Death by Dust

The frightening link between the 9-11 toxic cloud and cancer

by Kristen Lombardi

November 28th, 2006 5:22 PM















To date, 75 recovery workers at ground zero have been diagnosed with blood cell cancers that a half-dozen top doctors and epidemiologists have confirmed as having been likely caused by that exposure. Ernie Vallabuona is one of them.

photo: Scott McDermott photo: Scott McDermott



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Believe 9-11 is causing cancer?

An open thread in Power Plays It was October 6, 2004, three years after Ernie Vallebuona's three-month stint as a rescue and recovery worker at ground zero in the wake of the 9-11 terrorist attacks, and he was hunched over and trembling, racked by a pain like nothing he had experienced in his 40 years of sound health. He had just returned to his Rockland County home after finishing the midnight-to-8 a.m. shift in the NYPD vice unit, where he'd reported to work for the last six years. Vallebuona had bought some fish from a street vendor near his office, on the Lower East Side. And as he drove the 35 miles from Manhattan to New City, he chalked up a searing stomachache to food poisoning. Maybe the vendor had filleted that fish with a dirty machete? It was October 6, 2004, three years after Ernie Vallebuona's three-month stint as a rescue and recovery worker at ground zero in the wake of the 9-11 terrorist attacks, and he was hunched over and trembling, racked by a pain like nothing he had experienced in his 40 years of sound health. He had just returned to his Rockland County home after finishing the midnight-to-8 a.m. shift in the NYPD vice unit, where he'd reported to work for the last six years. Vallebuona had bought some fish from a street vendor near his office, on the Lower East Side. And as he drove the 35 miles from Manhattan to New City, he chalked up a searing stomachache to food poisoning. Maybe the vendor had filleted that fish with a dirty machete? By the time he pulled into his driveway, the pain had grown excruciating, too horrible for him to even lie in bed that day. The chills swept over his body; so did the shakes. He called his doctor, who suggested ulcer medication. His mother advised him to forget that diagnosis and consult a specialist instead, but like a lot of young, healthy men, he didn't listen right away. Vallebuona isn't much for complaining; what ailing cop is? But for six months, he had noticed his body betraying him. His toes had reddened; his joints had stiffened. They throbbed in prickly pangs, as if glass shards were wedged underneath his skin. When his own heartbeat began to hurt, he had visited the family doctor, who diagnosed him with gout. He was told to drink cherry juice and take anti-inflammatory medicine. Neither worked. Now as his stomach convulsed, Vallebuona listened to his mother at last. Later that day, he found himself at a gastroenterologist's office in Pomona, lying on a table, watching a nurse poke at his abdomen. She felt a lump and ordered tests. It would take a month to reach a definitive diagnosis of non-Hodgkin's lymphoma, a cancer of the lymphoid tissue. Evidently, Vallebuona had developed a golf-ball-sized mass in his abdomen that had grown so fast and so quick that pieces of it were dying and depositing into his blood, causing gout-like symptoms. One week after that, he was at a Manhattan hospital, meeting his oncologist, hearing about the heavy-duty chemotherapy he would have to undergo over the next four months. At the visit, a nurse explained he had an aggressive cancer—a rare stage-three—and asked a battery of questions. Did he ever do modeling with glue?

Did he ever handle insecticides?

