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New York Magazine

September 20, 2004

Fallout

Three years after the World Trade Center attacks, thousands of cops, firefighters, and people who worked and lived near ground zero are sick with respiratory problems. Some have cancer. Is 9/11 to blame? And how safe are the rest of us?

By Jennifer Senior

Detective John Walcott     
Detective John Walcott
(Photo: Gillian Laub)

 

Printable versionWhen cops are ailing, they are not, as a rule, especially noisy about it. Two springs ago, John Walcott noticed his energy deserting him, but he blamed it on the sorts of things that any man who’s six-foot-two and built like a barge would blame it on—his newborn daughter, his hockey coaching, the daily strains of working in the NYPD narcotics unit, where he’d finally returned full-time after months of World Trade Center recovery work. As his energy continued to drain away, Walcott allowed for the possibility of stress, even an illness—Lyme disease, maybe? He contemplated going to the doctor, even though, as he puts it, he’s not a “go-to-the-doctor kind of guy.”

Then came Mother’s Day, an occasion he and his wife would celebrate for the first time as parents—their daughter, Colleen, was born the previous June. Walcott spent that Sunday morning as he always did, running a local hockey clinic. His head swam. He tore through three Gatorades. He couldn’t catch his breath. He left practice early, stopped at ShopRite for groceries, and then pulled into his driveway. As he walked up the stairs to his home, his arms draped to the biceps in shopping bags (“I don’t like making more than one trip from the car to the house,” he says), he lost his breath again. And then Walcott, all 225 pounds of him, fell to his knees.

Two weeks later, Walcott was in the hematologist’s office with a two-foot needle plunged into his tailbone, trying to keep still as the doctor scraped out samples of his bone marrow. It took just minutes to deliver the diagnosis: acute myelogenous leukemia, a white-blood-cell cancer. The doctor ordered Walcott straight to the hospital, where he stayed for 22 days undergoing chemotherapy. He lost his hair, coughed up dark chunks of blood, and watched the whites of his eyes turn red. His immune system was so compromised he was allowed only one visit with Colleen, then 11 months old, who stayed in her stroller under a plastic veil.

“When I got diagnosed,” says Walcott, “I was going crazy. I’d never been sick. But I’ll never forget: I had a variety of doctors and nurses, and a question they all asked—which I found crazy at the time—was, ‘Were you ever exposed to radiation or benzene?’ They wanted to know if I worked in an airport or if I delivered airline fuel. And I was like, ‘No.’ ”

Later, a nurse explained that Walcott’s form of leukemia was sometimes associated with benzene exposure, a fact he mentioned to his sister the next time they spoke. She gingerly pointed out that of course he’d been exposed: What on earth did he think was stoking the flames of the World Trade Center if not jet fuel? The connection had never occurred to him. But when he thought about it, he was strangely relieved. “I sat back and said, ‘At least I know how I got this.’ In medical terms, I don’t know. But in my mind, I was sure.”

Three years after September 11, it’s clear that the dust and fumes from the World Trade Center wreaked silent havoc on the lungs of thousands of rescue workers. But people like John Walcott raise a far graver question: What if it isn’t just their lungs? What if it’s their kidneys, their hearts? What if 9/11 gave them cancer? And if rescue workers are already this ill, what does that mean for the rest of us? What if the first responders aren’t the only ones to get sick, but the first in a mutely expanding ring?

By Monday, lawyers for Walcott and a group of at least 600 other workers associated with the World Trade Center cleanup—cops, firefighters, sanitation workers, Transportation Department workers, Con Ed and Verizon employees, and independent day laborers, among others—are expected to file a class-action lawsuit in federal court against World Trade Center developer Larry Silverstein and a number of ground-zero cleanup contractors. The same attorneys are also filing suit against the City of New York, the Port Authority, and the Environmental Protection Agency. The suits allege that dust from the 9/11 attacks made the plaintiffs sick, and seek billions of dollars in funding for medical screening and treatment and billions more in damages. (Other law firms already have similar, if more modest, cases pending against the city on behalf of similar plaintiffs.) The majority of the plaintiffs are suffering from the respiratory problems we’ve all heard so much about: asthma, sinusitis, chronic bronchitis. But others have kidney and heart problems. And at least twenty have cancers, says Walcott’s attorney David Worby, including leukemia, Hodgkin’s disease, and esophageal and thyroid cancer. Two have died.

