Road to Resilience

Unknown Exposure

• Michael Crane, MD • Episode 16

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Nobody knows what was in the dust cloud that blanketed Lower Manhattan on September 11, 2001. But we’re increasingly sure about the health consequences, including asthma, PTSD, and cancer. On this episode, a 9/11 health expert and a volunteer responder talk about what it was like to work at Ground Zero, what we know about 9/11-related illnesses, and what their experiences taught them about resilience.

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Check out more episodes of Road to Resilience —as well as guest pictures, transcripts, and more— on the Mount Sinai website.

Road to Resilience brings you stories and insights to help you thrive in a challenging world. From fighting burnout and trauma to building resilient families, we explore what’s possible when science meets the human spirit.

BIANCA:

So on the morning of September 11th, 2001, I was going through my normal day—I was sleeping.

DR. CRANE:

I was stuck in traffic. I was stuck in traffic. I was on the Long Island Expressway.

BIANCA:

And then the plane went by, and my windows shook—buh, buh, buh, buh—and I was pissed. I was like,'Why are these planes flying so low and fast?'

DR. CRANE:

And everything just stopped. Traffic just stopped. And initially I said,'Oh my God, what a terrible accident. Let's get back in our cars and get going again.'

BIANCA:

Then the phone calls started, and the plane had gone in, and then another plane. I actually went up to my roof because I didn't quite believe this. And I saw Tower One, and I saw a lot of smoke.

DR. CRANE:

I broke the law at that point and I backed off the entrance ramp. Because my employer had a training center right there. Literally within minutes of getting there, the second tower imploded and collapsed, and I saw it fall. And I prayed. I prayed. I said,'If you let me do something about this, I promise I'll do it.'

BIANCA:

My first opportunity I got myself down there to 14th Street. When they said,'Go away. No volunteers'til Tuesday.' I was like,'Nope, you need me now. But you just don't know it yet.' So that's how it began.

HOST:

You're listening to Road to Resilience. I'm Jon Earle. Today on the podcast you're going to hear from two native New Yorkers who responded to the attacks of 9/11 with amazing dedication and grace. Bianca Bob Miller is a writer, filmmaker and musician who volunteered at Ground Zero for nine months after the attacks. In our interview, she talks about what it was like to work down there, and she also goes through some of the resilience strategies that workers used to keep going, even as they suffered from the toxic air and the psychological trauma. Next we'll hear from Dr. Michael Crane. He's medical director of Mount Sinai's World Trade Center Health Program Clinical Center of Excellence. The clinic provides healthcare to thousands of 9/11 responders. Dr. Crane told me about what we know and, critically, what we don't know, about 9/11-related illnesses. And he reflected on what he's learned from the brave women and men he's worked with over the years. Here we go.

BIANCA:

Howdy. My name is Bianca Bob. People call me BBob, or Bianca, or Bob. I'm a writer, filmmaker, musician and I also teach a lot of that stuff. And I'm a native New Yorker as well.

HOST:

After she watched the towers fall from her rooftop, Bianca went to Mount Sinai Hospital to visit her father. He was recovering from surgery, completely unrelated. Mount Sinai was bracing itself for a massive influx of patients—an influx that never came, by the way—from the Trade Center. And like so many that day, Bianca wondered how she could help.

BIANCA:

So I asked a doctor, who was my dad's doctor, if there was anything I could do to volunteer? And she looked at me and said,'There's not one thing you can do.' And so I kind of took that as a challenge, and I think that was the beginning of me thinking I want to get down there.

HOST:

But there was such an outpouring of support in the aftermath of the attacks that aid organizations completely stopped accepting volunteers. That didn't stop Bianca, though.

BIANCA:

So when I saw this sign outside of Salvation Army and it said,'No volunteers. Come back Tuesday.' And I thought,'Well no, I'm not coming back Tuesday.' Tonight's the night! I don't know why I thought that or why I thought I'm the badass that you need. But I just started picking up water gallons that were on the street that they were loading into a truck to bring downtown. And then I rearranged all the sandwiches and I went upstairs and made coffee for the sleeping iron workers. So it was basically 18 hours later, I think they realized that they weren't going to get rid of me, and it'd be best if they let me have a red badge and be part of this thing.

HOST:

Tell us about the first time you were on the site.

