Spinach recall: 5 faces. 5 agonizing deaths. 1 year later.

— -- Ruby Trautz was the first to die.

On Aug. 27, 2006, the 81-year-old Nebraska woman was rushed to the hospital. She was in so much pain that morphine was administered. Four days later, she succumbed to a food-borne infection later identified as a virulent strain of E. coli.

Two weeks after Trautz's death, on Sept. 14, the Food and Drug Administration took an unprecedented step: It told Americans to stop eating bagged spinach, a staple of healthy diets, until its safety could be assured. A day later, the FDA extended the warning to include all fresh spinach and almost as quickly, it vanished from grocery shelves, salad bars and menus.

By this time, two more people had died.

Before the outbreak of E. coli O157:H7 was over, at least five people were dead after painful, bloody illnesses. More than 205 others in 26 states had endured a sickness that left them vulnerable to future health problems. And the agricultural industry, government regulators and consumers were shaken by the vulnerability of America's system for delivering fresh produce to markets.

Since early this year, USA TODAY has interviewed dozens of key government officials, food producers, survivors who ate contaminated spinach and relatives of those who died. They offer new insight into the behind-the-scenes panic throughout the agricultural industry and government offices as the crisis unfolded nationwide, and of the detective work that led officials to suspect that the E. coli — commonly found in cow manure — came from spinach grown on a 2.8-acre plot in central California.

The FDA would partially lift the spinach advisory on Sept. 22, but it would be six months before federal and state investigators released their report.

The outbreak would ultimately cost the leafy green industry more than $350 million as the nation turned away from its growing appetite for fresh, ready-to-eat spinach. It's an appetite that has not returned: Sales of packaged spinach are still off about 20% from pre-outbreak levels, industry executives say.

The interviews reveal vivid details of the gruesome illnesses caused by the contaminated spinach, and show why such a deadly crisis remains possible today. In the past year, the industry has made strides in keeping produce safe, says Michael Doyle, head of the Center for Food Safety at the University of Georgia and a consultant to Natural Selection Foods, which processed the tainted spinach.

But while companies have imposed higher standards for farmlands and have increased testing of the greens before they get to the consumer, it's still possible for bacteria to get through the safety net.

In the past four weeks there have been two leafy green recalls, one for E. coli in mixed greens and another for salmonella in spinach. No illnesses were reported.

"Raw produce, even if you put it in a bag and seal the bag, is still raw produce. It's a high-risk food, even if the American consumer doesn't realize it is," says Oregon state epidemiologist William Keene.

One year ago, that risk changed families, an industry and consumer attitudes toward fresh spinach.

The victims

In July, the month before Trautz died, a 2.8-acre section of a 51-acre field was planted in spinach by grower Mission Organics at the Paicines Ranch in central California, an 8,000-acre spread largely devoted to cattle grazing.

The 1,002 pounds of spinach from that 2.8-acre section was harvested on Monday, Aug. 14, and processed the next day by Natural Selection Foods, one of the nation's biggest processors of leafy greens. The spinach went mostly into bags of Dole Baby Spinach, each tagged with the production code P227A. It was shipped nationwide.

FDA and California investigators would later say that spinach from this small section of the Paicines Ranch most likely carried the deadly E. coli strain into the homes of unsuspecting consumers.

They were consumers such as Polly Costello, who on Monday, Aug. 21, bought a package of Dole Baby Spinach at No Frills Supermarket in Bellevue, Neb. She, her husband and her mother, Ruby Trautz, would eat spinach from the bag over the next few days.

By that Saturday, Trautz was sick with nausea, vomiting, abdominal cramps and diarrhea. On Sunday she began passing blood, and her daughter and son-in-law rushed her to Creighton University Medical Center in Omaha.

When a nurse examined her on Sunday, Aug. 27, Trautz was light-headed and in extreme pain. On Thursday, after five days of increasing weakness, Trautz began to hallucinate and have seizures. She died at 6:15 a.m. that day.

Her doctors had no idea what had killed her. It wasn't until Sept. 25 that tests on the spinach from her daughter's refrigerator showed she had been infected with E. coli O157:H7.

The second death came Sept. 7, a week after Trautz's, when 77-year-old Marion Graff of Manitowoc, Wis., succumbed to kidney disease. Graff had always been a healthful eater. "My mother would cover her plate in salad," says her daughter, Leah Duckworth.

A woman who'd blossomed with age, Graff was with friends on a bus trip to Minneapolis for a weekend of museums and theater when she lost consciousness.

Graff deteriorated so quickly that Duckworth, on vacation in Canada, couldn't get home in time. Her sister, Annie Banks, held the phone to their mother's ear and Graff said, "I love you, my little mommy. Now it's time." Their mother died about 90 minutes later.

Next was June Dunning who, even at 86, was "a very proper British lady" who made a point of leading a healthy life, says her son-in-law, Chuck Swartz. Dunning lived with Swartz and her daughter Corinne in Hagerstown, Md. She got sick Friday night, Sept. 1, several days after eating lightly steamed spinach from a Dole bag. True to her stiff-upper-lip nature, Dunning didn't bother her family about the pain.

The next morning Corinne went into Dunning's room "and found this huge bloody mess all over," Swartz says. Corinne took her mother straight to the hospital.

It wasn't until Wednesday, Sept. 6, that tests showed she had E. coli O157:H7. "I said, 'What's that? That sounds like something from Mars,' " her son-in-law says. "The infectious-disease doctor said it came from hamburger. We said, 'She doesn't eat hamburger; she loves vegetables.' " Dunning lasted for another week.

The fourth fatality was the youngest, 2-year-old Kyle Allgood of Chubbuck, Idaho. Kyle had been born at home before his mom and dad could make it to the hospital. "He was in a hurry coming into this world, and he was in a hurry to leave it," says his mother, Robyn Allgood.

Kyle came down with flu-like symptoms on Friday, Sept. 15. His mom had worked hard to make sure her kids got good nutrition. A favorite trick was the veggie smoothie. "If you put enough berries and juice and yogurt in them, you can put spinach in, so I did," she says.

But it soon became clear that Kyle had something much more serious than the flu. The whole family got sick, but his mom, dad and his older sister fought it off. Kyle couldn't. He was rushed to the local hospital, then to Primary Children's Medical Center in Salt Lake City.