If it seems a bit surprising to be talking about cancer so soon after the attacks, consider what we’re now learning about the people who helped clean up the pile: In a study of first responders released last Thursday, doctors at Mount Sinai Hospital’s WTC Worker and Volunteer Medical Screening Program found that nearly three-quarters of the 1,138 subjects they surveyed experienced new or exacerbated respiratory problems while working at ground zero; half had respiratory ailments that persisted for an average of eight months after their cleanup work had ended. The doctors have seen persistent sinusitis, chronic throat irritation, gastroesophageal reflux disease (GERD), reactive-airways syndrome, and asthma. Then there’s “the Cough,” that infamous World Trade Center cough, which rescue workers once wore like a badge of honor, because it proved they were there. Few of them probably imagined they’d still be stuck with it today. “My tonsils look like strawberries—that’s a quote from my doctor,” says John Graham, an EMT and one of the screening program’s first patients. “They’re red and pitted with burns.”

“We were dumbfounded by how many people were sick, and how sick they were, and how sick they still are,” says Robin Herbert, co-director of the screening program. The Sinai doctors haven’t seen an uptick in cancer rates, she says. “But given that we’ve been surprised by how sick people are—badly surprised—and given that people sustained massive exposures to a mix of toxins with unknown health effects, I’m frankly very concerned about cancer.”

The Fire Department, meanwhile, says that firefighters who were exposed to the pile in that first, hellish week lost, on average, 300 milliliters in breathing capacity, with the most symptomatic losing a liter. Two and a half times as many firemen have retired on respiratory disability since 9/11 as did in the three years before the attacks. Their doctors have also seen twenty cases of the chronic lung disease sarcoidosis, as opposed to the usual rate of two per year; four bizarre cases of something akin to miner’s lung; and a slight increase in thyroid cancer, a trend they’ll be monitoring closely.

And the 9/11 dust cloud may have sickened not just rescue and cleanup workers, but people who simply lived and worked downtown. A group of downtown and Brooklyn residents and workers filed a class-action lawsuit in March against the EPA, alleging “a shockingly deliberate indifference to human health” and seeking compensatory and punitive damages. The State Department of Health, in conjunction with the NYU-Bellevue Hospital asthma center, conducted a study that found that roughly three times as many residents downtown as uptown were complaining of respiratory ailments—a year after 9/11. Some persist.

On a depressingly regular basis, Jerrold Nadler, the congressman representing ground zero, also says he continues to get calls from constituents complaining of coughs, headaches, and mysterious rashes. Even healthy constituents are worried. “I see a lot of these community groups, and I can tell you: Many people ask me about cancer,” says Joan Reibman, the NYU-Bellevue asthma center’s director. “And I never know what to say. I suspect there’s little risk. But I don’t know. I don’t know.”

“It’s rational to be nervous,” says Nadler. “There may be tens of thousands of people downtown who are slowly being poisoned, because their apartments and offices haven’t been properly decontaminated, and some percentage will come down with God-knows-what fifteen years from now.”

I ask Nadler if he feels comfortable going to his office on Varick Street. “Not when I think about it,” he says.

Apart from the occasional fantasy about being a professional athlete, John Walcott knew from the beginning that he wanted to be a cop. Even when he was training to join the police force, even in his rookie year, he never gave much thought to the risks. “Not to be macho,” he says, “but I never got scared.” He has blue, wide-set eyes, and the light brown hair on his head is still a bit fuzzy from chemotherapy. “The only thing that scared me was 9/11, because I didn’t know what to expect.”

On the day of the attacks, Walcott arrived at the World Trade Center just after Tower 2 fell, and spent the afternoon combing through the ruins with a shovel he’d grabbed from an abandoned hardware store. He wound up working for several months around the site—first in the pile, then on the search teams set up by the NYPD, checking abandoned buildings for survivors and escorting displaced residents back to their homes. But because the attacks were considered a crime, and because he’s a detective, Walcott was also sent to Fresh Kills, where he would systematically scan the tower debris for personal effects, human remains, and clues.

