The mystery fumes are still extracting their toll. The unidentified poison that sickened the emergency room staff at Riverside General Hospital nearly eight weeks ago still will not loosen its grasp on Dr. Julie Gorchynski and nurse Sally Balderas.
The 33-year-old doctor underwent surgery Wednesday to try to save her knees. The bones that make up the joints are dying for lack of blood circulation, she said--a condition that Gorchynski blames on whatever happened that night in February that affected her and five other emergency room workers.
Whether doctors can restore the circulation to her knees or will end up having to replace them with artificial joints is just one baffling question in the medical mystery. During her hospital recovery, Gorchynski suffered from chest-seizing muscle spasms and breathing lapses that necessitated use of a respirator.
Even now, she is unsure if she will ever be able to breathe normally again because the mystery agent that invaded her body somehow seems to have affected her lungs. She has been unable to draw a full breath since Feb. 19, she said.
"I'm frustrated," said Gorchynski, who returned to work April 1 but continued for just a week before the pain in her knees became excruciating. Now she can walk only with crutches. "We still don't know what those chemicals were, and we can't foresee these kinds of complications."
Sally Balderas remains off work too, her body racked by conditions caused by the same mystery fumes.
She has pounding headaches and often doubles up from abdominal pain. She is still vomiting. She cannot sleep for much more than an hour at a time--and when she does doze off, her mother, father and husband take turns watching over her.
Like Gorchynski, Balderas became afflicted with sleep apnea, a disorder in which breathing temporarily stops.
"Nobody knows anything," Balderas said, sounding tired and resigned. "It's so frustrating still not knowing what happened."
Gorchynski and Balderas were the two most seriously injured by the mystery fumes the night that cancer patient Gloria Ramirez, a 31-year-old mother of two, was wheeled into Riverside General, complaining of nausea and breathing difficulties. She was in cardiac arrest and died 36 minutes later.
Some of those who tended to Ramirez said her blood, drawn into a syringe, had a foul smell that sickened them. A couple of people said the blood smelled like ammonia. One doctor said it seemed to contain white crystals; another doctor said he noted yellow specks. One witness said Ramirez's skin looked oily.
Two doctors, two nurses and two respiratory therapists fell sick. Some just got dizzy. Others collapsed outright, including Gorchynski, who was hospitalized for two weeks, and Balderas, who was hospitalized for 10 days.
Nearly eight weeks later, authorities say they still are not sure what happened, despite an autopsy of Ramirez's body to determine whether she was the source of the toxin or was a victim of the same poison that affected the others.
So far, there are no answers.
Officials hope to make progress in their investigation this week, when a group of medical experts and scientists are to discuss what they have learned so far.
"This is clearly one of the most complex cases, if not the most complex case, we've ever faced in this county," said Tom DeSantis, the Riverside County government's public information officer who has served as spokesman for the county agencies involved in the case, including the county-operated hospital.
In a meeting today, experts assigned to the case "will focus on bringing all the pieces of this puzzle together, so we can start assembling them," DeSantis said.
Meanwhile, Ramirez's body, still not embalmed, remains sealed inside a body bag within an airtight, gray metal casket in a chilled storage room at the coroner's office.
Attorneys for the Ramirez family plan to seek a court order today that would allow a family-retained pathologist to conduct an independent autopsy on the body.
Ronald Schwartz, a Newport Beach attorney who specializes in environmental cases, also wants the county to turn over its investigative files so the pathologist can learn what is known so far. Schwartz also wants to get depositions from the coroner's staff. The county is resisting, saying the requests would compromise its investigation.
Schwartz suggests that the county is involved in a cover-up. He contends that it wants to disguise the fact that something went amiss in the emergency room that makes the county, not Ramirez, liable for what happened. Schwartz wants a grand jury to investigate.
"The county is destroying the single most important piece of evidence," Schwartz said. "They're destroying Gloria Ramirez's remains by having delayed things this long."
Particularly disturbing to the family, Schwartz said, is a condition by the county--supported by Cal/OSHA, the state job safety agency--that the casket not be opened, even to confirm the identity of the body inside it, until authorities are sure it no longer poses a public health risk.
"The children are suffering, the family is suffering," said Maggie Garcia-Ramirez, Gloria's sister. "We just want a normal burial, but we don't even know if it's her body in the casket."
The casket has been opened twice--once for the initial autopsy six days after Ramirez's death, when pathologists donned protective suits and worked inside a specially constructed and ventilated area, and a second time last month when, wearing just oxygen masks and protective clothing, the coroner's staff took additional tissue samples for further analysis, then prepared the body for burial. The family did not learn of the second procedure until two weeks later.
Neither time did the county say whether the body was emitting toxic fumes, but DeSantis explained the elaborate protocol as a necessary precaution because of the uncertainty over the source of the fumes in February.
Indeed, county officials have insisted that no details of the continuing investigation be revealed, even to the Ramirez family. Like other law enforcement agencies, the coroner's office must work in secret until something conclusive can be announced, DeSantis said.
DeSantis refused even to confirm that the syringe containing the suspect blood has been analyzed.
"This investigation," he says, "isn't as simple as testing a hypothesis by checking for the presence of a particular chemical. We're dealing with a complete unknown, so it's been a process of deductive reasoning. The testing that is being performed is designed to rule out the thousands of possible chemical compounds and to narrow the focus of the investigation."
Asked if the focus had been been narrowed, he said: "I can't give you anything on that."
Consulting the county on its investigation is Dr. Anna Maria Osorio, chief of the state Department of Health Services' division of environmental and occupational disease control in Berkeley.
Cal/OSHA is conducting its own investigation and studying whether the hospital itself may have been the source of the mystery fumes.
"It's a possibility we may never find out what happened," said Cal/OSHA spokesman Rick Rice. "That's particularly troublesome, but, in fact, that happens quite a bit, especially if you're dealing with airborne contaminants."
The fact that answers are not forthcoming frustrates Sally Balderas, who has weekly checkups with her neurologist.
Balderas said she is eager to return to work, but is not healthy enough yet. "There's nothing I can do but sit down a lot," she says. "I get so short of breath."
Gorchynski said what concerns her most is the possible onset of more complications, because she does not know what chemicals have contaminated her body.
"I'm getting a lot of support from my family and friends," Gorchynski said. "I used to deal with stress by surfing, but now that luxury is taken away from me.
"We're all still waiting to see what might come from the autopsy," she said.
There is a 70% chance, she said, that her knee surgery will prove successful. She wants to return to emergency room work.
"I realize more than ever," she said, "how fragile life and health can be."