The dust may have settled at Ground Zero, but for thousands of 9/11 responders, the health fallout is still unfolding.
As the 25th anniversary of September 11 approaches, survivors and responders continue to grapple with the long-term effects of their exposure, including upper and lower respiratory illnesses, gastrointestinal problems, musculoskeletal disorders, mental health conditions and various types of cancers.
For 16 years, Mount Sinai has been at the center of New York’s medical response through its World Trade Center Health Program Clinical Center of Excellence.
The program provides medical monitoring, treatment, mental health services and benefits counseling at no out-of-pocket costs to tens of thousands of 9/11 responders, including law enforcement officers, emergency medical workers, construction and ironworkers and asbestos handlers.
Dr. Michael Crane, a professor and deputy director of the WTC program, pointed to the institution’s longstanding work in occupational health, dating back to Dr. Irving Selikoff, a pioneer in asbestos epidemiology and worker safety who began his research and clinical involvement in asbestos exposure in the 1950s at Mount Sinai.
“These folks dove in head first into this work, doing the same type of protection and evaluation,” Crane said, reflecting on his colleagues who responded after 9/11. “They realized pretty much immediately, this is going to be a very long term issue and with thousands of people.
What began as an urgent response to an unprecedented disaster has evolved into a model of long-term care built on a commitment to understanding the health consequences of an exposure that doctors knew from the start could take decades to emerge.
“We all know that smell and the dust was here for months,” said William Corrar, a retired FDNY captain and WTC program patient. “I knew it wasn’t good for me.”
He was particularly worried about the young firefighters and police officers at the scene, many of them in their early 20s. “They have a lot of years in front of them with these toxins in their bodies.”
And the damage has not been limited to the body.
Mental health conditions among responders in the program include post-traumatic stress disorder, depression, adjustment disorders, anxiety and panic disorders and substance abuse disorders.
Dr. Craig Katz, a clinical professor of psychiatry, had started directing the psychiatric emergency room at Mount Sinai just one week before 9/11. With a background in disaster mental health, Katz knew that treating the psychological aftermath would require literally meeting responders where they were.
Donning hard hats, he and his colleagues went to Ground Zero to talk with workers and see how they were doing on the ground, an effort Katz said helped destigmatize mental health care among responders.
He also credits the decision to integrate mental health treatment with physical care as the “magical ingredient” of the WTC Health Program.
“This pairing has been such a unique opportunity to, in a sense, treat the whole person,” said Katz. “Because otherwise in medicine, to some degree, we can often wind up in our own little silos, and that is not to the benefit of our patients.”
From the beginning, medical professionals recognized that the health consequences of 9/11 would not disappear right away or even within the first few years.
“Environmental exposures are a different animal, said Dr. Raja Flores, chair of thoraic surgery at Mount Sinai. “They don’t hurt you on that day. They hurt you 20 years later, 30 years later.”
That reality makes the monitoring of the World Trade Center cohort especially important.
Now more than 20 years later, Flores is seeing significant numbers of patients with lung cancer and reflux, which can lead to esophageal cancer. But the work at the WTC Health Program is about more than identifying individual patients and treating them. It has also given doctors a rare opportunity to recognize patterns in how diseases linked to the disaster’s toxic fallout develop over time.
“We see how what we would treat 10 years ago, now we’re better at it because we understand it,” Katz said. “And when you have a better understanding, you can provide a better treatment.”
Corrar knows that evolution firsthand.
Eight years ago, after being diagnosed with Barrett’s esophagus, he began having trouble swallowing. An endoscopy revealed esophageal cancer. His wife researched the disease and discovered Flores. During their first appointment, Flores walked into the examination room and said, “I have one word for you: Curable.”
Esophageal cancer has a notoriously poor prognosis, with an overall five-year relative survival rate of about 22%. Corrar credits Flores and the nurses on his care team for helping him through treatment.
The WTC Health Program brings together a diverse array of specialists, including oncologists, occupational health, psychiatrists and surgeons, alongside researchers working to understand and treat the evolving consequences of 9/11 exposure.
Katz recalls writing the first grant for the program’s mental health services while staying at a hotel in Philadelphia for a conference. “I had no vision that it would be here all these years later,” he admitted.
But 25 years later, the work is far from over. There are patients who are sick now, and there will be others whose illnesses have yet to emerge.
“9/11 did not end in 2001,” Flores said. “It continues today.”
