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Hey Prime members, you can binge episodes 41 through 48 of Mr. Ballin's Medical Mysteries right now and ad-free on Amazon Music. Download the app today. A 40-year-old man stood next to his teenage daughter in a hospital room, clutching her hand as she lay there unconscious on a gurney. A flurry of doctors and nurses moved all around them, securing an oxygen mask over the girl's nose and jabbing her arms with needles. The father couldn't believe this was really happening.
Just an hour ago, he'd come home to find his daughter passed out on the floor of the kitchen, her face and neck were totally beet red. He didn't know what had happened, but his best guess was that maybe she had accidentally overheated the oven while making food, and then when she opened up the oven door, a rush of heat came out and it burned her. He didn't know what else could make her look so sunburned on such a cloudy December day.
A nurse put her arms on the father's shoulders and told him he needed to step aside. So, the father squeezed his daughter's hand one more time, then let the nurse guide him out of the hospital room. The nurse told the father that his daughter's kidneys were failing. They were going to rush her to the intensive care unit for emergency dialysis. The father blinked, trying to process what the nurse had just told him. He didn't understand how his daughter's burned skin could lead to kidney failure. People died from that.
He watched helplessly as the medical team wheeled his daughter's gurney out of the room and down the hallway. And as they disappeared through a set of double doors, it hit him that he might have just seen his little girl alive for the last time. The father prayed that her doctors could figure out what was wrong with her before it was too late.
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From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. If you liked today's story, please ask the follow button if you can borrow their favorite hairbrush, and then when they say yes, only use it on your main coon cat, and then without cleaning it, give it back. This episode is called The Sunless Burn.
It was December 1979 and a young woman named Rose Harmon shivered in the cold at a bus stop in Madison, Wisconsin. The ground was covered in icy gray slush and the whipping wind chilled her to the bone. But still, Rose couldn't help feeling cheery. All the lamp posts around her were decorated with Christmas lights and she just loved the way the city looked this time of the year. The 18-year-old high school student shifted her backpack from one shoulder to the other as her bus finally arrived at the stop.
When the hydraulic doors opened, Rose stepped on board, and immediately it hit her how much warmer it was inside of the bus than it was outside, to the point where her cheeks flushed and she lowered the hood on her jacket. But as she walked towards the back of the bus, it just felt like the temperature inside the bus was only rising. Rose unbuttoned her parka, but it didn't help. She began sweating, and then suddenly Rose felt so overheated she could barely breathe.
The edges of her vision went dark as she tried her best to gulp down air and get her coat off. She could hear people around her reacting to her strange, desperate behavior. Someone was telling the bus driver to pull over, pull over, call an ambulance. And then Rose felt a sharp pain in her knees as she collapsed to the floor and then everything went black.
A few hours later, Dr. Russell Chesney made his way to the intensive care unit at the University of Wisconsin Medical Center. Dr. Chesney was a kidney specialist, and any time he was paged to go to the ICU, it was usually bad news. And tonight was no exception. He just received a call from the emergency room letting him know that they were rushing a patient named Rose Harmon up to the ICU for kidney failure.
When Dr. Chesney reached Rose's room, he saw a doctor standing at the foot of her bed scribbling something down on a medical chart while a nurse rummaged through a black backpack that was sitting on the cabinet along the wall. The doctor at the foot of the bed looked up as Dr. Chesney came inside the room and the doctor kind of motioned to the unconscious young woman lying right there in the hospital bed with the oxygen mask strapped over her face. Dr. Chesney looked at Rose and felt his chest tighten.
He knew Rose was only 18 years old, but in person, she looked even younger. She was far too young to be suffering from kidney failure. Dr. Chesney stepped closer to the bed and noticed that the girl's face and hands were covered in a blotchy pink rash that made it look like she was very badly sunburned.
The doctor who had already been in the room told Dr. Chesney that Rose had come into the ER unconscious and with a very high fever. She was barely breathing and when the doctor performed an initial exam, he heard crackling in her lungs. It was a warning sign that her lungs were filled with fluid and they needed to perform a procedure to drain them. However, before they could extract the fluid, Rose's kidneys began to fail. And so that was when they had called Dr. Chesney.
