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In this handful of cases, neither family members nor lawyers contested Mash's cocaine-induced syndrome. It seems there was nothing else there to cause death.
As a police report put it in the case of 29-year-old Stephen Daugharty, who collapsed after running through his Homestead neighborhood while screaming that someone was trying to kill him: "His father said that he had a good heart, but he loved drugs more than life."
Even as the controversy has raged, Mash has spent the past decade studying patterns in the dissected brains of cadavers diagnosed with excited delirium. And she claims she is close to solving the mystery of why the disputed syndrome causes death.
Mash now believes certain people are genetically predisposed to excited delirium. Cocaine, methamphetamine, or in some cases unmedicated mental illness is the spark that causes the "electrical event" transmitted from the brain to the heart.
"It's almost like a jack-in-the-box," Mash says of those prone to excited delirium. "The springs are fully wound. You can walk around your whole life like this and you're not going to pop your cork. But if you start smoking crack and you've been hitting the crack pipe for a number of years and then one day — dun-dun-dun — you have full-blown excited delirium."
The brain goes into hyperthermia, sizzling like bacon at temperatures of 105 degrees or higher, causing extremely sudden cardiac arrest, which is why many sufferers tend to rip off their clothes or seek shade under vehicles. "Medical examiners have described cases," Mash says, "where paramedics get to the scene and the room is trashed, there are ice cubes everywhere, and the subject is dead. That tells me that person was trying to cool down."
Mash believes some people might suffer "flicker episodes" — nonfatal spells — of excited delirium. If true, that could explain the flashes of strange behavior Xavia Jones exhibited months before being tased in Coral Gables, and it might even solve the mystery of those briefly afflicted patients at the 19th-century McLean Hospital who snapped out of their madness as quickly as they had been smitten by it.
However, there's still no way to identify those cursed with excited delirium until it's too late, Mash says. She responds that it's "not [her] job" to give advice to cops or paramedics who encounter somebody in the throes of excited delirium. And she becomes glib when asked how people can protect themselves from dying of the syndrome: "Yeah, don't do drugs. If you're at risk for excited delirium — of course, we don't know who you are — no methamphetamine or cocaine for you. Start with that. And if you're a psychiatric patient, please keep your medicine compliant."
But Miami-Dade Fire Rescue paramedics have taken an unprecedented step in battling the body count: They are now equipped with excited delirium survival kits, designed to stop brains from hitting the griddle.
The new protocol was dreamed up by Miami-Dade's chief medical examiner, Dr. Bruce A. Hyma — an unabashed excited delirium bible-thumper and member of the Mash-founded UM research center — and fire-rescue officials. "We discussed how we can maybe abort this cycle and somehow save some lives," Hyma says. "The long and short of it is, if we can minimize the amount of physical exertion when this whole process starts, we can mitigate the amount of overheating that leads to death."
The plan, which has been in effect since 2007: First, a police officer tases the manic subject. Next, rescue workers quickly administer a nasal hit of Versed, a knockout drug commonly used on patients before surgery. Last, the subject is injected with iced saline to keep his or her temperature down. "The key is that when one of these events occurs," Hyma says, "it [should] be recognized as a medical emergency, not as a domestic altercation or a civil disturbance."
Hyma believes Miami-Dade is the only county to have such an approach in action, although "maybe others have copied it now and are using it." Hyma offers the unverified claim that 19 of 20 manic subjects hit with the Versed-and-saline cocktail have survived. One hitch: Because they lived, there's no way to prove those survivors were suffering from excited delirium in the first place.
Hyma hopes counties across the nation soon follow Miami-Dade's lead. Then comes the day, naturally, when paramedics are equipped with Tasers. Which is further gloom and doom for the civil rights set. Amnesty International's Jared Feuer sounds fatigued when told of the innovative approach: "So, wait, they tase them and then drug them?"
"Right in the midst there lay the body of a man sorely contorted and still twitching." — Dr. Jekyll and Mr. Hyde
It's apparent Linda Lewis misses being a mother. She attempts to gorge a reporter on soda, offers to make him lunch, and sternly advises him against speeding on his way back to Miami. Her Lantana home is a shrine with photos of her son, Donald Lewis, who lost his life at age 38 on the side of a road in October 2005. Every so often, she picks one up and shakes it. "Does this look like a drug addict to you?" she demands. "He could have been a model!"