PHILADELPHIA — Retired Philadelphia Police Capt. Mark Fisher gets winded and lightheaded while emptying the dishwasher or pushing his gas-powered lawnmower, his lungs forever scarred by the ankle-deep ash that he trudged through at ground zero.

When Fisher arrived at the nation’s worst crime scene, two days after the Sept. 11, 2001, terrorist attacks, each step he took kicked up a powdery plume, coating his tan work boots. Dense smoke from fires burning beneath the rubble of the World Trade Center site stung his eyes and clogged his lungs.

Then a lieutenant in charge of the Philadelphia department’s crime scene unit, Fisher scoured the wreckage for nearly two weeks. He helped recover the lifeless body of a firefighter crushed under concrete. A torso. The severed arm of a businessman.

The coughing fits started about a year later. Then, about six years after 9/11, a chest X-ray revealed a thick, hardened fluid around his lungs, making it difficult to breathe. He developed severe pulmonary disease linked to exposure to toxins.

Fisher, 69, needs a double lung transplant soon, his doctors say, that at best will extend his life by five to seven years. His deteriorating health shows how grossly federal and local health officials underestimated the environmental hazards.

“I can’t breathe worth a darn. My lungs just aren’t going to last,” Fisher said, as he sat in his Northeast Philadelphia home with oxygen prongs in his nostrils and a heating pad against his back.

“Everything aches,” he rasped, coughing relentlessly.

Fisher is among roughly 145,000 responders and survivors getting treated through the federally funded World Trade Center Health Program. They are afflicted by everything from respiratory and digestive diseases to mental health disorders and early-onset dementia.

Cancer is the fastest-growing diagnosis, now that enough years have passed for tumors and other abnormalities to emerge, soaring from about 3,200 cases to more than 57,000 within the last 11 years.

Most of the toxic dust — as deep as snow drifts in spots — formed when the concrete floor slabs of the 110-story towers collapsed on top of one another in quick succession. The wreckage, known as “The Pile,” contained more than 350 chemicals and mineral agents: potassium hydroxide in concrete, calcium sulfate in wallboard, jet fuel, asbestos, glass insulation fibers, heavy metals — all finely ground and aerosolized.

“It was such a mixture of stuff, like a witch’s brew,” said Iris Udasin, a Rutgers Health doctor who treats 9/11 responders and studies the long-term health effects of the attack.

The alkaline alone in “the cement from all these buildings was toxic in and of itself,” she said. “It basically burned holes in people’s noses and made them more likely to absorb other chemicals and gases that were in the air.”

From WTC cough to lifelong disease

Udasin directs the WTC Health Program at Rutgers University in Piscataway, New Jersey — one of six clinics created nationally to treat 9/11 responders.

When it opened in 2003, Udasin mostly treated responders for what she calls “World Trade Center cough,” a dry and persistent hacking that improved with asthma medication.

Now their cases are far more complicated and life-threatening, often requiring referrals to medical specialists, from pulmonologists to oncologists.

Udasin can name many of the roughly 3,000 responders she treats annually by their faces alone. She prefers to relay test results, both good and bad, to patients herself, rather than delegate.

On a recent morning, she escorted an older man from an exam room to the clinic’s lobby and asked: “Do you want me to call you with the results? If you are going to be scared, I can have somebody else call you with the results.”

Her patients, hailed as heroes after 9/11, could not have anticipated how working at ground zero would impact their long-term health.

Local and federal officials initially minimized the environmental health hazards. Christine Todd Whitman, who was the head of the Environmental Protection Agency under President George W. Bush, infamously assured the public within days of the attack that the air around the WTC was “safe to breathe.”

However, a 2003 report by the EPA’s inspector general concluded that the agency “did not have sufficient data and analyses to make such a blanket statement.”

“The (EPA) scientists did the best they could with the data that they had and with the knowledge they had at the time,” said Whitman, who had previously served as New Jersey governor.

“It’s a case of you don’t know what you don’t know,” Whitman added in an interview with The Philadelphia Inquirer late last month.

