Solved: a Medical Puzzle

updated 11/21/1994 AT 01:00 AM EST

originally published 11/21/1994 AT 01:00 AM EST

DR. JULIE GORCHYNSKI REMEMBERS very little about the night of Feb. 19. She knows that she was eight hours into her 10-hour shift in the emergency room at Riverside General Hospital near Los Angeles when a 31-year-old cancer patient, Gloria Ramirez, was wheeled in suffering from cardiac arrhythmia. As Ramirez's blood pressure plummeted and her heart rate soared, Gorchynski, 33, a third-year medical resident, prepared to stabilize her heartbeat with electroshock. She remembers smelling foul ammonia-like fumes coming from the vicinity of the patient, and she noticed unusual white crystals forming in a syringe used to draw Ramirez's blood. Then she passed out. As she floated in and out of consciousness during the next 72 hours, "I could see all my friends on gurneys being treated," Gorchynski recalls. "I heard people screaming."

So began one of the most bizarre mysteries in the annals of modern medicine. As efforts to resuscitate the patient failed, attending doctors, nurses and medical technicians—most of whom noticed either the smell, the crystals or an oily sheen to Ramirez's skin—fainted or felt dizzy and nauseated. Twelve staffers were treated that night, and six of them were hospitalized. Gorchynski, the most seriously afflicted, developed a debilitating bone disease and has been unable to work since the incident.

Ramirez's death and the lingering illnesses suffered by Gorchynski and others confounded the experts, who came up with one implausible theory after another. Ramirez, says her sister Maggie Ramirez Garcia, 32, was treated "like a toxic monster." Her body wasn't released to the family for burial for nine weeks, even though the official cause of death was established as kidney failure stemming from cervical cancer. And after nothing unusual was found in the hospital's ventilation system, the Riverside County coroner's office decided in April that the mystery fumes were simply "the smell of death." In September, the California Department of Health Services concluded that some of the health workers had succumbed to "mass hysteria."

So the case rested until Nov. 3, when scientists at the Lawrence Livermore National Laboratory in Livermore, Calif., announced that they had at last come up with a possible explanation for the toxic fumes. Based on the presence of dimethyl sulfone in Ramirez's blood, they speculated that Ramirez had been using dimethyl sulfoxide, or DMSO, a non-FDA approved anti-inflammatory drug believed to be something of a cure-all. The DMSO could have oxidized into dimethyl sulfone when Ramirez received oxygen, and then, when doctors drew blood from her body, the dimethyl sulfone, exposed to colder air, could have formed potentially deadly dimethyl sulfate crystals. Gorchynski feels vindicated. When she heard the news, "I celebrated," she says. "It's nice to know that other people know it's not all in my head."

Gorchynski, of course, was certain all along that she wasn't going crazy—she was just getting sicker. She was hospitalized for two weeks following Feb. 19, suffering from muscle spasms, numbness in her arms and legs, breathing irregularities, pancreatitis and hepatitis. When she returned to work on April 1, sharp pains in her legs became unbearable and she had to stop. An MRI revealed that she was suffering from avascular necrosis, a failure of blood circulation, that affected her knees. The condition has resulted in three knee operations to date, and earlier this month Gorchynski filed a $6 million lawsuit against Riverside County and the state of California for medical negligence, emotional distress and medical costs.

Gorchynski, born in Winnipeg, Manitoba, and raised in Northridge, Calif., comes from a medical family: her father, Orest, is a psychiatrist, and her mother, Sonia, helps manage his practice. These last months away from the emergency room have been difficult, she says. She has spent most of them in a wheelchair or on crutches, and she had to have a ramp installed by the front door of her one-bedroom home in suburban Red-lands, 90 miles east of L.A. She has been depending on friends, family and especially her new poodle, Zoe, to keep her spirits up. "I got her because I was bored as hell," says Gorchynski, who in June completed her residency requirements from home. "I miss work."

The Ramirez family, too, has had a frustrating eight months. Gloria Ramirez, a Riverside native, was studying to become a nurse at the time of her death, and left two children, Evelyn, 12, and Buddy, 10, for their father, Angel, and her siblings to care for. The family is not buying the DMSO theory and denies Ramirez used the substance. "This is voodoo science," says Ron Schwartz, attorney for the family, which has filed a malpractice and wrongful-death suit against the county.

Riverside County's chief deputy coroner Dan Cupido, however, feels confident that the mystery has been solved. "Crystals in the blood, the oily sheen, the effects on the employees—all match exposure to dimethyl sulfate," he says. And though Gorchynski will probably suffer permanent knee damage, she is walking again and hoping she will be able to withstand the rigors of her new job on the emergency room staff at Loma Linda Community Hospital. "I love medicine," she says, "but that's my fear—that my legs won't be able to last 12 hours. I'll give it my best shot."

LORENZO BENET in Riverside

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