Join me as I discuss the deaths of 3 American tourists in Exuma, Bahamas from last year. Why did they die? Did the medical examiners get the cause of death right or was there another possibility?
Join me as I discuss the deaths of 3 American tourists in Exuma, Bahamas from last year. Why did they die? Did the medical examiners get the cause of death right or was there another possibility?
Alright welcome back everyone. How are y’all doing? Welcome to this week’s episode of Emergency Minute Episode 5. I cannot wait to get started and talk to you guys about some mysterious deaths of vacationers in Exuma in the Bahamas. You are not going to want to miss this one! But first, as always, I need to show some love and appreciation to each and everyone of you for the support, much love to you. If it wasn’t for your support, then my entire audience would be my wife, my mother, and a few of my friends and colleagues I’ve successfully guilted into listening to me. I hope you enjoyed last week’s episode of “Why does my ER visit take so long.” If you haven’t heard it, be sure to check it out. This week’s show is sponsored by all of you, so please share this on social media to help get the word out. Don’t forget to turn your Auto-download feature on wherever you listen to your podcasts. Happy to announce we’re on all Podcast platforms Apple, Prime, TuneIn, iHeart Radio, and most recently we added Google.
So this week’s show is to discuss the mysterious deaths of 3 Americans at a Sandal’s resort in Exuma, which is in the Bahamas. And of course, my disclaimer: I did not take care of these individuals, nor do I have any inside knowledge from Sandals, the clinicians who cared for these patients, or any other anecdotal sources of information. Furthermore, what happened to these people is truly tragic, and my heart goes out to their families. Lastly, I absolutely love Sandals, and am not implicating any wrongdoing by them whatsoever. In fact, I just booked a trip to Sandals Barbados in the Fall.
So why on earth did I pick this for a podcast topic? Well, for one, I was at that resort with my wife and another couple just months before the tragic deaths. Also, my background as a board-certified emergency medicine physician is sort of in my DNA and anytime I hear of an unusual cause of death it grabs my attention. But I think the biggest reason I wanted to talk about this is because I think they may have gotten it wrong.
So here’s the story. In May of 2022 3 American tourists were found dead in 2 separate, but attached, villas in Exuma, Bahamas. They were all in their 60’s. In the 1st villa, Police found the male unresponsive and, on the ground, with a female in the room as well. They were then directed to the 2nd villa, where a female was found in bed and the male was found slumped against the wall in a bathroom, also unresponsive. It was reported that they showed signs of convulsion and there was no evidence of trauma.
At a press conference a few days later, it was stated that all 3 individuals had expressed feeling ill the night before with symptoms of nausea and vomiting. One source said they had been seen by medics. Another source said they went to the “medical facility” and were seen by doctors. So, it’s a little unclear what level of training the initial care provider had that saw these folks the night before. Now there was a 4th victim who was actually flown to a hospital in Florida and survived this tragedy and presents some clues.
According to a report from ABC News, the victim’s son stated that his mom couldn’t move. That her arms and legs were swollen, and she couldn’t move so she yelled to get someone to come to the door.
So, for my medical students, nurses, and residents out there, what could cause this constellation of symptoms? We know these 4 people were all in 1 building, yet 2 separate rooms. It appears that there was at least weakness, if not frank paralysis by the description from the victim’s son of not being able to move. We know there was nausea and vomiting; ok, not a great clue because that goes with just about every other illness on earth. We also know there may have been seizures, but that may not be completely accurate because a lot of people get fluid in their mouths after cardiac arrest. We also would think it would have to be some type of toxidrome, right? Like, you can’t have multiple people just coincidentally have cardiac arrest with such proximity in rooms right next door.
So, what kind of toxins do we think about? Well in 2017, 25 travelers died in Costa Rica, and this was deemed to be from tainted alcohol, which had toxic levels of methanol (a wood alcohol), which is not supposed to be in drinks (that’s called ethanol). Sometimes in countries where taxes on actual ethanol, like the drinking type of alcohol, are high (or perceived to be too high), someone could decide to add methanol and dilute the ethanol to save money. Now this wouldn’t make any sense in this case because that would lead to hospitalization from severe vomiting, eventually end organ damage (like people going into liver failure, kidney failure, etc.) and that was not the case in Exuma.
What about Carbon Monoxide? It certainly would explain many of the symptoms. So, what are the most common symptoms of CO toxicity? Well, headache, dizziness, nausea and vomiting, weakness, chest pain, shortness of breath, and even confusion. But CO poisoning in the summer? Exceedingly rare. Usually, we see this in the winter months with space heaters, stoves, hot water heaters, poorly vented fireplaces, or other gas or wood burning appliances. Could you become paralyzed from CO poisoning? I suppose it is possible, knowing what CO toxicity is, which is a displacement of the Oyxgen molecule from the Hemoglobin by the CO molecule. What does this mean for my non-medical listeners? The Hemoglobin is the car that drives around the body and deliver Oxygen and nutrients to all of the important organs and tissues, and it also picks up the trash and takes it elsewhere for removal, so to speak. Well, if the car is supposed to have Oxygen, but instead has CO, which has no intrinsic value, then that tissue starts to starve and die, and toxins (aka the trash) builds up (this is called lactic acidosis, or when very severe metabolic acidosis).
