Chapter 2: Sight, Sound, and Smell: Introducing “The Pile”
Another doctor and I elected to go to Ground Zero to see for ourselves just how severe the exposures were. We did not have passes to get into the Red Zone at the WTC, but we knew that we needed to get there to understand what problems we were trying to solve (We were also very curious and a bit voyeuristic, but we hesitated to articulate that fact to each other).
The security was intense. We needed to cross nine checkpoints to get there, after walking two miles from a point where no cars had access. We flashed our borrowed access passes and explained our interest as lung experts to a phalanx of officers as we advanced closer. We passed a mass of people waving signs to the rescue and recovery vehicles, and shouting, “Thank you” to the nation’s heroes.
From a distance I could see that there was some construction equipment. We entered a massive beehive of activity with construction vehicles and armed guards in military attire. We passed barricades, dump trucks, and bulldozers. When we were still four blocks away, they confiscated my backpack and camera (I was told that this was because no photographs were permitted, out of respect for grieving families, but I later learned that authorities had been warned that foreign agents may have used photos to analyze the way the response was conducted, which could have helped with additional attacks or aided the design of other terrorist activities). Just past the next checkpoint, I saw the school where our clinic was originally to be housed, IU89. If there had been mass casualties, this would have been a perfect triage or treatment center. Chills rolled up my back and down my arms when I thought about the White Paper I first drafted more than a year ago which detailed the use of schools as emergency health facilities.
A colorful collection of bright yellow, pink, red, and orange tents, trailers, and vehicles were everywhere. Command posts for the OEM, Red Cross, Secret Service, and dozens of other organizations were there. Workers from companies such as Verizon hustled about. There were many steel workers, and men and women working sixteen cranes spanned across my line of sight. We looked around in utter amazement. I imagined that a similar bustle of activity took place when this structure was built. We could smell raw sewage and nearly fell into a manhole as we walked along, mesmerized by the scene.
In an email to my wife, Beth, I described what it was like behind the barricades at Ground Zero that day:
…Some call it “The Pile.” Others call it “The Pit.” It is the debris that was once three buildings in the WTC complex. It covers four square blocks but follows the street grid in an orderly chaos of steel and cement and dust. There is dust everywhere. Over the last 18 days, workers had eradicated mountains of it from the area, but every wisp of wind and activity from the recovery effort raises more of it.
The Pile is like several heaps of Lincoln Logs, only these “logs” are twisted metal surrounded by cement and dust. Nonetheless, they are stacked one over another, as if a monstrous trash compactor had simply tried to push the buildings into the ground.
We are viewing the side that is the remains of Building Seven. It has been reduced to a height of seven stories. On it are three gigantic cranes, large enough to pick up a Volkswagen with one bite. They resemble robotic dinosaurs devouring a huge carcass. Two sit atop The Pile and are precariously balanced, grabbing debris and throwing it to the ground below. I wonder how they got up there. It seems horrific to think that the cranes are moving so aggressively when there may be bodies or even survivors beneath them.
On a subsequent visit to the NYPD headquarters as an official guest later that afternoon, I learned that this building collapsed six hours after the others and was fully evacuated.
Around it were men in cages, dangling fifteen stories above the ground in huge cranes, and cutting steel on buildings across the street. We looked up and realized that hundreds of partially broken windows were above us, and that they could fall on us—or on the workers—at any time. They had not yet been boarded up, a full eighteen days after the blast. There was too much else to do on the ground. We were not as brave as we thought we were; we moved on quickly to be out of harm’s way. The others stayed behind, continuing their work.
As we rounded another corner, the dust and the odor hit us full in the face. We were wearing our masks but felt silly because most of the hundreds of fatigued workers simply had them hanging around their necks.
Then we saw that familiar scene—the scene of jumbled, skeletal architectural remains of buildings that we had come to know from the images we had seen on television. It somehow seemed both well-known and detached from us, perhaps because we had seen this image filtered through the media so many times, it somehow did not seem quite real. Even though we were right there, near the workers, it was though we were a long distance away from them. I wished I had my binoculars, so I could see them better.
