Death of Gloria Ramirez

Gloria Ramirez (died Feburary 14, 1994) was a 31 year old woman from Riverside, California, who was dubbed by the media and internet as "the toxic lady" after exposure to her body and blood sickened several hospital workers.

The Emergency Room visit

About 8:15 in the evening on february 19, 1994, Gloria Ramirez was brought into the emergency room by paramedics, suffering from the effects of advanced cervical cancer. She was extremely confused, and suffering from bradycardia and Cheyne-Stokes respiration. The medical staff injected her with Valium, Versed, and Ativan to sedate her, and agents such as lidocaine stimulate her heartbeat. When it became clear that Ramirez was responding poorly to treatment, the staff tried to defibrillate her heart with electricity; at that point several people saw an oily sheen covering Ramirez’s body, and some noticed a fruity, garlicky odor that they thought was coming from her mouth. An RN named Susan Kane attempted to draw blood from Ramirez's arm, and noticed an ammonia like smell coming from the vacutainer.

She passed the syringe to Julie Gorchynski, a medical resident who noticed manila-colored particles floating in the blood. At this point, Susan Kane fainted and was removed from the room. Shortly thereafter, Dr. Gorchynski began to feel nauseated . Complaining that she was light-headed, she left the trauma room and sat at a nurse’s desk. A staff member asked Gorchynski if she was okay, but before she could respond she also fainted. Maureen Welch, a respiratory therapist who was assisting in the trauma room was the third to pass out. The staff was then ordered to evacuate all emergency room patients to the parking lot outside the hospital. A skeleton crew stayed behind to stabalize Ramirez. At 8:50, after forty five minutes of cpr and defribillation, Gloria Rameriez was proncounced dead from kidney failure related to her cancer.

Mass Hysteria

The county health department called in California's Department of Health and Human Services, which put two of its top scientists on the case, Doctors Ana Maria Osorio and Kirsten Waller. They interviewed 34 hospital staff who had been working in the emergency room on February 19. Using a standardized questionnaire, Osorio and Waller found that the people who had developed severe symptoms such as loss of consciousness, shortness of breath, and muscle spasms tended to have certain things in common. People who had worked within two feet of Ramirez and had handled her intravenous lines had been at high risk. But other factors that correlated with severe symptoms didn't seem to match a scenario in which fumes had been released: the survey found that those afflicted tended to be women rather than men, and they all had normal blood tests after the exposure.

Those findings led to an official report that the health department released on September 2. The conclusion: The hospital staff most likely experienced an outbreak of mass mass hysteria. Osorio and Waller cited the lack of evidence for a poison and the fact that women were more likely to suffer severe symptoms, both hallmark signs of mass hysteria. In addition, they pointed out, neither paramedic who had treated Ramirez in the ambulance became ill--despite the close quarters and their having touched her skin and some of her blood after starting an intravenous line.

DMSO

Dr. Gorchynski denied that she had been affected by mass hysteria, and pointd to her own medical history as evidence. After the exposure, she spent two weeks in the intensive care unit with breathing problems, she developed hepatitis and avascular necrosisin her knees. Eager to clear her name and win her lawsuit against General Hospital in Riverside, she and RN Susan Welch contacted Livermore Laboratories for a second opinion.

Livmore Labs discovered a high spike in Gloria's blood gases that indicated DMSO a preservative and popular folk remedy for muscle aches. This spike, combined with the garlic smell on her breath and the oily sheen to her skin, convinced the lab that Ramirez had been using DMSO to relieve her pain. DMSO is relatively harmless, but with one oxygen atom added, it becomes dimethyl sulfone, But now add two oxygen atoms to dimethyl sulfone it becomes dimethyl sulfate. Vapors of dimethyl sulfate kill cells in exposed tissues, such as the eyes, mouth, and lungs. When absorbed into the body, dimethyl sulfate causes convulsions, delirium, paralysis, coma, and delayed damage to the kidneys, liver, and heart. When Ramirez collapsed and was put in an ambulance, the paramedics put an oxygen mask on her face. Oxygen molecules flooded her bloodstreain, combining with the DMSO in her system, the researchers hypothesized, to form high levels of dimethyl sulfone. The higher the concentrations of the ingredients required, the more efficiently chemical reactions will run, with so much oxygen, no DMSO was left untransformed.

Now the Livermore team needed to figure out the next step: how the relatively harmless dimethyl sulfone could have been converted to the extraordinarily harmful dimethyl sulfate. They conducted an experiment to see how much dimethyl sulfone could accumulate in the blood at normal body temperature. They dissolved the compound in a transparent liquid called Ringer's solution and found they could load the solution with a significant amount of DMSO without the solution sweating, or separating. When they cooled a vial of this Ringer's solution crammed with dimethyl sulfone to room temperature (about 70 degrees), the solution became supersaturated, and dimethyl sulfone began to form white crystals. In real blood those crystals might have appeared manila-colored. Thus this process could have produced the crystals that had been observed in the syringe in the hospital, particularly since emergency rooms tend to be cooler than most rooms--about 66 degrees. In her warm blood, the dimethyl sulfate was unstable and quickly fell apart into its hydrocarbon and sulfate components. There was not yet a sufficient amount of nerve gas to harm the paramedics.

When Susan Kane drew blood at the hospital, however, the cool temperature had slowed the breakdown of the dimethyl sulfate. Appreciable amounts of it built up in the syringe, and some of it vaporized out of the blood. This was the gas that poisoned the emergency room staff. Dimethyl sulfate doesn't vaporize easily--the Merck Index lists its boiling point as 370 degrees. Nevertheless, according to Grant and other chemists, some fraction will still vaporize at room temperature. The crystals of dimethyl sulfone turned into dimethyl sulfate as well and vanished from sight. In the end, all of the dimethyl sulfate either vaporized or broke back down in the blood into its constituents.

Methamphetamine

The Los Angeles weekly New Times has come up with a possible alternative explanation for the toxic lady episode: the hospital where the incident occurred may been the site of a secret lab used to illegally manufacture the drug methamphetamine. In stories appearing in the May 15-21 and September 11-17, 1997 issues, staff writer Susan Goldsmith reports that "meth chemicals" may have been smuggled out of the hospital in IV bags, one of which was inadvertently hooked up to the dying Ramirez. This triggered the round of nausea, headache, and other symptoms that put six ER workers in the hospital. This theory is largely discredited by the blood tests performed on Ramirez's body, which showed no sign of methamphetamines or illegal drugs.

Final conclusion and burial

Two months after Ramirez died, her badly decomposed body was released for an independant autopsy and burial. The Riverside Coroner's Office hailed Livermore's DMSO conclusion as the probable cause of the hospital workers' symptoms, while her family disagreed. The Ramirez family's pathologist was unable to determine a cause of death because her heart was missing, her other organs were cross-contaminated with fecal matter, and her body was too badly decomposed. Ten weeks after she died, Ramirez was buried in an unmarked grave at Olivewood Cemetery. Her family held a yard sale to pay for the funeral.