Dr. Chesney couldn't believe how quickly Rose seemed to be breaking down. And Dr. Chesney had never seen anything like this list of symptoms she had, especially her sunburn-like rash. He knew that Rose's body was in shock, which meant that it wasn't properly able to pump blood to all her organs. That was why her lungs and kidneys were failing.
But he had no idea why Rose's body had gone into shock in the first place. And in order to save Rose, that was the question that Dr. Chesney would have to answer. Otherwise, even if he could stabilize her right now, she would eventually go back into shock.
Given the rapid onset of Rose's symptoms, Dr. Chesney guessed that she must have contracted a very serious infection. He needed lab work to better understand what was wrong with Rose, but there was no time to wait for test results, which could take up to a couple of days. She needed help right now. A moment later, the nurse returned and told Dr. Chesney that she'd found Rose's ID in her backpack and contacted her parents.
Dr. Chesney thanked the nurse and gave her a new task: to start Rose on a few different antibiotics. He hoped that one of them would stop the infection from spreading. And, in the meantime, after they used a long needle to drain the fluid from her lungs, he would order as many tests as possible to identify the source of the infection. Dr. Chesney also decided to put Rose on dialysis, meaning a machine would now be flushing toxins from her kidneys, since her own kidneys were not able to do that, they were failing.
While the nurses got everything started, Dr. Chesney left to go check on some other patients and promised he would be back soon. An hour later, Dr. Chesney turned back into Rose's room. The sunburn rash had spread up her arms, making her look even worse. He checked her vitals and was dismayed at what he saw. Rose's blood pressure had fallen, which meant that her body was not coming out of shock. So, Rose's body still was not pumping enough blood to her organs.
Dr. Chesney decided to give the antibiotics one more hour to maybe work. It was nearing the end of his shift, but he wanted Rose to stabilize before he left the hospital. But when Dr. Chesney came back to check on her the next time, he could immediately tell the antibiotics were still not working. The rash had spread even more, now it fully covered Rose's arms and legs, her blood pressure was even lower than before,
Dr. Chesney was bewildered. The antibiotics should be able to fight off a wide variety of infections. So whatever Rose was fighting had to be extremely rare and very potent. Dr. Chesney clearly could not afford to sit around and wait for Rose's test results to come back. Otherwise, it would be too late to help her. So he ordered a chest x-ray, thinking maybe it would reveal that she had a bad case of pneumonia.
As orderlies wheeled Rose's gurney toward the x-ray suite, a nurse came into the room and told Dr. Chesney that Rose's parents had arrived at the hospital. Dr. Chesney immediately hurried out into the waiting room, meeting the parents right as they stepped off the elevator. Dr. Chesney was anxious to speak with them about Rose's health and felt a pang of empathy at the looks of sheer terror on their faces. Dr. Chesney invited them to sit with him for a moment. He explained that Rose was getting a chest x-ray and they could see her after that.
And in the meantime, he asked her parents to walk him through Rose's medical history. Specifically, he wanted to know if she'd been sick at all in the past week or if anyone around her at home had been sick.
But Rose's parents shook their heads, no. The mother assured the doctor that they'd all been feeling fine. They also hadn't received any word of any illnesses circulating at Rose's high school either. And the more they talked about Rose's medical history, the more it became apparent to Dr. Chesney that Rose was a very healthy, average 18-year-old girl. And so Dr. Chesney was stumped. Dr. Chesney didn't have any more questions to ask, so he thanked her parents and promised he'd come get them the moment they could see their daughter.
Then he turned on his heels and hurried back down the hallway towards Rose's room, anxious for the results of her x-ray. Thankfully, as soon as Dr. Chesney arrived, Rose's nurse was putting up all the x-rays on a light box so he could look at them. And Dr. Chesney took one look at the x-rays and he gasped. Rose did not have pneumonia, but the reason she was having trouble breathing was very obvious. There was bleeding in her lungs. Dr. Chesney could clearly see that Rose's symptoms were getting more and more dire.
