Gloria Ramirez
Encyclopedia
Gloria Ramirez was a Riverside, California
, woman dubbed "the toxic lady" by the media when several Riverside General Hospital
workers became ill after exposure to her body and blood. Her case was the basis for a scene in one episode
of the American TV series The X-Files
, an episode of the American TV drama Grey's Anatomy
, a segment of a show on Discovery Communications
' channel Investigation Discovery called "The New Detectives
" , and the "Stink Bomb" segment of the animated film Memories
.
s, 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
to stimulate her heartbeat. When it became clear that Ramirez was responding poorly to treatment, the staff tried to defibrillate her heart; at that point several people saw an oily sheen covering Ramirez’s body, and some noticed a fruity, garlic-like odor that they thought was coming from her mouth. A registered nurse
named Susan Kane attempted to draw blood from Ramirez's arm, and noticed an ammonia
like smell coming from the tube
.
She passed the syringe to Julie Gorchynski, a medical resident who noticed manila-colored particles floating in the blood. At this point, Kane fainted and was removed from the room. Shortly thereafter, Dr. Gorchynski began to feel nausea
ted. Complaining that she was light-headed, she left the trauma room and sat at a nurse’s desk. A staff member asked her 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 stabilize Ramirez. At 8:50, after forty five minutes of CPR and defibrillation
, Ramirez was pronounced dead from kidney failure related to her cancer.
with breathing problems, she developed hepatitis
and avascular necrosis
in her knees. Eager to clear her name and win her lawsuit against General Hospital in Riverside, she and RN Susan Kane contacted Livermore Laboratories
for a second opinion
.
Livermore Labs postulated that Ramirez had been taking dimethyl sulfoxide
(DMSO), a solvent, as a home remedy for pain. Users of this substance report that it has a garlic-like taste. The Livermore scientists theorized that the DMSO in Ramirez's system might have built up, due to urinary blockage. Oxygen administered by the paramedics would have combined with the DMSO to form dimethyl sulfone (DMSO2). DMSO2 is known to crystallize at room temperature, and crystals were observed in some of Ramirez's drawn blood. Electric shocks administered during emergency defibrillation could have then converted the DMSO2 into dimethyl sulfate
(DMSO4), a powerful poisonous gas, exposure to which could have caused the reported symptoms of the emergency room staff.
However, while the conversion from DMSO to DMSO2 may be scientifically plausible, the subsequent conversion from DMSO2 to DMSO4 inside the human body is questionable at best. In addition, while DMSO4 is highly volatile, it seems unlikely that it would have completely evaporated, leaving no trace whatsoever.
Ten weeks after she died, Ramirez was buried in an unmarked grave at Olivewood Memorial Park in Riverside.
Everything that Grant ever speculated or concluded about this incident was evaluated by professional forensic scientists, chemists, and toxicologists, passed peer-review in an accredited, refereed journal, and was published by Forensic Science International. The first paper was very technically detailed and did, in fact, give two potential chemical reaction mechanisms that may possibly have formed dimethyl sulfate from dimethyl sulfoxide and dimethyl sulfone precursors. The second communication gave supplemental support for the postulated chemical scenario, as well as insight into some of the sociology and vested interests inherent in the case.
One of the letters proposed the production of toxic chloramine gas due to urine mixing with bleach in a nearby sink. This hypothesis, previously proposed to the investigators and to the medical personnel involved in the incident, was apparently never considered by all involved. The noxious effects of this gas are documented in the New England Journal of Medicine, Vol.341:848-849, Sept.9,1999, "Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners". In reality, Grant addressed this chloramine scenario in Ref. 8, and it did not come close to fitting the ER incident.
Riverside, California
Riverside is a city in Riverside County, California, United States, and the county seat of the eponymous county. Named for its location beside the Santa Ana River, it is the largest city in the Riverside-San Bernardino-Ontario metropolitan area of Southern California, 4th largest inland California...
