Do you have people in your lives that you can’t stand? A co-worker perhaps, or a family member, or a grumpy neighbor. You may call them “toxic”, but there was a lady who was so noxious that people couldn’t literally stand her. Her name was Gloria Ramirez.

On the evening of February 19, 1994, Gloria Ramirez, 31-year-old mother of two, was wheeled into the emergency department of Riverside General Hospital in Riverside, California. Ramirez, a patient with terminal cervical cancer, was complaining of irregular heartbeat and difficulty breathing. En route to the hospital, Ramirez was administered oxygen and given intravenous fluids. By the time she entered the ER, she was barely conscious, her speech was sluggish, her breathing shallow and her heartbeat rapid.

Gloria Ramirez

The medical staff injected her with a cocktail of fast-acting drugs to alleviate her symptoms, such as sedatives and agents to calm her heartbeat. When those failed to produce any change, the staff tried to defibrillate her heart with electricity. At this 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 nurse named Susan Kane pushed a needle into the patient’s arm to draw blood, when she noted an ammonia-like odor. Kane handed the syringe to Maureen Welch, a respiratory therapist, so that she could take a closer whiff of the dying woman. Welch sniffed the syringe in her hand. It smelled of ammonia. Welch then passed the syringe to Julie Gorchynski, a medical resident, who also noticed the unmistakable smell of ammonia. Gorchynski also observed unusual manila-colored particles floating in the blood. At this point, Kane collapsed and had to be carried out of the ER. Moments later Gorchynski complained of nausea and she too slumped to the floor. Maureen Welch was the third to pass out.

That night twenty-three people fell ill, of which five had to be hospitalized with various symptoms. Gorchynski was in the worst shape. Her body convulsed and she breathed intermittently. She also suffered from hepatitis, pancreatitis, and avascular necrosis in her knees, a condition in which bone tissue die off. Gorchynski was on crutches for months.

Gloria Ramirez died within 45 minutes of her arrival at the hospital. The official cause of her death was given as kidney failure due to metastasized cancer.

Ramirez’s death and the effect of her presence on the ER staff is one of the most baffling medical mystery in recent history. The source of the toxic fumes was undoubtedly Ramirez, but autopsy reports were inconclusive. The possibility of the emergency room harboring noxious chemicals and pathogens was also ruled out by a careful search by a HAZMAT team. In the end, the health department declared that the hospital staff most likely experienced an outbreak of mass hysteria, perhaps triggered by an odor. The report angered many staff members who were on duty that night. The conclusion of the health department, they felt, was an insult to their professionalism.

Eventually the federal research facility in Livermore was asked to take a look at Ramirez’s autopsy and toxicology reports. Forensic analysis had found a lot of peculiar chemicals in Ramirez’s blood, but none was toxic enough to produce symptoms as experienced by the emergency room workers. There was a lot of different drugs in her system such lidocaine, Tylenol, codeine, and Tigan. Ramirez was a cancer patient and was understandably under a lot of pain. Many of these drugs were painkillers.

Locating the source of the ammonia-like smell observed in the emergency room was easy. Scientists found an ammonia compound in Ramirez’s blood that had most likely formed when Ramirez’s body broke down the anti-nausea drug Tigan that she was taking.

The most peculiar chemical found in her blood was dimethyl sulfone, a sulfur compound that occurs naturally in some plants, is present in small amounts in many foods and beverages, and is also sometimes produced naturally in our bodies from amino acids. But in Ramirez’s blood and tissues there was a hefty concentration of dimethyl sulfone. Forensic analysts figured that the dimethyl sulfone had come from dimethyl sulfoxide, or DMSO, which Ramirez must have used as pain relief. DMSO came into existence in the early 1960s as a wonder drug and became very popular among athletics for treating muscular strains until the FDA found that prolonged exposure to the drug caused eye damage. Use of the drug was restricted except in certain formulation, but DMSO continued to gather an underground following as a home remedy.

It’s likely that Ramirez had applied DMSO to her body to ease her pain. The DMSO was absorbed by her skin and entered into her bloodstream. When paramedics and later the emergency room workers gave her oxygen, the dimethyl sulfoxide was oxidized to dimethyl sulfone. It was this dimethyl sulfone that crystalized into manila colored crystals inside the syringe when Susan Kane drew blood at the hospital.

Now dimethyl sulfone is relatively harmless, except for one thing: if you add another oxygen atom to the molecule, you get dimethyl sulfate, a truly nasty chemical. Vapors of dimethyl sulfate instantly kill cells in exposed tissues. When absorbed into the body, dimethyl sulfate causes convulsions, delirium, paralysis, coma, and even damage to the kidneys, liver, and heart. In severe cases, dimethyl sulfate can also kill people.

What caused the dimethyl sulfone in Ramirez’s body to convert to dimethyl sulfate is up for debate. The Livermore scientists believe that the conversion was caused by the chilled air temperature of the emergency room, but this theory is unsubstantiated. Organic chemists scoff at the idea since direct conversion of dimethyl sulfone to dimethyl sulfate had never been observed. Others believe that the symptoms shown by the hospital staff doesn’t match the symptoms of dimethyl sulfate poisoning. Furthermore, many of the known effects of dimethyl sulfate usually take several hours to show, and yet the fainting spells and other symptoms at the hospital began to occur minutes after the supposed exposure. Others still doubt that significant quantities of the suspect chemicals could have been produced from the DMSO.

Several years later, the New Times LA proposed an alternative explanation—the hospital staff was illegally manufacturing the drug methamphetamine and was smuggling them in IV bags, one of which was inadvertently hooked up to Ramirez. The exposure to methamphetamine may have caused the rounds of nausea, headache and blackouts. The idea of a secret meth lab in a major hospital not only sounds extraordinarily stupid, it probably is. The basis for such a wild theory is that Riverside County has been one of the country’s largest distribution points for meth.

The DMSO theory is still the best forensic experts could come up with, but it still doesn’t explain everything and its major caveat is the lack of established mechanism for the dimethyl sulfone to dimethyl sulfate conversion. The bizarre incident surrounding the death of Gloria Ramirez will continue to remain a medical and chemical mystery.