Now, I’ve never seen a case of paralysis from this. I did have a patient once who was working on his car in a garage and had CO poisoning. The neuro symptom he had was partial loss of vision. I think one of the main reasons we never see paralysis or worsening neuro symptoms is that typically patients will feel so awful with vomiting, shortness of breath, etc. that they come to the hospital. But I do think it would be possible to become somewhat paralyzed if enough of the CO displaced the oxygen, causing tissue death, making difficult for someone to move, as stated in the ABC News interview.
What about another possibility? What about Pesticides? What about organophosphate toxicity for my medical people? Can you tell me the common presenting symptoms for this syndrome? Vomiting and diarrhea, heart racing (can also be slow heart rate as well), weakness, tremors, confusion, seizures, amongst many others. Has anyone seen the movie “The Rock” with Nicholas Cage and Sean Connery? The “nerve gas” that is depicted in that movie functions the same way, meaning, it is a Cholinesterase Inhibitor just like pesticides. Could this explain these patients’ symptoms? Absolutely. And the part that is intriguing to me is the paralysis (or at least partial paralysis) of the surviving victim. This would also explain why several people were affected in proximity. Could they have gotten a larger dose, or a more concentrated amount? Perhaps that unit had their windows open, and everyone else’s were closed so they weren’t affected?
How do you diagnose organophosphate toxicity? Good luck. It is purely a clinical diagnosis. I once had an attending physician in my residency program who constantly told me “Parente, if you don’t think about it, you won’t diagnose it.” And in this case, he’s 100% right. Pesticides are odorless, essentially colorless, and don’t show up on a single lab test. This would be an extremely difficult diagnosis for anyone to make.
One thing we know for sure having been there just 4 months prior to these events, is that this resort does not mess around when it comes to pesticides. They literally had golf carts, fully loaded with a gas-powered device that would disperse the pesticides into the air and cover the entire resort with a thick pesticide fog every night around dinner! I hate bugs, mosquitoes, and everything that goes with them; and they do go to great lengths to spray for insects. I’ve been all over the world, but I have never seen anything quite like this when we were there. Did that play a role in their deaths?
Well, the case was ruled Carbon Monoxide toxicity leading to asphyxiation and ultimately cardiac arrest.
So, did the healthcare professionals miss this the night before? It’s very hard to say, and even harder to be critical of them when I didn’t see what they did, what the symptoms were, what tests did they run, etc. But I will tell you that the only way on earth to diagnose CO toxicity, is if you THINK ABOUT IT first. Meaning, you can’t just get lucky and stumble across it on a random blood test. You must consider it, and why on earth would they consider it when they probably see 10 patients a day with nausea and vomiting?
Your Pulse ox level would be normal and your ABG, if they did one, would have a normal P02. The only way it can be diagnosed is with a specialized ABG that measures “CarboxyHemoglobin levels” or with a specialized CO detector, similar to a pulse oximeter that you put on your finger. I doubt a Caribbean resort has either of these things, but I don’t know that for certain.
So, did they get it right? Short answer is probably, as I wasn’t consulted! Haha. No, what I mean is that they spared no resource and flew in Toxicologists from all over to investigate this, order specialized testing, etc. So, I’m sure they have knowledge of more details than I do. Both diagnoses would be extremely difficult to make, both while alive and after death.
There are parts to this case that don’t add up for my simple mind. Why did the surviving victim have partial paralysis? If the CO levels were so high that they were causing paralysis, I would expect her mentation to be severely depressed or completely unconscious. Why would there be CO toxicity in the summer? What “heating device” was being used in the Bahamas in May? And just mathematically, you are far more likely to have pesticide toxicity rather than CO toxicity, and the deaths are 10-20-fold higher worldwide.
My takeaway from this case is that you should always travel with an emergency medicine trained physician, who’s a psychopath and thinks like me. I’d gladly go on your next trip with you and sample all the drinks the resort has to offer to ensure your safety. In all seriousness, my heart goes out to the families of the victims. My hope is this podcast just raises awareness for those on vacation, but also for those in the medical field who may consider these diagnoses for a future encounter and perhaps save someone’s life.
Thanks again for joining us today, please don’t forget to like, comment, and share on social media at Drjparente or leave a review on Spotify, Apple, or any other platform. Join me next week for another show and as always, peace, love, and happiness to all of my brothers out there. Cheers guys!