The Philippines has been following the story of link a Philippino born cop who died of pulmonary fibrosis after working on Ground Zero. First, his story was hyped for political reasons, and now the newspapers are backpeddling, since it shows he only worked nearby for the first few weeks, and only claimed 8 shifts at Ground Zero itself, all in or after December 2001.

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In the early hours after the attack on the World Trade Center, we docs were aghast at workers digging in the smoke and fumes wearing limp surgical masks.

You see, the masks only filter out large particles (“they are good to stop you spitting into the patient’s wound”, as one of my instructors wryly observed) but after 15 minutes they get limp and soggy from the moisture in your breath and so don’t filter much, and of course they leak.

Now, in my work, I was fitted for a particulate mask (made of a felt like material, mainly used when we had TB or PCP pneumonia patients), which is a bit better. But for heavy metals, especially fumes, you need full blown respirators. And there simply were not that many respirators available in those first few days. Of course, this doesn’t stop the lawyers from suing the government, and so the just need to compensate the injured workers is in danger of becoming distorted for poltical gain by a New York senator who wants to be president and for lawyers seeking to become rich off the misery of the workers and their families.

The problem is that smoke, fumes, heavy metal particles and fumes (especially asbestos) and dust can cause problems if inhaled. The problem is not in everyone, and the problem is not the same for eeryone, but it is a known problem, and unless they establish a huge workman’s compensation fund similar to that which is used to fund medical care for coalminers and asbestos workers, the lawsuits will continue.

Now, Pulmonary fibrosis is not a diagnosis, but a description linkNYTIMES andLINK2 Emedicine

It’s like saying you have a rash, but a rash can mean poison ivy, measles, or an allergy to pencillin. From a doctor’s standpoint, you have to find the cause, remove the cause, and treat the symptoms. And the term covers several different ways that the lungs can get stiff, from smoker’s emphysema to coal miner’s disease, to asbestos or LINK heavy metal exposure, to post TB fibrosis, to viral pneumonia. to scleroderma/Rheumatoid/lupus lung disease, to farmer’s lung and even more. A whole list of reasons, and of course there is the “idiopathic” type, which means we don’t know the reason.

Now, not all these diseases have the same cause, the same look, or even the same pathology (how they look under a microscope).

Pulmonary fibrosis is a nasty disease. http://www.pulmonaryfibrosis.org/ipf.htm pretty well summarizes the problem. What happens is that your lungs get stiffer and stiffer, you have trouble breathing fast when you work or run or walk because you can’t breathe in and out as deeply as normal. Because you can’t breathe well you tire easily, you feel lousy, and because your body has to work hard to breathe, you use up a lot of calories and end up losing weight. You often get a dry cough, both from the disease and because you can’t cough normal phlegm out very well, and eventually you end up in a wheelchair with an oxygen tube, until you get pneumonia, which often kills you. It’s a miserable disease, and I always felt helpless when I treated them, because short of a lung transplant, you know they are going to die of it.

Most of the cases I treated were either coal miners or collagen disease (lupus and rheumatoid lung). These people go along for years fairly stable. But Borja seems to have had a fairly fast version of the disease, which makes exposure a more likely candidate, although it could be a sub acute infection or auto immune disease.

The press now argues he wasn’t at Ground Zero in the early days, so the early hype on his case is wrong, but their backtracking and denying him as a casulaty of the fumes of 9-11 is also overdoing it. Yes, most of the fires were out, but not all, and the dust exposure in the open air nearby could very well contribute to lung problems in a vulnerable population.

As LINK the NYTimes reports:

Officials at Mount Sinai said in a statement: “The fact that Mr. Borja worked there for many days (and nights) provided ample opportunity for exposure to dusts.”

But this brings up another worry. Hundreds of thousands had some exposure to the dust. There is a possibility that civilians living on Manhattan or to the east of the city where dust clouds spread could also in the future develop lung disease.

This could run into billions for just compensation, but like the coal miners and asbestos workers, it opens the door for both overdiagnosis (e.g. heavy cigarette or marijuana smokers) and for outright fraud.

In the meanwhile, perhaps the White House has the best summary of Mr. Borja’s heroism:

“…(Borja) father was a hero from what we know of New York law enforcement and his work at the World Trade Center,” Mr. Fratto said. “It is almost beside the point what the specific details were.”Enlarge This Image

And a cop who did his daily duty in the mundane traffic patrol in the early days and on the burning pile of Ground Zero after the first days of terror and excitement had gone may not be as heroic as those first responders, but he also did his duty. He was one of the estimated 40 thousand who worked there, and that is enough.

Finally, what is also shown in this story is the often ignored story of Ground Zero, where people from 100 countries perished. This is the story of immigrants, and of how New York City continues to be a city of immigrants. Borja, a poor farmer’s son from Bicol, like many of the two million Philippinos in the United States found a job and a new country without giving up his love of his motherland.

And probably died serving his new country, because he was faithful to his ordinary duties.

As Milton wrote: They also serve who only stand and wait.

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Nancy Reyes is a retired physician living in the rural Philippines with her husband. Her webpage is Finest Kind Clinic and Fishmarket and she posts medical essays to Hey Doc’s Xanga blog.

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