Autopsy Concludes Tumor, Not Medication, Killed Woman

An autopsy has determined that Pam Trebon's sudden death apparently was not connected to her treatment for a wrist injury but was from an adrenal-gland tumor near her kidney.

The results are viewed as reassuring for people who take some of the common medications Trebon had received in the hours before she fell into a fatal coma. Those medications were the anti-inflammatory cortisone, Vicodin for pain and Compazine for nausea.

Dr. Ed Almquist, a Seattle hand surgeon who helped treat Trebon for the wrist injury, said yesterday that virtually all of the research into her death, including an autopsy by Swedish Hospital, has been completed and there is nothing apparent to connect the death to any medication she had taken.

Almquist said he and other doctors have been deluged with calls by people fearing allergic reactions or death from cortisone shots or pain medication since the story was reported Saturday in The Times.

Such reactions are "extraordinarily rare," he said.

Trebon's tumor released chemicals that attacked her heart, causing her death on March 9, Almquist explained. The mystery is why the tumor reacted the way it did, because Trebon had taken those medications before and there was no reaction. It was not a new tumor, he added.

The death of Trebon, 27, baffled medical personnel because she was in apparent good health.

She had been operated on twice for ganglion, a cyst on her wrist, possibly caused by repetitive-strain injury, a common workplace malady. Trebon was not operated on for carpal-tunnel syndrome, as originally reported by her father, but she may have suffered from it as well, said Dr. Carleton Keck Jr., also of the Seattle Hand Surgery Group.

Trebon was given a shot of cortisone by Keck on March 6 because of wrist pain.

The next afternoon, Trebon took a mild pain pill, Vicodin, which had been prescribed by Keck for her wrist pain, but she began throwing up.

Trebon later took Compazine, a stomach sedative, on the advice of Almquist. But then she reported intense pain, coughed up blood and was rushed to the emergency room at Swedish.

Doctors could not diagnose her illness and she died some 30 hours later.

Trebon's family said last night they had not yet received the autopsy results.

Swedish Hospital spokeswoman Jan Wilder last night declined comment on the report, as did Dr. John Batjer, the pathologist studying Trebon's death for the hospital.

Compazine, a trademark name for a drug used to control nausea and psychosis, has caused severe muscle spasms and breathing difficulty in some patients, according to several people who telephoned The Times with reports of frightening episodes they believe threatened their lives.

But medical experts said that reaction, while rare, is well-known to physicians, non-fatal and easily correctible.

Dr. Stewart Tepper, a neurological surgeon with the Polyclinic in Seattle, said reaction by some people to Compazine and related drugs known as neuroleptics is always reversible with an antidote such as the antihistamine Benadryl.

Tepper said he could not imagine how cortisone, Vicodin or Compazine could cause a death.

"Each of the three drugs independently is benign, and all of the three together are benign," he said.