One of those stricken would say later that Ramirez "had this film on her body, like you see on the ground at a gas station." Others would report seeing crystalline particles in Ramirez's blood.
"I've never seen anything like that," said Dr. Humberto Ochoa, the hospital's chief of emergency services. "I have no explanation."
No one can explain it even now.
Two months after her death on Feb. 19, Gloria Ramirez was finally laid to rest here yesterday - but not the mystery that has haunted her passing.
There were no moon-suited medical detectives at Ramirez's burial, as there were at her autopsy - no airtight cubicles or decontamination baths or high- tech air monitors.
Friends and relatives who gathered Tuesday night for a memorial service remembered Ramirez not as a medical oddity but as a generous and playful soul, the kind of person who ran through sprinklers, shared her last dollar, and double-checked the schoolwork of her children, Evelyn, 12, and Buddy, 10.
But even as the family sought to reclaim the Gloria they knew from her tabloid image as the Fume Lady of Riverside, questions hung as heavy as
heartaches over her service.
What killed Gloria Ramirez?
Was she the source of the toxic fumes that felled emergency workers?
Or was she a victim, too?
"We may never really know what caused this," said Rick Rice, a spokesman for California's Occupational Safety and Health Administration, one of several agencies still investigating the case.
As authorities await the results of lab tests that may finally shed light on the case, family members struggled this week to put aside the bitterness they feel toward county and hospital officials whom they blame for "turning Gloria into a toxic monster," in the words of brother-in-law David Garcia.
Garcia and other family members are convinced that the toxic fumes originated inside the hospital, which has a history of contamination problems, and that authorities have sought to shift the blame to Ramirez.
'KEPT IN THE DARK'
"It's very hurtful," Garcia said. "The family has been kept in the dark while she has been a hostage and scapegoat."
So far, the county has denied the family access to lab results and other information on the case. And it refused to release the body until late last week, by which time the unembalmed corpse had so badly deteriorated that a private autopsy arranged by the family revealed little.
"We hardly recognized her," Garcia said.
County officials insist they have acted only to safeguard their investigation and protect the public health.
"What we know is that a very critically ill patient was brought to the emergency room and, while trying to save her life, six of our medical workers fell ill," said Tom DeSantis, a county spokesman. "Is there a link? That's what we're trying to find out."
County officials have tried to be sensitive, DeSantis said, "but they also understand their responsibility to the public health cannot be compromised."
COFFIN REJECTED
By yesterday's funeral, relations between officials and family members had become so contentious that the family rejected a coffin donated by the county and bought its own.
The family has also hired a Newport Beach lawyer to handle whatever civil litigation might arise.
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Gloria Ramirez's autopsy, which took place six days after her death, was a spectacle worthy of science fiction.
Conducted in an airtight 8-by-15-foot cubicle fashioned from plywood, duct tape and plastic sheeting, the procedure was performed in the middle of the night, when fewer people would be around and at risk of contamination.
Before pathologists were allowed into the cubicle, two industrial hygienists entered. They slowly opened Ramirez' airtight coffin, poked holes in two bags that enveloped her body and monitored the air inside the chamber for 90 minutes for toxic gases.
Finding none, they cleared the way for pathologist Robert Ditraglia and forensic expert DeWayne Matthews, who performed the autopsy. Throughout the
procedure, a rescue team waited outside, monitoring the air and watching the two men on closed-circuit television.
RESULTS AWAITED
Afterward, Ditraglia and Matthews took four decontamination baths, using children's wading pools set up in the parking lot of the coroner's office. For the last bath, they stood in their underwear in the cold morning air.
Blood and tissue samples from Ramirez's body, as well as air samples from her aluminum coffin, were shipped to laboratories around the country for analysis. Some results are still awaited. Those that have come back have been closely guarded by county officials.
In the absence of facts, theories have abounded.
"Not too many things can cause a first-whiff knockdown punch," Dr. Rick Dart, toxicology spokesman for the American College of Emergency Physicians, said early in the probe.
The two most likely culprits - hydrogen sulfide and cyanide - were quickly ruled out by blood tests from sickened workers.
Another possibility - insecticide poisoning - seemed to be supported by the symptoms of stricken medical workers and the ammonia-like smell they reported coming from Ramirez's blood.
Dr. Julie Gorchynski, a third-year medical resident who was the worst hit, was hospitalized for 13 days. Left unattended, her breathing would stop without warning, and she suffered excruciating muscle spasms. She underwent surgery last week to restore failing circulation in her knees, which doctors have attributed to her poisoning.
Authorities said a similar poisoning case occurred three years ago in Perth, Australia, when a man attempted suicide by swallowing Phostoxin, an organophosphate used to kill weevils. When he was brought into a hospital emergency room, fumes from his body felled emergency workers and forced an evacuation.
But unlike the Riverside case, paramedics who transported the Australian man were also affected. In Ramirez's case, none of the ambulance attendants complained of illness or odors, even though they reported spilling blood while inserting an intravenous line.
Other theories - including suicide poisoning and an adverse reaction to chemotherapy - also were discounted. Family members said Ramirez, who was in the late stages of cervical cancer, wound up at the emergency room after becoming violently ill from drugs she had taken to relieve the pain.
But they said she was not undergoing chemotherapy and that she would not have taken poison to kill herself.
The focus later shifted to the emergency room itself. Although tests done the night of the incident revealed no contamination in the room or adjoining air shafts, investigators acknowledged that drains in the emergency room had not been tested.
Also, Dr. Ochoa recalled that, as his colleagues began collapsing, he had noticed liquids in the drain of an emergency room basin and flushed it.
State health and safety investigators also have focused on the plumbing, which they said had caused problems in the past. In 1990 and 1991, the hospital was cited for a series of violations involving exposure standards for ethylene oxide, a highly toxic gas used for sterilizing surgical instruments.
Days after Ramirez's death, the county brought in specialists who examined the hospital's plumbing and pronounced it clean. Later, however, a former patient at the hospital came forward to say that he had been forced from his room weeks earlier by noxious fumes eminating from the hospital air shaft.
"I heard the sink gurgling and then there was a horrible smell," the man's wife told the Los Angeles Times. "It was an awful smell, a toxic smell, and I knew if I stayed in the room any longer, I'd get sick."
In the end, Gloria Ramirez's family did what it could to erase the indignities of recent weeks.
At the memorial service Tuesday night, the Rev. Brian Taylor said he agreed that "her death was unjust and the treatment of her body was unjust." But he urged her loved ones to "let go of the pain and anger."
Ramirez's daughter, Evelyn, wrote her mother a farewell poem, which was read to mourners as Mariah Carey's song "Hero" piped softly over the chapel's loudspeakers.
And yesterday morning, before her body was lowered to its grave, Ramirez's brother, Eddie, sent three balloons soaring into the sky to symbolize her soul's flight into heaven
Ramirez was buried without her heart. It has been retained as evidence by the county coroner.
