City of Dust

by Anthony DePalma

  Not for several hours later that day did Marty actually get to touch the debris pile, making his way in from West Street. “Where the sidewalk would have been, we found lots of debris there, and that’s when we started to find people—firefighters, people, and stuff,” he remembered, “but whoever was attached to what we found wasn’t alive.” They had to squirm through the tangled girders and piles of concrete dust, making their way down into a subway station where they recovered more bodies. Marty said there was heaviness in the air, caused not just by the intense emotion, but also by the contamination that had been aerosolized over the financial district. There was so much uncertainty at the time. No one knew for sure how many people had been in the towers when they came down. No one knew how many firefighters had been caught on the stairs when the world went dark around them. No one knew what was in the air they were breathing that day, but these were experienced New York City firefighters. “Oh, yeah, I went twice to a clinic to get my eyes cleaned out. My breathing, I could feel it. I mean, at that point, I was a fireman for 20 years. I knew it wasn’t good. But that wasn’t what I thought about that day.”

  Carefully worked-out firefighting protocols, refined over decades, went out the window. On this day, everyone did what it made sense to do, for as long as it seemed to make sense to do it. About the only thing people could agree on was that if there were people to be rescued, there was no time to waste, even for something that might be as critical as making sure that the rescuers themselves did not become victims.

  “The fire department has a lot of safety rules, but they weren’t prepared for this large of an operation,” Marty said. They knew they had lost so many men—an unthinkable number of the guys they had worked with, laughed with, exchanged family photos with, and played softball with—and they held out hope of finding them far longer than was reasonable. That, in the end, made worrying about protective gear seem selfish. “To stand around and wait for somebody to tell you to put on the right mask or the right cartridge, while maybe somebody’s laying there still alive ... it just didn’t make sense to us.”

  At about the same time Marty Fullam was marching into the dead zone at ground zero, his younger brother, David, was on duty at Ladder Company 46 in the Bronx. Dave, born on the Fourth of July 1963, was seven years younger than Marty and had come to the fire department indirectly. He had originally toyed with the idea of joining the police department, and he had done well on the test while he was still finishing his bachelor’s degree in finance at the College of Staten Island. But Dave had turned down the idea of a civil service job to try Wall Street. A few years in the financial district convinced him to try something else, and by 1991, he had made up his mind to follow Marty into the fire department. Dave spent his first years on the job at a firehouse in midtown Manhattan. When he moved with his family to Orange County, New York, he transferred to the Bronx, shortening his commute considerably.

  On the morning of 9/11, Dave’s company had just come back from an easy run. He was on house duty and used the time to study for the lieutenant’s test he planned to take in March 2002, the same time as his brother. He had turned on the television in the firehouse and saw what was happening in Lower Manhattan. Before any instructions had come in from headquarters, he used the loud speaker to tell the others to prepare to move fast. The firefighters scrambled to check their gear, grabbing coats and air tanks, and when the order came in, they were ready to roll.

  They were sent not to the trade center, but to 2 Truck on Manhattan’s east side, As the day wore on and the events downtown became more desperate, Dave’s company itched to be sent down. But the fire dispatcher insisted they stay put, just in case something happened in that part of the city. From their position on 51st Street and Lexington Avenue, 2 Truck, now the relocated Ladder 46, could quickly respond to an emergency at some of the city’s most notable landmarks—the Empire State Building, Penn Station, Grand Central Terminal, the United Nations. If the nation really was at war, any one of those buildings could be a target. The department was already stretched thin.

  Dave had managed to get a call through to his mother, Helen, that first day. “Where’s Marty?” he needed to know. His mother said he had called her from the World Trade Center. Marty was all right.

  The first day after the attacks, a new crew relieved Ladder 46 so that it could return to its own house. Their tour ended, but instead of going home, Dave and four other guys in bunker gear crammed into their captain’s Honda Civic and drove to ground zero to help. Almost no one was wearing a respirator mask that day or the next when Ladder 46 was officially sent down to work the pile. The dust made breathing difficult. Before Dave had reported for work that morning, he had picked up paper dust masks at a fire department depot. The masks wouldn’t protect him from much, but he thought something was better than nothing.

  By the beginning of October, when the department had established regular working shifts, Dave and the Ladder 46 crew started their tours by driving out to Shea Stadium in Queens. The department had established a staging area where firefighters could pick up gear, including proper respirators, before being bussed to ground zero. Dave was fit-tested there for a P-100 cartridge mask and told to wear it over his moustache and to change cartridges frequently. In the days to come, firefighters were able to pick up gloves and other supplies, too, including the hockey puck–sized asthma inhalers that Dr. David Prezant had recommended.

  In all, Dave spent about 20 full days working at ground zero, starting the day after the towers went up in smoke and lasting through the end of 2001, after the fires were extinguished. “We were wearing masks on the pile,” he said.2 “There were some guys who wore them whenever they were down there ... others, as soon as they’d come off the pile, it was the first thing [they] took off. You did some of the worst things down there that you ever had to do. And as soon as you got off that hill, you wanted to start taking everything off, get relieved from that stuff. And the first thing you did was take off that face piece.”

