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  “Describe your vacation last week for me.”

  “Graeme had a client who had requested his presence in Puerto Rico 3 weeks ago. Graeme figured that he could meet the client’s needs and give ourselves a brief break from the wedding madness. It was to be a four-day extended weekend trip. He would meet with his client, I could explore San Juan, and then we would have time to scuba dive, golf, and simply relax at the resort close to Old San Juan.

  “We arrived in the early afternoon on Friday, and after checking into the hotel, Graeme went off to meet with his client and I headed for the interior décor stores of Old San Juan. We met up again in the hotel suite to change clothes and leave for dinner. Graeme was somewhat distracted over dinner, as he was occasionally after meeting with a client. We retired to our room where we both did some work, answered e-mails, and simply relaxed.

  “Saturday morning, Graeme met again with the client, while I visited the local museum. We met for lunch, and were excited to experience the scuba diving trip that the hotel concierge arranged for that afternoon. When Graeme booked the trip, he asked the resort to have the concierge arrange a scuba trip to his specifications. Apparently, that is something that the resort frequently does for guests. We had not been to Puerto Rico, it was a short trip, and Graeme thought it more expedient to allow the hotel to arrange activities for us.

  “We arrived at a Fajardo scuba shop to board the boat that would take us out to the Sandslide reef. Graeme had done some quick research before we left and knew that this was where he wanted to go scuba diving. We tried to scuba dive whenever we visited a part of the world that offered a body of water to explore. We had scuba dived together at least 20 different dive sites. We kept a bag packed with our scuba gear, wetsuits, masks, fins, regulators, underwater cameras, and other items. It also contained a second copy of a current dive certification for both of us”.

  Emma paused a moment to take another drink of her tea. The pause gave Jill some time to catch up on her notes.

  “We took the boat out to the reef and put on our wetsuits. We went through our usual pre-dive check list, and then something peculiar happened. The tanks are always supplied by the dive shop. Obviously you can’t fly tanks on an airplane. Graeme’s tank was unusually light. The regulator read that the tank was full, but given that it was so light, we asked for a different tank. We got a little argument from the guys operating the boat, but in the end Graeme was unwilling to use that tank, so another one was supplied. We continued with our pre-dive procedure without any further incident.

  “We got in the water, and the dive master indicated that he would join us in 10 minutes to show us where Sandslide was located. He gave us general directions about which way to swim.”

  “Emma, I have only been snorkeling. I have never been scuba diving. Was it unusual for the dive master not to immediately be in the water with you?”

  “Yes and no. Graeme and I were very experienced divers. We could have been certified as dive masters, but we never had an interest in completing the coursework. As we always seemed pushed for time, often the dive master was helpful in getting us to a particular reef so we could spend the most time exploring the reef, rather than sometimes losing time finding the way to the reef. This is most important at deeper dives. We also like the safety of having a dive master in case of an equipment problem or sharks. Sandslide is 15 to 75 feet deep. Recreational divers can go up to 130 feet, and beginners can go to 60 feet, so we were well within our limit. This was not a deep dive, so we were not concerned or surprised with the dive master’s delay.

  “Graeme and I swam in the direction the dive master had pointed. We were happy to be in the water heading for a reef. We could see the edge of the coral and briefly waited for the dive master to catch up to us. Once he joined us, we began our descent while he directed us around the reef. We shot some pictures and made slow progress around the reef. The fish were vivid blues, greens, and yellows. We videoed a school of tiny seahorses and a turtle swam with us for a few minutes.

  “The dive master led us in the beginning, and then he directed us and followed behind. We had been diving for 30 minutes and were wrapping it up and traveling back the way we had came. I led, Graeme followed, and the dive master brought up the rear. As we neared the end of the reef, we had one last constricted coral fissure to go through. As we did, the dive master banged Graeme’s lower leg pretty hard against the coral, tearing his suit and causing a small gash on his leg”.

  Jill felt like she was under water with Emma and Graeme, Emma’s description of the dive, coral, and fish was so detailed and vivid.

  Emma continued with her story. “The dive master apologized profusely and motioned us to continue to the surface. We surfaced and returned to the boat. Graeme gingerly removed his wetsuit, and we examined the gash. It was not deep enough to require stitches and looked like it would soon heal. The dive master provided his first aid kit, and Graeme put ointment and a Band-Aid on the cut. Despite the accident, we were in good spirits, as we had enjoyed the dive and had taken some great pictures.

  “We returned to shore and then to our hotel. We cleaned up, had dinner, sat on our balcony sipping wine, and retired to bed at an early hour.

  “At about 4:00 the next morning, Graeme awakened me. He was hot, not feeling his usual self, and the leg was slightly swollen, red streaks already running up from the gash. He was able to change our flight to a 7:00 a.m. departure that morning rather than returning the next day. We packed and made it to the airport for the flight. Graeme was walking fine, but he was tired. During the flight, the leg swelled some more, and the red streaks moved up to his knee. We decided that we would go straight to University Hospital from the airport.”

  Emma paused again and took a few sips of her iced tea.