BIANCA:

Sure. The first night that I actually got down to the site, I think it was Saturday. And we get down there and everything is basically sepia. There's no color. It's very dusty. It's very—at one time, it's like dark, but it's extremely bright because New York filmmakers have brought these gigantic lights to light up everything. And everything was on fire. And I'm looking at this thinking,'Oh my God, this is just hell. This is unbelievable that this is in my town.' I had no idea what was north or south at that point. And up to my truck comes this little tiny Italian fire guy, a"volley," a volunteer firefighter, with a big tray of lasagna. And he shoves it up in my face and says,"Hey, you hungry? Come on, let's eat!" I'm like,'Only the Italians would want to eat in the middle of hell, and bring lasagna to the World Trade Center. But it made me laugh, and that was like the first time I had laughed in like a week. And so it felt weirdly like home, that there was some hope in the middle of chaos.

HOST:

Sounds like there were a lot of things that were surreal.

BIANCA:

The whole thing was surreal. Definitely. And it's like—even driving through it and standing right on top of what used to be Tower One, you still don't get it.

HOST:

Say more.

BIANCA:

The scale of it and the physics of what happened in the such a short time. The buildings came down in like 10 and 11 seconds. And what was found, what we found, in the months that followed, like intact soda bottles in the basement and gigantic steel beams that were compressed into things you can hold in your hands. Just tiny remnants. So the physics of it was very bizarre and the suddenness. Like there was no going back. This thing had happen and maybe the doctor was right. There wasn't much you could do in that moment. But in the nine months that followed there, I felt there was a lot that could be done.

HOST:

Tell us more about your work, your day-to-day work on the site. What did a typical day look like?

BIANCA:

The first couple months, I think the first two months, we were out in the middle of the highway at like a MASH tent giving out candy and food and supplies and boots and socks. And then we moved into the big, what they called the"Taj Mahal" tent. And at that point, we had Gators, which again are the John Deere little 4x4s as they call them, kind of a pickup truck but squat. So that was my job to go around, bring coffee, bring supplies and drop off and pick up people.

HOST:

You were on the site for about nine months. What motivated you and other volunteers and first responders to keep coming back and work so hard?

BIANCA:

I think the goal was we wanted to make as many recoveries of people and remains possible. And I think we also felt, and we were part of a gigantic community and a big team. Because it was a lot of moving parts. It wasn't just firefighters, it wasn't just cops, it was iron workers and sanitation people and volunteers from Canada and people from all over the world. So it was community spirit, and we felt like we were doing some good in the face of horribleness. So that's what kept me going. There were times when I was like,'Okay, I cannot do this anymore because it's just too hard.' And it's emotionally hard. I think part of being on the site as a driver, I got to see a lot of stuff that I had to protect myself from, and I made a conscious choice to do that because I knew if I kept seeing recoveries that I would not be able personally to stay as long as I did.

HOST:

You're talking about recovery of remains.

BIANCA:

Yes, recovery of remains. We always kind of knew when this was happening a lot of times. And I would go on the honor guard, but if I knew that they were doing a recovery, like, say, over there, I would make it my business to turn my back and not witness that because that's how I needed to protect myself.

HOST:

What were some of the other strategies that you employed or saw other people using?

BIANCA:

I think comedy, definitely comedy and humor. There was a lot of dark humor on the site because it was a dark place to be. There was that and I did a lot of writing when I was on the site. Every time I went down on the subway with my little hard hat I would write.

HOST:

What sort of things would you write?

BIANCA:

Just a kind of an account of what I saw and what happened and names. Because I know that I was watching history unfolding here, and I didn't want to forget it. And I didn't want to forget the actually good moments that happened down there, and the beautiful moments between people. So that's what I would write about.

HOST:

Is there one that comes to mind, a beautiful moment?

BIANCA:

Hmm, there's so many. It's really hard. It's kind of like, I just can get glimpses right now. Like I love the grandmother from Florida who drove up in her little Winnebago and somehow got past the National Guard and like parked her gear and made cookies for us and soups. And then the awesome New Orleans people who came up with their gumbo and their jambalaya in the truck and just fed us and loved us and beaded us. They made it like Mardi Gras. Because, you know, let me reframe this. In the middle of winter, we had a mild winter, but it kinda sucked to be down there when it was all—everything was wet, everything was cold. You didn't know what you're covered in, and it could get very weird and lonely. And you don't know what you're driving over either. You really don't, because the roads keep changing. It's either really blindingly bright or really dark, and so it's disorienting. But when the jambalaya truck pulls up, it's a reminder of life. It's like here comes some life into the tent where everybody is just trying to get by.

HOST:

This is a big one.

BIANCA:

Go for it.

