Answers With Joe

Why Did This Woman’s Blood Produce A Toxic Nerve Gas?

On February 19, 1994, Gloria Ramirez was wheeled into the emergency room at Riverside Hospital in California. Within minutes, the staff began collapsing to the floor and the hospital was evacuated. What turned this woman’s blood into a chemical weapon? It’s one of the weirdest medical mysteries of all time.


It’s Halloween, and chances are many of you have indulged in some scary movies over the last few weeks, maybe you have plans to do it tonight. Maybe you’ll be in bed by 8:00, I’m not here to judge.

A popular subgenre of horror films is known as body horror, which plays off our fears of losing control of our own bodies. Either to aliens like invasion of the body snatchers, or to technology like The Fly.

Or to The Thing in… The Thing.

Or The Stuff in… The Stuff.

Or The Blob in… You get the idea.

The idea that our own bodies, or the bodies of those around us could be weaponized is a deep instinctual fear. There’s a reason why the trope of “patient gets wheeled into the emergency room and infects the entire staff with a mystery illness” gets used so much.

And yet in February of 1994, this actually happened. A woman was wheeled into an ER, and as soon as a needle pierced her skin, she emitted a mysterious toxin that poisoned dozens of people.

She became known as The Toxic Lady. And scientists and doctors have been struggling to explain it ever since.

February 19th, 1994 was just like any other day for the staff of Riverside General Hospital. A car accident or two, a drug overdose. An old guy complaining of chest pains. Nothing out of the ordinary for an LA suburb.

And then, at 8:15 in the evening, paramedics wheeled in a 31 year old hispanic woman who was breathing shallow and barely conscious. They moved her into a space marked Trauma Room One and began trying to stabilize her.

They assessed what they knew so far. Her name was Gloria Ramirez, she was 31 years old, and she was being treated for cervical cancer. And now, for whatever reason, her vital signs were crashing.

Along with the shallow breathing, her blood pressure was dropping fast. Her heart was beating too quickly for its chambers to fill with blood.

So they gave her lidocaine and Bretylium to help control her rapid heartbeat, as well as Ativan, Valium, and Versed to help sedate her.

At this point, hospital staff were pouring into the room to get her situation under control, including RN Susan Kane, Resident Julie Gorchynski, and Head of Emergency Humberto Ochoa

Respiratory therapist Maureen Welch used an Ambu Bag on her to help her breathe.

But nothing they did seem to work. Ramirez’s vital signs continued to plummet to the point that they had to use a defibrillator to reset her heart.

When they cut off her shirt to apply the paddles, they all noticed an oily sheen covering her body that seemed to give off a fruity, garlicky odor.

Susan Kane, the RN, took a blood sample for analysis and noticed that the blood smelled… strange.

This actually isn’t that uncommon for chemotherapy patients.
But a chemo scent usually smells a bit putrid. This had a weird ammonia flavor to it.

Even weirder, she noticed that there were small manila-colored particles floating around in the blood sample. And this is where things start to get really weird.

Because she barely had a chance to say anything about it before she literally fell to the floor, saying her face felt like it was burning.

Unable to even stand, the staff had to put her on a gurney and whisk her out of the room, but as she was being wheeled out, Gochynski starts to feel light-headed.

She left the room to sit down at the nurse’s station to get her head together, and when one of the nurses asked if she was okay, she fell to the floor and began to shake uncontrollably, barely able to breathe.

At about the same time, Maureen Welch fell to the floor back in the trauma room, her arms and legs stiff and uncontrollable.

This prompted Humberto Ochoa, the Head of Emergency to order the ER evacuated. Nurses and doctors immediately scrambled to wheel their patients outside into the parking lot where they attempted to set up a temporary outdoor trauma center.

Ochoa and a few others stayed behind to work on Ramirez, trying to save her life. Unfortunately they were unsuccessful and she was pronounced dead at 8:50pm. Just 35 minutes after she had arrived.

But now, they had to figure out what just happened. To be safe, they moved her body to an isolation room. Along the way, one of the two orderlies began to vomit and complained that her skin was burning.

In the end, 23 of the 37 people on staff that night experienced some kind of symptom, and five were hospitalized.

Julie Gorchynski got it the worst. She would eventually spend two weeks in intensive care, suffering from hepatitis, pancreatitis, and avascular necrosis, a condition where bone tissue is deprived of blood and begins to die.

What the hell happened to Gloria Ramirez that caused her to secrete this mystery toxic substance that affected two dozen people? Was it the chemo medicine? Was she poisoned? Was this like an act of terrorism that used her as some kind of human chemical weapon?

There’s been no shortage of theories around this event, and for good reason, this is one of the craziest medical mysteries ever documented. One that would have Gloria Ramirez go down in history, unfortunately, as The Toxic Lady.

Here’s what we know about what happened. And the best theory that has been put forth so far.

All right, so back on the night of February 19th, as the ER staff was busy treating their patients in the parking lot – some of those patients being the staff themselves – a team of investigators arrived in hazmat suits to search the ER.