Whitman said her agency did urge responders on “The Pile” to wear protective gear, preferably respirators. The EPA distributed masks, but many refused to wear them, she said.

In hindsight, she said, the masks were not protective enough. Responders are now paying “the price” of breathing toxic air: “It sickens me to say it,” Whitman said.

The Rutgers program grew out of early alarms about air quality hazards, of which details are still emerging. On Tuesday, New York City officials publicly released a trove of documents revealing that toxins lingered in the air for months after the attacks.

Medical monitoring and free healthcare for responders continue to evolve as the responder population ages.

The Rutgers site recently added on-site neuropsychological testing after researchers at Stony Brook University in New York found increased rates of dementia among 9/11 responders. Responders with more exposure to toxins had higher rates of early-onset dementia compared with those with fewer exposures.

Researchers evaluated more than 5,000 WTC responders, with an average age of 53 at the start of the eight-year study.

“As this population ages, we are seeing increasing concerns related to memory, attention, and executive functioning, sometimes at ages when the responders themselves are surprised to be experiencing them,” said Jodi Streich, mental health director at Rutgers’ WTC Health Program.

A stubborn and spreading blood cancer

Udasin’s clinic currently treats 1,177 cancer patients. Research shows that 9/11 responders suffer from thyroid, prostate, lung and blood cancers at higher rates than the general population.

“The question is: Are certain cancers higher because we looked for them, or are they higher because they’re really higher?” Udasin said. “We really don’t know the answer to that, but my job is to treat everybody.”

In 2023, Udasin successfully lobbied to have gynecologic cancers, including uterine, included on the list of WTC-related conditions.

Greg Masi, 71, a retired Philadelphia police sergeant from the Northeast, was diagnosed with a form of blood cancer known as T-cell lymphoma in 2019.

First, red bumps appeared on his left arm. A scaly rash has since spread over much of his body, killing hair follicles. His oncologists worry the cancer will find “a road map” into his organs.

Light therapy and topical medications did not work. Chemo and radiation would be a last resort. Since there is no cure, the goal is to slow it down.

Masi, an expert in radio communications, can still hear the horns that blared each time responders thought they found someone still alive beneath the rubble at ground zero, or to signal an imminent structural collapse.

The dust that caked cars and blanketed fire escapes struck him as a mere nuisance.

“We figured it was just dust, like dirt,” Masi said. “We had no idea it had harmful toxins in it.”

An avid runner and marathoner, Masi developed bad chest colds with wheezing about five years after Sept. 11. He was later diagnosed with asthma and nodules on his lungs, both common afflictions among responders.

He recently learned that one nodule has doubled in size, and doctors plan to monitor it for signs of cancer.

Mental health toll still mounting

Multiple diagnoses are commonly seen in 9/11 responders. Frank Geffre Jr., a retired firefighter from Central Jersey, has asthma, two types of cancer and post-traumatic stress disorder.

In 2013, surgeons removed a “grapefruit-sized tumor” and parts of his colon and stomach to treat his stage-four colon cancer. Two years later, he learned the cancer had spread to his rectum.

After more than a decade of chemotherapy and radiation, his cancer is in remission. He credits Udasin, his primary care doctor, with saving his life.

He sees a psychiatrist and a therapist for PTSD, which he finds especially hard to manage as Sept. 11 approaches each year. He lies awake after a recurring nightmare in which he is trapped in Manhattan with his family amid a terrorist attack, and he can’t get them out.

After the first plane struck on 9/11, Geffre and five other firefighters from Fire District No. 3 in Piscataway were immediately dispatched. His team got to ground zero shortly after the second tower violently pancaked.

“It was dark as can be, even though it was daylight. You had smoke clouds so thick you couldn’t even see your hand in front of your face,” Geffre said. “The dust was so thick it was like you had 2 foot of snow the night before.”