HOST:

How do you feel that working down there changed you as a person?

BIANCA:

Hm. I think it made me more compassionate and empathetic on one level towards people. And also lowered my tolerance for BS.

HOST:

Say more.

BIANCA:

All that stuff in the same cup, right? I can be much more patient and think about people in a more rounded way. And think about—Elaine Stritch says it best. Elaine Stritch said,'Everybody's got a sack of rocks.' Right?

HOST:

Yeah. It's like, everybody's got baggage.

BIANCA:

Exactly. So maybe the goal is, find out what the sack of rocks is. Listen to what they say about it and help people. You know, there's a lot of people who helped people down there. And that's all we could do. So back to the original doctor who, I think, was trying to protect me by saying,'There's nothing you can do.' Well, she was wrong. There's plenty that we did and that could be done, and that everybody has something to offer. So I think that was amplified for me by 9/11. And also much less tolerance for people who don't treat each other correctly. For people who lie, people who don't add to the good. I tend to not identify them as food. I just keep walking. And I think I would have given them more truck before 9/11.

HOST:

So what are the ways that you integrate those lessons into your everyday life?

BIANCA:

Well, I've continued volunteering since then. I got the bug, right? And so that's part of my life. I took the FEMA training to be a CERT member, which is community emergency response team. I also joined the Medical Reserve Corps as one of the non-medical people, because someone's gotta hold the clipboard while they're doing CPR. That would be me. So volunteering that way has been really helpful and fulfilling to me. And it's definitely a big part of my life. I still do a lot of things with my 9/11 people, my 9/11 community. I try to help people get into the health program who maybe didn't get checked and maybe should, and that's not just people who were down there but people who lived there, like residents and students. It's important that everybody gets checked. That's why we went for years to Congress to make sure that this was a reality and a safe, legal and guaranteed thing for all of us. So I'm big advocate for that.

HOST:

I want to back up to the initial days afterwards. When did you first realize that the site was dangerous?

BIANCA:

The minute I got there. It just wasn't right. I think we all knew this. We wanted to believe that it was going to be okay because we kept on being told that it was. But the smell, the stuff in the air. You would see the little maps they did of,'Oh the air is good today! Look at this little map we did! And look at these air filters that we've got over here! Pay mo attention to the man behind the curtain.'.

HOST:

What did it smell like?

BIANCA:

It smelled like Band-Aids. A lot of times it smelled like Band-Aids. Cement-y, dusty, and like burning plastic. So it was a big mélange of stuff. And, yeah, I think we wanted to believe it was safe, but I think in our guts we knew it wasn't. But what are you going to do? You know? Are we going to walk away from it?

HOST:

Did you see people exhibiting symptoms? You know, coughing and other things?

BIANCA:

Oh my God, yes. People were coughing and clearing their throats and the eye problems and the nose problems and the stress problems.'Cause there's a lot of stress.

HOST:

You wanted to be careful about what you say about your own health. Is there anything that you could share with us about what you experienced then or since then?

BIANCA:

I struggle sometimes with throat clearing and some breathing issues and some sinus stuff. But in the big picture, I think I'm actually healthier now than I maybe was back in the day when it happened.

HOST:

How's that?

BIANCA:

I think because I'm managing the sometimes and I'm being more mindful about how I live and my choices. So I'm also actively of fan of stress management.

HOST:

What are some of your techniques for managing stress?

BIANCA:

Mindfulness, meditation, definitely a breathwork. And, yeah, It's been helpful. And so has dancing. I think it's the best stress-reducer. Even if it's stupid dancing, like stupid wedding dancing. I'll take it. I'll take it. It works!

HOST:

Bianca Bob Miller is a writer, filmmaker and musician here in New York. Next we'll hear from another New Yorker, Dr. Michael Crane. As you may recall, Dr. Crane is medical director at Mount Sinai's World Trade Center Health Program Clinic. The clinic provides free medical monitoring, treatment, mental health services, and benefits counseling to about 22,000 9/11 responders. It's the largest of its kind. When we last heard from Dr. Crane at the very top of the episode, he was standing on a rooftop in Long Island City watching the second tower collapse in the distance. Back then, Dr. Crane was chief medical officer at a major utility company in the area. He and other occupational health specialists recognized immediately that the air at Ground Zero was potentially dangerous. Here's Dr. Crane.