Did he ever work with chemicals like benzene? Vallebuona answered no to all the questions. He had led a clean life; before becoming a cop, he'd worked in a bank. Sitting in the examining room with him, Vallebuona's wife, Amy, finally spoke up. "What about 9-11?" she asked. "What about all that smoke and dust?" Only then did Ernie Vallebuona first consider the possibility that the events of September 11 could be the cause of his cancer. This is not the story of rescue and recovery workers at ground zero getting sick with respiratory illnesses from their exposure; you have read those stories, and you have heard those cases. This is the story of 9-11 and cancer. To date, 75 recovery workers on or around what is now known as "the Pile"—the rubble that remained after the World Trade Center towers collapsed on the morning of September 11, 2001—have been diagnosed with blood cell cancers that a half-dozen top doctors and epidemiologists have confirmed as having been likely caused by that exposure. Those 75 cases have come to light in joint-action lawsuits filed against New York City on behalf of at least 8,500 recovery workers who suffer from various forms of lung illnesses and respiratory diseases—and suggest a pattern too distinct to ignore. While some cancers take years, if not decades, to develop, the blood cancers in otherwise healthy and young individuals represent a pattern that experts believe will likely prove to be more than circumstantial. The suits seek to prove that these 8,500 workers—approximately 20 percent of the total estimated recovery force that cleared the rubble from ground zero—all suffer from the debilitating effects of those events. The basis for the suits stems from the plaintiffs' argument that the government—in a desperate attempt to revive downtown in the wake of the catastrophic events on 9-11—failed to protect workers from cancer-causing benzene, dioxin, and other hazardous chemicals that permeated the air for months. Officials made these failures worse by falsely reassuring New Yorkers that they faced no long-term dangers from exposure to the air lingering over ground zero. "We are very encouraged that the results from our monitoring of air-quality and drinking-water conditions in both New York and near the Pentagon show that the public in these areas is not being exposed to excessive levels of asbestos or other harmful substances," Christine Todd Whitman, the then administrator of the EPA, told the citizens of New York City in a press release on September 18—only seven days after the attacks. "Given the scope of the tragedy from last week, I am glad to reassure the people of New York . . . that their air is safe to breathe and the water is safe to drink." Those statements were not only false and misleading, but may even play into the basis for the city's liability for millions of dollars in the recovery workers' lawsuits. Last February, U.S. District Judge Deborah Batts cited Whitman's false statements as the basis for allowing a different class-action lawsuit to proceed—this one, against the EPA and Whitman, is on behalf of residents, office workers, and students from Lower Manhattan and Brooklyn, many of whom suffer from respiratory illnesses as a result of 9-11. "No reasonable person would have thought that telling thousands of people that it was safe to return to Lower Manhattan, while knowing that such return could pose long-term health risks and other dire consequences, was conduct sanctioned by our laws," Batts wrote in her February 2 ruling. "Whitman's deliberate and misleading statements made to the press, where she reassured the public that the air was safe to breathe around Lower Manhattan and Brooklyn, and that there would be no health risk presented to those returning to the areas, shocks the conscience." And that was before anyone knew of the apparent cancer link, first reported in the New York news media in the spring of 2004. Even more shocking is the incidence of cancer and other life-threatening illnesses that have developed among those participating in the recovery workers' lawsuits. Given the fact that some cancers are slower to develop than others, it seems likely to several doctors and epidemiologists that many more reports of cancer and serious lung illnesses will surface in the months and years to come. The fact that 8,500 recovery workers have already banded together to sue, only five years later—with 400 total cancer patients among their number—leads many experts to predict that these figures are likely to grow, meaning a possible death toll in the thousands. In many ways, these illnesses suggest the slow but deteriorating health issues that faced the atomic-bomb survivors of Hiroshima and Nagasaki, where thousands died in the years and decades that followed the United States' use of nuclear weapons. And that similarity has not been lost on David Worby, the 53-year-old attorney leading the joint-action suits on behalf of those workers who are already sick, and even dying. "In the end," Worby declares, "our officials might be responsible for more deaths than Osama bin Laden on 9-11." In the five years since the attacks, much of the focus on the 9-11 health crisis has missed a broader question, the one that every ground zero worker fears most and the one that Ernie Vallebuona has already had to ponder: What about cancer? What if all that pulverized concrete and ground glass and caustic mist that Vallebuona inhaled while on the Pile didn't attack his lungs but instead went straight for his lymph nodes? Could this noxious mix have caused his lymphoma? No one has done a comprehensive study of the health consequences on the estimated 40,000 rescue and recovery workers who raced to ground zero after the attacks. A study by Mount Sinai Medical Center—one that received widespread media attention two months ago—released statistics on the five-year anniversary of 9-11 that focused almost exclusively on respiratory problems and bypassed any mention of cancer today. But David Worby has tracked the cancer patients among his growing client base for the last two years. Here are the latest tallies: Of the 8,500 people now suing the city, 400, or about 5 percent, have cancer. The biggest group by far consists of people like Vallebuona, who have blood cell cancers. Seventy-five clients suffer from lymphoma, leukemia, multiple myeloma, and other blood cell cancers; most are men, aged 30 to 60, who appeared in perfect health just five years ago. The field of cancer research is not known for consensus. But six prominent specialists on cancer and the link to toxins—on the faculty of the nation's top medical schools and public health institutions—all come to the same conclusions when told these statistics. They are Richard Clapp and David Ozonoff, professors of environmental health at Boston