City of Dust

by Anthony DePalma

  By the end of 2001, Landrigan and the other Mount Sinai doctors were carrying almost the entire medical care burden for thousands of ground zero workers. The Church of Scientology offered rescue workers a detox and purification program that used saunas, high-dosage vitamins and oil, but it did not have the backing of the medical community, and most responders stayed away, even when they learned that actor Tom Cruise was paying most of the bills. The city government continued to focus on the recovery operation and offer limited help with health issues. The state health department had supported Dr. Joan Reibman, the director of an asthma clinic at Bellevue Hospital, when she canvassed downtown residents and compared their post-9/11 respiratory symptoms with those of city residents who lived farther from the disaster site. Reibman’s study was one of the earliest to show that people who lived close to ground zero had a marked increase in immediate respiratory complaints. But neither the city nor the state offered medical screening or treatment for residents, students, or office workers.

  Collaborating with Mount Sinai’s doctors, the Central Labor Council had put together a funding proposal for a formal screening program. The demands of New York’s congressional delegation, backed by the unions, had been heard in Washington, and $12 million had been appropriated for the workers. The funds took a circuitous route, from Congress to FEMA, to Landrigan’s former employer, NIOSH. By the time the money was available to Mount Sinai in February 2002, severe restrictions governed how it could be spent. Because it was FEMA money, it could not be used for treatment. And NIOSH would not allow it to be used for research. From the very start, the unions insisted that no matter how much trust they had in Mount Sinai’s doctors, they did not want the screening to turn into an academic research program. Ed Ott was firm: He refused to have workers treated like “lab rats.” He wanted a health clinic that would check everyone on the pile and get them the help they needed. That position was markedly different from what had transpired at the New York Fire Department, where Kelly and Prezant, working with the full confidence of the members of the force and department brass, were able to launch detailed studies right from the start.

  In July 2002, the World Trade Center Worker and Volunteer Medical Screening Program at Mount Sinai formally initiated operations with a total staff of about 25, including doctors, industrial hygienists, and clerks. They were still unclear on the range of diseases they would face because of the complex nature of the dust and smoke. Taking a cue from the fire department’s screening program, they focused on three critical areas: respiratory problems, broken bones, and mental health issues related to extreme stress. Cancer screening was not included then because malignancies were understood to take decades to develop. The initial intake exam included a comprehensive questionnaire that established a worker’s medical history, economic resources, and employment record. Each worker was given a chest x-ray, blood test, and standardized mental health evaluation. The doctors intended to create a baseline by conducting spirometry tests to measure breathing capacity, a relatively quick and easy way of looking for asthma or pre-asthma conditions.

  It was to be a screening program only, but that raised an ethical issue for Landrigan and the others. If the doctors found something seriously wrong, they would have to refer workers to their own doctors for medical care because treatment costs weren’t covered. But they knew that most doctors lacked the training to deal with exposure properly. And a good number of the construction workers might not be adequately covered by health insurance plans. They would have no place to go for the treatment, medications, or therapy the clinic prescribed. Landrigan turned to the Red Cross and several private philanthropies for help and was able to secure enough money to get the treatment program rolling, at least temporarily.

  Despite the restriction against research, Landrigan realized that he would have to collect clinical information on the patients as they were being screened. As an advocate for the workers, he would eventually need hard data to overcome doubts about the dangers of the dust that the nation’s top environmental official had said was not harmful. He also needed to make a strong case for workers to volunteer to be screened. Science—good science, based on quality data—would make the case for more funding, and that extra funding would provide for more monitoring. There wasn’t money in the grant for sophisticated electronic data gathering, so the doctors put together a system on-the-fly. They used standardized printed forms and later transferred the information to electronic files. It was a time-consuming process that could be fraught with errors, but it was the best they could do under the circumstances.

  In many ways, the Selikoff clinic was being forced to punch way above its weight. Although it had more expertise and experience than any other occupational medicine center in the Northeast, it clearly lacked the resources necessary to handle such a massive and open-ended job. It was a task more appropriate for government, but other factors prevented that from happening. The federal, state, and city governments were determined to show that the attack had only grazed the country, not wounded it mortally, and that things could return to normal quickly. Lingering health problems or, worse, a looming medical catastrophe could cripple the country’s recovery. Besides, after what Giuliani and Whitman had said about safety, funding a big health screening program would be contradictory.

  Landrigan worked with labor to establish a steering committee to oversee the screening program and to guide it as the doctors navigated between clinical care and research. As a model, they used the city’s system of HIV clinics, which were run with the substantial input of the people they were serving. Mount Sinai received enough federal funding to screen about 9,000 people, but Landrigan did not really know how many workers were down at the pile and how many might come in to be examined. He assumed that intake would follow a bell curve, growing as more people found out about its existence and then tapering off as time elapsed. As the program expanded, space became an issue. The Mount Sinai Medical Center provided room, although administrators made clear they could not bear the cost forever.