The recognizable façade still stood and I remembered walking through those doors with Mike Curley, my colleague at InnerLink, when we visited New York just a few months before for a meeting. We had wanted to go to the top to see the view, but the $18 price—and the prospect of waiting in line with dozens of tourists—had not seemed worth it at the time. I wondered aloud if there was a line to go to the top of the towers on the morning of the attacks.
At the Pile, my senses were overwhelmed. What I saw was far worse than I had anticipated—far worse than what I had seen on TV. The scale was immense, filling my visual field with the devastation all around me. The air held an odor that reminded me of my childhood. I realized that it reminded me of the scent I had smelled when the motor on my Lionel train had burned out. I had not thought about that train for years. There were also occasional whiffs of decay, the smell of death. The smell was subtle—not dramatic or overpowering—but it was there.
The noise was loud and continuous. My ears were assaulted by the sounds of construction equipment gnawing at the Pile: steel cutting, saws slicing through the beams, the morgue refrigerator trailer compressors, hundreds of vehicles, and, occasionally, voices. It was not the still, silent memorial- or cemetery-like atmosphere I had expected.
The biggest surprise, however, was the distinctive, chalky taste of drywall dust in my mouth. The air itself was dusty, and it instantly made my nose and mouth dry. My eyes watered. I thought that if the air left a residue to taste in the mouth, the dust must have also been getting in my eyes and lungs. I looked around and saw the same moist eyes in the volunteers from the Red Cross and from the tough, rugged construction and rescue workers. I wondered if perhaps this was a result of chemical and particulate irritation.
My own tears, I knew, were caused not only by environmental irritants; my emotions were trying to rise to the surface. As I moved through the site, I knew I had to work to keep these emotions in check.
As I continued walking, I saw a striking technique employed by the workers. Using trolls and spades, they gently sifted through the pile, looking for remains. Then a crane took it down a bit lower, as it gently removed one piece of steel at a time. Men and women with acetylene torches cut steel to help with its removal. I later learned during a working group conference call that an analysis of the CDC’s personal contamination monitors showed very high levels of carbon monoxide in these workers. That news made monitoring for heart disease an even bigger priority.
The workers were hit with a plume of dust that billowed high into the sky. There was a hint of smoke, but I assumed that it was only dust. I later learned that a fire still burned deep inside the pile. The steel is hot, and the organic debris smoldered, leaping to flame once oxygen was allowed in. It was reminiscent of the fires in the ground near Centralia, Pennsylvania that have burned for years in an old coal mine.
These brave workers were performing a difficult and thankless job. There were no more bucket brigades in view. There was nothing to find. Everything was pulverized or vaporized. We saw no desks or chairs, rugs or curtains. We saw no bodies. We were watching the cremation of the remains of thousands of people. We felt and smelled the presence of death.
The officers used search-and-rescue dogs in vain, and some these animals had been cut and injured. Some were dehydrated, and I was told that two dogs had died.
We also saw what was called a “cadaver dog,” a highly skilled animal that was trained to find dead bodies based on a foul, distinctive odor. It was clear that the dog was excited, but could not settle on one location, perhaps because so many bodies did not survive the long, hideous fall intact. We learned that many of the dogs were despondent, because they had been trained to find and rescue live people in wreckage at disaster sites but had instead found so many corpses and remains. Some volunteers had hidden in the rubble, in order to lift the spirits of these animals—giving the dogs and opportunity to “rescue” a live human and enabling them to continue working.
As we walked through the Pile, witnessing all these extraordinary sights, we were simply fascinated observers. Then, as I began to think of the braveness and heroism that surrounded me, amid all the construction site noise and activity, it suddenly seemed to me to be strangely quiet, as if these noises were, instead, angels humming a hymn. Then the doctor part of me suppressed that emotional side of the experience for the moment. It would not have helped to let that side go free, even though internally, I realized I was surrounded by heroes and angels.
Except for the flags and the traffic, I was struck by just how normal the city seemed only a fifteen-minute walk from Ground Zero. I wondered what Gettysburg, Berlin, Pearl Harbor, Hiroshima, Seoul, or Saigon looked like in the weeks and months after their infamous attacks. I developed a deeper appreciation for the challenges that previous generations had faced, and the things that they had feared. We had all endured a horrible and day and it had affected us all. I hoped we would not have a series of days or years like this ahead of us.