  Marty and Dave never actually saw each other on the debris pile, but they knew what the other was going through. Their routines were slightly different. The established muster spot for Staten Island firefighters was the Homeport, an old Naval base on the island’s northeastern shore. But Marty was too impatient to wait there for instructions. “You could kill hours there waiting,” he said. Instead, he’d load up his Chevy pickup and drive into Manhattan, flashing his ID at the military guards so they’d let him through the barricades. He was able to park a block and a half from the site and report for work several hours earlier than he would have had he reported to the Homeport. That gave him even more time on the pile. But it meant he never was fit-tested for a respirator mask.

  In all, Marty spent over 50 days at ground zero, winding down toward the end of the year just as his brother did. He worked there a few more days in 2002 before the cleanup ended. He’d never worn a P-100 respirator in 20 years on the job, and he didn’t intend to change now, despite the possible consequences. “I knew better,” Marty said. “I mean, I knew it wasn’t good. I’ve done this long enough to know. But what are you gonna do? You’re not gonna stay home.”

  That winter, Dave came down with pneumonia. He thought it was just a cold. Like most other firefighters, he had developed World Trade Center cough. In time, his symptoms grew less severe. But then as temperatures dropped, his breathing grew labored. At one point, he felt a stabbing pain in his chest every time he took a breath. Even simple motions, the kinds of things he’d done for 20 years, became so painful that he was forced to go out on medical leave. A doctor diagnosed pneumonia. Dave had never had pneumonia. He was still studying for the lieutenant’s test, and the stress was affecting him in ways he hadn’t expected. Two days before the test, he was driving somewhere, thinking about all the funerals for fellow firefighters he’d attended and worrying about how he’d do on the exam. Suddenly he felt a pain shooting down his left arm. He couldn’t feel his hands. Certain he was suffering a hear
t attack, he thought he’d never see his wife or daughters again. He pulled over, closed his eyes, and tried to calm down. When he started feeling better, he went home.

  Two days later, Dave and Marty took the lieutenant’s test, and both passed (Dave got the higher score and rarely misses a chance to remind his older brother). Both were later promoted—Dave in January 2003, Marty in March. But that didn’t end the anxiety. Dave was eventually diagnosed with post-traumatic stress disorder. He put on extra weight, and he thinks the added pounds may have contributed to him blowing out his knee so badly he couldn’t work. Lieut. David Fullam retired from the fire department in May 2006 and tried to put everything behind him to start life anew in Syracuse, where his wife, Lynda, had grown up. The fire lieutenant who had once thought of becoming a cop took a position with the safety department at Syracuse University, analyzing risk. He tries not to dwell on ground zero and has not joined the responders, including his brother, who sued the city of New York for not providing them with the protective equipment that might have kept them safe. He just wants to forget 9/11.

  Marty continued working at Ladder 87 until his promotion, when department regulations required him to move to another house. He chose 10 Engine on Liberty Street in Manhattan, a few yards away from ground zero. Marty and Tricia continued working on the renovation of their home in the suburban Annadale section of Staten Island and eventually completed a pool in the backyard. But by 2005, something was terribly wrong. Marty was nearing 50; he knew time would eventually take its toll, but not like this. Almost overnight, it seemed, he lost most of his upper-body strength, a significant setback for a firefighter who loved skiing, biking, and swimming. He was sleeping up to 14 hours a night and still waking up exhausted. Local doctors couldn’t diagnose anything definitive, although they suspected a range of diseases, from carpal tunnel syndrome to lupus. Finally, Tricia convinced him to see a specialist in Manhattan. In November 2005, Marty went in for a blood test. The following morning, the doctor’s office called back with an urgent message: Get to the hospital immediately.

  The telltale sign that had set off the alarm was an abnormality in Marty’s blood. Because he had complained about fatigue and a lack of strength, the physicians had ordered a complete blood test, including an intensive look at what was happening to his muscles. The test had calculated the levels of a particular enzyme—creatine phosphokinase, or CPK—that floods the bloodstream when muscles are damaged. Normal CPK levels are less than 200. When Marty came in, his were raging at about 15,000, a clear indication that he had done some serious damage to his muscles, although the doctors didn’t know what had triggered such a severe reaction. He was admitted to New York University Hospital on November 12, 2005. In the ensuing days, he grew progressively weaker, until he couldn’t even sit up in bed. He had to admit that he felt like a tired old man. At this time, he wasn’t connecting his deteriorating condition to his work at ground zero. He just knew that he was sick, and he was scared. Tricia thought she was going to lose him.

  Marty never returned to work at the firehouse. Eventually, the doctors at NYU Hospital diagnosed polymyositis, a disease in which the body’s own immune system, designed to protect against infection and disease, attacks itself. In Marty’s case, the target was his own muscles, which the immune system suddenly became intent on breaking down, causing widespread damage that released the flood of CPK enzymes. During a particularly long night at the hospital, when he was feeling depressed and angry, one of his doctors bent low over Marty, drew close to his ear, and said, “This is from 9/11, and we’re going to prove it.” That was the first time anyone had told him there might be a connection between the dust and what was happening to his body. Proof, however, would be hard to come by. As with many autoimmune diseases, including sarcoidosis, the cause of polymyositis is not at all clear. Some evidence suggests environmental links, although none that have been proven conclusively.