University School of Public Health; Michael Thun, director of epidemiological research at the American Cancer Society; Francine Laden, assistant professor of environmental epidemiology at Harvard School of Public Health; Jonathan Samet, chairman of the epidemiology department at Johns Hopkins Bloomberg School of Public Health; and Charles Hesdorffer, associate professor of oncology at Johns Hopkins School of Medicine. These doctors and epidemiologists agree that the incidence of cancer among this subset of workers sounds shockingly high, that they cannot and should not be dismissed as coincidence, and that the toxic dust cloud that hung over downtown Manhattan, and particularly the Pile, likely caused or promoted the diseases. Some even went so far as to say that the blood cancer cases, especially, indicate what could become a wave of cancer cases stemming from 9-11 over the next decades. "Those numbers seem quite outrageous," is how Hesdorffer puts it. Now at Johns Hopkins, Hesdorffer directed until last year the tumor immunotherapy program at Columbia University Medical Center, where he treated two recovery workers who got cancer post–9-11. He notes that the average healthy adult person has a 20 percent risk of having cancer over a lifetime. Calculate that risk over five years—the time frame from the events of 9-11 until today—and it drops to about 1 percent. Yet 5 percent of the suits' workers—1 percent of the overall worker population—have already been diagnosed with malignancies. And these patients don't include the thousands whose illnesses have yet to be recorded because they aren't participating in the lawsuits or in the World Trade Center medical-monitoring programs. What the experts find most telling are the types of cancer now emerging. They say the blood cancer cases seem too disproportionate to be random. Two percent of these workers have been diagnosed with what amounts to related diseases, none of which fall into the "high-frequency" category, which includes prostate cancer. One out of 9,000 people nationwide gets lymphoma a year; for myeloma, it's one out of 30,000. By contrast, the 75 blood cancer patients translate into several dozen new cases a year. "That's not just a fluke," says Ozonoff, who studies cancer clusters and toxic waste sites. Samet, a worldwide expert on smoking and cancer, notes that when so many cases of related cancers emerge, it can signal a forming cluster. "It sounds like an impressive cluster of cancer cases, and I would want to study it," he says. To be sure, the experts advise caution until more evidence is collected. They acknowledge that the data needed to draw a definite link between 9-11 and cancer don't exist. None of the cancers emerging now are the kinds that come only from toxic exposures—like, say, asbestosis, which is caused by asbestos and can take two decades to grow. This sentinel cancer would go a long way toward proving a 9-11 connection. Absent that, scientists would want to determine whether a higher proportion of cancer patients exists among the workers than in the general public. But because there are no independent data on the 40,000-strong group, they can't make this calculation yet. Meanwhile, the latency periods for most cancers from the time of a full-blown carcinogenic exposure to a full-blown malignancy can take years, if not decades. Says Thun, of the American Cancer Society: "It is the exception rather than the rule to have cancers develop this quickly." Despite the lack of definitive data, we may still be in the midst of a cancer epidemic. Indeed, according to these experts, traditional data don't help much here because 9-11 represents such a singular exposure. No one can deny that the workers were exposed to a blend of pulverized and aerosolized toxins that had never existed in any occupational setting before. And this mix of toxins alone is enough to cause more aggressive cancers. "It's also enough to throw out prescriptions on timing," Hesdorffer adds. Back in May 2004, before most doctors even contemplated a 9-11 link to cancer, Hesdorffer provided testimony to the federal government's September 11 Victim Compensation Fund on behalf of one police officer who had developed pancreatic cancer within a year after his recovery stint. Hesdorffer finds it odd that two of his patients had been diagnosed with the rare cancer after working on the Pile. "It's strange to have two people who were subjected to the same exposure," he says, "developing the same cancer in the same time frame." Now that he has learned of Worby's statistics, he is convinced that "there is definitely more than a likely link between the 9-11 exposures and cancer." Francine Laden, who specializes in air pollution and cancer, agrees. Because so many of Worby's clients have blood cancers—which have faster incubation periods than tumor cancers, forming in as little as five years—Laden confirms that it's not a stretch to attribute their diseases to the dust cloud. "Blood cancers are different," she says, noting the tie between benzene and leukemia, as well as dioxin and lymphoma. "It's not beyond the realm of feasibility that these chemicals caused these cancers." Ozonoff puts it more firmly: "For an acute episode like this, it's definitely possible these blood cancers were caused by 9-11." Ozonoff echoes all five of his colleagues when he draws parallels between the aftermath of 9-11 and that of another massive exposure: the atomic-bombs dropped on Japan. Bomb survivors experienced excessive spikes in leukemia rates within the first five years, a surprising discovery for epidemiologists in the mid 20th century. While this outbreak resulted from radiation, both it and 9-11 involved a sudden and intense blast of carcinogens. For bomb survivors, leukemia appeared first, followed by breast and lung cancer. "That could happen with 9-11," says Samet, the Johns Hopkins epidemiology department chair. "It might be what we're seeing today." It's also possible that the carcinogens in the Trade Center dust accelerated cancers already dormant or developing in the recovery workers, epidemiologists say. According to Richard Clapp, who directed the Massachusetts Cancer Registry from 1980 to 1989, toxins can not only instigate the genes that cause cancerous cells to divide, but also hasten their dividing. That means that a person with an undetected cancer will develop it faster and in a more virulent manner. He calls this the "promotional effect" and says some toxins associated with 9-11 have been known to speed up lymphomas and leukemias. "The promotional effect could have happened already," he says. Either way, Clapp adds, "It's hard not to attribute these cancers to 9-11." His gut, he says, is telling him one thing: "We'll be seeing a cancer explosion from 9-11, and we're starting to see it today."