  As the clinical effort grew larger than anyone imagined, the unplanned way it was put together, improvising as everyone went along, inevitably caused trouble. The questionnaire given to incoming recovery workers ended up being 74 pages long, most of it self-administered, but with one part that had to be mailed in and another that was taken by an interviewer. With x-rays and a breathing test, the whole process could take more than four hours. Once word spread at ground zero, recovery workers thought twice before deciding to travel uptown to volunteer for a program that might find a medical problem but couldn’t necessarily treat it.

  Who did make the trip? The answer to that would have a profound impact on the studies Landrigan and his staff conducted over the coming years. Several fundamental flaws in the intake program could not be corrected. Despite his November 2001 call for a registry of ground zero workers, Landrigan never got an official count of who was down at ground zero and how much time they spent there. In time, however, Mount Sinai’s programs, along with the fire department’s outreach, would come to include a substantial number of responders. Together, they provided an acceptable approximation of the total and further backed up the reliability of their studies.

  The federal government eventually recognized the need for a comprehensive study of the ground zero population. In July 2002, the same month in which the Mount Sinai program began, FEMA provided $20 million to establish a World Trade Center Health Registry. Everyone who worked on the pile, lived or worked or went to school downtown, or happened to be in Lower Manhattan on the day of the attack was eligible to sign up. The government expected more than 200,000 people to register, but the unions suspected that the city might manipulate the data to obscure the true health impact of the dust and discouraged members from cooperating. In the end, only 71,000 people signed up.

  While the fire department could guarantee that everyone who was called in for a screening showed up, Mount Sinai’s program was entirely voluntary. There was no telling
who was coming in. One of the earliest attempts at evaluating the responders was done by the CDC, which looked at a sample of 1,138 workers and volunteers who had been screened by Mount Sinai between July and December 2002. They were predominately union members who worked on the pile from day one through Friday of that first week, when it rained. Three-quarters of them reported upper-respiratory symptoms such as sinusitis, runny nose, and cough.4 Half had shortness of breath and other lower-respiratory problems. Among those who had never smoked, lung capacity tests showed more abnormalities than expected in the general population of nonsmokers. But who did this group represent? Were they the people who went to the clinic because they were coughing persistently, while others whose cough had improved stayed away? Did they include people who were sick from some cause other than the dust, while those who were healthy stayed away? Was the population skewed because the number of people who had symptoms was not a representative sample of everyone who had worked at ground zero during the recovery operations?

  Those questions underscored a deeper, more mysterious question that the responders themselves had been forced to ask. As time went on, it became clearer that although some ground zero workers who had been exposed to the trade center dust had come down with a growing number of ailments, not all did, even though their exposures were similar. On top of all the other uncertainties that responders were living through, this one seemed to pinch the heart. The doubts that had arisen with the dispute over the EPA’s early statements and that had colored so many negative reactions now started to hang over the responders as well. Despite some of the early indications coming out of the clinical research, questions were being raised about who was truly sick and who might be exaggerating. Without definitive answers, some in New York, Washington, and the rest of the country wondered, were they heroes, or victims, or whiners looking for pity?

  Endnotes

  1 Gillespie, Angus Kress, Twin Towers: The Life of New York City’s World Trade Center (New Brunswick: Rutgers University Press, 1999, reprinted 2001).

  2 Personal interview, 29 July 2009.

  3 Personal interview, 18 August 2009.

  4 Centers for Disease Control, Physical Health Status of WTC Rescue and recovery Workers and Volunteers—NYC July 2002–August 2004 (10 September 2004).

  7. It’s not the dying

  Few New Yorkers asked the fundamental questions of 9/11’s aftermath—“Why me and not him?” or “Why him and not me?”—more often or with more apprehension than Marty and Dave Fullam. Both brothers were veterans of the FDNY on 9/11, and both had responded to the disaster; spent plenty of time on and around the pile; smelled the raw, penetrating, inescapable odor of burning flesh that they couldn’t shake for weeks afterward; and went back to their homes doused in fine gray grit that clung to every exposed inch of their skin except the moons around their eyes. Both thought nothing in this world was nobler than being part of the fire brotherhood.

  One brother came out of the fire scarred but whole. The other nearly died and will spend every day of the rest of his life taking a medicine cabinet of medications, keeping track of what he eats, keeping score of what he can no longer do, and hoping against hope that, with a new lung and a team of doctors who care, he can watch his three daughters grow into fine young women.

  The youngest of those three girls, sweet little Emma, was born just five weeks before the September 11 attacks, but she knows the story by heart of how her daddy, firefighter Martin Fullam, Ladder Company #87, loaded nine fellow firemen into the cab and the bed of his red Chevrolet Silverado Z71 that morning and drove them as fast as he could to the muster point where they boarded buses that took them to the Staten Island Ferry. She has seen photographs of the truck, and she’s heard her father retell the story of that day many times over. On the Saturday morning when Lieutenant Fullam recounted for me in painful detail what had happened to him, Emma stuck close by, frequently hanging on his wheelchair, at other times rubbing his short gray hair until it stuck straight up on his head. He never once shooshed her away or asked her to stop. They both seemed to realize how close they had once come to losing each other.