DR. CRANE:

Looking at it come down, you first figured that it's all gonna be metal fragments and fiberglass and probably asbestos and other stuff. The first thing that happened, though, is we realized it was still on fire. So that is a whole different kettle of fish. You have not only the particles, but you have gases and vapors and new combustion products which are known to be very, very dangerous as well. Polycyclic aromatic hydrocarbons, for example. I mean, just to be clear about this, nobody knows what was in that dust cloud to this day. Nobody. Because nobody has a measurement of it. And so when you see those pictures of those people wandering through what looks like the thickest fog that London ever had or any city ever had—which is really the dust particles—covered in that stuff, that is an unknown exposure. We don't know what got into those people that day or what they breathed or what they swallowed, even with our responders and especially not the people who were just walking along. So it's a scary thought and it remains scary. And it's the reason why we at the programs are really pushing for as complete an ascertainment of this population as we possibly can get.

HOST:

When did the first symptoms appear?

DR. CRANE:

Oh, the symptoms were immediate. People choked on that dust. They were coughing and hacking. But the first guy I saw, roughly two weeks into the response, was a young utility worker. He had been working down there pretty much the whole time. He had started to get this cough. And I think I gave him some medication and he responded to it, and I said,'I think you're getting asthma. Let me get to the pulmonary doctor tomorrow. I think you're going to be fine.' I'm doing my doctor stuff. And he said,"You know what, doc? Thanks, but no thanks. I'm going back to work." And I said,"You're not going back to work.""Doc. Doc, let me tell you something. Some of them are family's in there." You know, it wasn't—this was not business with him. This was not job with him. This was a personal thing to him, and I wasn't going to get in his way.

HOST:

Is there a person, when you think about the heroism of that effort that their story jumps to mind that you could share with us?

DR. CRANE:

My personal hero. My personal hero is Dr. Dave Prezant, medical director of the fire department. He raced down there with all those guys. He was buried when the towers collapse. He was pulled out and he immediately went to work establishing superb healthcare and evaluation for his troops, for all those firemen. He wrote up the experience of the treatment of those guys, the welfare of those guys, the healthcare of those guys, and published an incredible paper in the New England Journal of Medicine, which basically created the structure and framework for everything to come in the World Trade Center Health Program. Dave is just a hell of a man and another one of those heroes working, working, working without regard for himself for others.

HOST:

We know a lot more now than we did in the months and even the first few years after the attacks. What can we say about where we sit now in 2019. What percentage of the 95,000 have an illness related to their work there?

DR. CRANE:

That's a great question. So if you don't mind, I'll answer in slightly different way just because I know probably more about the Sinai population. So here with our roughly 20,000 people, I believe we have something like, I guess at this point it's between like 9,000 and 10,000 of them who have some World Trade Center-related condition. So that's what say 45, 40, 50 percent, something like that.

HOST:

I've read about some of the most common illnesses. There's GERD, there's sinusitis. Can you explain to me what it means to live with, say, GERD? What does that feel like?

DR. CRANE:

It ain't so nice. So a lot of times heartburn is actually a much more pronounced condition called reflux, which occurs to you at night. And you're lying there sound asleep, and the stuff, acid, refluxes up from your stomach into your airways and passages, and you wake up feeling like you can't breathe. It's terrifying.

HOST:

Yeah. What do we know about the connection between working at Ground Zero and cancer right now?

DR. CRANE:

It's a mixed picture right now. We know that certain of the cancers are significantly increased in some of our populations. Those increases tend to be small, but definitely you see some spikes in some of the cancers in a variety of the papers you see a spike in prostate here, you see a spike in one of the survivor groups in brain cancers. So you will see a variety of responses that suggest strongly that something's going on. Dave Prezant's fire department paper showed an increase in all cancers across the fire department when you looked at—.

HOST:

A dramatic increase?

DR. CRANE:

No, it's low. They're all low. And that's the difference between what we see in the media and what we deal with here. So the headline in The Post is cancer, you know, and there's the picture, the terrible, terrible picture of that heroic police officer sitting there with Jon Stewart, and it is heartrending to see that. And it's real, and he's really dying, and likely that is due to World Trade. But that doesn't seem to be happening, yet. It may be in a statistically significant amount in some of the population for some of the cancers, but it's not a huge increase in cause of death. When you look at how we're doing our across the board as far as living and dying, the responders are still doing a little bit better than the normal population. They're still healthy workers and they're carrying that effect forward.

HOST:

Does that surprise you?

DR. CRANE:

No, no. It is the paradox of most occupational medicine studies that healthy workers are healthy and look healthy even after the exposure.

