9/11: The Toll on Rescue Workers

By Roni Rabin
Staff Writer

September 16, 2003

Loud noises still startle Karin DeShore. When an airplane swoops down low over the highway, she prays and ducks her head.

DeShore, an FDNY emergency medical services captain, arrived at the World Trade Center moments before the first tower collapsed. She had just herded people to safety under a pedestrian walkway and was crouched behind a large concrete pillar when a roar enveloped them from behind.

The pillar saved her life, and DeShore says that now, when she's in the city or surrounded by high- rises, she finds herself scouring the area for the closest concrete pillar.

She talks about Sept. 11, 2001, as if it were last week. The sound of bodies hitting the ground. The sight of couples holding hands, hurtling from the sky. And running, not knowing if the towers would fall in her direction. The roar of the first tower's collapse was followed by an eerie silence, she said. No screams, no cries.

"Then, I heard this voice," said DeShore, 59, of Bay Shore, who was captain of Emergency Medical Services Command Battalion 46 in Elmhurst. "I don't know who it was; it was like the voice of God. He said, 'Is there anybody out there?' I said, 'I'm over here, please don't leave me.'

"He said, 'I can't see.' So we talked till we heard each other getting closer -- total strangers, I wouldn't identify him on the street -- but we found each other and held hands."

The physical and psychological toll the tragedy has exacted on thousands of rescue workers who arrived at the site in the immediate aftermath, as well as in the days and weeks that followed, is still being assessed. But directors of the federally funded World Trade Center Worker and Volunteer Medical Screening Program say two things are clear: At least half have developed severe and persistent upper or lower airway disease, including severe sinus problems and reactive airways disease, an asthma-like condition, according to preliminary analysis of the data. And a smaller but surprisingly high number continue to suffer emotionally and psychologically almost two years later.

Questionnaires filled out as part of the initial medical evaluation have consistently found that about half of all WTC workers and volunteers experience significant problems with their family relationships, social lives and work, said Dr. Craig Katz, director of the mental health part of the WTC screening program. He noted the questionnaire may be an overly sensitive screening tool that could be picking up mild problems.

But a striking 15 percent to 20 percent of those screened have also been diagnosed with post-traumatic stress disorder, a condition triggered by traumatic, usually life-threatening events such as war, rape or natural disasters, Katz said. The condition, which used to be called shell shock or battle fatigue, is characterized by vivid and disturbing memories that make people feel as though they are re-experiencing the trauma, and it is often accompanied by depression and anxiety.

"That's a pretty high number almost two years after the event," Katz said, explaining that PTSD symptoms disappear over time in many cases. The figure is also double or triple what's been observed in population studies of post-traumatic stress syndrome. "We thought we'd see a drop-off, and we really haven't."

A larger number of the screened workers, about 40 percent, experience vaguer symptoms of unease, such as difficulty sleeping or concentrating, increased irritability and decreased enjoyment of life, Katz said. Their condition is milder than typical depression, he said, calling it a sub-syndrome of "unnamed suffering" that appears related to the 9/11 experience. About 20 percent of the total group is receiving ongoing mental health services, Katz said, a high number for blue-collar workers who generally do not rely on mental health services. They include police, fire and emergency medical personnel as well as construction workers, engineers and tradespeople who excavated and cleared the site.

The comprehensive medical screening project, based at Mount Sinai School of Medicine in Manhattan with regional centers on Long Island, has evaluated more than 7,000 patients so far, with a goal of 12,500 by March.

The combination of physical and psychological illness has prevented many from returning to work and taken a toll on their family relationships, said Dr. Robin Herbert, co-director of the program.

"There's a spectrum of how severely impacted people are," Herbert said. "But, certainly, we have many patients who, at this point it is fair to say, have become permanently disabled as a result of their WTC-related problems."

Those include many in the building trades who often cannot return to work at their old jobs for fear of re-exposing themselves to dust and other irritants that can trigger asthmatic attacks, she said. "Many were at the peak of their earning years, with kids about to go to college. It's been terrible," she said.

One patient, a police officer from Nassau County who asked that his name not be used, said respiratory disease and psychological difficulties have prevented his return to work. He had responded to previous disasters, including the 1990 crash of Avianca Flight 52 in Cove Neck that killed 73 of the 158 passengers, but he said the World Trade Center was a trauma of a different magnitude.

"If you were to die and step into hell, that's what you would look at when you got there: all gray, black, no colors, smoke and puffs of smoke and dust and fire," said the officer, who is fighting for disability benefits with help from Woodbury attorneys Richard Brandenstein and Victor Fusco. "The things I saw, I won't even tell my family.

"They say, 'Why don't you talk about it?' I don't talk because if I tell you what I saw, you'll have it in your head, too. I'd rather go to my grave with it."

DeShore does talk, mostly with two emergency medical technicians who were with her that day and have since become close friends: Bonnie Giebfried, 38, of Lindenhurst, an EMT with Flushing Hospital Medical Center, which responds to 911 calls, and Timothy Keller, 39, of Levittown, an FDNY EMT who was under DeShore's command in Battalion 46 on 9/11. DeShore lost track of Keller that morning, and she had dispatched Giebfried into the south tower just minutes before it collapsed and feared Giebfried was dead.

That they all thought they were going to die that day is one of the recurring themes in their conversations.

"I was behind that pillar, it was dark, I was by myself. I knew I was going to die. I didn't want to die alone," DeShore said.

"'Take care of my family, take care of my friends.' Those were my last words -- I thought I was going to go," Giebfried said. "That fireball went right by me."

They talk about the horrors: Not being able to sidestep bodies. Giebfried picking up napkins from the floor at an Au Bon Pain to use as bandages. Keller spitting up handfuls of sand, dirt and small pebbles for two days, as if someone had ground his face and mouth into a sandbox.

He is the only one who has been able to return to work regularly; Giebfried has gone back to work but since January has been hospitalized twice and taken to the emergency room seven times due to asthma.

The trio credit one another with saving their lives. "He said to me, 'Whatever you do, don't go into the building. We don't know if it's a terrorist attack and a bomb is set to explode when the rescuers go in,'" DeShore said. "We didn't have a chance to go in, but I never forgot it."

Though DeShore thought she had sent Giebfried and her partner into the building, Giebfried says DeShore actually saved her.

"She kept pushing us away [from the building]," Giebfried said. "The fire chief went to the left -- they're all dead. We went to the right. Because of her."

They still have hypersensitive startle reflexes. Earlier this month, Giebfried jammed on the brakes on the Triborough Bridge when a plane zoomed by. Keller was on a quiet side street helping a friend change a tire a few months ago when a plane flew low overhead. "I hit the ground on that one," he said. "I was shaking."

They all have the uneasy sense that while other people are moving on, no one really understands or quite believes them. They worry about their health and feel they have not been treated with the same respect or accorded compensation and services in line with those of the uniformed city firefighters.

"Every time I get sick, it puts me 10 steps behind," Giebfried said. "People keep telling me there's nothing wrong with me, but I used to fish, play racquetball and soccer, paddleball. I can't run anymore. I get wiped out." DeShore, who is also pursuing a workers' compensation claim, said she recently had a noncancerous lump removed from her throat, something she fears may be related to her 9/11 exposures.

"You will not get over this," she says, partly to herself, partly to her friends. "You will get better. You'll tell yourself you survived it, it's OK. "But I used to run a battalion. Now, I walk up the basement stairs too fast, and I can't breathe. ... It's a constant. It's constantly with you."