A nurse would ask John Walcott about possible causes of his acute myelogenous leukemia. Like Vallebuona, Walcott answered no to all the questions. And like Vallebuona, he didn't connect the dots between his time at ground zero and the cancer growing in his body.

photo: Scott McDermott At 8:30 on the morning of the terrorist attacks, Ernie Vallebuona was driving with his three-year-old son, also named Ernie, to a nearby Home Depot in search of the perfect paint color for the family bathroom. Vallebuona always listens to 1010 WINS in the car, so he turned on the radio. He soon heard the incredible news that a plane had crashed into one of the twin towers. Instantly, he got the call to respond. "We're all mobilizing," his NYPD supervisor told him via cell phone. "Get to work as fast as you can." Over in Pomona, some 36 miles away from Manhattan, 37-year-old NYPD detective John Walcott was at his suburban home, killing time before a midnight tour on the narcotics unit, where he'd worked for a dozen years. He was relaxing on the couch when a friend from St. Louis called. "What the hell is going on in New York?" the friend asked, incredulously. Walcott had no idea what his friend meant. He flipped on the TV, only to see flames raging from the twin towers. Minutes later, he was behind the wheel of his minivan, speeding down the highway toward the World Trade Center. Some 200 miles southeast of the Trade Center site, 49-year-old Gary Acker was working in a bomb shelter dubbed the "earth station," an undisclosed location where AT&T; keeps its large satellite dishes. At the time, Acker was managing the company's disaster recovery team, which restores critical communications after catastrophes. He had long viewed the post as the crowning achievement in his 31-year career, one that suited his desire to make a difference. When the first plane hit the north tower, he was sitting in an equipment room, four floors below ground, running emergency drills. No one had turned on the TV, so he remained oblivious to the events unfolding in Manhattan. His wife, Alison, called him. "Look at the TV," she said, just as the second plane hit the south tower. Acker knew that New York City officials would be calling AT&T; for help. "Pack up your equipment," he heard his wife say, "and get ready to ride." Back in Manhattan, Jessy McCarthy was not about to roll anywhere. The Verizon field technician was sitting in his office on East 91st Street, listening to the news on the radio, when he heard about the planes hitting the towers. He froze in place, unable to pull himself away from the broadcast for hours that day. Only that afternoon did he manage to go to a nearby work site to repair phone lines. Sitting in his truck, he stared in disbelief at all the people doused in gray dust walking up Third Avenue from downtown. His eyes locked on the caravan of people who'd been caught in that cloud. By the time McCarthy was taking in this ghostly scene, Vallebuona and Walcott had joined thousands of first responders at the World Trade Center. Both arrived at the site shortly after the 110-story twin towers came crashing down, and they spent the next 15 hours sifting through the wreckage. Racing to the scene from the Seventh Precinct, on Pitt Street, Vallebuona encountered a giant cloud of dust and smoke so hazy and dense, he couldn't see his hand in front of his face. He circled the periphery of what he thought was the scene, following the blaring sirens and running past pumper trucks and police cruisers twisted up like discarded tin cans. The dust caked his eyes and coated his lips. It filled his nostrils with a horrible smell, like burned plastic and flesh. Vallebuona happened to have a bandanna in his pants pocket, which he wrapped across his face. It did little to ward off the rancid odor. Walcott was also experiencing the noxious effects of the chemical brew. While the massive cloud had dissipated, the crystalline particles hung in the air like speckles in a snow globe. He waded though mounds of pulverized dust, knee-deep, tasting it on his lips, spitting it out of his mouth. Without a mask, he was coughing immediately. First came the black mucus and ashen chunks, then the dry heaves and blood. For hours, he wiped away dark gunk dripping from his eyes. He couldn't help but think that something was wrong. But he focused on the mission at hand, on the faint hope of discovering survivors. That day, he stepped over the only human body that he would find intact—a female, burned beyond recognition, a charred bra over her face. Acker arrived on the scene 24 hours later, after driving with 11 team members up the East Coast in a company trailer equipped with satellite transmission consoles and multiplex cables. He would spend the next 33 days in and around ground zero—first setting up a satellite at 1 Police Plaza, then manning phone lines across the street from what came to be known as the Pile. The plume enveloped the area from the moment he set foot there until he left. Many nights, he'd oversee the satellite atop 1 Police Plaza, just east of ground zero, and watch as the prevailing winds subsided and the bright-blue smoke settled in. It hung so heavily on the city that he couldn't see the guards stationed across the street. In these early days, Acker, Vallebuona, and Walcott all struggled to protect themselves from the toxic dust. The foul odor clogged the air for the three months that Vallebuona ended up working at the site—first on the Pile, hauling rubble with buckets, then around the perimeter, providing security and escorting residents to their dust-laden homes. When he and Walcott searched the rubble as part of the initial bucket brigade, they wore nothing over their faces but surgical masks. Respirator masks came weeks into their months-long recovery work; sometimes they came with the wrong filters. Because Walcott was a detective, he ended up spending his five-month stint not just at ground zero, but also at Fresh Kills. As much as he choked on the Lower Manhattan air, he dreaded the Staten Island landfill. Walcott knew everything in the towers had fallen—desks, lights, computers. But apart from the occasional steel beam, the detritus that he sifted through there consisted of tiny grains of dust—no furniture pieces, no light fixtures, not even a computer mouse. At times, the detectives would take shelter in wooden sheds, in an attempt to get away from what Walcott likes to call "all that freaking bad air." One day, he was sitting in the shed with his colleagues, eating candy bars and drinking sodas, when some FBI agents entered. They were dressed in full haz-mat suits, complete with head masks, which they had sealed shut with duct tape to ward off the fumes. As Walcott took in the scene, contrasting the well-protected FBI agents with the New York cops wearing respirator masks, one thought entered his mind: What is wrong with this picture? The same thought would cross Acker's mind only fleetingly, and only after weeks of working near ground zero, while he was hacking so hard he vomited something akin to chewed-up licorice. During his first days at the site, he wore the painter's mask that an NYPD lieutenant had given him, but it soon became too filthy from debris. By October, he was spitting up so much gunk that he called his doctor for an antibiotics prescription. But he wouldn't leave the site; when the fumes got bad, he'd sit in the company trailer and flip on the air conditioner. That had a filter, at least. AT&T; had stocked its disaster trailers with almost everything—rubber boots, hard hats, rope, a first aid kit. Funny, Acker thought, staring at the shelves. All this stuff, yet no one had ever considered respirators. , Acker