Because there is never a dull moment, never a routine, a career in emergency room medicine beckoned Dr. Julie Gorchynski. Standing on her feet 12 hours a day was a small price to pay for the most exciting and challenging career she could imagine.
But the 33-year-old physician said she never dreamed that emergency room work would send her into intensive care--the victim of a bizarre poisoning that forced her to undergo knee surgery and that, for now, has left her unable to stand.
Gorchynski was the most seriously injured of six emergency room workers in what became known to the world as the "mystery fumes" case after a dying cancer patient was brought to Riverside General Hospital in February.
Gorchynski, who is on leave from Loma Linda University Medical Center, is ready to file a claim against Riverside County, angered by what she characterizes as the county "stonewalling" her attempts to get to the bottom of the mystery.
A Riverside County spokeswoman would not comment on Gorchynski's threatened claim, which is a precursor to a civil lawsuit. But officials have steadfastly maintained that the aging county hospital was not the source of the mystery fumes.
"The impact on our employees, some of whom remain ill, greatly concerns us," hospital administrator Tomi Hadfield said in April after the emergency room's plumbing and ventilation systems were examined by industrial hygienists and others in search of an explanation. Based on those reviews, "any reasonable person must conclude that the hospital's facilities continue to be safe and effective," Hadfield said.
The controversy over the fumes began Feb. 19, when Gloria Ramirez, a 31-year-old cancer patient, was brought to the county hospital's emergency room with severe breathing difficulties. The room was evacuated when Gorchynski and others fell ill after inhaling what she said were ammonia-like odors. The toxic fumes, Gorchynski believes, came from blood drawn from Ramirez minutes before she died.
Another doctor, two nurses and two therapists also complained of dizziness and nausea, and two of them, who also collapsed, were hospitalized for several days.
Gorchynski was hospitalized for two weeks with breathing problems, muscle spasms and pancreatitis, and today is recovering from avascular necrosis of the knees--deterioration of her knee bones caused by lack of blood circulation. Her prognosis is uncertain.
"It was the worst pain I'd been in in my life," she said of the damage to her knees. "It shot up my thighs and down to my ankles."
Gorchynski believes that the bone destruction was the direct result of whatever toxins she unwittingly inhaled that night because she had no existing conditions that could explain what afflicted her.
Gorchynski's orthopedic surgeon, who is treating her for the knee damage, agrees.
"Something entered her body by breathing, some sort of a volatile chemical," said Dr. Christopher Jobe at Loma Linda University Medical Center. "We have found no other reason for this."
The result, shown through magnetic resonance imaging, was "massive osteonecrosis"--dead knee bones, he said.
Gorchynski was in a wheelchair for three months and today, even with crutches, can stand for only 15 minutes at a time. Full recovery, after two surgeries in April to reintroduce blood flow to her knees, might take two years, doctors said. If her body is unable to regenerate new bone, she will have to be fit with prosthetic joints.
Charging that Riverside County officials have botched the investigation into the highly publicized incident, Gorchynski said she will file a $6-million damages claim against the county Monday for emotional distress, medical costs and loss of earnings.
Most of all, though, Gorchynski said she wants the answers to the question that continues to baffle scientists and medical experts: What were those mystery fumes?
"The frustration and the anger is with me every day," Gorchynski said. "Because of the stonewall from the county, we don't know 100% for certain what happened. But the people responsible need to be held accountable. (Emergency room) doctors don't go to work and expect to be poisoned."
Her attorney, Russell Kussman--who is a former emergency room doctor and board-certified internist--said the county's refusal to concurrently share the findings of its investigations with Gorchynski, to aid in her recovery, is suspicious.
"The county's behavior suggests either incompetence or a cover-up," he said. "It's hard to believe that they're that incompetent, and that leaves only one other alternative.
"All we know is, something happened that night, and it either came from Gloria Ramirez or it came from the hospital."
Ramirez's family has filed its own wrongful death claim against the county, contending that fumes in the hospital were responsible for her death.
The Riverside County coroner's office determined that Ramirez died of cardiac dysrhythmia and acute renal (kidney) failure brought on by cervical cancer.
Kussman said it is his medical opinion that the only way cervical cancer could lead to kidney failure is if the tumor spread upward and obstructed both kidneys or both ureters, the tubes that carry urine from the kidneys to the bladder.
The final, nine-page autopsy report was released Thursday, concluding the most bizarre autopsy in county history--one in which the forensic pathologist and his assistant donned moon suits and entered a specially built examination chamber, to the fascination of gathered media and the public.
In his final report, pathologist Dr. Robert Ditraglia blamed the renal failure on "obstructive uropathy, kidney." But he made no reference to tumors affecting either the ureters or the kidneys--a curious and bothersome omission, Kussman said.
"We still don't have all the answers," he said.
In a previously released toxicology summary report, the coroner's office said it found nothing in Ramirez's system that might explain the emission of toxic fumes. But the complete toxicology report has not yet been released--and it is needed to explain chemical findings that otherwise make no sense, Gorchynski said.
There were missed opportunities in the investigation to collect clues, Kussman said.
Even though the blood drawn from Ramirez was preserved, the syringe was disposed of in a hazardous materials container by an emergency room worker as the staff was dropping to the floor, and later destroyed in the hospital incinerator before anyone thought to save it.
Furthermore, no effort was made to shut off the emergency room's ventilation, to preserve whatever fumes might have been present. When the city Fire Department's hazardous materials team probed the room for gases more than two hours later, nothing unusual was detected.
Kussman also complains that Ramirez's body--double-bagged, then placed in a sealed aluminum casket--was not preserved properly by the coroner's office in the days between her death and the autopsy so that chemical agents could be better preserved.
Cal/OSHA, which investigates accidents in workplaces, and epidemiology experts with the state Department of Health Services are still investigating the incident but have not released any conclusions.
One state official said he has never seen his office resort to "such high science" to try to get to the bottom of a mystery.
But whether an answer will be forthcoming remains unclear.
"There is no guarantee that our epidemiology study will find the answer to the mystery," said Scott Lewis, spokesman for the state health department.
Gorchynski says she has no doubt that something poisoned her that night. Both she and the head emergency room doctor said they saw a mysterious, yellowish, spiked crystal in the syringe containing Ramirez's blood. When Gorchynski was treated that night at a different hospital, a doctor and nurse there noted strange crystals in her blood, Gorchynski said.
Given the absence of organic causes, some medical experts having no special insight into the Gorchynski case have publicly suggested that she and the others may have fallen victim to mass hysteria, perhaps prompted when one person in the emergency room legitimately fell sick for reasons unrelated to Ramirez.
Gorchynski seethes at the speculation. "I had chemical burns in my throat and nose, lungs working at half-capacity, biopsies showing dead knees, a drop in enzyme levels and crystals in my blood as well. It's all medically documented," she said.
She wonders if the culprit might be ethylene oxide, a toxic gas that is used to sterilize medical equipment and that causes symptoms that she says are "identical" to hers when a person is exposed to it. Riverside General Hospital has previously been cited by Cal/OSHA for improper handling of ethylene oxide. The syringe, however, was in a sealed container from an outside medical supplies distributor until it was opened and used on Ramirez, Gorchynski said.
She has received psychiatric help to deal with nightmares, traumatic flashbacks and her mixed feelings of anger and sadness over what has happened to her.
"When I learned of my prognosis," she said, "I was devastated. I thought I'd be back to work in a few months. Now it's been nearly six months and I still don't know.
"I'm learning to be patient," she said. "I'm doing research on what's happened to me, I'm doing physical therapy, and I'm studying for my specialty board. I want to stay with emergency medicine."