Death of Gloria Ramirez

Gloria Cecilia Ramirez (January 11, 1963 – February 19, 1994) was an American woman from Riverside, California, who was dubbed the Toxic Lady or the Toxic Woman by the media when several hospital workers became ill after airborne exposure to her body and blood. Ramirez had been admitted to the emergency room suffering from late-stage cervical cancer. While treating Ramirez, three hospital workers fainted, and others experienced symptoms such as shortness of breath and muscle spasms. Five workers required hospitalization, one of whom remained in an intensive care unit for two weeks. Ramirez herself died from complications related to her cancer shortly after arriving at the hospital.

The incident was initially considered to be a case of mass hysteria. An investigation by Lawrence Livermore National Laboratory proposed that Ramirez had been self-administering dimethyl sulfoxide as a treatment for pain, which converted into dimethyl sulfate, an extremely poisonous and highly carcinogenic alkylating agent, via a series of chemical reactions in the emergency room. This theory has been endorsed by the Riverside Coroner's Office and published in the journal Forensic Science International.

Emergency department visit
At about 8:15 p.m. on February 19, 1994, Gloria Ramirez, suffering from severe heart palpitations, was brought into the emergency room of Riverside General Hospital in Riverside, California, by paramedics. She was extremely confused and was suffering from tachycardia and Cheyne–Stokes respiration.

Hospital staff administered diazepam, midazolam and lorazepam to sedate Ramirez. When it became clear that she was responding poorly to treatment, staff tried to defibrillate her heart; at that point several medical workers saw an oily sheen covering Ramirez's body, and some noticed a fruity, garlic-like odor that they thought was coming from her mouth. Registered nurse Susan Kane drew blood from Ramirez's arm and noticed an ammonia-like smell coming from the tube.

Kane passed the tube to Julie Gorchynski, a medical resident, who noticed manila-colored (yellow-brown) particles floating in the blood. At this point, Kane fainted and was removed from the emergency room. Shortly thereafter, Gorchynski began to feel nauseated. Complaining that she was lightheaded, she left the emergency room and sat at a nurse's desk. A staff member asked her if she was okay, but before she could respond, Gorchynski also fainted. Maureen Welch, a respiratory therapist who was assisting in the emergency room, was the third to faint. Staff was then ordered to evacuate all emergency room patients to the parking lot outside the hospital, while a skeleton crew stayed behind to stabilize Ramirez. At 8:50 p.m., after 45 minutes of CPR and defibrillation, Ramirez was pronounced dead from kidney failure related to her cancer. 23 people who were in Ramirez's vicinity became ill, and five were hospitalized.

Investigation
The Riverside County health specialist department called in California's Department of Health and Human Services, which put two scientists, Drs. Ana Maria Osorio and Kirsten Waller, on the case. 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 did not appear 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. They believed the hospital workers suffered from an incident of mass hysteria.

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 unit with breathing problems. She developed hepatitis and avascular necrosis in her knees. The Riverside Coroner's Office contacted the Lawrence Livermore National Laboratory to investigate the incident. Livermore postulated that Ramirez had been using dimethyl sulfoxide (DMSO), a solvent most commonly used as a degreaser, as a home remedy for pain. Users of this substance report that it has a garlic-like taste. Sold in gel form at hardware stores, topical application to Ramirez's skin could explain the greasy appearance of Ramirez's body. Livermore scientists theorized that the DMSO in Ramirez's system might have built up owing to urinary blockage caused by her kidney failure. 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), the highly toxic dimethyl ester of sulfuric acid, exposure to which could have caused the reported symptoms of the emergency room staff. Livermore scientists postulated on The New Detectives that the change in temperature of the blood drawn, from the 98.6 °F (37 °C) of Ramirez's body to the 64 °F (18 °C) of the emergency room, may have also contributed to a conversion from DMSO2 into DMSO4.

Burial
Two months after Ramirez died, her 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 staff's symptoms while her family disagreed. On April 20, 1994—ten weeks after her death—Ramirez was buried at Olivewood Memorial Park in Riverside.

Status of technical forensic analysis
The possible chemical explanation for this incident, by Patrick M. Grant of the Livermore Forensic Science Center, has appeared in some forensic science textbooks. In one such textbook, Fundamentals of Forensic Science, the authors state 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."

Grant's conclusions and speculations about the incident were evaluated by professional forensic scientists, chemists, and toxicologists, passed peer review in an accredited, refereed journal, and were published by Forensic Science International.

In popular culture
The Murdoch Mysteries episode "A Most Surprising Bond" is loosely based on the Ramirez case, using the DMSO hypothesis to explain how a hospital patient's blood is causing those around her to fall ill.

Gloria Ramirez's story also played a part in inspiring the 1995 episode "Stink Bomb" of the three-part film anthology Memories by Katsuhiro Otomo, where a lab technician ingests an experimental drug and becomes a walking biohazard.

Episode 14 of season 3 of Grey's Anatomy, "Wishin and Hopin", features a patient who is based on this case. The cancer patient causes any doctors who come in contact with her to faint and require immediate medical attention due to her taking a herbal supplement, causing her blood to become toxic.