thought, staring at the shelves. Around this time, McCarthy was just beginning to report for recovery duty. When Verizon asked for volunteers to restore phone lines near ground zero, he didn't hesitate. He arrived for his first assignment in early October and wound up staying downtown for the next 13 months, going from basement to basement, moving from Wall Street skyscrapers to Chinatown walk-ups. The first thing he saw in the company terminals was the Trade Center dust, piled on top of consoles, crammed into corners. He had to wipe down the equipment with his bare hands to see the wires. The dust had an orange hue; at times, it twinkled. And it always stunk, an unforgettable smell he struggled to get past every time. Invariably, he'd find it in his hair, on his eyelashes, in his tool belt, even under his fingernails. Sometimes, he'd gaze at the ceiling and get the sense of standing in the middle of a meadow thick with pollen. He could see the soot and dust floating in the air. When it occurred to these responders that they might be sacrificing their health for the sake of the cleanup—as it did to anyone who came in contact with the foul-smelling smoke and dust—they took comfort in the official word at the time. In the immediate aftermath of 9-11, the EPA issued multiple statements on the air quality downtown. All were reassuring in nature. On September 18, the day after the New York Stock Exchange reopened for business, the EPA's Whitman said the air was safe to breathe. It has turned out those words were, in fact, false. In August 2003, the EPA inspector general issued a scathing 155-page report concluding that the agency hadn't had the data to make such blanket declarations at that time. By then, more than a quarter of EPA samples showed unsafe levels of asbestos, and the agency had yet to complete tests for mercury, cadmium, lead, dioxin, and PCBs. The inspector general's report went on to disclose another disconcerting fact—that the White House had pressured the EPA to sanitize its warnings about ground zero. The inspector general revealed that the White House Council on Environmental Quality had taken a red pen to the agency's press releases, adding reassuring statements and deleting cautionary ones, creating the overly rosy picture that the air was clean. In reality, the 9-11 fallout was like nothing anyone had been exposed to before. Everything in the towers had been ground into dust—concrete, steel, glass, insulation, plastic, and computers. Dust analyses would detect glass shards, cement particles, cellulose fibers, asbestos, and a mixture of harmful components, including lead, titanium, barium, and gypsum. In all, the dust contained more than 100 different compounds, some of which have never been identified. And then there were the fires that smoldered for three months. They gave off not only the putrid plume, but also a blast of carcinogens—asbestos, dioxin, and polycyclic aromatic hydrocarbons, or PAHs. They also emitted benzene. In one disturbing analysis done by the U.S. Geological Survey, the dust had such high alkalinity levels it rivaled liquid Drano. Thomas Cahill, a physicist who sent a team to analyze the plume from a rooftop a mile away from ground zero, says he got worried once he noticed the color of the smoke had turned a fluorescent blue. That's a sure sign that ultra-fine particles (which can go deep into the lungs and enter the bloodstream) were coming off the Pile and permeating the air. When his team tested the plume, the scientists found higher levels of sulfuric acid, heavy metals, and other insoluble materials than anywhere else in the world, even in the Kuwaiti oil fields. "Not nice stuff," says Cahill, a professor emeritus of physics at the University of California at Davis, who has published three papers on the 9-11 plume, "and it was all being liberated by that smoldering pile, so those people got the full force of it." Today, Cahill is trying to identify what exactly the recovery workers were inhaling, but the data are incomplete. He does know one thing for certain: "You'd have to stand by a busy highway for eight years to get what these people on the site got in just four weeks." He then adds, "These poor people are part of an enormous experiment, I think." In May 2003, John Walcott was 39 years old. He had just become a first-time father—of his daughter, Colleen—and had proudly coached a Bedford high school hockey team to the state regionals. That spring, he had noticed his energy fade. But he figured his 16-hour days juggling the narcotics beat, hockey practice, and parenthood were finally catching up to him. Still, the fatigue would consume him for weeks. He'd fall asleep at his desk or behind the wheel. Often he'd nod off in the middle of a conversation. Then he got the diagnosis: acute myelogenous leukemia, a white-blood-cell cancer. He was ordered straight to the hospital, where he underwent chemotherapy for the next 28 days. Eventually, a nurse would ask Walcott questions similar to those put to Valle-buona, the ones meant to pinpoint the possible causes for his cancer. Like Vallebuona, Walcott answered no to all the questions. And like Vallebuona, he didn't connect the dots between his time at ground zero and the cancer growing in his body. Visiting him in the hospital later, his sister, Debbie, did. "John," she said, "what the hell do you think you were around at ground zero?" It was a question that Gary Acker would also have to confront that summer, in a visit to his own doctor's office. The AT&T; manager had never shaken that World Trade Center cough, struggling with sore throats and lung infections for 18 months after completing his recovery work, suffering through all kinds of inhalers and antibiotic regimens. At one point, his doctor diagnosed him with sleep apnea and ordered him to wear a pilot-like mask strapped over his face at night, so as to reduce his roaring snores. It didn't work. A perennial optimist, Acker ignored any hint that his health problems were 9-11 related. In September 2002, he got the first warning that his health was deteriorating from exposure to the dust cloud when he underwent a pulmonary test for the company. He was stunned by the doctor's response. "How many packs of cigarettes do you smoke a day?" the doctor asked Acker. "I don't smoke. I never have in my life." "Well, you have a real breathing problem," the doctor informed him. His second warning came in the summer of 2003, as Walcott was getting chemotherapy. In August, Acker was landscaping the backyard at his home, in Columbus, New Jersey, carrying two 50-pound buckets of stones, when his body buckled under a jolt of pain. It felt as if somebody had jabbed a fishhook into his rib cage and was slowly gutting him. He allowed for the possibility of a kidney stone and paid a trip to the doctor. Days later, he got a diagnosis that would stop his heart cold: multiple myeloma, a plasma cell cancer. Already, the super- advanced cancer had eaten its way through the bone marrow in his ribs, as well as many other bones in his body. For a fleeting moment, Acker thought about that thick and foul plume hanging over the Pile; could it have caused his cancer? But his optimism flooded back and he focused on his treatment instead—on the chemotherapy pills that he would take twice a day for the next 28 days. Only days later, after his oncologist confirmed that his myeloma likely formed in the last two years, did he finally make the tie-in to 9-11. By the spring of 2004, Acker and Walcott had endured not only months of chemotherapy, but also stem cell transplants. They experienced a series of life-threatening infections and trips in and out of the hospital before beating their cancers into remission.