Fresh Kills has always had a certain aesthetic peculiarity, but in those days, it was a sci-fi moonscape. The first sight the detectives saw, as they snaked up the 160-foot mesa of WTC remnants, was off-road trucks disgorging heaps of detritus, while a grappler organized the heaps into tidy rows. The detectives combed through it all. Whatever seemed peculiar or significant they threw into a bucket. House keys. Fragments of artwork. A foot in a boot.

Walcott remembers staring at the ground late one evening, green bubbles heaving all around his feet—methane gas, probably, a common and pungent by-product of landfills. As he listened to his co-workers joke about the similarities between Fresh Kills and Homer Simpson’s nuclear-power plant, he looked around and thought: This cannot be healthy.

Anyone who lived or worked near ground zero remembers the rancidness of the fumes—so indescribably foul they were, you could smell them in your eyes. Yet few of us left. Downtowners, for the most part, moved back into their homes; Wall Street went back to work; 40,000 men and women spent months on that pile, clearing it away. If it occurred to any of us that we were paying a price for our decisions, we brushed those thoughts aside. This was our city. This was war. And besides, what else were we going to do?

In the aftermath of the attacks, the EPA issued multiple reassurances about the air quality around ground zero. But a scathing report, released last summer by the EPA’s Inspector General, declared that it was impossible to say how safe the outdoor air was at that time. It turns out that on September 18, the day that EPA head Christie Todd Whitman issued a press release saying she was pleased to note that the air was safe to breathe, the EPA still hadn’t completed testing for mercury, cadmium, lead, dioxin, PAHs, or PCBs. The Inspector General’s report later revealed that the EPA was required to send all of its press statements to the White House Council on Environmental Quality, which ran them through a heavy clean-and-rinse cycle before releasing them to the public, transforming modest yet cautionary public advisories into cheerful proclamations that the air was clean.

Here, today, is what we know about the dust and air at ground zero: It contained glass shards, pulverized concrete, and many carcinogens, including hundreds of thousands of pounds of asbestos, tens of thousands of pounds of lead, mercury, cadmium, dioxins, PCBs, and polycyclic aromatic hydrocarbons, or PAHs. It also contained benzene. According to a study done by the U.S. Geological Survey, the dust was so caustic in places that its pH exceeded that of ammonia. Thomas Cahill, a scientist who analyzed the plumes from a rooftop one mile away, says that the levels of acids, insoluble particles, high-temperature organic materials, and metals were in most cases higher in very fine particles (which can slip deep into the lungs) than anyplace ever recorded on earth, including the oil fires of Kuwait.

“What you had,” says Cahill, a UC-Davis professor emeritus of physics and atmospheric sciences, “was a ground-level municipal incinerator that smoldered for months. And it was burning up the most heavily computerized building in the world.”

For those who lived through September 11, it makes sense that cancer would have a certain metaphorical potency. Like terrorism, it plucks at an unconscious fear about cells—sleeper cells—working silently with the ultimate intention of claiming your life. Most mainstream doctors, however, would be loath to say outright that there’s an aborning cancer cluster downtown. The latency period for most cancers, even after full-saturation exposure to carcinogens, is typically years, if not decades.

Many of those who were exposed to Agent Orange during Vietnam, for instance, didn’t develop prostate cancer, skin cancer, or chronic lymphocytic leukemia until decades after the war. “For anyone who has a cancer now, I think it’s overwhelmingly unlikely that it’s related to the World Trade Center,” says Jacqueline Moline, a colleague of Robin Herbert’s at Mount Sinai.

Kelly Colangelo     
Kelly Colangelo
(Photo: Gillian Laub)

 

David Worby, Walcott’s attorney, hardly views it that way. A veteran trial lawyer, he made his fortune from personal-injury cases, including seven-figure settlements on behalf of children hit by drunk drivers and victims of unjustified police shootings. Today, he owns a $10 million English-manor estate in Bedford and was in the midst of slowing down his legal career and turning to other interests, like writing pop songs and screenplays, when he heard about Walcott through a friend.

