by Peche, Alec
“Normally I would have slides to present a lecture, but I don't have time to put together a slide deck, and I don’t have the data from my lab with me in Belgium. So if I could limit the lecture to say, ten minutes, and spend the rest of the time in questions and answers, that would be the best I could do. Would that style of lecture offend any of the physicians?”
“Dr. Quint, this was a fascinating case and I'm sure that you have other cases in your career that are just as captivating. Your lecture would be a welcome break to our routine. I'm going to reserve our largest lecture space as I am sure that even with just two or three days’ advance notice, the lecture hall will be filled to capacity. I will also invite our own medical examiner. Thank you for agreeing to interrupt your vacation to provide a guest lecture.”
“You're welcome, Dr. Janssens. We just arrived at noon today in Antwerp. Now that the adrenaline rush from saving Laura is gone, we both want nothing more than to return to our hotel, grab a quick dinner and fall asleep. Can you tell us on how to get a taxi to take us to our hotel?”
“Dr. Quint and Ms. Simon, after all the work you've done today, it would be rude to direct you to a taxi stand to get a ride back to your hotel. Give me a few minutes and I will find a ride for you.”
Dr. Janssens left the room. Jill and Marie were left alone.
“Wow! I did not know I was traveling with a famous pathologist. I thought you were just an obscure winemaker!”
“I had no idea that Dr. Meyer’s case synopsis of death by necrotizing fasciitis had reached international fame. I hate to interfere with our sightseeing, but I feel I have a duty to educate whenever possible.”
“I'm just glad he's arranging for a ride since neither of us remembered our purses when we left in the ambulance. It would be embarrassing to pull up in front of our fancy hotel and then make the taxi driver wait while we ran in to get some cash. Angela and Jo might not be back from dinner, and then what would we do, without our purses?”
“Good point. I was so caught up in thinking about how to design a lecture, that I forgot we didn't have our purses.”
Dr. Janssens returned.
“We have a medical transport car that will take you to your hotel. It is waiting now outside our entrance. Let me take you there.”
They exited the employee lounge. A staff member hurriedly walked up to Dr. Janssens.
“Je bent meteen in de kamer met Laura Peeters nodig.”
Jill and Marie did not speak Dutch, but with the mention of Laura's name and the urgency in the staff person’s voice, they suspected that there was a problem with Laura.
“We will find our way to the exit. You go take care of your patient.”
Dr. Janssens uttered a “thank-you” as he hurried off to Laura's bedside.
Chapter 2
Jill and Marie left the emergency area and spotted a medical transportation car. They walked toward the vehicle and a driver got out.
“Hi. Were you asked to give two people a ride to their hotel?” Jill asked.
“Yes, Madame. Dr. Janssens made a special request for us to transport two people who saved a woman's life tonight. What hotel are you staying at and do you know the address?”
“We just arrived from the United States today. We are staying at the DeWitt Hotel. We don't have an address for the hotel. Have you heard of it? Do you know where it's located?”
“Ah yes. I am familiar with the DeWitt Hotel. Please, have a seat in the car and I will take you there. It is a short drive.”
“Thank you. I’m Jill, and this is Marie. What's your name?”
“I am pleased to meet you. My name is Thomas.”
They got in the back seat as the passenger front seat had a big box on it. The two women spent a very pleasant ten minutes chatting with Thomas about his country. After the car stopped in front of the hotel, they got out of the car and leaned into the driver’s window.
“Thank you very much for the ride, Thomas, and the tips on what to see and where to eat in Antwerp. Have a pleasant night.”
“Goodbye, ladies.”
Jill and Marie entered the hotel and approached registration for a key. The hotel did not recognize them as guests and they had no identification on them. After explaining their unusual story to registration, a staff member checked the room that Angela and Jo were staying in to see if they were available to verify their identity. Fortunately, the women were in the room and volunteered to come down to the lobby and meet them. A minute later the foursome was re-united in the lobby.
“Did the woman make it to the hospital alive?” asked Angela.
“She did make it although there was some emergency with her as we were leaving the hospital,” Jill responded. “So she's not out of the woods yet.”
“I bet you guys are hungry,” suggested Jo. “When we returned to the hotel we asked what the food options were in this neighborhood. If you want to grab a jacket and your purse from upstairs, we can head over to the pub next door.”
The four friends headed upstairs to do just that. A few minutes later they were seated in a pub. Angela and Jo had finished their dinner at the restaurant, so they settled for beer.
Marie was adventurous with food so she tried the mussels. Jill’s stomach was still fragile, so she wanted something salty. She convinced the waitress to melt some cheese on top of pommes frites. Cheesy french fries were just the sort of bland, salty food that she needed to settle her stomach. She ordered a ginger ale to quench her thirst.
“How was your meal? I was really looking forward to trying the Flemish stew. I'm grateful I only had a few bites before we got in the back of the ambulance. You know how easily I get carsick under the best of circumstances. By the time we arrived at the hospital, I had grabbed a plastic bag and was ready to puke.”
“It took the restaurant a few minutes to settle down once you left in the ambulance,” said Jo. “After everything returned to normal, the owner came over to our table for a quick chat. He had never had an emergency in his restaurant before and wanted to assure us there was nothing wrong with the food.”
