Hey y’all, it’s Julie Mattson, and this week on Pushing Up Lilies, we’re taking a closer look at a case that raises more questions than answers, the death of veteran flight attendant Diana Ramos. Diana was on what should have been a routine layover, staying at an airport hotel between flights. But days later, she was found deceased inside her room under circumstances that immediately raised concerns. One of the most unsettling details reported was that a piece of fabric, described in different ways as a sock, a cloth, or even a t-shirt, was found in her mouth. That inconsistency alone opens the door to a much larger conversation about what may have happened. In this episode, I walk through the known details of Diana’s case and explore the complexities that often come with forensic death investigations. Why do reports sometimes conflict? What can small details actually tell us, and what can they not? And how do investigators begin to separate assumption from evidence when a case doesn’t follow a clear path? We’ll also talk about the broader concerns this case brings up, including safety during travel, the realities of working in transient environments like hotels, and why these types of investigations are rarely as simple as they may appear from the outside. Because sometimes, the most important question isn’t just what happened… it’s why the answers aren’t as clear as we expect them to be. * Listener discretion is advised.
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00:06
Welcome to Pushing Up Lilies. I'm your host, Julie Mattson. Pushing Up Lilies is a weekly true crime podcast with spine-tingling, unusual, and terrifyingly true stories from my perspective as a forensic death investigator and a sexual assault nurse examiner.
00:24
Do I have some stories for you? Are you ready? Hey guys, welcome to another episode of Pushing Up Lilies. I have to apologize because my voice, y'all, I seriously sound like a little 80-year-old with emphysema, not a smoker, but the weather change in Texas is crazy.
00:50
And I know I talk about the weather a lot, but it was like 85 degrees the other day. And then that night, a cold front blew in, and the wind gusts were ridiculous. But not only that, the temperature dropped to 30.
01:03
How are we supposed to stay well? I mean, it's raining. There's ice one day. The next day it's warm. My body is freaking out. I don't know if I got the flu or if it's allergies or a combination of both.
01:20
I'm thankful that school is out right now so I can spend a little bit of time resting. I'm not sure I know the definition of that word, but it's been exciting. This week, I'm a speaker at the 16th Global Webinar on Forensic Science, and this takes place the 18th and 19th, and it's virtual.
01:44
But my talk is the Forensic Nurse Death Investigator Bridging Medicine and the Medical Legal Death Investigation System. I'm kind of getting exciting about all the speaking engagements, y'all. I'm excited about the book and I'm excited about the education program.
02:01
I have a lot of people asking me a lot of questions. So, there's just a lot going on. I thank God for this little two-month break from school because it is much needed. My brain kind of needs a reset.
02:15
MedSpa is busy. I'm missing medical examiner work and life is life. And anyway, I hope everyone is well and still excited about the outcome we had at our meet and greet at the Mercantile Hearing Crime a couple of weeks ago and excited about planning future get-togethers.
02:38
And then, also excited about our murder mystery dinner this year. It's going to take place in October at Studio 141 here in Crum. And I don't know any other details yet. Not sure on the name, not sure on the time, but it's going to be so much fun.
02:54
So, I just want everybody to mark their calendars because when we have a date, we're going to have a limited number of tickets, and I have a feeling it's going to sell out really quick. Our show up last year was amazing, and we had so much fun.
03:08
So, I want to talk this week a little bit about the case of Diana Ramos. I don't know if y'all are familiar with it, but she was a veteran flight attendant. She was on a routine layover, and she was inside her hotel at the airport, but her body was discovered days later.
03:28
The suspicious part about this case, there's a lot of things, first of all, but one of them is there was a sock found in her mouth. Now, the reports have been different. There have been reports that there was a sock.
03:44
There have been reports that it was a cloth. And then there were reports that it was a T-shirt. So, it was something made out of fabric is pretty much what we can conclude from all of that. But this raised a lot of questions about foul play and airline safety and the complexities of forensic death investigation and how things aren't always as they seem.
04:10
Whereas a lot of people will look at it from the outside, look at cases and go, why can't they figure that out? There's so much more that goes on behind the scenes that just makes that determination of cause and manner very, very difficult.