  After the brief break, Emma continued with her story. “Upon our arrival at the emergency room at University Hospital, we explained the injury and the symptoms since returning to shore to the doctor. The nurse took Graeme’s pulse, respirations, and blood pressure, as well as some blood. His blood pressure was low and his temperature elevated. The nurse took a swab of the wound. The physician started him on antibiotics within 30 minutes and made arrangements to admit him to the ICU. Both Graeme and I were alarmed until a team of physicians gave us an explanation. It seemed that Graeme’s wound was in the early stages of necrotizing fasciitis. We didn’t immediately understand what this was, so the team provided us with answers. It was scary that so bad an illness could be connected to a wound that didn’t even require stitches.

  Graeme’s prognosis was good as we had gotten to the hospital quickly, and powerful antibiotics were being pumped into him to counteract the infection. A surgeon numbed Graeme’s leg and removed the dead skin around the wound and cleaned it out with an antiseptic solution. This all happened very fast and caused Graeme’s lawyer mind to think of his own mortality.”

  Emma sighed. “Naturally, we had planned to re-do our Wills and other legal documents after we got married, but after the conversation and paperwork that Graeme had to sign so that the hospital staff could tell me about his condition, he arranged a lawyer associate of his to come to the hospital and draft a new Will and a healthcare power of attorney. I had no idea what was in either document. I hadn’t wanted to intrude on the conversation, and to be frank, I thought that Graeme was overreacting, despite the seriousness of his condition. Graeme spent about an hour with his associate, who then left to draw up documents on his computer. He returned several hours later with a notary and a video camera, wanting to make sure that the documents couldn’t be contested. That was completed, and everyone left. By then Graeme was exhausted. The day and the infection had really taken a toll on him. I left to go home, planning to return in the morning.

  “The next morning I returned to the hospital. Graeme and his leg appeared much better, and there was talk of transferring him to a regular bed later that morning. The wound cultures had come back from the laboratory, and the antibiotics that he was on appear
ed to be fighting the infection. The red streaks were disappearing, the leg swelling had gone down, and his temperature and blood pressure were normal. This was good news. In fact, the doctors planned to discharge him to home care the next day if he continued to improve. The physicians felt that they had started antibiotics early enough, and Graeme was young and healthy, which pointed to a good prognosis.

  “Graeme’s friends and family stopped by the hospital to visit him after he was transferred to a regular bed. Again that night, I returned home, planning on going to the hospital the next day to take Graeme home. However, at around 6:00 in the morning, I received a call from someone at the hospital who said that Graeme was being transferred to the ICU, as his blood pressure was unstable and he had a fever.”

  Emma paused again, got up, and paced the library. Jill could see how this situation, which had happened so fast, had been a real roller coaster ride for Emma. After more pacing, while Jill quietly reviewed her notes, making additions where necessary, Emma sat back down.

  Emma said, “I drove fast to the hospital and was shocked by the decline in Graeme’s condition. He was in and out of consciousness and seemed to not always recognize me. The leg was puffed up some, and the red streaks were back.

  “The surgeon wanted to take him to the operating room and amputate his leg below the knee. While the surface wound looked worse compared to the previous day, I did not see the rationale for removing the lower leg. The surgeon explained that the leg infection was releasing powerful toxins into Graeme’s blood and that his prognosis was poor. The only way to halt the disease at that point was to remove the original source of the bacteria.”

  “I desperately wanted Graeme’s input and asked the surgeon to give me an hour to either get a decision from Graeme or make it myself. He gave me 30 minutes. Graeme’s parents were in the air flying back from a vacation in Russia. I couldn’t reach them in time to make the decision. I leaned over the bed and explained the situation to Graeme, looking for some hint of what he would want.”

  “All I got from him was mumblings that someone was trying to kill him. First, a shove down the stairs at his office building, then a gentleman who pulled a knife on him the day before we left for Puerto Rico, the regulator on the tank, the gash from the coral, and finally, he murmured that someone was in his hospital room in the middle of the night with a vial of something in their hand. It took him several attempts to tell me all of this, and at the time I thought it was the fever talking.

  “In the end, I let the surgeon take him to the operating room to remove his lower leg. By mid day he was back in his room. He was weaker and more confused for the rest of the afternoon, and then he seemed to lapse into unconsciousness and never recovered. His heart stopped working by early morning yesterday, and despite the best efforts of the doctors at University Hospital he was gone”. Emma broke into soft sobs.

  Jill looked around her for help. Emma needed support from someone other than a consultant. She had seen many a grieving family in her role as the medical examiner, and she had always felt awkward trying to comfort the strangers that passed through the Coroner’s office. In her role as someone who gave a second opinion in the cause of death, she still had grieving relatives to deal with, and since they employed her, she felt honor bound to provide comfort, but really all she felt was hugely uncomfortable at a time like this.

  Death was so clinical to her. She never got attached to the dead, rather she did what she could by bringing them justice. She made sure that in the rare case of a covered up murder, she found justice for the victim and their family. What happened to the killer was beyond her control, and she did her best to stay away from the courts. Sometimes she was dragged into court by defense attorneys, but she did her best to give her findings to the local medical examiner so the case could be closed from a death certificate perspective. This tactic allowed her to smooth any affront felt by the ME and to avoid testifying in court about 80 percent of the time.