, woman dubbed "the toxic lady" by the media when several Riverside General Hospital
Riverside County Regional Medical Center
The Riverside County Regional Medical Center, or RCRMC, is a public hospital in Moreno Valley, California, United States, operated by the County of Riverside. It is classified as a Level II Adult & Pediatric Trauma Center....
workers became ill after exposure to her body and blood. Her case was the basis for a scene in one episode
The Erlenmeyer Flask
"The Erlenmeyer Flask" is the 24th episode and the first season finale of the science fiction television series The X-Files. "The Erlenmeyer Flask" introduced several new plot elements which would continue in later seasons and featured the death of recurring character, "Deep Throat"...
of the American TV series The X-Files
The X-Files
The X-Files is an American science fiction television series and a part of The X-Files franchise, created by screenwriter Chris Carter. The program originally aired from to . The show was a hit for the Fox network, and its characters and slogans became popular culture touchstones in the 1990s...
, an episode of the American TV drama Grey's Anatomy
Grey's Anatomy
Grey's Anatomy is an American medical drama television series created by Shonda Rhimes. The series premiered on March 27, 2005 on ABC; since then, seven seasons have aired. The series follows the lives of interns, residents and their mentors in the fictional Seattle Grace Mercy West Hospital in...
, a segment of a show on Discovery Communications
Discovery Communications
Discovery Communications, Inc. is an American global media and entertainment company. The company started as a single channel in 1985, The Discovery Channel. Today, DCI has global operations offering 28 network entertainment brands on more than 100 channels in more than 180 countries in 39...
' channel Investigation Discovery called "The New Detectives
The New Detectives
The New Detectives: Case Studies in Forensic Science is a documentary true crime television show that aired two to three different cases in forensic science per episode. Episode reruns currently air on the Discovery Channel, TLC and the Investigation Discovery network...
" , and the "Stink Bomb" segment of the animated film Memories
Memories (film)
Memories is an anime produced in 1995 by artist/director Katsuhiro Otomo which were based on three of his manga short stories. The film is composed of three episodes: , and...
.
The emergency room visit
About 8:15 in the evening on February 19, 1994, Ramirez was brought into the emergency room of Riverside General Hospital by paramedicParamedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
s, suffering from the effects of advanced cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
. She was extremely confused, and suffering from bradycardia
Bradycardia
Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...
and Cheyne-Stokes respiration
Cheyne-Stokes respiration
Cheyne-Stokes respiration is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2...
.
The medical staff injected her with Valium, Versed
Midazolam
Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...
, and Ativan to sedate her, and agents such as lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
to stimulate her heartbeat. When it became clear that Ramirez was responding poorly to treatment, the staff tried to defibrillate her heart; at that point several people saw an oily sheen covering Ramirez’s body, and some noticed a fruity, garlic-like odor that they thought was coming from her mouth. A registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
named Susan Kane attempted to draw blood from Ramirez's arm, and noticed an ammonia
Ammonia
Ammonia is a compound of nitrogen and hydrogen with the formula . It is a colourless gas with a characteristic pungent odour. Ammonia contributes significantly to the nutritional needs of terrestrial organisms by serving as a precursor to food and fertilizers. Ammonia, either directly or...
like smell coming from the tube
Vacutainer
Vacutainer is a brand of test tubes specifically designed for venipuncture, which was developed in 1947 by Joseph Kleiner.In phlebotomy the word “vacutainer” has come to be used as a genericized trademark to describe any vacuum-based blood collection vial, regardless of brand. Becton Dickinson...
.
She passed the syringe to Julie Gorchynski, a medical resident who noticed manila-colored particles floating in the blood. At this point, Kane fainted and was removed from the room. Shortly thereafter, Dr. Gorchynski began to feel nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
ted. Complaining that she was light-headed, she left the trauma room and sat at a nurse’s desk. A staff member asked her 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
Skeleton crew
A skeleton crew is the minimum number of personnel needed to operate and maintain an item at its most simple operating requirements, such as a ship or business, during an emergency and, at the same time, to keep vital functions operating.- Uses :...
stayed behind to stabilize Ramirez. At 8:50, after forty five minutes of CPR and defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, Ramirez was pronounced dead from kidney failure related to her cancer.