They were looking for any kind of volatile toxicant that could still be in the emergency room’s air. One of which was hydrogen sulfide.

Hydrogen sulfide is a poison that can kill someone after one or two whiffs if it’s at high concentrations. It also tends to smell like rotten eggs – that’s the sulfide bit.

And that was also a bit of a problem because nobody reported smelling rotten eggs when the incident occurred. Doesn’t really matter because the investigators didn’t find anything.

They also looked for phosgene, a gas that’s used in the preparation of several organic chemicals but has also been used in chemical warfare.

It’s pretty brutal, what it does is it rips open the capillaries in the lungs, and its victims basically just drown in their own blood. So, that’s fun.

Luckily for everybody on staff that night, that’s not what they experienced and it also wasn’t found in the air by the investgators. That or anything else that could explain it.

So then they examined the body, still in their moon suits to be safe.

They took blood and tissue samples and then sealed her body in an airtight aluminum crate. Again, just to be safe.

These samples were sent to the Riverside coroner, and he couldn’t find anything that stood out to him, so he sent it on for more advanced testing.

Using a computer-guided combined gas chromatograph-mass spectrometer, they found codeine, lidocaine, Tylenol, and Tigan, an antinausea medication. None of which is unexpected for someone going through chemo.

There were however, a few things that were unexpected.

One of which was amine, which is a derivative of ammonia. This may have contributed to the ammonia-like smell that Susan Kane noticed in her blood.

The second standout result was nicotinamide.

Nicotinamide is a B vitamin that’s crucial to our health. You can find it in a lot of multivitamins, I’ve taken it myself at times.

So that might mean nothing but… It can also be mixed into drugs like methamphetamines. Which could be a whole different thing.

And last but not least was dimethyl sulfone; and this one was interesting because it’s usually used as an industrial solvent.

But it can be produced naturally in our bodies from amino acids that contain sulphur. It usually breaks down in the liver in three days so it’s rarely detectable. But there was a lot of it in Gloria Ramirez’ blood.

This was weird… but regardless, it wasn’t at a high enough level to kill her, much less poison the rest of the ER.

So, yeah…

With still no answers, the California Department of Health and Human Services stepped in to investigate.

They assigned doctors Ana Maria Osorio and Kirsten Waller to the case, and they interviewed 34 people who were on staff that night, compiled all the data and eventually concluded that… wait for it… It was an outbreak of mass sociogenic illness.

Mass hysteria. Like the Dancing Plague.

Their theory is that whatever that smell was in the blood triggered a panic attack that just kinda traveled around the room.

They cited the lack of any evidence for poison and the fact that the women on staff suffered the most severe symptoms. Which sounds really sexist, but the authors of the report were both women so do with that what you will.

They also found that the people who were most affected by the fumes had skipped dinner that evening, not to mention the fact that the paramedics who were in the ambulance with Ramirez suffered no symptoms, even after being in close contact with her blood and skin. In a small, enclosed area.

That… is weird actually but still, so much of this theory just doesn’t make sense.

First of all, these weren’t a bunch of shrinking violets, these were experienced ER doctors and nurses. They saw car accident victims and gunshots on a daily basis, there’s no way a bad smell would be enough to make them faint.

And by the way, it wasn’t just fainting, they had real, diagnosed physiological problems from this. Julie Gorchynski lost so much bone density, she had to be on crutches for 6 months.

6 months that she wasn’t able to work and because of this report now she couldn’t collect any kind of workers’ comp. So I think it’s pretty understandable why she filed a lawsuit.

This is when Gorchynski and her lawyer reached out to Brian Andresen at the Lawrence Livermore National Laboratory – he’s the guy who ran the gas chromatograph tests back in March.

They felt that there must have been something to those anomalies that were found, that I talked about a minute ago.

He was still pretty stumped by the whole thing so he enlisted the help of the lab’s deputy director, a guy named Pat Grant.
Let me stop for just a second and acknowledge that I know I’m throwing a lot of names at you and it’s probably starting to feel like we’re getting a bit in the weeds here. And we are. And we’re going to go deeper into these weeds but just hang with me. This is about to get super technical but it’s worth it.

All right so we’ve got this new guy Pat Grant, he’s looking at this file while flying to a business meeting in Washington D.C. New pair of eyes and all that, and he notices something.

He speculated that the lab’s detection of dimethyl sulfone might have actually been the product of a slightly different chemical, dimethyl sulfoxide, or DMSO. What the hell is DMSO?

DMSO is a heavy-duty degreaser; it’s often sold in gel form at hardware stores. But it has a really interesting history.

It turns out Grant used to work in a kinesthetics lab with athletes and back in the day, it was a bit of a folk remedy for achy muscles and joints.

It used to actually be sold for that purpose but it was kinda banned in the 1970’s after some lab tests showed that it could alter the lens of the eye.

