CHAPTER   13

“They’d do it again tomorrow.”

IN THE DAYS following the boat lift, New York Waterway Port Captain Michael McPhillips was in charge of waterborne transportation for the New York National Guard, and transporting family members of the deceased to the trade center site. As such, he was among the many first responders who spent weeks—some for up to 18 hours a day—breathing the toxic air.

When the planes hit, the explosion of 91,000 liters of jet fuel started fires that then ignited an estimated 100,000 tons of organic debris, 490,000 liters of transformer oil, 380,000 liters of heating and diesel oil, and fuel from several thousand cars in the underground parking garage.

When the towers fell, the smoke from these fires combined with the destruction of the buildings to produce a plume of toxins and irritants containing a complex mixture of chemicals—including the combustion products of jet fuel, soot, metals, volatile organic compounds, and hydrochloric acid—as well as particulate matter from pulverized building materials and contents—including cement dust, glass fibers, asbestos, gypsum, heavy metals such as lead, polychlorinated biphenyls (PCBs), benzene, and dioxins. Among these were numerous well-known carcinogens. Researchers estimate that between 60,000 and 90,000 first responders were exposed.

Two years after his time in the dust cloud, McPhillips became too ill to work. The mariner who had run away to sea at age 16 wound up developing pulmonary issues and end-stage liver disease that he said resulted from dust exposure, and he was forced to retire from the industry. “I eat all the right foods,” he explained. “I never drank—I never drank in my entire life.” Still, he said, he’s on the liver transplant list. “I have stage 4, grade 3 cirrhosis. And it’s grade 4, stage 4 when they do the transplant.”

Today he serves as director of social services and benefits for the FealGood Foundation—named after its founder John Feal, who was injured while volunteering at Ground Zero—that provides ailing first responders and victims with medical and financial assistance. As part of this work, McPhillips has spoken before government officials more than 100 times, advocating for the James L. Zadroga 9/11 Health and Compensation Act. “We’re a casualty of war,” he explained. Among those lost, he counts three New York Waterway captains who he said died from September 11-related health issues.

It’s impossible to know exactly how many of the mariners who participated in the evacuation wound up suffering from illnesses related to their service. Even counting the overall number of mariners involved in the boat lift itself poses challenges. A total of more than 150 boats—vessels of all shapes, sizes, and purposes—were tallied by maritime consultant and event producer John Doswell. But, as evidenced by its exclusion of the Staten Island Ferry’s boats, for example, that list is certainly not comprehensive.

Complicating matters further, each of these vessels could have been operated by between one and fifteen or more crew members. Reason would suggest that approximately 800 (and possibly many more) mariners actually worked on the water, participating in the evacuation that day, while still others provided essential assistance from shore. Reinforcing this estimate is the list of approximately 800 recipients of the Department of Transportation’s 9/11 Maritime Medal, awarded in a ceremony in the rebuilt Winter Garden on September 17, 2005, “for meritorious service and sacrifice in the wake of the horrific terrorist attacks.”

Calculating how many of those have since suffered from September 11-related conditions is equally difficult. A search for terms like ferry captain, deckhand, and mate made by data crunchers at the World Trade Center Health Program (WTCHP) counted at least 120 mariners currently registered with the program, 53 percent of whom are suffering from at least one illness or condition that doctors and researchers say is related to World Trade Center exposures.

The Zadroga Act, signed into law in early 2011, created the WTCHP to provide monitoring and treatment services through a Responder Program to rescue and recovery workers (including nearly 17,000 New York City firefighters), as well as treatment through a Survivor Program to those who lived, worked, or attended school in Lower Manhattan at that time. To date, the list of covered conditions—illnesses directly linked to trade center site exposures—includes more than 90 health conditions and more than 60 types of cancer. Demonstrating a clear connection between September 11 exposures with the various diseases that followed has taken years of research, based largely on studies tracking the higher rates of illness among exposed people than the general population.