Angela added, “I overheard Laura say she had a nut allergy. So I explained to him from my layman's view what allergies were. Once I mention a nut allergy he understood and was reassured there was nothing wrong with his food, unless he had told her that there were no nuts in a dish but in fact the cook put nuts in. He said he had not brought her any food as she was waiting to meet someone for dinner, so I assured him he was in the clear.”
“He was so pleased that we had handled the situation with Laura that he gave us our meal for free and invited you back on another night. He said he uses his grandmother's recipe for Flemish stew and you'll want to taste it at his restaurant. The food was good and I wouldn't mind going back if we have time.”
“I was so glad you guys went back to the hotel. Marie and I are running around in a foreign country with no cash, no identification, and no room key. The hospital arranged a ride back to the hotel for us. Our options were really limited without our purses,” Jill said.
Marie smiled. “So until tonight, I had no idea how famous Jill is in the world of academic medicine. When she introduced herself to the physician in the emergency room, he invited her to deliver a lecture on the Graeme St. Louis case before she leaves Antwerp. Apparently they had discussed the case in Grand Rounds. Can you believe that? Over five-thousand miles away and they’ve heard of Jill!”
“Really,” said Jo, “that’s cool. I knew the case was dangerous and full of intrigue, but I'm surprised that they're discussing it in Belgium. Did you publish an article?”
“The San Francisco medical examiner published an article,” Jill responded. “He devoted a paragraph to my work and the context of the case. I explained to Dr. Janssens that I didn't have my data or a slide deck with me on vacation, so I asked if I could do like a ten-minute lecture off the cuff and leave the remaining minutes for Q and A. He said that was fine.”
“How about if all of us attend the lecture,”
suggested Jill. “I would like to introduce you and give you credit for helping me break the case and keep me alive. Some of the questions may be in your areas of expertise and it would be best to hear the answers from you. It will mean giving up about two to three hours of our vacation, but it might be fun and we might meet new friends or someone to hang out with in the pubs.”
“I'm in!” said Angela.
“I can't imagine they would have any questions on the financial trail of evidence, but it will be a unique vacation experience so count me in,” said Jo.
“Well, I guess if everyone else is attending, I'll go too,” said Marie.
Lifting their drinks, they toasted.
“All for one and one for all!”
They finished their meal and returned to the hotel. Jill could barely keep her eyes open. As they passed through the lobby, one of the hotel staff approached them with a note in her hand.
“Dr. Jill Quint?”
“Yes, that is me.”
“I have a note for you from Dr. Janssens.”
She handed the note to Jill, who proceeded to open and read it.
“Wow, he works fast. The lecture has been scheduled at noon two days from now. He will send a taxi to fetch us to the lecture hall,” said Jill.
“I'm going to send a message to him letting him know that he's getting the whole team for free and to warn the audience that we will be casually dressed tourists.”
They headed up to their rooms and quickly dropped off into sleep.
Chapter 3
The friends met at breakfast to plan their stay in Antwerp. Each of them took a turn picking a favorite must-see site.
“I think we should visit the Royal Art Museum and the Rubens House.”
“We also want to take a day trip on the train to Bruges.”
“I want to see the diamond district.”
“I want to visit lots of chocolate shops.”
“Okay how about if we take the train to Bruges today, do the diamond district tomorrow morning, do the lecture thing in the middle of the day, then visit Rubens House and St. Bartholomew’s Church. The following day we can do more museums and churches. Shop and eat chocolate wherever we go.”
Marie was the organizer. She was always quick to come up with a great itinerary.
They finished breakfast and returned to their rooms. Jill used the hotel business center to get a note to Dr. Janssens confirming the team’s appearance for the lecture the next day. They collected their coats, purses, cameras, and umbrellas and set off for the train station.
The ninety-minute train ride was beautiful. The fall colors were out in full force. It was interesting to observe the architecture of homes as they whizzed by. Bicyclists were everywhere, dressed in clothes signifying that they were riding to work. Very few were decked out as though they were racing in the Tour de France.
The gentle rocking of the train lulled Jill and Jo to sleep. Angela was keeping an eye open to make sure they didn't miss their stop.
“Hey, ladies, wake up, our stop is coming up.”
They gathered up their belongings and exited the train, then took a taxi to the clock tower. They spent the day touring the canals, two churches, a brewery, and some amazing chocolate stores.
The group caught the late train back to Antwerp. Tired from the time difference and a very busy day, again they all fell asleep on the train, depending on Angela to wake them for the Antwerp station.
“Taxi or walk back to the hotel?” asked Marie.
“Let's walk,” replied Angela. “Nighttime always gives you a different perspective on the city. It certainly gives me different pictures to take of our travels.”
They walked back toward their hotel, pausing for Angela to take pictures. Photography was her profession and she did a fabulous job on their vacations documenting their travels.
When they arrived back at the hotel again, it was nearly ten at night Belgian time, which meant it was much earlier in the United States. They were exhausted from their day, but not ready to go to bed because their bodies had not yet adjusted to European time. A staff member approached them.