HOST:

But even that this group that from the very beginning was exposed something very dangerous, that almost 20 years later, they're still doing pretty good.

DR. CRANE:

Relatively speaking. I think in all of this, we—officially, I—have to be cautious, and I have to stick with what I know from the science. And if it's not significantly elevated, I have to live with that. However, I also know as a person who's looked at a lot of studies and a lot of exposures that this will start to be magnified the further out we go. And just the example that always comes up is asbestos. Asbestos just sits there and it's in your lungs and you don't even know from it. And then 25, 30 years later you are there with a lung cancer, and people are like,'What? That guy never smoked. Why did that happen?' Now again, it doesn't happen in great numbers. Even lung cancer, and you think about it compared to heart disease and other things that kill us, is a relatively rare disease. But in a population like this of healthy workers we're going to see it at a higher rate than we would have seen it without World Trade. Unfortunately, I know that in my bones.

HOST:

Yeah. When are you expecting that? How many years from now do you think we might start to see that?

DR. CRANE:

The number for me has always been past 20.

HOST:

So is we're creeping up on 20 now—.

DR. CRANE:

Yes, we'll start seeing it now. I mean, again, it's not going to be all of a sudden we're seeing all these positive X-rays, but it's certainly going to become a more significant morbidity for our population. By the way, I think we can cure a lot of those. I think we've improved with our screening. I think if we stay on our program, if we use our technology, if we use our new drugs, if we use our new diagnostic techniques, I think we may be able to lick this a lot. But we really have to be on our toes now and going forward for that one. We have the ability to beat it. We just got to have the opportunity. I'm jumping around the topics now, but we know roughly the number of responders, we know—.

HOST:

About 100,000.

DR. CRANE:

We know pretty well who was there when. And the thing that's a concern is the folks who were living there. To me from my side of this desk, that's a completely unknown variable. They estimate about the total size of population that was exposed is about 400,000 living there, working there, going to school there, et cetera. And I'm still not sure about the number of people who were really dramatically exposed, like in that dust cloud, in that group on that day. And I think we're just learning about that now. Just to go again on another tangent. It's just today, recently—where are we, 2019?—that there's a study where they're really looking in detail about the kids who were in school, and about what's happening with them. And that is really critical. These are young people now who are having their careers, having their own children. We really need to know more.

HOST:

So I want to turn now to your experience of working with this population that I know you have a ton of—.

DR. CRANE:

I don't like them.[laughs] Jesus, these people.

HOST:

Bunch of jerks. Bunch of self-centered jerks.[laughs]

DR. CRANE:

My God! I've been working here—.

HOST:

And you've been here now for—.

DR. CRANE:

So I've been here at Mount Sinai since 2006, so I'm in year 14. Which is amazing'cause I'm only 32 years old.

HOST:

And getting younger.

DR. CRANE:

Thank you. Thank you. You're beginning to understand me. This is the greatest honor of my life. There is not a day when I come in here and I don't either experience something or meet someone who makes me feel that everything I do is worthwhile. And that's no joke. It's no exaggeration. It's true for so many of the people. They are responders. They are this altruistic bunch of people. It is a remarkable population and it's a joy. It truly is.

HOST:

What have you learned from them?

DR. CRANE:

Ah, what have I not learned from them? I've learned that generosity is a virtue. I've learned that selflessness is often hiding in big, burly, scary looking people who are really tough, but very, very, very altruistic. And I know I've learned what courage is. I've learned what a hero is. And it's a lesson I get every day.

HOST:

Sounds like you'll be doing this work for the rest of your career.

DR. CRANE:

So the health program was renewed for 75 years about a couple of years ago. I calculated that when it ran out, I would be 138 years old. That'll be roughly the time I retire.

HOST:

Thanks again to Bianca and Dr. Crane and to everybody out there who lives by the words,"never forget." In the show description, you'll find a link to Mount Sinai's World Trade Center Health Program Clinical Center of Excellence. We'll also include links to some resources for responders that Bianca recommended to us. That's all for this episode of Road to Resilience. We're a production of the Icahn School of Medicine at Mount Sinai. This episode was produced by Katie Ullman and me, Jon Earle. Justin Gunn and Matt Kozar produced video for the episode. Our executive producers are Dorie Klissas and Lucia Lee. Help us bring you more great stories by filling out the listener survey in the show notes. And if you enjoyed the podcast, please rate and review us on Apple Podcasts or wherever you're listening. From all of us here, thanks for being with us. We'll see you next time.

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