04:27
So today we're going to walk through a little bit about what happened and what investigators found and why a death that appears suspicious does not always produce a definitive answer. Because in forensic medicine, evidence drives the conclusion.
04:44
Now, again, this was a very routine layover. Diana Remos, 66-year-old American Airlines flight attendant, she worked for decades in aviation, and she was based with Los Angeles crew. So, she'd been a flight attendant for over 25 years.
05:03
She was very well respected. In September of 2023, she traveled to Philadelphia. And this was part of just a routine flight assignment. So, these airline crews, they're on really tight schedules and they fly into a city, and they'll stay overnight at a contracted hotel and then they'll return to the airport the next day for their next flight.
05:29
And Ramos and her crew stayed at the Philadelphia Airport Marriott that particular night. But when it was time for her to return to the airport to fly back, she never showed up. So, two days went by. And I guess one of the questions that I've had about this case from the beginning is, if they're all at this same airport hotel, why didn't her crew check on her?
05:58
And, you know, it sounds like she'd been a flight attendant for a long time. I'm sure it was unusual for her just not to show up, especially in a city that was not where she resided. But two days went by.
06:10
And then on September 25th, this is 2023, hotel housekeeping entered her room and inside reports all say they found her unresponsive. I personally, as a death investigator, don't like the word unresponsive.
06:27
Unresponsive to me implies that they're not responding, but that they're still breathing. So, I always used, and I learned this years ago when I worked in Houston, pulseless and apnic. They're not breathing and they have no pulse.
06:44
They're not just unresponsive. They are apnic. Those words are all big in my vocabulary. And a lot of investigators that I've worked with in the past made fun of me because I use those words and they are very medical terms.
07:00
But a lot of people I worked with didn't have medical background. They were more law enforcement. So, to them, unresponsive is more of a police term, whereas pulsal and apnic are a little more medical.
07:12
Police were called at about 1045 p.m. Investigators, of course, quickly identified the victim. She'd only been there for a couple of days, probably wasn't decomposed. I'm sure they were able to easily identify her by looking at her and then her ID, which she most likely had with her.
07:31
It cannot use her American Airlines ID card. It has to be a government-issued ID. So, it would have had to have been her driver's license. But one detail at this scene that stood out immediately was that she had this sock or this cloth or this t-shirt or whatever it may be in her mouth.
07:49
And of course, that's going to trigger some concerns. Objects in somebody's mouth could indicate restraint, suffocation, assault. And because of that detail, police classified this death as suspicious from the beginning.
08:06
But the rest of the scene, total… a more complicated story. So, first of all, if someone's going to put something in someone's mouth, it can be for a lot of reasons. It can be to silence them, to prevent them from making noise.
08:21
It can be used on purpose to block the airway. It can be degrading and humiliating to the person that's having it done to them, which allows the attacker a little more control over the victim. And a lot of times, socks are readily available to use as a gag.
08:43
I always use this as a weird example, but when I worked in the hospital back in the day, if a prisoner came in in handcuffs with the police, with a medical emergency, they would many times try to spit on us, which I never really understood because we were trying to take care of them without passing judgment.
09:04
And back then, we could just stuff a washcloth in their mouth. Well, what would happen to us now as nurses if we did that? Assault. We're trying to silence them. We're humiliating them. We're getting control over them, cutting off their airway, reducing their ability to breathe.
09:22
A lot of things we could be accused of as nurses for doing that now. So, I can guarantee you that it's no longer allowed, but I can promise you that it was done because who wants to work on a patient that's spitting on you, much less verbally assaulting you?
09:38
So, it just reminds me of that with the whole gag sock in the mouth thing. But investigators, of course, documented the room very carefully. And what they found surprised them. There were no signs of forced entry, no visible signs of a struggle, no weapons found.
09:56
There were several sealed prescription bottles inside the room. And when investigators evaluate a suspicious death like this, they look for patterns that are going to support violence. There was no broken furniture.