  Jill waited for Emma to regain her composure. She had a few more questions about Graeme’s deathbed mumblings, and she had forms for her to sign. She would then drive to the mortuary to evaluate Graeme. Jill asked Emma to repeat what Graeme had said before he was taken to surgery. She re-told the story twice, and Jill thought she had enough new information to perform some additional tests on Graeme. Emma signed the release of information paperwork for the hospital, the medical examiner, and the mortician, as well as Jill’s consultant contract.

  She informed Emma that she usually spoke with clients at least daily until she was able to reach a conclusion. Most cases took 2 to 3 weeks depending upon the complexity of the analysis.

  Some specialized DNA tests were beyond the capability of her lab, and outside labs could take a week to get results back to her. Occasionally, those results directed her to further testing. Frequently it took time for the hospital and medical examiner to provide copies of their records to her. She would need to take many blood, skin, and tissue samples. She would photograph a variety of body shots at various magnifications. Finally, she had micro goggles to examine the deceased.

  She would check with the hospital to see if the lower leg that had been removed in surgery was still available for her to examine. Typically, something like that would be sent to the hospital’s pathologist for examination. This was routine in order to confirm that the surgeon had made the right decision in recommending amputation.

  After the pathologist’s examination, the tissue was often sent to medical waste. Depending on the disposal schedule and the pathologist’s workload, the hospital might still have the leg, or it might have been sent along with the body to the ME.

  Chapter 3

  Jill called the mortician to see if he had the leg. He indicated that the leg had not come with the body. He had contacted the ME, but neither had he received the leg. She could only hope that the hospital still had it.

  As she pulled up to University Hospital, she paused to make a list of every possible part of the medical record that she would need a copy of to review. She wanted to collect all the information as if she had been at Graeme’s bedside during his entire hospital stay. She would likely have to wait a few days to get the requested information, as it would probably take the information clerk a while to find everything on her list. She would leave 3 pre-paid overnight delivery envelopes so that the hospital could mail the records to her in bundles.

  The leg was going to be difficult to locate. Jill knew that it would do no good to ask the record clerk, so she headed to the Pathology Department. She had to determine if someone still had the leg. If they did, she thought she might be able to get them to release the leg to the mortician. As it was getting later in the day, she wasn’t sure that it would get moved today. She might have to make another trip back tomorrow to separately examine the leg.

  Jill fortunately had an old medical school classmate in the University Hospital Pathology department. She prevailed upon her classmate to locate the leg. It took a few minutes, but she found it within the department. She would press the funeral home to make arrangements to transport the leg and reunite it with the body. If the funeral home fetched it today, she would just stay late in the city and re-schedule her date with Nathan.

  The San Francisco medical examiner’s office was within walking distance of the hospital, so Jill set out at a brisk pace to deliver her request that all findings related to the autopsy be provided to her. She needed more than the death certificate. She wanted the weight of every organ and all of the findings that the ME had regarding Graeme’s cause of death.

  Her visit to the ME’s office complete, Jill drove to the funeral home. In her role as consultant, she visited too many funeral homes. She was often perceived by morticians as delaying a funeral. They could not embalm, dress, and otherwise do the hair and make-up of the deceased until after she completed her review. She hoped that this mortician was busy enough not to hover over her while she did her examination, collected specimens, and took pictures. If nothing else,
she would put pressure on the mortuary to transport the leg. That would avoid having her in the way for 2 days in a row.

  Luck was with her. The mortician was busy elsewhere, and he would transport the leg today. That meant that she could wrap up her tasks in San Francisco today.

  She called Nathan. “Hey, I’ll be occupied in San Francisco longer than I thought. Let’s re-schedule our pizza date for tomorrow.”

  “Okay, babe. If you feel like it, drop by my house for a glass of wine on your way home.”

  They said their good-byes. Jill returned to thinking about the case and Graeme’s final comment to Emma, someone is trying to kill me. If her second opinion on the cause of the death matched that of the ME, then this would be a straightforward case.

  If Jill found anything suspicious, she might need to enlist the aid of her 3 closest friends, Jo, Marie, and Angela. Jo was a CPA and a fabulous forensic accountant. She could always make sense of any individual’s or company’s financial activities. Jo wasn’t certified as a forensic accountant, but she was hugely curious about cash flows. From Jill’s non-accountant view, Jo was almost psychic about knowing where to look for illegitimate financial transactions. Money was so often the reason for a covered-up homicide that it was frequently where she started her investigation if she had to move beyond a simple cause of death opinion for the family.

  Marie performed candidate reference checks for a multinational company. She had many tools at her disposal to investigate an individual, both in the United States and throughout the rest of the world. It was all public data if you knew where to look. She was as good as a private eye and generally had a complete picture about anyone in less than 2 hours of computer work. She had spent 20 years in human resources. She had performed hundreds of searches of employee candidates while working for a manufacturing company. She was fabulous at investigating candidate backgrounds. Jill rarely used her services, as usually the killer was obvious.