But almost worse than that, they seemed kind of random and disconnected. They were not pointing him anywhere. There was one piece of good news though. When Dr. Chesney checked Rose's vitals, he saw that her blood pressure was rising. This meant the treatments they were doing were finally working and Rose was coming out of the shock. And so Dr. Chesney decided that Rose was stable enough for her parents to come see her even if she would not be awake.
So he turned out of Rose's room and headed back to the reception area where Rose's parents were waiting patiently, still looking absolutely terrified. He called them over and then led them back into their daughter's room, standing back to give them room by her bedside.
He told the parents that in his opinion, Rose would likely regain consciousness as her body stabilized. But what Dr. Chesney did not tell them was that he had no idea why their daughter's lungs were bleeding. He also had no idea why she landed in the hospital in the first place. Her symptoms were just totally confusing. And so Dr. Chesney knew he would need to consult with someone he trusted.
So, Dr. Chesney said goodnight to Rose's parents and he left the hospital and made his way to the home of a respected colleague. It also happened to be his own home. Twenty minutes later, Dr. Chesney's wife, Joan, had just thrown two chicken breasts in the oven when she heard keys rattling in the front door, then a familiar sound of footsteps moving through their foyer. Joan turned to greet Dr. Chesney as he walked into the kitchen and threw his car keys on the built-in desk near the fridge. He had a distant look on his face as though he were lost in thought.
Joan frowned. She could tell that her husband was stressed out about something. As she pulled more vegetables from the fridge, she asked him what was wrong. Dr. Chesney sighed and told her all about his new patient, Rose, and her baffling list of symptoms. He was at a total dead end and he needed his wife's help to figure out what was wrong with her. Joan nodded and put down her knife so she could think. Dr. Chesney's request was not unusual because Joan was also a doctor. The couple frequently bounced ideas off of each other when they had challenging cases.
Joan was an infectious disease specialist, and odd cases like this came across her desk all the time. And to Joan, something about Rose's symptoms, the fever, shock, and kidney failure, sounded familiar. But for the life of her, she couldn't remember why. Joan asked more questions about Rose, hoping that something might jog her memory, but she had no luck. She promised her husband she'd keep thinking about it, and then she went back to chopping up the vegetables. Now she was lost in thought as well.
When Joan woke up the next morning, Rose was immediately on her mind. In fact, the night before, she had even had a dream about Rose. It felt like the answer to what was going on with Rose was just beyond her fingertips. As Joan got out of bed, she decided she would pay Rose a visit herself that morning. She thought that maybe just seeing Rose in person might help her put the pieces together. An hour later, Joan followed her husband, Dr. Chesney, into Rose's room in the ICU.
Joan was shocked as she laid eyes on Rose who was still unconscious. The sunburned looking rash now covered Rose's entire body including the palms of her hands. Joan had never seen a rash like this in her entire career. She thought it looked almost like a chemical burn and wondered aloud if Rose could have been exposed to a chemical that her body absorbed through her skin. Or maybe she took a drug that her parents were not aware of at maybe a high school party or something like that
Dr. Chesney told his wife that the lab results should be ready any moment, and hopefully they would help them find an answer. Dr. Chesney said he'd go check on the test results progress, and then he stepped out of the room. While Joan waited for him to come back, she decided to check Rose's pupils and her reflexes. So Joan pulled a flashlight from the pocket of her white lab coat and then gently pulled back Rose's eyelids. Joan was surprised to see that Rose's eyes were totally bloodshot.
Joan was alarmed. She didn't know of any infections that cause shock and bloodshot eyes like this. She began to wonder if they were witnessing the birth of some new and potentially deadly disease. The prospect was terrifying and it sent Joan hurrying out of the room and down the hallway to find her husband.