“Dr. Quint I have a message for you.”
It was the same staff member from the previous night. Jill opened the message and read it.
“This is strange. A Dr. DeGroot would like to speak with me. He was referred to me by Dr. Janssens, the note states. It is signed ‘Chief medical examiner, St. Elizabeth's Hospital’. Hmmm, I wonder why he wants to talk to me? It’s kind of late, so I'll call him in the morning.”
“"You're becoming famous and in demand,” said Jo with a smile. “Are you still going to take vacations with your friends? Maybe the paparazzi will keep us separated in the future.”
“I did not know that I was famous in Belgium,” said Jill with a smirk. “Certainly the paparazzi don’t trail me around in the United States.”
They all headed for the suite. No one was quite ready to go to sleep yet, so they had a bottle of wine and chitchatted for another hour before Jill started nodding off. One by one they left the living room of the suite to retire to their bedroom.
Shortly after breakfast, Jill took a moment and dialed the number for Dr. DeGroot.
“This is Dr. Quint. I am looking for a Dr. DeGroot.”
“This is Dr. DeGroot. Thank you for calling me back. Dr. Janssens told me you were on vacation in Antwerp. I am aware of your work in the United States. Unfortunately, Laura Peeters expired the day before yesterday in the hospital after you left. I am responsible for her autopsy and I have some questions.”
“She died the day before yesterday? She was alive when we left. That’s unfortunate. Allergic reactions rarely cause death when the person gets to the hospital in time. Her allergy had unusual symptoms. If she had not told me she had a nut allergy, I'm not sure I would've recognized anaphylactic shock. As you know, she really had no rash, no swollen lips, no swollen eyes, but instead had low blood pressure. Less than 10 percent of allergic reactions exhibit Laura’s symptoms. What have you determined to be her cause of death?”
“Officially, Laura Peeters expired from empty vena cava/empty ventricle syndrome. She assumed an upright position, and all of the blood left her heart.”
“I’m surprised the staff sat her up. It is well known that victims of anaphylactic shock should be kept flat on their back with their feet raised. What happened?”
“Someone had her sit up. None of the staff admits to it and she was doing well and even had a second injection of epinephrine about five minutes before she flat lined. No one was in the room to see her sit up and the staff was notified when the alarms went off on her heart monitor. She was found slumped sideways on the gurney, feet hanging over the edge.”
“Did anyone instruct her to stay flat on her back?”
“Yes it is written in the chart that she was instructed to stay flat on her back, and Laura acknowledged that she understood the reason for the requirement.”
“As I recall from my brief exposure to the staff at St. Elizabeth's, they carried a communication device that might have GPS. Was that looked at? Who was at her bedside according to the GPS system when she flat lined?”
“Dr. Quint, let me explain how deaths are investigated in Belgium. There are no private autopsies. Less than 2 percent of deaths undergo an autopsy and we’re wrong about the cause of death on 10 percent of cases. The perfect murder really does exist here.
“We don't have coroners or medical examiners that routinely look at “killing cases” as we call them in Belgium. The vast majority of my time is spent looking at expected deaths in our hospitals. I don’t look at deaths that occur outside the hospital walls. If it weren’t for criminals injured while committing a crime, brought here by police and dying, I would never have the opportunity to look at a death and debate if it is a killing. It either is or it isn't, and I know that at the start of my examination.
“This is around-about way of saying I would appreciate if you would consult on this case, as it
would be an exceptional learning opportunity for the police and I.”
Jill was very conflicted. This was supposed to be a best-friends-forever vacation. If she took herself out of the tourist activities, it would weigh on the other three. If she involved them in the case, then it wouldn't be a vacation.
She also had a passion for helping her fellow pathologists. Getting the cause of death correct was important to the deceased, their family, the police, and the justice system. Naïvely she wondered if her involvement in a case in Antwerp might start a revolution to improve forensic pathology in Belgium.
Maybe she could do a little of both – be a tourist and be a forensic pathologist.
“Dr. DeGroot as you know, I am here on vacation. With me is the team that helped crack the Graeme St. Louis case of necrotizing fasciitis. They are not medical people. Their area of expertise is interrogation, background investigation, and financial sleuthing. Let me talk with them to see if we can both tour Belgium and assist you with this case. At the very least I will give you some suggestions of things to look for during the autopsy and tests to perform on Laura's body.
“I will prepare a list of those suggestions and deliver it while at my lecture at the university. Dr. Janssens graciously and quickly set up a teaching opportunity today at noon on your campus. If you are not planning to attend that lecture, I will find some way to get my notes to you.”
“Dr. Quint, that is very gracious of you. I appreciate any assistance you and your team can deliver. I did hear of your lecture and was planning to attend, so we will meet face-to-face and I will get your suggestions at that time. Thank you for taking the time, Dr. Quint, to speak with me this morning.”
Jill’s friends were waiting for her after she completed the call. On the way to the diamond district, she told them about Dr. DeGroot's request.
They all felt bad about Laura's death. One moment she was a random stranger sitting next to them in a restaurant, and in the next moment, they had tried to save her life. She had looked to be younger than the four of them.