Dear Cecil: Enclosed are two of the many articles on the death of Gloria Ramirez, who became known as "the toxic lady" because she downed several medical attendants with her fumes. Pesticides, nerve gas, cervical cancer, kidney failure, cardiac arrest, crystals in blood, and other obscure causes were cited in these and many TV reports. Did they ever find out what killed Ms. Ramirez and made the workers sick? J. Pilla, Tucson, Arizona

Cecil replies:

What killed the 31-year-old Ramirez was no big mystery. She died of kidney failure due to advanced cancer of the cervix. What stumped people was what caused all those emergency room staffers to keel over. Nearly two dozen vomited or passed out, six wound up being hospitalized, and at least one suffered complications that persisted for months. Nobody’s sure exactly what happened, but investigators have come up with a promising theory, as we shall see.

It all began when the terminally ill Ramirez began having heartbeat and breathing problems at her home in Riverside, California, on the evening of February 19, 1994. Paramedics rushed her to Riverside General Hospital, administering oxygen en route. Shortly after arriving at the ER she passed out.

Dr. Julie Gorchynski tried to fix Ramirez’s fluttering heartbeat by shocking her with defibrillation paddles. A short time later a nurse took a blood sample with a syringe. Dr. Gorchynski smelled ammonia and felt dizzy. The nurse keeled over. Dr. Gorchynski took the syringe and sniffed it. She smelled ammonia again and noticed the blood had funny straw-colored crystals in it. Seconds later she blacked out and went into convulsions.

Soon medical staff all over the place were retching and fainting. The ER was ordered evacuated. Further attempts to revive Ramirez failed, and she was pronounced dead. The body having been sealed in an airtight casket, the experts arrived to clean up and figure out what had gone wrong.

They didn’t get very far. An autopsy conducted by doctors wearing space suits revealed that Ramirez was suffering from a urinary blockage, among other things. But no known toxic chemicals were found. An inspection of the ER’s plumbing and ventilation systems and whatnot also turned up nothing.

Baffled officials came up with one inane explanation after another. The coroner’s office said the ER staff were sickened by the “smell of death.” The California department of health services blamed the whole thing on mass hysteria. This POd the victims no end, particularly Dr. Gorchynski, who was in the worst shape. She was in the hospital for two weeks, stopped breathing repeatedly, came down with hepatitis and pancreatitis, and later developed bone rot in her knees.

Finally some folks with IQs in the triple digits got into the act. Scientists at the Forensic Science Center at Livermore National Laboratory found a chemical called dimethyl sulfone (DMSO2) in Ramirez’s blood. Dimethyl sulfone is a reaction product of dimethyl sulfoxide (DMSO), a solvent sometimes used by cancer patients as a home pain remedy.

Neither DMSO nor DMSO2 is especially dangerous. But while reading up on the subject a Livermore scientist came across a related chemical, dimethyl sulfate (DMSO4). DMSO4 is a powerful poison gas, and it can cause nearly every symptom suffered by the Riverside ER staff.

The Livermore scientists hatched the following hypothesis: (1) Ramirez doses herself with DMSO. Due to urinary blockage, the stuff builds up in her bloodstream. (2) Oxygen administered by the paramedics converts the DMSO in her blood to a high concentration of DMSO2. (3) When the DMSO2-laden blood is drawn out in the syringe and cools to room temperature, crystals form (this was confirmed by experiment). (4) DMSO2 is converted to DMSO4 by some unknown mechanism (the defibrillation shock?) and clobbers the medical staff. (5) The volatile DMSO4 evaporates without a trace.

Step four is obviously the weak link. The Livermore scientists have proposed some possible chemical scenarios. While skeptics have raised objections, Livermore’s Pat Grant tells me, “There weren’t any showstoppers.” Those people got zapped by something, and right now this is the best explanation we’ve got.

Another theory

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.

“Those smells and symptoms are classic to meth-fume exposure,” a forensic chemist who analyzes drug-lab materials is quoted as saying. Meth manufacturing is said to be big business in Riverside county, where the hospital was located–authorities have shut down more than 1,000 meth labs since 1988, and many more may remain undetected.

Still, you gotta think: a secret meth lab in a major hospital? A meth lab, moreover, that’s run by people so stupid they somehow allow an IV bag full of meth chemicals to wind up in the emergency room? Hard to believe. On the other hand, Goldsmith points out, the authorities never took the precaution of testing the IV bags to see what was in them. Cover-up or just incompetence? Right now it’s anybody’s guess.

Cecil Adams

Send questions to Cecil via cecil@straightdope.com.