Now Graham carries a bag full of medications around with him each day. He takes 17 different drugs for ailments ranging from asthma to chronic infections, and sees his doctor so often that he’s had to ask the receptionist to call and remind him of upcoming appointments so he can keep track.
Graham, whose office was blocks from the World Trade Center, was able to get down to the Twin Towers so quickly after the first plane struck that he was standing across the street from the North Tower when the second plane hit. Because of his unusual combination of medical and carpentry skills, Graham ended up staying at the site for more than nine months helping out, despite his own mounting health problems. His first sought treatment three weeks after the attacks. The initial diagnosis: respiratory problems including asthma, and chemical burns on his esophagus and throat.
Doctors and researchers now believe that Graham is one of tens of thousands who suffer debilitating health problems stemming from their exposure to contaminants in the air around the World Trade Center site–and it’s not just rescue and recovery workers who are affected. A report published this month in the journal Environmental Health Perspectives found that pregnant women who were inside the Twin Towers or within a 10-block radius at the time of the attacks showed a twofold increase in the incidence of smaller than average infants compared to pregnant women in a demographically similar population who weren’t in Manhattan on September 11.
The findings are part of a comprehensive report believed to be the first to combine extensive environmental and medical data on the effects of the World Trade Center attacks; it draws a direct link between the contaminated air at and near the World Trade Center site and “significant adverse effects on [the] health” of those who were in the area.
As the 9/11 Commission holds hearings this week in New York to examine the coordination and communication between response units on September 11, the recently published health report sheds new light on the environmental dangers that those first responders and rescuers, as well as construction workers, were exposed to that day and for several weeks afterward.
Air sampling, the report found, showed dust in the plume above the towers had high alkaline levels (about 10 pH–the same as ammonia or detergent) and contained contaminants like asbestos, lead and polychlorinated biphenyls (or PCBs)–in addition to pulverized cement and glass fibers. Among workers involved in the cleanup and recovery, many of whom–like Graham–spent several months in and around the disaster site inhaling that air, almost one third experienced a chronic cough that began shortly after employment at the site, 24 percent reported new onset of phlegm production and 18 percent reported new onset of wheezing. About half of all workers reported at least one new symptom after they began working at the site. Residents in the area reported similar health problems. Of 10,116 firefighters evaluated, 332 suffered from a persistent cough and other respiratory symptoms so severe as to require at least four weeks leave of absence. Other rescue and construction workers were treated for a host of ailments ranging from asthma and alkaline burns to rashes and respiratory infections.
“One problem is that no one was insisting that workers wear respirators,” says Dr. Philip J. Landrigan, chair of the Department of Community and Preventive Medicine and director of Environmental and Occupational Medicine at Mt. Sinai School of Medicine in New York, and principal author of the recently published study. “I wouldn’t fault anyone in the first 48 hours during the immediate response,” he adds, “but for months afterward most workers at Ground Zero were still not wearing respirators and, in my mind, that is a terrible failure in regulation and it’s going to result in a lot of diseases that could have been prevented.”
Graham did not use a respirator when he started work at the site, though he wore a mask later. Still, he says, he believed the air was safe after the Environmental Protection Agency Administrator Christie Whitman declared it so a week after the attacks (a statement she has since been widely criticized for making). “The government lied to us,” he says. “They said the air was clean.”
Graham continued to work after his initial diagnosis. But his symptoms only worsened. When he left Ground Zero in May 2002, he could no longer work as a carpenter–the combination of dust and exertion provoked asthma attacks so bad he had to be rushed to the emergency room once when he was working with an apprentice. So he took a cut in pay and a job as a health and safety instructor for the New York District Council of Carpenters. Even that is a struggle at times; last winter he suffered a severe attack in class and was unable to talk until a student brought him medication.
“This was a life-changing event medically for people who were caught in the dust cloud–and probably tens of thousands were caught in that cloud,” says Dr. Michael D Weiden, a medical officer for the Fire Department of New York who has treated hundreds of firefighters–many of whom suffer permanent disabilities. “There are hundreds who are no longer able to work,” he says.
Weiden, Landrigan and other doctors who have treated or studied those who spent time at Ground Zero are urging continued long-term follow-up of the health impact of exposure to the contaminants as well as long-term treatment for those affected, some of whom risk developing more serious ailments like mesothelioma, a relatively rare form of cancer (with no cure) associated with asbestos exposure.
Making sure that long-term treatment is covered is a particular challenge to those representing the residents and rescue and construction workers who were in the area, as there’s no way to predict what symptoms may yet emerge.
“The real concern is that we do not yet know the long term effects of 9/11, and the period of manifestation differs from person to person,” says Michael Palodino, the president-elect of the Detectives’ Endowment Association, which represents about 15,000 active and retired police detectives. “But despite the possible fiscal costs, you can’t turn your back on these people.”
Lawyer Michael Barasch, who has helped file hundreds of injury claims with the Victim Compensation Fund, says all but a handful of those he has represented have had their claims approved. But the fund has turned down some claims for lack of medical proof or because the victim’s symptoms improved. “It’s so ironic that so many of these guys who were rescue workers are now in need of being rescued themselves,” he adds.
There are bills under consideration at the state and federal level that would help cover the costs of long-term medical care and follow-up for a wider range of those affected by the attacks. Nationally, the Remember 9/11 Health Act, sponsored by New York Congresswoman Carolyn Maloney in March, would expand those eligible for coverage for health problems related to the attacks; it has been referred to a House subcommittee. Proposed state legislation would shift the burden of proof from the rescue workers to the compensation board in determining whether health problems were a direct result of exposure at the World Trade Center site.
“There are those who are active[-duty] today but suffering from some symptoms and may get sick down the road when the answers come out, but there is no mechanism now to bring them back then and get them what they deserve–unless we get this bill passed,” says Palodino. He adds that about 5 percent of active detectives have been treated for symptoms, from rashes to respiratory problems. “And I am positive that there are plenty more who are running around that are not reporting them.”
It’s not clear how many of those who were exposed to the contaminated air around Ground Zero have yet to come forward for treatment, but there is widespread agreement within the medical community that the number who are suffering lingering health problems from the September 11 attacks is greater than initially anticipated. Weiden, who treats the New York firefighters, says there’s still “a large unmet need” and warns: “Some–or many–of those caught in the cloud will be in crisis if they don’t understand what’s going on.”
“It’s much more serious than we initially realized,” says Landrigan, the principal author of the study. “It took awhile to realize just how toxic this dust was.”
It could take even longer still–Landrigan says the first related cancer cases may not appear for at least a decade–to realize just how serious the consequences will be for the thousands like Graham who were exposed to the dust.