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Two mornings later, Joan was on her way out of the hospital to attend a local conference on infectious diseases. Rose's test results had finally come back, but they were inconclusive. Thankfully, Rose had finally woken up and was stable for the time being. But Joan and her husband were not any closer to solving her case. Joan hoped that talking to some colleagues at this conference might help her come up with some new ideas. But before she could leave the building, she received a page calling her down to the ER.
This was unusual. She wondered why an infectious disease specialist would be needed in the emergency room. But in the pit of her stomach, she feared she already knew the answer. That she was right, that Rose was suffering from some brand new deadly disease, and now it was spreading and so they might have new patients downstairs. Joan hustled across the hospital, anxiety really starting to settle in.
Moments later, she rushed into the ER to find another young woman lying on a gurney covered in a sunburn-like rash who was also struggling to breathe. An ER doctor was helping two nurses wheel the patient into a hospital room. As Joan walked beside them, the doctor told her that the patient was a 15-year-old girl who had collapsed in her kitchen. Like Rose, this new patient had developed her symptoms suddenly and her parents had rushed her to the hospital right after she'd collapsed.
Joan suddenly felt a knot in her stomach. She knew that two young women with the same bizarre symptoms could not be a coincidence. But she didn't have time right now to worry about a potential new epidemic. The patient in front of her was crashing. Joan followed the ER doctor into the patient's room, and as she did, she told the doctor the exact cocktail of IV fluids and dialysis that her husband, Dr. Chesney, had given to Rose. The ER doctor thanked Joan for saving him a call up to the ICU.
Joan gave him a grim smile. She knew this treatment she had suggested would likely stabilize this new patient for the time being, but she knew it would not cure her. Joan looked down at her watch and realized she might be late for this conference and so she needed to leave right now. She needed to attend this conference really for the sake of Rose and this new patient.
Joan hoped that one of her colleagues at this conference might recognize the symptoms these two girls were showing and be able to help figure out what was making them sick so they could finally treat them and cure them. An hour later, Joan walked into a large lecture hall, a styrofoam cup of coffee in her hand. The desks had all been arranged in a big circle, and so Joan took a seat on the far side of the room. There were already a few colleagues getting settled, and so Joan waved at a friend as she set her things down and took out her notepad.
All morning, specialists took turns presenting cases that involved different infectious diseases. Some had been solved, and others still needed to be diagnosed. They were all interesting, but it was the last case that caught Joan's attention.
The speaker handed around copies of a file for one of his current patients. She was a 25-year-old woman, also local to the area, and just like Rose and the 15-year-old girl at the hospital, this patient had also experienced sudden kidney failure, a high fever, and a sunburn-like rash. The presenter broadly described the diagnosis as kidney failure with shock, although they had no idea what had caused her kidneys to fail in the first place.
As soon as the presentation was over, Joan hurried over to the last speaker to talk to them about their patient and maybe compare notes. The two doctors looked over the patient's files together and quickly they saw all three cases were basically identical. The other doctor looked at Joan hopefully and asked if she'd been able to figure out what was making these young women go into shock.
Joan just shook her head. She said she was still trying to figure it out, and in fact, that was why she had come over to talk to this doctor, because she was hopeful that they had the answer to what was going on. And so Joan silently ran over the symptoms again in her head, trying to put the pieces together, and then out of nowhere, it just clicked. Suddenly, Joan remembered where she had read about this disease before, in a journal article published a year earlier.
That was why when her husband, Dr. Chesney, had come home and first told her about the symptoms Rose was showing, they seemed so familiar. This article was the reason. Joan quickly thanked her colleague and promised she'd be in touch. Then she hurried out the door and drove back to the Madison Medical Center as fast as she could and then nearly ran to her office. Once she got there, she began rummaging through the stacks of articles and journals that she'd spent the past two days piling up on her desk.
Finally, she found the one she'd been looking for. It was in a medical journal called The Lancet. Joan flipped through the pages and found the article that had been published a year earlier. It described the case of an adolescent girl who'd suffered the exact same rashes and other symptoms as Rose and the other two patients. The article described how the girl had contracted a strange new illness caused by a potentially deadly bacteria that entered her body through an open wound.