Fifteen years after the attacks, the Centers for Disease Control and Prevention (CDC) reported that more than 75,000 people were enrolled in the WTCHP, including 65,672 responders and 10,067 survivors. To date 35,420 of these individuals have received at least one diagnosis, including cancers, respiratory or digestive illnesses, or some combination thereof, with conditions ranging from mild to severe. Many had presented with cancers at much younger ages than expected, or been diagnosed with multiple cancers. By September 2016, at least 1,000 people had died from illnesses related to their exposure to the toxic cloud that engulfed the area for months after the attack. And experts anticipate that rates of some diseases among people who were exposed to the toxic dust will continue to rise.

Not until 2007 did the New York City Medical Examiner’s Office begin to include in the official death count people who died of illnesses related to breathing in World Trade Center dust. The first such victim was a civil rights lawyer, 42-year-old Felicia Dunn-Jones, who died from a chronic lung condition six months after the attacks. By the fifteenth anniversary, the official death toll had reached 2,977.

Some reports have predicted that by the twentieth anniversary, the death toll among those sickened by the dust and debris from Ground Zero will exceed the number of people killed on September 11, 2001. But Dr. Michael Crane, medical director of the WTCHP at Mount Sinai Medical Center, is not one for dooms day prognostication. He said he feels more optimistic now than he has at times past. While he is concerned about rising rates of lymphoma, for example, and he is certainly concerned that some of his patients are gravely ill, Crane is also encouraged by increased options for helping people to stay, and get, well. More recent, “more complete” data suggests to him that “we may have more levers to pull and push” in terms of both treatment options (including new drug regimens effective against multiple myeloma, for example) as well as prevention. Particularly encouraging to him are findings that lifestyle changes can make a big difference. “Diet and exercise seem to be pretty damned good. Exercise has a very positive impact on a lot of cancers. That’s very encouraging,” he said. “It really isn’t all doom and gloom.”

Even though he’s “suffering greatly for it now,” McPhillips still considers his ability to serve at Ground Zero an honor. “I’ve been blessed. I’ve been so lucky to be part of this,” he said. “We saved a lot of lives that day. We saved a lot of people. I really think that’s why I feel like I was lucky. Not that we had a choice, because . . . Well, I guess we did have a choice. We could have just not acted. But that’s not in our DNA. . . . If you ask anybody that was down there they’d do it again tomorrow.”

In reality however, many responders would wind up never having that chance. In addition to the 414 first responders who lost their lives that day, some 2,000 were injured, some so badly they could no longer serve. Bob Nussberger, the volunteer firefighter who was thrown against a building as the South Tower came down, was among them. September 11, 2001, turned out to be Nussberger’s last day of firefighting duty.

At the hospital, doctors found that his back was not, in fact, broken. Just his nose, and six toes, which had been fractured by the tips of his steel-toed boots. He’d suffered a concussion, nerve trauma to his neck, injuries to his shoulders, and significant damage to his ears. Before long, members of the Broad Channel Volunteer Fire Department found him, picked him up by ambulance, and took him home to his wife who’d thought he was dead. The heart attacks he suffered in the months thereafter spelled the end of his career with the fire department. Years later, he would wind up restricted to face-to-face conversations because he counted on lip reading to make out the words.

For others, that day of service was just the beginning. Rich Varela was back at work a few days after that September Tuesday when his company called him to say that the New York City Fire Department had tried to reach him. When Varela called back, he spoke with Tom Sullivan. “We’ve got your bag down here,” Sullivan said and then made a joke. “These are some good checks,” he said of the two sizable paychecks they’d found in Varela’s bag. “We’re gonna cash ’em if you don’t come get ’em.”

When Varela arrived at the firehouse to pick up his bag, the firefighters from Marine 2 recognized him. “Aren’t you the guy that was running around with no shirt helping on the boat?”

“Yep, that was me.”

They thanked him, gave him a T-shirt, and before long invited him down for lunch. Over the meal Varela asked Sullivan ‘“What do you gotta do to become a New York City fireman?”