10:10
There was no blood spatter. It is spatter, not splatter. I was watching the show last night. It was like literally forensic files, and someone said splatter and it just makes me cringe. It is spatter.
10:24
There were no defensive injuries. Her belongings were not disturbed. So, in this case, there were a lot of missing indicators. And that created the first major forensic puzzle in this case. Now, the SOC raised alarm because that's going to trigger a lot of possibilities.
10:44
Investigators are going to consider homicidal gagging. Did she put it there herself, which I don't know, people do weird things. Was it a behavior from being in medical distress? In homicide cases involving gagging, usually if a cloth or a sock or a t-shirt is forced into someone's mouth, you're going to have bruising around the lips.
11:10
You're going to have cuts inside the mouth from force. You're going to have some damage to the gums. You're going to have some patiea in the eyes or face, which are the tiny hemorrhages caused by pressure changes when somebody's air flow is cut off.
11:28
And these are going to appear when someone suffocates. But forensic investigators cannot assume suffocation without evidence. And they have to confirm it medically. And that's one reason why autopsies are done.
11:44
Now, in the autopsy process, once a suspicious death occurs, of course, the body's going to go to the medical examiner's office and the forensic pathologist, who is a doctor, is going to perform a detailed examination.
11:59
That's going to include an external inspection, internal organ examination, airway evaluation, and then toxicology testing. And they're based on the story, of course, it can be much more detailed. But if someone dies from suffocation using a gag, the airway can show evidence.
12:22
Investigators might find fibers deep in the throat or bruising again in the mouth or swelling or injury in the airway. But suffocation can also leave very little evidence. And sometimes the autopsy can't confirm it.
12:42
Another critical clue is that investigators learned that Ramos had been taken several medications. And toxicology testing determines whether drugs contributed to her death or not. Some medications can actually suppress breathing, even if taken as prescribed.
13:01
Others can't affect the heart rhythm. And certain combinations don't work well together and can cause worsening issues. So, police suggested that Ramos may have just suffered a sudden medical advance, but the investigation remained open because of this airway obstruction, this soft cloth t-shirt.
13:28
Now, cause of death versus manner of death. Forensic death investigations have to answer two questions. What caused the death and how did the death occur? The cause of death is going to refer to the medical reason someone died.
13:41
Examples are like heart attack, overdose, trauma, asphyxia. The manner is going to be the circumstances. Was it natural? Was it accident? Was it a suicide? Was it a homicide? Was it undetermined? And for a medical examiner to rule homicide, they have to show, prove that another person caused the death.
14:04
And you can't just call it a homicide because you suspect it to be a homicide. Yes, the sock in her mouth is weird. It's unusual. It's unexplained. We don't know how it got there. We don't know yet if it even contributed to her death, if she died of asphyxia.
14:21
Was her airway obstructed? Was she still able to breathe? I don't know how far down it was in there. There's so many things. I just wish I had been the investigator. But you can't call it a homicide if you don't have evidence.
14:37
This case was pretty much ruled undetermined, and that's because it means investigators can't eliminate multiple possible explanations. And you can't guess, or it's not like spinning a wheel, where today we're going to do spin the wheel, today's homicide day.
14:57
Let's call it a homicide. In the Rainless case, several possibilities remain open. So, she could have had a sudden medical event. Her airway could have been accidentally obstructed. It could have been caused by medication or combination of medications or overtaking medication or foul play.
15:18
But if the evidence can't confirm one scenario over the others, the medical examiner has to acknowledge that uncertainty. And it can be so frustrating, not just to the families, but also to the investigators.
15:33
I mean, we want answers too. Many times, it's hard for me when I would have my cases come back undetermined and it seems so obvious to me what happened. But if it's not obvious and there's any uncertainty, it has to be undetermined.
15:52
That also protects the integrity of forensic science. We don't want to go willy-nilly just calling it what it's not because we want to call it something. And I understand that because it's hard to not have answers and it's hard not to know.
16:08
Her death triggered outrage among flight attendants across the country. A lot of people criticized airline procedures because she was dead in the hotel for days before anyone found her, which to me is weird too, because when it's time for me to check out, dude, my maid is knocking on my door wanting to know why my house is still in the room because she wants to clean it because someone else is coming.