For a fleeting moment, Gary Acker thought about that thick and foul plume hanging over the Pile; could it have caused his multiple myeloma?

photo: Scott McDermott Meanwhile, Vallebuona had just begun noticing gout-like symptoms. They started in his big toes, which doubled in size and became hot to the touch, and then moved to his knees, joints, and chest. For six months, he went back and forth to the doctor, getting more medicine, seeking more remedies. He wouldn't doubt that diagnosis until October 2004, when the searing stomachache tipped him off to what had really been causing pain in his abdomen. When he got the cancer diagnosis, Valle-buona was relieved about one thing. His doctor had been wrong about the gout. If nothing else, at least he wouldn't have to live with that excruciating pain for the rest of his life. As Vallebuona was coming to grips with his cancer in the fall of 2004, Jessy McCarthy was still feeling healthy. The Verizon technician had managed to evade the kinds of respiratory problems that have afflicted so many ground zero workers—the cough, the sinusitis, the asthma—in the two years since his recovery assignment had ended. He would experience nothing to suggest the grave disease that would sneak up on him. At least not until one day in October 2004, while taking a shower, when he saw a swelling around the glands under his arm, about the size of a marble. He thought: This is not right.

In March 2005, after a biopsy of one of his lymph nodes, Jessy McCarthy finally was given the definitive diagnosis of non-Hodgkin's lymphoma. By then, the recovery workers' lawsuits had been more than a year in the making.