“If you expose a person to this amount of lead, cadmium, benzene, asbestos, and glass shards, they are going to be sick,” says Worby. “They’re going to be sick in a way that this country has never seen except maybe for Agent Orange.” And it’s not just the sheer volume of toxins in the air, he adds. It’s what he calls the “cocktail pulverization effect.” No one, he points out, has ever studied what this particular mix of chemicals might do to people. “How can they say it’s not harmful?” he asks. “That’s just arrogant.”

Like many trial lawyers, Worby tends to use bold letters when plain type may suffice. “I am prognosticating,” he says, “that these men who came home and passed out in their beds, with the fibers and glass shards all over them, and these women who came home every night and washed their clothes, with their children’s clothes . . . ” He trails off. “More people could die from this than died on the day of 9/11.”

If it were only plaintiff’s lawyers who were making these allegations, their claims might not seem so credible. But there are doctors who are at least willing to countenance the notion that 9/11 was different, if not the impending health disaster that Worby predicts. Charles Hesdorffer, the director of the bone-marrow transplant and tumor immunotherapy program at Columbia Presbyterian, provided testimony to the federal government’s Victim Compensation Fund. He consented because he found it odd that two of his own patients at Columbia Presbyterian were diagnosed with pancreatic cancer after working at the World Trade Center pile, and one of those patients knew of two others. Four cases in 40,000—that was a much higher incidence than in the population at large. And while prepared to believe that it was a coincidence, a freak cluster of some kind, he was also aware of the unusual exposures of the day. “I thought it was strange,” says Hesdorffer. “And while it was a short time for these patients to present, it wasn’t that short. Though we think cancer’s a slowly developing process, no one knows for sure.”

It’s also possible, doctors say, that the carcinogens in the World Trade Center dust accelerated cancers that were already under way in some rescue workers, either by promoting further mutations in genes whose cancerous transformations were nearly complete, or by tampering with genes that suppress these deadly mutations. According to James Manfredi, a cancer researcher and molecular biologist at Mount Sinai, there are certain compounds that “alter genetic expression in a more global way,” meaning that if a person were first exposed to a carcinogen and then to one of these compounds, cancer could more rapidly ensue. And Lord knows what, coming from that pile, could have qualified as a cancer promoter.

When John Walcott was diagnosed with leukemia, he at first asked his doctors nothing about his future. Later, as he came to accept his condition, he tried to do some research. It made him crazy. Forty percent recovery rates from chemo? He found himself breaking down in front of his computer terminal in the evening and asking his oncologist about what he’d read in the morning. She advised him to quit reading. “I became the ‘What-If Guy,’ ” he says. “The guy everyone hated in the police academy was the What-If Guy. ‘What if this happened? What if that . . . ?’ I was never that. And I became that.”

For six months, Walcott led the life of Sisyphus. He’d go for chemotherapy, which would utterly deplete him; then he’d receive blood transfusions, feel his strength return, and have to start chemo all over again. After months of deliberation, he decided to go for a stem-cell transplant, figuring the odds of a full recovery were greater. It didn’t take. Instead, he was in the hospital for 30 days, near-dead from a lung infection. For four days, he slept on an ice mattress to get his fever down; for two weeks, he was too weak to pick up a glass of water. His friend Richard Volpe, who worked with him at Fresh Kills and is now ailing from two partially functioning kidneys (he has signed on as a client of Worby’s), had to pour water down his throat.

On the day Walcott was supposed to go home, a doctor came by and read his chart. His kidneys were going haywire. “My wife had already told my daughter I was coming home,” he says. “Colleen sat on the stairs for like an hour, just waiting. On the bottom step. And I never came through the door.” He starts, discreetly, to weep.

For men like John Walcott, the greatest health threat posed by the 9/11 attacks clearly came from breathing the air and from prolonged exposure to the pile. But what about downtown residents and workers, who not only breathed the air at the time of the attack, but potentially continue breathing some modified form of it to this day, in their offices and homes? Kelly Colangelo is one such person. She’s one of the twelve original plaintiffs in the EPA lawsuit initiated by downtown residents.