The result, the researchers concluded, was a disease that had never been seen before. Joan tapped her foot, thinking. The symptoms matched, but neither of her patients had any open wounds on their bodies. There was clearly some piece of the puzzle that was still missing. Joan decided to order one more test for both Rose and the 15-year-old girl to see if they were infected with the same bacteria as the girls referenced in this article.
In a day or two, she would know whether her current cases and the cases from this article were actually linked. But in the meantime, she knew that if there were already three cases of this potential bacterial illness, there would be more. And so she decided it was now time to call the Wisconsin Department of Public Health and tell them they had a potentially very big problem on their hands.
The next afternoon, Joan was sitting in her office catching up on paperwork when a tall man wearing a nice suit knocked on her doorframe. He looked anxious and out of breath as he introduced himself as Dr. Jeff Davis, an investigator with the State Department of Health. He'd spent the entire morning interviewing family members of the three women affected by this mystery disease.
Jones stood up immediately and thanked him and said, please come in and sit down. But Dr. Davis just shook his head and said he couldn't stay. He just wanted Jones to know that he did find a link between the three cases. Dr. Davis explained that the three patients had almost nothing in common. They didn't eat the same things, they didn't go to the same places, or lived similar lifestyles. The only thing they shared was the fact that they were all young women.
And so he thought that they could have something in common biologically, and he'd wondered if maybe they had all been menstruating at the time they got sick. So he checked their charts and learned that yes, all three were having their period when their symptoms developed. Also, Rose, who was now able to speak, would tell Dr. Davis that she actually remembered getting a similar-looking rash on her body the month before when she had her period the last time.
This was a promising link, but Dr. Davis said he didn't know what it meant or if it was even relevant at all. After he was done speaking, Dr. Davis just looked at Joan expectantly as though she could now solve the mystery.
But Joan wasn't sure what to say. It didn't make sense. There was nothing about a period that would make these women so sick. But Joan knew that this connection was really all they had to go on, so she couldn't just dismiss the theory outright. And so instead, she took a seat and picked up Dr. Davis's notes from all the family meetings he had just had, and she began to read over them. The next morning, Joan stepped into her office to find the lab results sitting on her desk. She felt a rush of energy as she grabbed them and began scanning the documents in her hand.
It would turn out both of her patients, Rose and the 15-year-old girl, had tested positive for a life-threatening infection from bacteria called Staphylococcus aureus. This was the same bacteria that infected the girls in the Lancet article Joan had read, which meant Rose and the 15-year-old girl had the new syndrome outlined in the article which the researchers named Toxic Shock Syndrome.
Joan breathed a small sigh of relief. At least she knew what she was treating now. She hoped that with enough specialized care, both of her patients lying in the ICU would make a full recovery. But Joan still had a very big problem. She still didn't know how her patients could have contracted the deadly staph infection in the first place. They had no open wounds, no place for the bacteria to enter the bloodstream, and no
She remembered Dr. Davis' observation that all the women were on their periods at the time. Joan wondered if Rose and the 15-year-old girl had taken a contaminated painkiller to alleviate their cramps and maybe that's why they got sick. But this was only a theory, and until doctors figured it out, more people would likely get sick. Joan hoped Dr. Davis and the other investigators at the Department of Health would be able to find the cause quickly.
About six weeks later, on a cold morning in late February 1980, an epidemiologist at the National Centers for Disease Control, named Bruce Dan, drove to work feeling completely at a loss. He had spent almost two months trying to find the cause of the toxic shock infections in Madison, Wisconsin and other locations all over the United States. To date, no one could figure out what was causing the illness or how to stop what was now a nationwide epidemic.
By now, the mysterious infections had become national news. And as Dr. Dan pulled into the parking lot at the CDC, a story about toxic shock came on the radio. He listened as the reporter summarized the stats that Dr. Dan had already memorized. Since early December, 107 cases of toxic shock had surfaced in 33 states around the country. Thankfully, no deaths have been reported yet.