photo: Scott McDermott But McCarthy didn't feel sick; there were no dizzy spells or nausea. A trip to the family doctor to ask about the lump yielded little information, just something questionable about his blood. So McCarthy plodded on with his life, holding down his full-time job, taking care of his teenage son. Suddenly, within weeks, he noticed the lump had grown, and more had developed. His lymph nodes swelled all over his body, underneath his arms, in his groin, around his neck and chest. The lumps just seemed to sprout; they grew so big that they looked like mini-baseballs. Suddenly, McCarthy found himself undergoing a battery of medical exams—CAT scans, PET scans, blood tests, and anything else that would help narrow down the possibilities. It took six months to rule out every type of lymphatic infection. In March 2005, after a biopsy of one of his lymph nodes, McCarthy finally was given the definitive diagnosis of non-Hodgkin's lymphoma. By then, the recovery workers' lawsuits had been more than a year in the making. Back in the winter of 2004, Walcott had just survived the worst of his hospital stays, a 17-day stretch of 106-degree fevers, and was confined to his home. Months had passed since he learned that his leukemia likely resulted from his exposure to benzene while on the Pile, but he went in search of legal advice. He started with a lawyer friend, who encouraged him to keep looking. One attorney offered to take Walcott's case, as long as he put up his modest house to cover the fees. "Forget it," he said. Eventually, parents of the kids on his high school hockey team heard about his plight. During a visit, Walcott told some parents about his fruitless search. They had an idea. They could contact a trial lawyer whose son went to the same high school; his name was David Worby. "I took the case as a favor," the lead attorney in the recovery workers' lawsuits says, sitting in his spacious penthouse office in White Plains. A trim man whose brown hair is graying at the temples, David Worby exudes confidence as he reclines in his chair and recalls the early days of what has become his greatest legal crusade. Long before the 9-11 suits, he had built a reputation as a gladiator lawyer on personal-injury cases; in 1989, he set a Westchester record by winning $18 million for a construction worker run down by a car. Fifteen years later, he was settling into early retirement when one of the Bedford parents told him about the ailing Walcott. "What was I supposed to do?" Worby asks. What started out as a case for one sick recovery worker quickly snowballed. Today, a team of 20 attorneys at his firm of Worby Groner Edelman Napoli & Bern is handling the suits, filed in U.S. District Court in Manhattan, for the thousands of workers associated with the Trade Center cleanup—police officers, firefighters, sanitation workers, iron workers, and Latino day workers. Last month, Federal District Judge Alvin Hellerstein rejected the city's claim for immunity in the Worby lawsuits and recently capped its liability at $1 billion. The judge is expected to appoint a special master to settle the workers' claims. Worby's client list continues to grow. It now includes Vallebuona, Acker, and McCarthy, all of whom came to him after he filed the first suits in September 2004. They found out about him as most of his clients do—by word of mouth, one sick recovery worker to another, one worried spouse to another. Others have called him after hearing about the cases on TV or the radio or in the papers. Most of the clients have grown ill from respiratory problems like asthma, sinusitis, and bronchitis. But some have kidney failure, and 400 people have developed cancer. So far, 83 clients have died. The number of cancer patients has multiplied at a rate that Worby says he never anticipated. Back in 2004, he represented only 20 workers who had cancer. But by last March, he had watched that number soar to 200, and within six months after that, it had doubled. Now he gets at least several calls a week from clients who have just been diagnosed with some cancer. Or from new clients who have had the cancer for weeks or months. Like many trial lawyers, Worby has a penchant for talking in fervent, breathless tones, as though his words were writ large, in bright, blinking letters. Convinced that the 9-11 fallout has made for a cancer explosion, he doesn't hesitate to say so. "There is going to be a cancer catastrophe the likes of which we've never seen in this country," he says. "The numbers are going to be staggering." Perhaps it'd be easy to dismiss him as another hot-aired plaintiffs' attorney were it not for his own command of numbers. He has become something of a gumshoe epidemiologist, compiling the data on his cancer patients that are lacking in the larger worker population, tracking their diseases, ages, diagnosis dates, and their 9-11 exposures. "Look at the cancers my clients have," he says, flipping through a dozen pages of a document entitled "Seriously Ill Clients." It's updated every month; this one is dated September 13, 2006. The document outlines what he calls his "cancer clusters" and lists rare cancers often associated with the 9-11 toxins, such as thyroid (30 people), tongue and throat (25), testicular (16), and brain (10). He keeps a separate document on the 75 people with blood cancers. Two dozen of them have various forms of leukemia; the remaining four dozen have various forms of lymphoma, multiple myeloma, and other blood cell cancers. "If I had two blood cancers, it'd be a strong coincidence," Worby argues. "But 70? That defies coincidence. The word coincidence should not be in anyone's vocabulary." Worby contends that it wasn't just the unprecedented amount of toxins in the air that caused his clients to develop cancer; it was that the toxins worked together. Worby calls it a "synergistic effect," and cancer specialists say there is such a thing as toxic synergy, which occurs when chemicals combine. They can enhance the damage that the other ones would cause. Think of it this way: The benzene at ground zero may have caused Walcott's acute leukemia; the dioxin probably sped up its development. "This amount of toxicological exposure is going to speed up normal latency periods," Worby argues. He makes this assertion with the same zeal that he exhibits in the courtroom, citing medical studies on animals, rattling off the findings as if they were second nature. Why would the doctors monitoring the effects of 9-11 on people's health not understand this connection, he wonders. "Why would people not make this link?" Five years after September 11, there's no doubt that the toxic dust cloud has devastated the lungs of those who participated in the Trade