On the morning of September 11, 2001, Colangelo had the misfortune of leaving her windows open on John Street and Broadway. On September 12, after sneaking back to her apartment to appraise the situation, she was astonished at what she found: a neat slope of dust, starting under her windowsill and finishing at her doorway, like a ramp for the disabled. She was so disoriented that the only things she thought to grab were CDs, DVDs, beer, cookies, handbags, and some matching belts.

Colangelo’s landlord threatened to sue anyone who broke his lease, so Colangelo hired a contractor who brought in a team of immigrant day workers to clean her place. On September 30, she moved back in. Her symptoms began almost immediately. She developed a rash on her hands and mouth, a benign nodule on her thyroid, joint pain, sinus problems, coughing fits, sharp stomach aches, even sharper headaches, crushing fatigue. Eventually, she hired two independent companies to analyze the dust that was still trapped in her window frames. One company found no asbestos; the second found ranges of 1.4 to 2 percent. The EPA considers any level above 1 percent in the air to be dangerous. Both companies also found high levels of fibrous glass.

David Worby      
David Worby
(Photo: Gillian Laub)

 

Colangelo went to see many doctors for her symptoms. Colangelo went to see many doctors for her symptoms. None believed they had much to do with her apartment. “They think we’re a bunch of hypochondriacs,” she says.

Colangelo finally moved out of her apartment in February 2002. Around the same time, she was diagnosed with post-traumatic-stress disorder. She took time off work and went on partial disability. Today, though her headaches and sinus problems are gone, she’s still suffering from a host of allergies, GERD, and a mysterious stomach ailment, for which she was being tested the day after I saw her. “I feel like an 80-year-old,” she says, running a hand through her cinnamon hair. “This governs my life.”

It would seem logical to assume that the farther away from ground zero you were on September 11, the safer you were. But here’s the reality: No one knows for certain what the fallout from the World Trade Center is or will be. Not for rescue workers. Not for residents. Not for anyone. Read the EPA Inspector General’s report, in fact, and it’s official: No one in our government has a clue. In the weeks following the attack, the outdoor air around Wall Street might have been safe; it might not. Today, the air indoors downtown might be okay; it might not. The uncertainties outlined by the report are frank, real, and maddening. A representative statement: “[A] definitive answer to whether the air was safe to breathe may not be settled for years to come.” Or: “The full extent of public exposure to indoor contaminants resulting from the WTC collapse is unknown.”

In the face of this uncertainty, Worby, Nadler, and other advocates believe the best recourse is to set up and fund monitoring and treatment programs. Yet this doesn’t seem to be a priority for the city, the state, or the federal government—a conclusion shared by the Government Accountability Office in a report it issued last week. The only city-run attempt at monitoring the health effects of 9/11 is something called the World Trade Center Registry, and that’s not even a medical program but a list of people who submit themselves to a half-hour interview, describing the ways they’re unwell. The Mount Sinai monitoring program sees only first responders, allows only three visits a patient, and has only five years of funding. Its $1.5 million treatment program, a smaller effort involving just 880 patients, is funded entirely by philanthropy. Forty percent of its patients don’t have health insurance. “If we see cancer among these people,” asks Robin Herbert, “who’s going to pay for their medical care?”

In March, Congresswoman Carolyn Maloney, who along with Senator Hillary Rodham Clinton successfully pushed for the money for the Mount Sinai monitoring program, introduced the Remember 9/11 Health Act, a bill that demands a coordinated federal response to the terror attacks—not just in the form of monitoring potential victims, but in treating them, and for a period of twenty years. Nadler, meanwhile, has been holding press conference after press conference, demanding the EPA test downtown buildings in concentric circles for contamination. But given Congress’s reluctance to spend money on New York, it’s hard to imagine Maloney’s bill ever getting traction. And for three years, the EPA has maintained that cleaning indoor air from the disaster site is not its statutory responsibility, but the responsibility of the city.