But still a lot of people swore by it, and let’s face it, when you’re in pain, you’ll do pretty much anything to make it go away.

So it wasn’t uncommon for people to just get the industrial gel form of it at the hardware store and use it to treat all kinds of painful ailments like arthritis, muscle strains, and, yes, cancer pain.

This could also explain the oily sheen they saw all over her in the ER. As well as the garlicky smell.

AND… DMSO can combine with oxygen to create dimethyl sulfone, which would explain why that was so high in her blood.

Plus the paramedics had put her on oxygen on the way to the hospital, so her blood was flush with it.

Ah, see, the pieces are coming together now, it’s all making sense. Ah-ha!Except this still doesn’t explain the incident at all, none of these chemicals are toxic in any way.

But, this started Grant thinking, if adding oxygen to DMSO creates dimethyl sulfone, what other chemicals could one create with that combination?

Especially considering how high her oxygen level was.

So he hit up the Merck Index, basically a bible of more than 10,000 biological, chemical, and drug substances.

It turns out that if you add two more oxygen atoms to dimethyl sulfone, written as (CH3)2SO2, you get dimethyl sulfate, (CH3)2SO4.

And yes, we’ve gone from dimethyl sulfoxide to dimethyl sufone to dimethyl sulfate. Thanks science.

All right, so there’s a chance she made dimethyl sulfate, what is that… Oh… It’s a poison gas.

And not just a little poisonous either, tests have shown that a 10-minute exposure to half a gram dispersed over a cubic meter of air can be fatal.

In fact it was tested as a nerve agent but never used in war.

It basically kills cells in exposed tissues like eyes, lungs, and mouth. And its symptoms include convulsions, delirium, paralysis and coma.

All of which is lining up perfectly with the symptoms from the hospital staff.

So… Here’s where things stand.

Gloria Ramirez was suffering from cancer and used DSMO as a folk remedy to help with the pain.

She collapsed – possibly from cancer-related kidney failure and the paramedics put an oxygen mask on her in the ambulance.

Her blood became oversaturated with oxygen, which mixed with the DMSO to form dimethyl sulfone, which mixed with more oxygen to create dimethyl sulfate dissolved in her blood.

The guys at Lawrence Livermore tested this theory using a substance called Ringer’s solution as a stand-in for blood.

Not only were they able to get it to work at normal body temperature, when the solution cooled to room temperature, the dimethyl sulfone began to crystalize.

This explains the white particulates that they found in the sample of Ramirez’ blood.

All of which leaves only one mystery, which is how did this dissolved dimethyl sulfate become gaseous?

Dimethyl sulfate has a pretty high vapor point, around 148 degrees celsius (300F), which is maybe one of the reasons why it was never used in combat.

But that high vapor point is at one atmosphere of pressure. The lower the pressure, the lower the vapor point.

Put water in a vacuum chamber and start lowering the pressure, it will eventually boil at room temperature. Which is why if you were ever exposed to the vacuum of space, the last thing you would experience would be the water on the surface of your eyes boiling.

Sleep tight kids.

With that in mind, when you get your blood drawn by a nurse or a phlebotomist, they use one of these. This is called a vacutainer. Which is a container… filled with a vacuum.
So when they take your blood, they stick the needle into the vein, then pop the vacutainer on there and that vacuum pulls the blood into the tube. It’s pretty brilliant.

But in this… Incredibly specific and unique case, that vacuum caused a tiny amount of the dimethyl sulfate to vaporize, and poison 23 people. Because say it with me folks… PRESSURE CHANGES EVERYTHING.

And this provides the last ribbon and bow to wrap up the mystery of Gloria Ramirez, the Toxic Lady.

Of course, this theory has its detractors.

Those who disagree with this theory point out the fact that dimethyl sulfate doesn’t hit people like it did the staff. It’s more like tear gas.

So, while the staff didn’t start to cry from the vapors, they did report a burning sensation.

And its effects take hours to materialize, but the staff experienced it immediately.
Rameriz’s family wasn’t buying the theory, either. They insist that she never used DMSO and requested an independent autopsy two months after she died.

But by that point the body was extremely decomposed, and her heart and other organs were missing. Also, apparently what was left was contaminated with fecal matter. Yikes.

This of course, has led to a lot of suspicion that the hospital is involved in some kind of cover-up.

Maybe the wildest theory that has been floated was the hospital was manufacturing methamphetamine and smuggling it into IV bags, one of which was accidentally used on Rameriz.

In the end, the Livermore Lab’s theory is the most accepted so far. And it’s got plenty of tests and experiments to back it up.

But still it is just a theory. We’ll likely never know exactly what happened on that weird night in 1994. Luckily nothing like that has happened since that we know of.

Which actually leads me to believe the DMSO theory, it was just such a unique set of circumstances, everything had to be just right for it to happen.

And I should probably close by recognizing that at the heart of this mystery is an actual person, who was tragically taken far too soon, and is sadly remembered for the single weirdest thing about her life, that thing being how it ended. Rest in peace.

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