“Why the hell would you wanna do that after these guys all died?” Sullivan replied.

“I dunno, I just felt like this was the first time in my life I felt like I did something worth a shit,” responded Varela. At the time he was miserable at his information technology job. “I couldn’t stand it.” He had started in the field because his dad was involved in the industry. “I just kinda knew it, and it was good money so I just took it,” he explained.

Sullivan gave him a little information, pointed him to a website, and that was it. A while later, Varela called Sullivan with news: “I’m on the list.” Sullivan was shocked. “He didn’t really think I was gonna go through with it.” Today, Varela serves as a firefighter with the FDNY’s Engine 28, Ladder 11. “Now, it’s funny to have beers with Tom, both in our dress blues,” said Varela. “We try to see each other every year, each 9/11, or at least get a phone call in.”

When he started with the fire department, Varela had the idea that if he ended up putting in 20 years on the job, he would like to work his last year aboard fireboat John D. McKean, to complete the circle. “I didn’t know they were going to decommission it,” he said. Yet, indeed, 56 years after the boat began its service in 1954, McKean was retired. In early 2016, it was purchased by a pair of restaurateurs who said they plan to operate it as a museum, of sorts, that will be open for tours led by former firefighters.

Auctioning off the old fireboats to make way for the new was part of the FDNY’s post-September 11 efforts to overhaul and expand its maritime operations, revamping its approach to emergencies on the city’s waterways and along more than 400 miles of shoreline. Fleet expansion, including both large and small boats, was a significant part of that mission. Fireboats’ participation in evacuation and firefighting efforts on September 11 had made clear the essential role of the Marine Division in protecting the region from new perils. “We have the same mission, but the threat environment is very different,” explained Assistant Chief Joseph Pfeifer (the former battalion chief who was the first chief to arrive at the World Trade Center after the first plane hit) in his current position as founding director of the FDNY’s Center for Terrorism and Disaster Preparedness.

In 2010, two new 140-foot floating fortresses were commissioned, incorporating new technologies, with features including on-board protections against chemical, biological, radiological, and nuclear agents, as well as equipment to support the boats’ use as command and control centers. One was dubbed Fire Fighter II while the other was named 343, for the 343 FDNY members who lost their lives on September 11. Their construction (with a price tag of $60 million) paid for by a grant from the Department of Homeland Security and New York City, marked the first major capital investment in new boats for the FDNY marine fleet in more than 50 years. In addition to the powerful 140-footers that can pump 50,000 gallons of water a minute, FDNY added smaller fast and maneuverable rapid-response fire and medical rescue boats designed to improve medical care to victims in surrounding waterways.

Although the boats enlisted on September 11 were part of an aging fleet from a different era, their work providing the only firefighting water available at the trade center site for days following the attacks highlighted the importance of an FDNY division that had long suffered what some considered neglect, and even disrespect. Thus, the influx of new equipment. As one firefighter put it: We’re going from The Flintstones to The Jetsons.

In January 2011, firefighter Tom Sullivan, who retired from Marine 1 later that year, told a New York Times reporter that his schedule was a lot fuller than it had been. “Day to day, there is a lot more training, there’s new equipment,” he said. “There’s a lot of upkeep, maintenance, involved. It’s a new era in the marine division.”

Karen Lacey didn’t learn that the John D. McKean was the fireboat that had rescued her from the water until more than a decade later. While a number of her Wall Street colleagues quit their jobs on October 1, Lacey was “steadfastly against quitting” out of fear. “I, honest to God, did not blame them,” she explained years later. “It was crazy.” Still, she was determined to proceed as she and her husband had previously planned: she would quit after receiving her January bonus. As it turned out, downsizing that fall led Lacey’s company to offer generous early retirement packages. “The timing of that was just right.” And before long she began spending her days raising children on the New Jersey side of the Hudson.