It’s difficult to assess whether downtown needs an expensive cleanup. When the EPA finally tested 3,405 apartments, it didn’t find much—though private firms, Nadler says, found plenty of contaminated buildings that the agency had said were clean. Joachim Pleil, an EPA scientist who studied PAH levels around the periphery of ground zero, concluded that those breathing that outdoor air increased their risk of getting cancer by only one millionth of a percentage point—though he concedes his numbers did not apply to indoor air, where the PAHs he studied may never have broken down.

So Nadler is unappeased. Why, he argues, should New Yorkers live with this question hovering above their heads like so much smoke? “If the government doesn’t do a proper cleanup,” he says, “the officials who are resisting it will be responsible for excess deaths. They may never be held accountable legally, but I wouldn’t want to be in their position when they meet their maker.”

This fall, the Deutsche Bank Building, which sits wrapped, Christo-like, on the periphery of ground zero, is scheduled for demolition. The bank claims parts of the building are glutted with asbestos and other contaminants; the Lower Manhattan Development Corporation, which now owns the building and is responsible for the tear-down, hasn’t yet made its assessment public. Will this be the moment when New Yorkers finally have a frank public discussion about World Trade Center fallout? And find the right balance between science and melodrama, precaution and alarm? It’s something to think about—before the wrecking balls swing and the asbestos and bad memories are rereleased into the air.

Because of his “chemo brain,” as he puts it, John Walcott can no longer recall certain details of his life. He can’t remember exactly when he met his wife, for example—only that it was “the year it rained and snowed.” The details of his daughter’s second year are fuzzy for a different reason. For much of the time, he wasn’t home for them, or he was too weak to notice.

After each chemotherapy session, Walcott didn’t have the strength to pick up Colleen. Having so few white blood cells, he was also tremendously susceptible to infections and colds, which children, of course, tend to attract.

He says his daughter, now 2, understands that her father is unwell. “She knows I take medicine,” he says. “Now that she takes those chewable vitamins, we take them at the same time.” Once, when Walcott started having an uncontrollable nosebleed, she raced to get him cotton balls. Now she sometimes offers him cotton balls even when he doesn’t need them, just as a show of affection.

So you live in Battery Park. Or maybe you live in Chelsea. Or Brooklyn, even. Should you worry? If you do worry, is it more sensible to indulge your fears or to ignore them? There’s no right answer, of course—there are too many unknowns. But for what it’s worth, EPA Inspector General Nikki Tinsley, who wrote that scathing report, says she’d live downtown: “We take risks every day,” she says. This is just one more. Another part of the new normal.

What about someone like John Walcott? Someone who was right there, on the pile, and is now sick? Do we indulge his fear, if you can call it a fear, that 9/11 made him sick? Perhaps we should, if not for reasons of science, than for reasons of philosophy. Perhaps the least we owe him is to give him the benefit of the doubt.

That’s how Gregory Fried, the former NYPD chief surgeon, sees it. It’s not that he’s convinced cancer clusters are destined to develop around ground zero. Rather, it’s that he can’t say the opposite, and he knows enough about the history of medicine to recognize that one century’s orthodoxy is the next century’s folly. “For 400 years, we thought leeches cured disease,” he says. “For 500 years, humors were the mainstream explanation for most ailments. Up until ten years ago, ulcers were caused by stress. When I was chief resident, I must have taken out 75 to 100 stomachs because of this. And it turns out it’s a germ! A germ! So just because something’s not in the literature or demonstrated or proven yet—so what?”

Fried shifts in his chair. He’s an affable man, pleasant-faced and Long Island–sounding, who looks people in the eye when he speaks. “What happened downtown has never been equaled except, maybe, at Mount St. Helens,” he says. “But that was natural stuff. This was abnormal stuff from the late seventies, a highly toxic soup. No one has a clue how it comes together.”

Too often, says Fried, the onus has been on the cops to prove that 9/11 made them sick. “But what does proof, here, mean?” he asks. “With John Walcott, you got a cause, you got an effect, and if you’re not going to link them, shame on you. The tie goes to the runner.”