Investigation
The county health department called in California's Department of Health and Human Services, which put two 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.Possible role of dimethyl sulfoxide
Dr. Gorchynski denied that she had been affected by mass hysteria, and pointed to her own medical history as evidence. After the exposure, she spent two weeks in the intensive care unitIntensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...
with breathing problems, she developed hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
and avascular necrosis
Avascular necrosis
Avascular necrosis is a disease where there is cellular death of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses...
in her knees. Eager to clear her name and win her lawsuit against General Hospital in Riverside, she and RN Susan Kane contacted Livermore Laboratories
Lawrence Livermore National Laboratory
The Lawrence Livermore National Laboratory , just outside Livermore, California, is a Federally Funded Research and Development Center founded by the University of California in 1952...
for a second opinion
Second opinion (medicine)
A second opinion is a visit to a physician other than the one a patient has previously been seeing in order to get a differing point-of-view. Second opinions may be sought by a patient under the following circumstances:*Physician recommends surgery....
.
Livermore Labs postulated that Ramirez had been taking dimethyl sulfoxide
Dimethyl sulfoxide
Dimethyl sulfoxide is an organosulfur compound with the formula 2SO. This colorless liquid is an important polar aprotic solvent that dissolves both polar and nonpolar compounds and is miscible in a wide range of organic solvents as well as water...
(DMSO), a solvent, as a home remedy for pain. Users of this substance report that it has a garlic-like taste. The Livermore scientists theorized that the DMSO in Ramirez's system might have built up, due to urinary blockage. Oxygen administered by the paramedics would have combined with the DMSO to form dimethyl sulfone (DMSO2). DMSO2 is known to crystallize at room temperature, and crystals were observed in some of Ramirez's drawn blood. Electric shocks administered during emergency defibrillation could have then converted the DMSO2 into dimethyl sulfate
Dimethyl sulfate
Dimethyl sulfate is a chemical compound with formula 2SO2. As the diester of methanol and sulfuric acid, its formula is often written as 2SO4 or even Me2SO4, where CH3 or Me is methyl...
(DMSO4), a powerful poisonous gas, exposure to which could have caused the reported symptoms of the emergency room staff.
However, while the conversion from DMSO to DMSO2 may be scientifically plausible, the subsequent conversion from DMSO2 to DMSO4 inside the human body is questionable at best. In addition, while DMSO4 is highly volatile, it seems unlikely that it would have completely evaporated, leaving no trace whatsoever.
Final conclusion and burial
Two months after Ramirez died, her badly decomposed body was released for an independent 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 Memorial Park in Riverside.
Status of technical forensic analysis
The possible chemical explanation for this incident by Dr. Patrick M. Grant of the Livermore Forensic Science Center is beginning to appear in basic forensic science textbooks. In Houck and Siegel's textbook, the authors opine that, although some weaknesses exist, the postulated scenario is “the most scientific explanation to date” and that “beyond this theory, no credible explanation has ever been offered for the strange case of Gloria Ramirez.”Everything that Grant ever speculated or concluded about this incident was evaluated by professional forensic scientists, chemists, and toxicologists, passed peer-review in an accredited, refereed journal, and was published by Forensic Science International. The first paper was very technically detailed and did, in fact, give two potential chemical reaction mechanisms that may possibly have formed dimethyl sulfate from dimethyl sulfoxide and dimethyl sulfone precursors. The second communication gave supplemental support for the postulated chemical scenario, as well as insight into some of the sociology and vested interests inherent in the case.
One of the letters proposed the production of toxic chloramine gas due to urine mixing with bleach in a nearby sink. This hypothesis, previously proposed to the investigators and to the medical personnel involved in the incident, was apparently never considered by all involved. The noxious effects of this gas are documented in the New England Journal of Medicine, Vol.341:848-849, Sept.9,1999, "Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners". In reality, Grant addressed this chloramine scenario in Ref. 8, and it did not come close to fitting the ER incident.