For years, Lacey saved the shirt and skirt she’d worn that day. The gray garments, with bits of paper stuck to them, stiffened, almost as if they had “frozen solid.” But time went on. She and her husband moved. When Lacey heard the concerns about asbestos and other toxins in the dust, she tossed the clothes. She didn’t want them in the basement where her kids played.

After years of recounting her story at bars and family functions, Lacey decided to volunteer with the 9/11 Tribute Center, a project of the September 11th Families’ Association, which “brings together those who want to learn about 9/11 with those who experienced it,” offering tours led by guides who share their personal stories of the events of that day. She thought her maritime story would add something to the tour experience.

Not long after the attacks, a coworker who had tried to take shelter from the avalanche of debris commended Lacey for her decision to jump into the river. “I give you a lot of credit,” he said. “I would have never done it.”

“I give you a lot of credit for standing there,” she responded. “I couldn’t stand there another minute.” People still ask her why she wasn’t afraid of the water. “At the time, I was more afraid of being trapped.”

Florence Fox, another evacuee who had found herself walking shoeless through Jersey City’s streets on that Tuesday morning, struggled to find any sense of normalcy for a long while after the attacks. Though Fox couldn’t recall how she had been wearing her hair that morning—maybe cornrows—she did remember that her hair fell out in the fall of 2001. From trauma, she said. Kitten’s parents, both psychologists, urged Fox to get counseling, but she didn’t. “I am from Africa. We have our own ways,” she explained, years later. “And I’m stubborn.” Instead, she slept for days.

At some point, she reemerged from her bed. “I had to see Kate, and she needed to see me.” She visited the child, but nothing was ever the same. “It was so bad,” she explained. “People don’t understand. When you go through something like that . . .” she began, her voice trailing off. “I would try and take her to the park and we would try to behave normal but we knew it wasn’t.” Fox could tell that Kitten felt the same way she did. She could see it in the little girl’s face. When they went out in the city, Kitten clung tightly to Fox’s hand. The child had always told the nanny who had cared for her since infancy that she loved her, but now she said it with a frequency and an urgency that revealed deep fears. She had trouble sleeping and remained terrified of another attack. “This was a child that was happy, and clever, and full of life,” Fox explained. “You could see a lot of that was lost.”

An estimated 25,000 children were living or attending school in Lower Manhattan on September 11, 2001. Few studies have yet been published about the mental and physical health impacts of the World Trade Center attacks on children, but investigations into the health of 985 children exposed to Ground Zero dust found that respiratory symptoms present six or seven years after September 11 “were associated with 9/11 dust cloud exposure in younger children and with behavior problems in adolescents.”

Kate was among those affected, both by breathing troubles, which manifested as repeat bouts of pneumonia as well as asthma, and by post-traumatic stress disorder. Years of treatment for both conditions have since helped her grow into a thriving teenager. In the years after the attacks, she and her family moved several times within Manhattan. They even tried to resettle back into the Albany Street townhouse. But the memories haunted them, and before long the family relocated to Arkansas.

Tammy Wiggs never expected to make a home in New York City for so long after she’d wound up in the Hudson River. She figured she’d stay for a year or so (“for the proverbial you fall off of a horse, and you get back on experience”), but she wound up remaining at Merrill Lynch as an equity trader until moving to Maryland in early 2007. The fifteenth anniversary of the attacks found her living in Baltimore with her husband and three daughters, and working as a senior trader at T. Rowe Price. For all these years, she’s mostly kept her story of that morning to herself, only sharing the details with family and very close friends. “It just seems too hard sometimes,” she explained.

She still shoulders the survivor’s guilt of losing one of her best college friends that day. Wiggs’s sister—the one who had evacuated her office in the corner of the Lehman building before World Trade Center tower beams sliced through it—also lives in Baltimore, works in finance, and has three girls. Their families now spend lots of time together.

Each year Wiggs and her sister mark the anniversary together, taking off work to ride horses, take walks, or play golf with their father—steering clear of television and refocusing on family, health, and what truly matters.