9/29/01            1:40 AM

Dear Beth,

I can’t sleep. I have seen things today that amaze me and challenge my ability to understand them. It is a day of contrasts and extremes. It is a grand adventure and a fascinating mission. But most importantly, it is a time for me to be among the angels and the heroes who are here.

The day begins at 5:30 AM. I make my way past huge trucks that are blocking the entranceway to a secure street in the NYPD’s 13th Precinct. There are American flags everywhere in Manhattan. But even with these visual reminders, it doesn’t truly hit me that there is anything wrong until I enter the Police Academy Building. Then it gets much more real.

I initially notice a small memorial for Glenn, a videographer who was shooting tape for analysis of the terrorist crime scene when he was killed in the collapse of the towers. Inside the Academy, candles, pictures, wreaths, and cards are everywhere. Near the elevator, beyond another checkpoint and inside the building, I see more reminders of where I am. Xeroxed papers with the words “missing but not forgotten” are affixed to the walls. A poster with pictures of thirteen lost police officers, draped with the green and blue colors of the NYPD, is in full view. Ribbons of the same colors are on everyone’s nametags.

The building is a mess. A huge gymnasium has been transformed into a dormitory, complete with piles of towels and underwear, bare cots—no sheets or pillows are on them—and a table of food in huge, plastic, thermos-like trays from the Red Cross. The trash cans have not been emptied. In what is usually a regimented, paramilitary drilling area, there is a television quietly tuned to CNN. Throughout the building, people try to nap.

We begin to prepare the makeshift clinic. We are given a room that is used to train the SWAT team. We have no exam tables. We move tables and desks and put the workout mats on them. One officer, who had worked beneath the collapsing buildings and survived, now finds himself tumbling off our exam table when a mat unexpectedly shifts. Another table has a broken leg, so we scrounge around this run-down 1940’s fortress for sturdier furniture (We find some duct tape and manage the best we can).

The volunteers here are from Las Vegas, Portland and from just around the corner, on 23rd Street. There is a sense of adventure and apprehension as we await the officers who have learned of the opportunity to get their lungs checked. We don’t know how many to expect. We had planned on using certain equipment, but it didn’t arrive, so we use our laptop computers, and then go out to a store to buy a printer. Despite the décor, we are safe and comfortable.

I worry that I will be hit with a wave of emotions and will have trouble keeping my composure when I start to interact with these officers—much as I did on September 11, when I thought about how we would tell our children that their innocent world had been forever changed.

            I wrote that email on my first night at Ground Zero when I, and a small corps of volunteers, forfeited a few days with our families to help determine the health effects that many police and rescue teams had experienced as a result of the toxins they had been exposed to at Ground Zero.

            Our job was to give the rescue and security workers an opportunity to get a medical checkup without having to worry about the impact the results might have on their jobs. The workers had been consistently told that they faced no health risks, but they read in the newspapers, and saw on television, that the air quality at Ground Zero was dangerous. One of the officers assigned to the Office of Emergency Management (OEM) was not shy about reporting that the city and the state had conducted a series of tests and had said that the air was safe. Later, federal authorities came in with great fanfare, and created alarm by declaring it a contaminated area, where the use of respirators was now an absolute requirement.

            The politics of inter-departmental issues, disability, workman’s compensation and liability weighed heavily on the minds of city administrators and the unions that represented the workers. Men and women who had lost friends, relatives, and colleagues—and who had put their own lives on the line—were exhausted and apprehensive. They also, of course, worried about their health. For the next four days, I heard the same questions: “Am I going to be all right, doc?” and “Did the tests show that there is no damage or risk for the future?”

            And although I saw no signs of hate or anger, I did see a deep concern over the lack of preparedness for the next possible terrorist event.

            Despite these many fears, the rescue workers were appreciative of the volunteers. The heroes referred to the volunteers as “angels” and the volunteers reciprocated, calling them the same.

            The first volunteer I met was a cardiology technician who was there to do echocardiograms and ECGs. He was shy about telling me his first name, explaining, “It is not a good name to have these days.” I noticed he worked harder than anyone that first day, and that he did his job without ceremony, then quietly left. I never got a chance to thank him for his help. Later, I learned why he was reluctant to divulge his identity; his name was Osama.

            One by one, I interviewed, examined, and conducted heart and breathing tests on officers who were there when “It” happened on September 11. They did not say much about the attacks until they were asked about them; then they answered in ways that reminded me of my father when I asked him about his experience on Iwo Jima during World War II, speaking in somber tones, and offering brief, unembellished answers. The members of our team explained to them that it was necessary to document their degree of exposure in order to study the effects and to help make medical decisions. We told them that what we learned about the risks of their exposure could help scientists and doctors advise the general public and their colleagues who experienced less exposure from the Twin Towers collapse.