16:34
I don't understand how two days went by and no one cleaned her room or saw her or went to check on her, including her friends who were there at the hotel with her. But a lot of crew members wanted to know why there was not a wellness check sooner.
16:52
And there were also a lot of discussions about safety protocols for airline crews on layovers. But the central question remains unanswered. And that is, what exactly happened? Did anyone enter her room?
17:09
I don't have access to any of this. Nothing has come out on this case. No one is suspicious. The cause of death is undetermined. I know the key cards keep up with who goes in and out of the rooms. There’re cameras in the hallways.
17:26
I have to think that this investigation was performed appropriately, but there's just a lot of unanswered questions. But from a forensic standpoint, this case illustrates a difficult truth, which is that death scenes can look suspicious without providing proof of homicide.
17:44
And although a sock in the mouth is alarming, there is no evidence that it contributed. There's no evidence that it was placed there by someone else. So, her cause of death remains undetermined. Everything has to align.
18:00
Autopsy findings, toxicology reports, scene reconstruction, before investigators can label a death a homicide. Science requires certainty, and sometimes that certainty never comes. So, in cases like this, we don't always get answers.
18:17
Sometimes it seems so obvious. Oh my God, there's a sock in her mouth. Someone must have killed her and stuffed it in there. But how did they kill her? There's no wounds. There’re no injuries. There’re no defensive wounds.
18:28
There's no petite eye. There's no bleeding to her gums. She's not missing any teeth. Like all of the things we look for to confirm homicide are not there. There's no proof that anyone else was in the room.
18:42
There's no weapons. There's no blood. There's nothing. I'm not privy to toxicology results, but I'm curious to see if there was too much of something in her system. And a lot of times when there is, it's not always on purpose.
18:58
Sometimes it's accidental. Sometimes it's a drug reaction. There's just so many things that can happen. And there's so many things that have to be aligned before they can say this is a homicide. Diana Ramos spent decades caring for passengers, and her final hours remain a mystery inside this quiet airport hotel room.
19:23
But again, and we learn from cases like this, safety, procedures, all of those things. Hopefully the airline learns something. Hopefully the hotel learns something. Go in your rooms more frequently. I can tell you what.
19:37
I was at a forensic conference. It was the IACME conference in Vegas. I, oh, we were supposed to call if we wanted a room clean. Two days had gone by and literally I'd barely slept in my bed. I didn't need my room clean.
19:57
It was just me. And I did not call the front desk to ask where my room would be clean. Well, I'll be daggum. They didn't have security coming up there, beat on my door for a welfare check because my room hadn't been cleaned in two days and they wanted to make sure I was okay.
20:12
I have never had a hotel or never heard of a hotel just like letting someone overstay their welcome. It surprises me that she lay dead in it for two days and a maid didn't even try to come in. And because she didn't check out that no one went in there to check on her earlier.
20:31
So, there's not a lot of clear answers on this case. And sometimes the evidence just stops speaking. In those cases, we have to accept the uncertainty. And it's real easy as a non-investigator for someone to look at the picture and go, oh, that sock had something to do with it.
20:53
And we can all just imagine in our heads how it got there. Because we've been watching shows and we've been seeing people assaulted and people injured and people killed. And we just feel like we know in our heads what happened.
21:08
But it's not always that clear. And you have to be sure. Again, accepting uncertainty is very difficult in this field. I always hated when I went back to check on my cases to find that they were undetermined.
21:23
It's always disheartening. It's really hard to explain to family. And it's really hard to explain to someone who doesn't understand that sometimes the evidence just stops speaking. And that uncertainty just has to be accepted.
21:39
I hate cases like this because I always want an ending. I'm like, y'all, like, I want to know what was the crime, who committed it, what happened to them. Did the family get justice? This may not have been a crime at all, but it definitely became a headline because of the suspicion, because of the airline not checking on her, the hotel not checking on her.
22:04
She was found by a lot of different systems. Could have been a completely natural death. Again, I wish I could get my hands on the autopsy report. I've looked online for it and gosh, you can find everyone else's.