Dr. Dan switched off the radio, parked his car, and walked to his office in silence. As he said good morning to his secretary, his secretary handed him a stack of memos. This had become routine, because ever since the newspapers, TV, and radio started publishing daily reports on toxic shock, Dr. Dan had received hundreds of calls from women all across the country experiencing similar symptoms.
Dr. Dan thanked the secretary and was about to leave when she stopped him and she handed him one more memo. He looked down at it and as he read it, his stomach dropped. That morning, a young woman living in Wisconsin had become the first person to die from this mysterious infection. This woman was not one of Joan's patients, so she was not Rose or the 15-year-old girl. And in fact, by this point, Rose and the 15-year-old girl had actually fully recovered and were back with their families.
But now it was clear to Dr. Dan that this infection could turn deadly and Dr. Dan had been too late to stop it. He walked into his office so upset he wanted to kick his desk chair. He had always been very motivated to solve this mystery, but now his motivation was through the roof. He decided it was time for drastic action. He would find the answer to this riddle no matter the cost.
Over the next few weeks, Dr. Dan and his team made thousands of phone calls interviewing women who were being treated for toxic shock. They also talked to young women who were not getting sick for comparison. At the end of each day, Dr. Dan would spend hours in his office reading the notes taken during each of these calls, searching for anything that stood out. Meanwhile, the number of toxic shock cases mounted.
Within a month, more than 100 serious cases had been reported. And this only motivated Dr. Dan to work harder and stay later, losing himself in his notes. And finally, after four weeks of hard work, Dr. Dan found a link. He discovered that all the women who developed toxic shock syndrome used tampons when they menstruated, not pads. Dr. Dan sat at his desk scratching his chin.
He knew he was onto something. Granted, tampons had been on the market for more than 50 years. In fact, 50 million women used them every month in the United States alone. Out of that 50 million, only several hundred had gotten sick. So, clearly, the vast majority of tampons were causing no problem at all. Dr. Dan wrapped his pen on the desk thinking. And he wondered, maybe it was just one brand of tampons that had somehow become contaminated in some way.
And so he decided to begin calling tampon manufacturers and what he found would finally solve the mystery. As Dr. Dan and his colleagues conducted their surveys, they discovered that in about 70% of the toxic shock cases, the women used tampons from a brand called Rely. Specifically, they used the heavily absorbent version.
At first, this didn't make sense to Dr. Dan. Rely had introduced the heavily absorbent tampons six years earlier, in 1974, but there was no evidence linking them to toxic shock until this outbreak had started in late 1979. However, right before the outbreak began, Rely began using synthetic materials. And the other brands, which accounted for the other 30% of toxic shock cases, also were using synthetic materials, just not as much.
It turned out that while these materials allowed for much better absorbency, they also helped promote the growth of the bacteria that causes toxic shock. Once Dr. Dan discovered the link between relied tampons and toxic shock, the CDC published an article with their findings. For Dr. Joan Chesney and her husband Russell, the study was a huge relief. Thankfully, all their patients had fought off the deadly infection, and now that the word was out, they were hopeful the outbreak would taper off.
After some initial resistance, Rely superabsorbent tampons were finally pulled from the shelves in September of 1980. By that point, 772 women had developed toxic shock syndrome from using tampons and the majority of them used Rely tampons. Tragically, 38 of those women died.
Their deaths inspired new industry regulations to reduce the absorbency of tampons and also to print mandatory warning labels on the boxes. And since then, toxic shock syndrome has become incredibly rare with only a handful of deaths every year.
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From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories. We use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
This episode was written by Aaron Lan. Our editor is Heather Dundas. Sound design is by Matthew Cilelli. Our coordinating producer is Taylor Sniffen, and our managing producer is Sophia Martins. Our senior producer is Alex Benidon. Our associate producers and researchers are Sarah Vytak and Tasia Palaconda. Fact-checking was done by Sheila Patterson.
For Ballin Studios, our head of production is Zach Leavitt. Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our head of sound is Marcelino Villapondo. Senior producers are Laura Donna Palavoda and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery.
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