            They remained polite and courteous. In a “just the facts” manner, with little emotion, they told us their respective locations and the things they experienced or observed on September 11. While we had all turned to television or rushed home from work when the news of the attacks on the Twin Towers and in Washington broke, they had gone to the World Trade Center as fast they could to help.

            I met a man who told me that a person standing next to him died instantly when a body fell on them from one of the WTC towers. Two officers told me they were trapped for hours inside the remains of their car. Many were enveloped in dust and debris after looking up and realizing that the towers were falling. These were the people that the world saw covered in dust on that horrible day. These were the heroes who, when the dust settled, realized that dozens of their friends and thousands of their fellow citizens were inside those collapsed buildings. These were the men and women who stayed and dug and assisted, working double shifts for the next eighteen days. Their stories are fascinating, but the quiet and calm way they conveyed them to our corps of volunteers was extremely eerie.

            They were so appreciative of us and wondered why we went to the trouble of coming to New York to check them out. We were amazed that no one had come sooner. After all, it had been three weeks since the attacks. Medical science had not seen a situation like this before, and now the world was risk for it to occur again—and possibly again and again. We needed to figure out how to best care for these heroes. If we were to be prepared for the ensuing personal and public health medical treatment issues, we needed to learn what the effects from the inhalation of a multitude of toxins would be.

            The officers were gripped by a fear that they would not find their friends, and that the families of the victims would not be able to find a semblance of closure on it all. We also met some officers who were not allowed to search but were instead assigned to other necessary jobs elsewhere in the city. They had not even seen Ground Zero. Some of them complained of insomnia and chest pains. In some ways, they experienced the kind of tortured feelings that some of us who were far from Ground Zero felt, when we wished that we could do something to help them.

            I met cadets who had only just started the introductory weeks of their New York Police Academy training when “It” happened. They had been assigned police officer tasks, working the streets and “securing buildings and checkpoints”—without guns or vests—while their colleagues went into disaster mode. I met police officers from Deerfield, Illinois and Toledo, Ohio, who came to Manhattan on their vacation time, to help fill in for the NYPD officers.

            Every one of these men and women were gracious to us, and they thanked us for caring for them. They treated us like heroes, as we sat in relative comfort in the Police Academy SWAT team training room. While we worked, food was delivered, along with notes of thanks. Some gave us an NYPD patch, a ball cap, or a shirt to thank us for caring.

            When we pointed out the obvious paradox—that we had come to take care of them, while they cared for us, in return—we were told by some that they had never, in their careers, felt cared for by others. “We are givers, not takers,” said one officer. “are really a little bit meek and shy when someone shows us any courtesy. It just rarely happens, and we are grateful but comfortable in this role.” Another officer, with tears in his eyes, said, “One thing is for sure: Those letters and pictures from kids across the country kept us going.”

            I believe their acknowledgement of our presence there represented their need to say “thank you” to the people they will never meet personally—those who sent food, clothing, cards, and donated blood. I vowed to myself that I would push to encourage people all throughout the country to stop and thank the police and fire departments in their communities for being there, twenty-four hours a day, seven days a week. I thought of the water and the power and the communications workers, who brought back lights, water, and phone service after the attacks. I wondered if anyone ever thanked them for being on call and working in dangerous situations after storms, fires, and other disasters, and I thought of ways that the technology my company employs could help those departments in case something happens in their towns.

            The officers did not realize it, but the team of doctors there—and others across the country—really did not know the exact effects of the contaminants on their systems. We discussed among ourselves the possible triggering agents of asthma, alveolar proteinosis, hypersensitivity pneumonitis, asbestosis, and mesothelioma. We queried each other about previous studies regarding the effects of dust arising from ruins filled with the organic material that was once human beings. We called upon our colleagues at Mayo and Hopkins for help. We held meetings. We talked about science, but also about politics, so that we could design a study that could be made without jeopardizing the department or the unions. We set a deadline for forty-eight hours to have a proposal ready.

            We were working in an environment in which the acute phase of the illnesses that some of the officers had experienced had passed, due to delays. We did not have good information on the air quality or dust analysis. Our specific inquiries led to an invitation, days later, to join the representatives of the Centers for Disease Control (CDC), the National Institutes on Occupational Safety and Health (NIOSH), New York State Department of Health, New York City Department of Health, and other doctors and epidemiologists in a series of conference calls, where I share our clinical observations and concerns.

            We faced many logistical challenges. We realized that we did not have access to previous records for a department that lost its operational headquarters in the WTC, and then we found that its phone lines were nearly useless in its main headquarters. We found abnormalities in many officers, but without previous records to compare the results with, we did not know if the conditions were acute or chronic (I filed this away as something that could easily be solved with an electronic medical record with Smart card technology backup).