22:17
Michael Jackson's is on there, but I can't find Diana Ramos's, but all the police are saying is that she suffered a sudden death. You know, we still know nothing. And I think the case kind of went away.
22:31
But I think one reason why I wanted to cover it is because when you see things like the sock, you automatically jump to conclusions. And there's just not always answers for everything. She could have put it there herself.
22:46
I mean, you and I can't fathom that, can't imagine that, would never do that, or we don't think we would, but she could have. I mean, there were no signs of forced entry. Again, no blood, no, I mean, nothing.
22:57
I'm not privy to the medication she was on again. So, there's a lot of information that I would like to know, but I completely understand how this was ruled undetermined. And so, I like to kind of help explain that sometimes because it's hard to wrap your head around when it just feels wrong.
23:16
And so, these cases are interesting to me, though. And that's one thing that I miss about my job is not being able to go back and look at cases that I worked and see the outcome, especially when it's a young person and it's completely unexplained.
23:34
Just to be able to go back and look at the toxicology and to look at the autopsy results and to see what happened is always so interesting because many, many times it's not what you expect. People do weird things to themselves and sometimes it's just hard to pinpoint the cause and manner.
23:53
And so as hard as undetermined is to accept sometimes and just has to be the reality. Again, always hate explaining that to family because it's difficult. It's a difficult pill to swallow because we want answers.
24:08
And when we don't get them, we're disappointed. So, but I'm going to start doing YouTube, y'all. I'm a little bit weirded out about myself on camera, but we're going to do this. And I got to go get my driver's license renewed today.
24:23
It expired on March 9th. And, you know, I know you're supposed to get it like a month before your birthday, but hey, I've been busy. And so, I went online the other day to try to make an appointment, and I couldn't get in with the dad gum DMV until April 20 something.
24:38
So, I couldn't sleep last night. I got up at like two this morning, logged in, and I'll be dang if there wasn't an appointment today at three. I guess somebody canceled. So, I took it. I got to go up to the DMV, and I haven't had my picture made forever.
24:51
I'm hoping to God I pass the vision test because I probably should be driving with classes and I do at night, but there is not a stipulation on my driver's license. So yeah, there's that. So, this is what I'm doing today.
25:05
School is on halt until May 19th when clinicals start. Super excited about that. Doing those at my medical director's office and cannot wait. Can't wait. I have applied for a declination for my immunizations because I really don't want to get them, y'all.
25:22
COVID scared me and I have a lot of friends who passed from complications, what they think was related to the vaccine. And I just don't want to do it anymore. I don't want to do it anymore. So, I have requested a declination from the Texas Department of State and Health Services to turn into the school.
25:42
And hopefully they won't make me get any shots. I mean, I've had them all. It's just that, you know, over the years, you get them at different places and there's no central location. And heck, if I know who has all my records, like, I don't know.
25:55
I've switched doctors so many times and moved and who knows? I mean, it would take me forever to chase them all down. So, I might have to have some titters done just to see where I stand. But anyway, I don't think it's that uncommon anymore to decline vaccines.
26:10
So, I'm not going to stress about it too much. But anyway, I hope you all have an amazing week. And I'm so sorry about my voice. I am freaking out because I'm supposed to speak at this conference on Thursday.
26:21
It's a global and I really want to sound and look my best. I definitely do not sound my best. So, I'm trying to rest my voice a little bit. I'm doing some warm liquids. I would love your advice if you have any.
26:33
I'll tell you what, I've been drinking medicine balls at Starbucks and they are so good. I don't know what's in them, but they're delicious. So if you haven't tried that, I highly recommend it, especially if you're under the weather.
26:44
But y'all have a great week and I will talk to you next week. Bye, y'all. Thank you so much for joining me today on Pushing Up Lilies. If you like this podcast and would like to share with others, please do me a quick favor and leave a review on Apple Podcast.
27:01
This helps to make the podcast more visible to the public. Thanks again for spending your time with me and be sure to visit me at pushinguplilies.com for merchandise and past episodes.