We headed back to the clinic to do several more hours of screenings. We had smelled the odors, breathed the smoke, and coughed the dust in our throats. This was all on the eighteenth day following September 11; the conditions earlier after the attack must have been unlike anything I have ever seen, medically speaking. We realized we had to get our hands on the sophisticated data analysis that someone must have done on the exposures.
It took us five hours before we finally got access to some data—but only by working our way up the tedious chain of command at NIOSH. There was no coordinated effort to share the information already gathered, and wild and unfounded rumors abounded. I was determined to get the best minds in the country involved in our effort. I made calls that led to a meeting with the leadership of the American Association of Respiratory Care, American College of Chest Physicians, and the National Lung Health Education Program.
Back at the clinic, I described the end of my day to my wife in an email home:
I am exhausted and, as I move the medical equipment out of the way, lay out the mats the SWAT team uses to practice takedowns, I try to get some sleep. I think about my first day as a volunteer. I am nervous that our help won’t be needed an I will suddenly feel silly. I struggle with my ignorance about inhalation injury as I plan a meeting to design a study with the experts involved. I spent three hours in hell at Ground Zero. We have seen more than 70 people today, each with a horrific experience as bad as the next. Each one is mourning the loss of one or more friends. The housing is a haphazard arrangement of cots, with people sleeping in the locker room, gymnasium, and in our modified clinic. Some of our staff goes to hotels on their companies’ expense accounts; others go home to New Jersey.
Honey, I choose to sleep here to watch over the equipment and clean up after everyone leaves. I am glad I did. There is camaraderie among all of us during those rare evenings when things slowed down. I was an outsider but was treated like a brother. I enjoy this part of the experience more than anything I have done in a long time. I try to sleep. I am interrupted by three different officers who come up to make sure I have a blanket or something to eat. One officer lingers until after midnight and shares his story, asking for my advice and counsel. How do you tell a man who had lost his partner, and has been working every waking hour for days at the Pile, that you are tired and want to sleep?
I learn about how he lost consciousness for an indefinite period after the first tower nearly fell on him. Immediately enveloped in dust, he remembers taking two breaths, then being unable to breathe, but still passing out. He still coughs up muddy-looking material. He is concerned for his health, his job, his emotional condition, and his family. Our visit lasted until 1:00 AM. We conducted a visit that no doctor or patient could ever have had in today’s medical machine system. We are both grateful for the visit.
I meet people who witnessed the collapse of the first tower and emerged from the dust. Rather than lick their wounds and retreat to safety, they ran into the second tower, knowing a collapse was imminent. They are surprised at my amazement, saying that it is all part of the job. During my career I have met astronauts, governors, famous actors, and even a king. I have never, ever met more impressive people than I have met today…
I maintained my composure and professionalism throughout the day. In many ways the day was filled with fascination as well as denial. The combination of that fascination and emotion was very much like what I felt while waiting for one of our babies to be born. I remember as I “helped” in the deliver room, I denied the risks and maintained my focus, so that my emotions wouldn’t distract anyone else. The process fascinated me. Then, once I realized what had just happened, the emotions washed down over me.
I try to sleep with my eyes closed, but the stories and the images of the day won’t go away. I recall a brief phone conversation I had during a break in the action at the clinic. It was a call home to wish Maria a happy 8th birthday. Then the phone was handed to one of her sisters, who asked, “Did you actually see it?” She was referring to the devastation at the site of the former World Trade Center. I told her that I had. Her voice got really quiet and she said in the same slow, somber tone—the same tone I’ve been hearing all day: “Then I guess that’s it. That’s it. That means it really happened. I was hoping you would say it wasn’t true and that this was all a big, cruel lie.” As I think back on her words and especially the way she said them, that is when my fascination ends, and my emotions hit home.
Give the kids a big hug for me. I promise to stay safe. Thanks for allowing me to leave everything to you at home while I enjoy the privilege of living here with the angels and heroes.