Center cleanup. In September, the Mount Sinai Medical Center released data from its WTC Worker and Volunteer Medical Screening Program, which has tested 17,500 recovery workers to date. In that analysis, doctors found that nearly 70 percent of the 9,500 subjects they surveyed experienced new or worsened respiratory symptoms at ground zero; close to 60 percent saw those symptoms persist for years. Doctors have seen chronic sinusitis, laryngitis, asthma, gastroesophageal reflux disorder, and disabling musculoskeletal conditions. Even the famous World Trade Center cough has lasted much longer than anticipated. "All of us have been badly surprised by the persistence and the chronicity of the World Trade Center diseases," says Robin Herbert, the director of the screening program. But at the Mount Sinai program (and at the WTC program of the FDNY, which declined to comment for this article), the link between the dust cloud and cancer is discussed more as a possibility than a reality. It's not that doctors aren't extremely concerned about the connection, Herbert says, given the cancer-causing agents and other toxins in the mix. While individual cancer cases may be attributed to 9-11 toxins, she says, the doctors, so far, lack full epidemiological proof linking the two. "We don't know if we're seeing a spike in cancer rates," Herbert says, as they have in the rates of respiratory illnesses. Herbert confirms that the Mount Sinai doctors have seen some workers with cancer, including unusual cancers, but says they'd expect some workers to develop malignancies over the last five years anyway. Is there more incidence of cancer among Pile workers than among those who didn't toil on the Pile? "That's the key question," she says. The Mount Sinai epidemiologists have just begun to try to answer that by launching an initiative to update medical records, document new diagnoses, and track less-com mon diseases like cancer. It's a slow process, with no timeline. Still, she says, "We are now aggressively investigating every case of cancer that has been reported to us." But the WTC programs—funded by the federal government—have their share of critics, who wonder how interested the doctors are in the 9-11 and cancer issue. Al O'Leary, the spokesperson for the Patrolmen's Benevolent Association, says that many of its members feel as if the doctors are ignoring the signs of a growing cancer cluster. "It was our impression that no one in the medical-monitoring programs believed the cancers could be happening this early," he explains. Over the past year, the police union has fielded a steady increase in calls from members who have developed cancer since working at ground zero. Last July, the PBA started its own World Trade Center health registry for its members, listing seven cancer cases at the time. Today, there are 20 cases; they include the 35-year-old who worked on the Pile and at Fresh Kills and now has multiple myeloma, the 45-year-old who surveyed the Trade Center site for two years and now has leukemia, and the 41-year-old who manned the landfill morgue for three weeks and now has myeloma. "Now, don't you think this is all very suspicious?" O'Leary asks. "The medical community needs to be more open-minded about what diseases can be caused by 9-11." Some cancer specialists agree. Hesdorffer, of Johns Hopkins, still remembers the reaction to his testimony before the Victim Compensation Fund, back in 2004. He was called back about a half-dozen times to explain why he would attribute the pancreatic cancer in his two patients to the dust cloud so soon after 9-11. It was as if no one wanted to make the connection; one patient lost his claim despite the doctor's opinion. "We're in this period where no one wants to accept the link," Hesdorffer observes. Maybe the official denial stems from economics, from a desire to limit the amount of money owed to the thousands who have lost their health. Or maybe it has to do with politics. Admitting a link, as he points out, "would mean that the fallout from 9-11 was a lot bigger than we'd thought." What it would mean is that people got cancer from government decisions. From the decision of Whitman to lie about the air quality in Lower Manhattan, which gave the recovery workers and many other New Yorkers a false sense of security. From the decision of the White House to put Wall Street ahead of public health, which the EPA inspector general found had influenced all those rosy statements. And from the decision to let workers toil without proper respirators for weeks, or without any respirators at all. For Gary Acker, now 54 and still undergoing monthly chemical drips to heal his bones, gone are the annual trips hunting for caribou in Canada and fishing for trout in the Adirondacks. Those years in the late '90s when he threw the javelin and shot put in the New York version of the Olympics seem like an adolescent memory. No longer working at AT&T;, he devotes his time to trying to relax, watching mindless sitcoms on TV, anything to make himself laugh. "If I'm laughing, I'm not stressed," he says. His doctors tell him that no stress means less chance of a cancer relapse. Last year, Jessy McCarthy, now 48, had to work through his chemotherapy treatment, juggling the 72-hour drips with his job and his son for six months. He didn't have much choice; otherwise he'd lose his medical benefits. He could never afford the medical bills on his $65,000 salary; some of his medications cost $5,000 a dose. Now in remission, he continues to fix phone lines, though he knows the day will come when he can't anymore. Already, he has had to call for help on assignments he used to do alone. He also knows, in the back of his mind, that his cancer is the kind that will likely return, and possibly kill him. Walcott and Vallebuona, both retired from the force because of their cancer, continue to live with the side effects of their treatments—the lost feeling in their hands and feet and the extreme fatigue. While Vallebuona has undergone chemotherapy, radiation, and a stem cell transplant, he still hasn't been able to beat his lymphoma into remission. They also grapple with what they both like to call "chemo brain." The drugs left Walcott, now 42, too incoherent to witness or recall the first time his daughter learned to walk or talk. For Vallebuona, now 41, the littler things seem to escape him, like the weekend plans his wife mentioned earlier in the day. But even their foggy minds have not erased the memories of two planes hitting the World Trade Center on that sunny September morning, when they had woken up healthy and happy to be alive. send a letter to the editor go to next article in news ->



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