just check to see if they need any information from you or me. Then I'll find out how to get a taxi back to our hotel. I don't know about you, but my adrenaline rush is over and I'm crashing. Not enough sleep, no food, and I'm carsick from the ambulance ride and the beer sloshing in my belly.”
Marie looked at her and said, “It's been an astounding thirty minutes. I’ve had my CPR card for twenty years, but that’s the first time I’ve done CPR on a real person. It was physically hard, and you did it for longer than I did. I'm not queasy, but otherwise I feel exactly like you do. When we get to our hotel, let's hope we can find some food. I was so happy when Laura's heart started beating on its own in the ambulance. I feel we need to toast her tonight.”
"She's not out of the woods yet,” Jill replied. “Let's go inside and leave our information there and maybe they will tell us how she's doing.”
Jill and Marie walked inside the emergency unit and approached the central desk. The unit looked much the same as its American counterpart. There were multilingual signs in English, Dutch, German, and French.
They explained who they were to the attendant who seemed to be directing the flow of patients. After the explanation, the attendant took them into the employee break room and offered them cookies and coffee. He asked Jill and Marie to wait while he checked on Laura and her team to see if they needed any further information from them.
He returned in a few minutes with the request that they wait ten to fifteen minutes for a hospital staff member. The staff caring for Laura thought they would have her stabilized by then.
The two sat down in the lounge with a huge sigh. Jill was grateful for a can of ginger ale. The soda, combined with some saltine crackers, settled her stomach. Marie likewise had a drink and cookies.
“Wow, this is a wild start to our vacation. I feel exhilarated and exhausted and jet-lagged. Jill, what do you know about the Belgian health system?”
“I know it's good. Probably better than the U.S. in some regards. I worked with a pathologist educated in Brussels about ten years ago. He seemed to have an education equal to that provided in an American medical school. Other than the language barrier, since Dutch is the predominant language, I would feel pretty comfortable getting my care here.”
Several minutes later, a man in surg
ical scrubs with the word ‘dokter’ in front of a name tag stepped into the lounge.
“Hello, I'm Dr. Janssens. I am the lead physician caring for Laura Peeters. I understand you cared for Laura until she arrived at our emergency room.”
“Hello, I'm Dr. Jill Quint. I am an American physician on vacation. I happened to be seated next to Laura in the restaurant.”
"Hi, I'm Marie Simon. I have no medical background but I know CPR so I shared the chest compression duty with Jill.”
“Welcome to Belgium. Thank you for saving one of our citizens. Laura was fortunate to be seated next to you in the restaurant. Dr. Quint, what is your medical area of focus?”
“I am a forensic pathologist. I have examined a few bodies for anaphylactic shock. From an autopsy point of view, I'm very aware of the symptoms. If Laura had not told me before she lost consciousness that she had a nut allergy, I don't think I would've recognized her condition. Less than 10 percent of patients display her symptoms while in anaphylactic shock.”
“I am impressed with your knowledge, especially now that I know you don't routinely care for those of us among the living.”
“I worked for the State of California crime lab for ten years. For the past five years, I have operated a vineyard, but I also provide consulting services that offer second opinions on the cause of death. A couple of months ago, I had a different opportunity to perform CPR on a FBI agent and she survived my treatment. I am getting really good at keeping people away from their local medical examiner!”
“Ah Dr. Quint, now I recognize your name. We actually discussed how you determined that a patient with necrotizing fasciitis was a homicide in our grand rounds a month ago. As I recall an article published by Dr. Meyer from the San Francisco Medical Examiner’s office described the case. It was a very well-attended lecture. Will you be in our city for a few days? I would love to have you come and present at a medical staff meeting.”
“I’ll be in Antwerp for three nights with my friends before we move on to Amsterdam, and then finally to Brussels. If you like, I could arrange my sightseeing to give you an hour one day. If you have a business card, I’ll leave you my contact information,” Jill offered.