  During the interview,1 he sat at the same table where he had been sitting on that bright September morning. September 11 was his day off, and Marty was taking advantage of the extra time to brush up on a fire department manual. He had just completed 20 years as a firefighter for New York City and was preparing to take the test for lieutenant in a few months. With three young daughters, he couldn’t even think about retiring. Besides, he loved being a fireman. His own father, Martin Thomas Fullam, had worked in a Manhattan corporate office and made the long commute from Staten Island before the Verrazano-Narrows Bridge had been built. But it was clear early on that life behind a desk wasn’t for Marty. He loved helping people, and he loved everything about the fire department, most of all its sense of duty and its deep and heroic tradition. When he married, he chose the daughter of a battalion chief.

  The morning of the attacks, his two older girls, Kelly and Caroline, had just gone off to school, and Patricia, his wife, was upstairs with the new baby. A neighbor knocked on the door shouting at Marty that a plane had crashed into the World Trade Center. A burly guy, slightly overweight, with pale eyes and an easy, glad-to-help smile, Marty rushed upstairs and turned on the TV in time to see the second plane crash into the towers. Without thinking, he prepared to do his job. He hopped into the red pickup, hightailed it over to the school to get Kelly and Caroline and bring them back home, kissed Tricia and the baby goodbye, and headed to Ladder 87, a few minutes away. Other guys piled into the truck there, and they rushed over to Rescue Five headquarters on Clove Road, where buses waited to bring firefighters from all over the southern half of Staten Island up to the ferry terminal on the north end for the tense trip to Manhattan.

  It was an unusual response in many ways, but particularly because they left their rigs behind, along with nearly all their equipment. They boarded the buses with their bunker gear—the heavy pants and coats and their old-fashioned hardened leather helmets—and little else but their wits. At the ferry terminal, Marty walked aboard one of the huge double-ended, push-me/pull-me ferries along with maybe 200 other firefighters from New York City’s most unlikely borough for the 20-minute voyage to Manhattan. It was a trip he’d made countless times, growing up on suburban Staten Island. None, however, had ever been filled with such tension and awe. On this extraordinary day, there were no private vehicles and no commuters as they headed toward a scene that no firefighter could imagine.

  The firefighters landed at an empty terminal. But amassed outside were hundreds of commuters desperate to flee the chaos. As Marty and the other firefighters marched off toward the trade center site, the dusty people waiting there applauded, as though they knew something the men and women under the bulky gear did not.

  Marty’s first impression of the disaster scene was deceiving. He remembered that it was an unusually sunny day. “But then, looking up Broadway, it was like looking up at a night sky,” he recalled. “As you walked up, you could tell it wasn’t dark, but there was dust in the air. And the prevalent overwhelming smell in the air was—I know what it was, the smell of people, the people who died. Bodies burning. That’s what we smelled overall. What you smelled for the whole time you were down there, for weeks you’d smell it. Then it got a little worse as the bodies started to rot.”

  As the corps of firefighters boldly marched up Broadway toward ground zero, Marty noticed the dust that seemed to be wrapped around everything. Pieces of the vertical aluminum tracks that made up the façade of the towers were everywhere, and then he saw something odd—a car parked a few blocks from the trade center site totally engulfed in flames, even though no building near it was burning. The fuel and fire expelled from the towers by the exploding jets had sent out incendiary bombs for blocks, torching parked cars.

  Marty arrived at ground zero about 11:30 a.m. The towers had already come down, and the air was still thick with smoke and ash
. He knew the conditions were hazardous, but all his equipment was still on his fire truck. Each firefighter normally is assigned a full face mask and a 30-minute tank of compressed air. Even if he had lugged his gear on the ferry, the air tank wouldn’t have protected him for very long. And replacement tanks were hard to come by. Marty entered ground zero with nothing covering his face but a look of determination. As far as he and the other firefighters were concerned, the trade center—or the pile of rubble that remained of it—was still an occupied building, and the first thing a New York City firefighter is taught is to never give up an occupied building to a fire, mask or no.

  Marty was assigned to work with a crew that was checking elevators, stairwells, and other areas of buildings 5 and 6 of the trade center complex. They searched for people who might have been injured or left behind. These two buildings were far smaller than the gigantic towers that had loomed over them, and they had been heavily damaged by the falling debris but were still standing. Marty knew there was a day care center in one of them, and thinking of his own girls, he searched thoroughly to make sure all the children had escaped. The firefighters did not find any civilians, but in the lobby of one of the buildings, they came across the still body of Father Mychal Judge, the department chaplain. His lifeless body had been found in the rubble earlier that morning and brought into the lobby. Now Marty, Lieut. Butch Pepe, firefighter Mark Heintz, and others carried him to St. Paul’s Chapel, one of the oldest buildings in Manhattan, and carefully laid him on the altar.