  After a five-week stay in the hospital, Marty regained enough strength to return home. Although he had some good days, his condition steadily worsened. When he suffered a relapse in 2006, tests showed that his lungs were stiffening. Every breath of air became a struggle, even if he walked just a few feet. Tests showed he had only 34 percent of his breathing capacity, and he had to drag around an oxygen cylinder to keep from suffocating. He also developed an intense interstitial lung disease, called pulmonary fibrosis. By this time, Dr. Prezant had taken a direct interest in his care, lending a degree of consistency to what had become an increasingly chaotic and frightening situation for Marty and his family. Prezant was also aware that although Dave was fighting his own demons, he had gotten off much easier than his brother. Both had been exposed at some point to the same stuff, although Dave had sometimes worn a mask and Marty had not. Marty was told repeatedly that although he and Dave shared the same background, something in his makeup made him more vulnerable than his brother.

  The situation was becoming dire for Marty. He started on physical therapy during his hospitalization, but his lungs were so weakened that sitting up in bed was an ordeal that took three days to master. He lost 60 pounds and much of his optimism. He stuck with the therapy, and eventually his lung capacity went back up to 60 percent, but that didn’t last long. By 2006, he had dropped back to 40 percent, and doctors wanted him to start thinking about a very drastic step: a lung transplant. They were clear: A transplant was not a cure. It was simply a way to tame the disease he’d have to live with for the rest of his life. In November 2008, Marty’s name was added to the lung transplant list at Columbia Presbyterian Hospital. By then he was pretty banged up. He hadn’t been in the backyard pool for years. In fact, he couldn’t do anything without his oxygen mask. His Staten Island home resembled the set of a science fiction movie. “I always knew when Marty was coming down the hall then because he sounded like Darth Vader,” Tricia recalled.

  Marty finally caught a lucky break. After a little more than four months on the transplant list, the call came in from Columbia Presbyterian. Doctors replaced his severely damaged left lung with a donor organ. Tests on the lung that was removed showed not only the fibrosis, but glass shards embedded in the tissue, probably from the pulverized glass, fiberglass, and asbestos at ground zero. A few weeks after the surgery, Marty was allowed to go home and begin his long recuperation. Tricia gave up her job as an insurance broker to take care of him. Marty doesn’t expect to jump into the backyard pool for quite a while, but Dave gave him a mountain bike that he hopes to someday take for a ride. He’s confronted daily with just how much his life has changed, from skipping fresh fruits or vegetables (for fear of infection), to never working at a firehouse again.

  At first the fire department did not link polymyositis to ground zero and denied his application for a line-of-duty pension. But just before the transplant surgery, the department reversed itself. The updated diagnosis of polymyositis with interstitial lung disease was presumed to have been connected to his work at the trade center site.

  What truly bothers Marty is not that he had to adjust his routine to include more than 40 prescription pills a day, along with regular checkups and physical therapy, but that when he is at the doctor’s office, he runs into other firefighters who also worked ground zero and who, like him, are struggling with polymyositis. The typical age group for the disease is between 50 and 70, but the normal incidence in the general population is about 1 in 200,000. Marty counts five other firefighters with it, and Prezant believes there could be even more, which would push the incidence rate way beyond the expected. Because Marty also had interstitial lung disease, he has so far been the only firefighter with polymyositis to undergo a lung transplant. He joined the lawsuit against New York City, one of the thousands who believe the city did them wrong. If the suit is successful, he would win additional compensation beyond his fire department disability. But Marty doesn’t expect the money, if it comes, to change his life. He once thought of moving away to someplace warmer, but now he’s reluctant to leave his network of docto
rs, especially Prezant. He plans to stay in Staten Island and use the money to pay for the girls’ college—and maybe draw attention to the other guys who were hurt. That’s it. As for himself, his second chance at life is a sweet enough reward: “I just want to live in peace.”

  Two brothers with the same job—similar exposures, different outcomes. That leaves mysteries for science to ponder and emotions for the two men to come to grips with. Did the respirator Dave wore make the difference? Or was it something else? “Yeah, absolutely, I do consider why it happened to him and not me,” Dave wrote in an e-mail. But Dave didn’t come out of it unhurt. He must deal with survivor’s guilt because he is still strong, whereas his brother nearly died. And he lives with uncertainty, always the worry about what might happen to him in the future. “Through it all, every little thing that feels different inside my body leads me to ask, ‘Is this it?’” With the stress he’s lived with since 2001 everything that goes wrong is multiplied. “There are small issues, but right away you think the worst.” That’s what happened on September 11, when he heard that Marty had gone down to the trade center. And that’s what he’s felt while watching his older brother struggle with the disease and then recover, only to get even sicker. Inevitably, Dave has thought about the possibility of his brother dying, about the funeral and the eulogy he’d be asked to deliver. He hates having those thoughts and not knowing why he was kept whole but his brother was not, and this has made his own emotional recovery even more difficult.