He initially wore respiratory gear, but the oxygen tank ran out as he worked nonstop over the first 30 hours. He saved roughly a dozen people after putting out fires that were blocking their exit from the burning buildings within the World Trade Center complex.

He vividly recalls finding a brown dress shoe with a foot still in it. A blue polyester suit jacket with a torso seared to its lining. A wristwatch. A ring.

In all, he worked The Pile for 20 days, smearing Vicks VapoRub under his nose to cope with the “unforgettable, unbearably horrid smell of burning human flesh,” he said.

Now he can’t use the menthol and eucalyptus goo for his bouts of sinusitis, because the scent stirs bad memories.

“It feels like it was yesterday and a lifetime ago,” Geffre said. “The ‘Never Forget’ vow is not for first responders. We won’t ever forget. It’s embedded in us.”

He is ever-vigilant, prone to panic attacks. He avoids movie theaters and other places with crowds. “Too many variables,” he said.

He has a second home in Florida but drives back and forth. He won’t get on a plane. “I get paranoid that somebody on the plane is going to hijack it,” he said.

Two of the five firefighters with him on Sept. 11 have since died of cancer. He keeps in touch with four of the people he helped out of burning buildings. One committed suicide in recent years.

Geffre, enrolled in the Rutgers program since its start, gets his mental healthcare through the clinic, which has seen a significant increase in demand for these services.

As more responders become ill or die from 9/11-related diseases, some have developed “heightened anxiety and vigilance about their own health,” Streich said.

Having more unstructured time in retirement, along with the loss of job identity and camaraderie, can be detrimental for mental health, she said.

“Things that we once buried — they come fully alive during retirement,” Streich said, adding that the support group she runs for retirees is now the most widely attended after the cancer support group.

Emergency responders who had felt too embarrassed or ashamed to seek help while working — because they feared being seen as weak — are coming in for the first time. Many are unable to eat or sleep, Streich said.

“We see them when they are at rock bottom,” Streich said. “They’ll come in and say, ‘I’m ready to talk about what I’ve been holding in for 25 years.’”

‘Exhaustion, desperation and heartache’

When asked if he regrets being dispatched to ground zero, Mark Fisher is emphatic: “Absolutely not.”

But he is tormented by images of people standing outside makeshift morgues with photos of their missing loved ones.

Fisher recalls becoming so distraught that a Red Cross volunteer pulled apart two tables piled with fresh clothes for responders to reach and embrace him.

“She hugged me for the longest time,” Fisher recalled, blowing air through his lips to steady his breathing and control tears. “I’m an Irish Catholic, so I wear my heart on my sleeve and face. I just had that look of exhaustion, desperation, and heartache.”

These days, he feels exhausted both emotionally and physically as his lung disease progresses. Fisher spent most of this summer in the hospital with a kidney infection that required two surgeries.

Five days after he got out of the hospital, his gall bladder became infected. “If I die, I want to die in a Catholic hospital,” he told his wife. Doctors removed his gall bladder in July.

The once-burly cop is rail-thin. He’s lost 35 pounds.

Fisher’s priority right now is spending time with his wife and former sweetheart at Archbishop Ryan High School, and making sure she will be in decent financial shape when he dies.

Fisher, Masi, and two other responders from the Philadelphia Police Department are seeking written assurances from the city that if they die from their World Trade Center-related illnesses, their families will receive line-of-duty death benefits.

The status would enable their spouses to collect their full pensions, rather than half.

City officials said their families can apply to the Philadelphia Board of Pensions and Retirement, which would review each case individually after death.

Sue Fisher tries not to cry in front of her husband of 42 years; she’ll do it behind the shed in their backyard or on a walk with their golden retriever, Bentley.

He wants to delay as long as possible a double lung transplant, for which the survival rate is about five to seven years. “If they say that’s all he’s got, I’ll take it,” Sue Fisher said. “It’s better than him suffering the way he is.”

At night, she lies awake listening for the sound of Fisher’s breathing. Sometimes, she fears he has stopped. Then she nudges him with her toe until he stirs.

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