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  • Turns out the deadliest part about being one of our city’s rescuers isn’t running into a burning building. By Blair Miller | Boston Magazine | March 2017
    Updated On: Mar 21, 2017

    http://www.bostonmagazine.com/news/article/2017/03/19/firefighters-cancer/2/

    It was nearly 100 degrees outside when the emergency call reached Engine Company 39. A triple-decker in Savin Hill had erupted in flames, and a haze of thick black smoke was all but blanketing the sky. Firefighter Glenn Preston, a burly father of four who had only recently returned to action after breaking his neck on the job, was among the first to arrive. The blaze was larger than Preston had expected, and he knew the punishing summer heat would only make matters worse.

    Saddled with 80 pounds of gear, Preston charged toward the building. He tried to haul himself over a fence into the yard, but his boot caught on the top, sending him to the ground like a sack of bricks. After the initial shock, Preston felt a rush of adrenaline lift him to his feet and he scrambled into the smoky abyss.

    Visibility was awful as Preston felt his way through unfamiliar territory inch by inch. At first he didn’t even notice that he was gasping for air. “Who is breathing like that?” a fellow crew member barked over the radio. Preston snapped to: “It’s me, it’s me,” he yelled, pressing deeper into the smoke. “I’m fine.” After all, he thought to himself, these were precisely the moments he’d dreamed of as a boy growing up in Boston—plunging into hell in service to the nation’s oldest fire department.

    Backup soon arrived, and the blaze withered. By no means was Preston’s tumble over the fence the worst he’d had, but something was wrong: He couldn’t stop wheezing. When he finally stepped out of the smoldering house and into the sunlight, he tried to inhale and catch his breath. “It felt like a gunshot,” he recalls. “There was a pain that brought me to my knees.” No stranger to the physical toll of the job or the macho culture inside the firehouse, Preston concealed his suffering. He told himself it was likely a cracked rib, just one of those pesky injuries that doctors can’t do much for other than write a painkiller prescription and tell you to get some rest.

    After several days, though, Preston didn’t feel any better. He winced with each deep breath; sneezes brought him to the brink of tears. Finally—at the urging of his wife—he visited the hospital, where X-rays showed his ribs were unscathed. The pain, it turned out, was caused by something else: a malignant tumor the size of a small banana that stretched from his lung toward his heart. The news was devastating, but it wasn’t exactly a shock. “I’m a fireman,” Preston says matter-of-factly. “I had a feeling that it would happen. But not when I was 39.”

    As it turns out, the greatest risk of being a firefighter in Boston isn’t burning to death or even breaking an ankle—it’s cancer. Preston wasn’t the first case, and he certainly won’t be the last.

    Boston’s fire commissioner, Joseph Finn, has been a firefighter for 32 years, and at least once a month he learns that yet another member of his crew is sick with cancer. “It blows my mind,” he says, estimating he’s known nearly 200 colleagues who’ve died from the disease. Even scarier, Finn says, is that the number of notifications he receives is not shrinking. “These are guys who are 40 or 45 years old,” he says. “And some of them have been on the fire department for just 10 or 15 years.”

    Understanding and quantifying why Boston’s bravest appear to be at such a high risk of cancer is no easy task. Unlike plastics workers or coal miners, who log consistent hours in the same environment five days a week, firefighters are not all exposed to equal amounts of smoke and flame. “There’s no standard amount of fire a firefighter fights,” explains Peter Chai, a medical toxicologist at Brigham and Women’s Hospital. Moreover, firefighters don’t all have just one type of cancer. Going back to the 1960s and 1970s, Chai says, they had high rates of mesothelioma, an aggressive form of cancer that’s associated with exposure to asbestos. Today, though, doctors are diagnosing firefighters with what Chai refers to as the “liquid cancers”—lymphoma, leukemia, and myeloma.

    While the science may be “imperfect,” as Chai says, there’s little debate that firefighters are more likely than the average desk jockey to succumb to cancer. The National Institute for Occupational Safety and Health combed through the health records of 30,000 firefighters from several major cities and found that they were at notably higher risk for digestive, oral, respiratory, and urinary cancers. Meanwhile, an examination of Massachusetts’ health records from 1987 to 2013 found that firefighters were at a greater risk than non-firefighters for colon and brain cancers.

    None of this, when you stop to think about it, seems counterintuitive. Firefighters earn their living by running into smoke-filled structures that everyone else runs away from, and the job is essentially a prolonged assault on the respiratory system. There are oxygen tanks and masks, of course, but as Finn knows firsthand, the cultural norms of Boston’s firehouses don’t always place a premium on personal safety. Firefighters, he says, are a tribe steeped in machismo; to its members, bravery means everything. As a younger man, Finn loved ripping off his mask and marching out of a fire, his face ashen, clothes reeking like a chimney. Among his generation, this grizzled look was dubbed a “Salty Jake” and was a source of immense pride—war paint from a hard day’s work under deadly conditions. “I consider myself a true firefighter,” Finn says, before hesitating. “But in hindsight, it was a stupid thing.”

    Bravado, though, is only a small part of a much bigger problem. Today’s homes and offices are jam-packed with plastics, electronics, and furniture covered in flame-retardants. “When they combust,” Finn explains about household goods, “they are extremely toxic.” That means the smoke firefighters are exposed to is often loaded with a litany of septic chemicals—formaldehyde, vinyl chloride, chlorophenols, dioxins, trichloroethylene, ethylene oxide, polychlorinated biphenyls, methylene chloride, orthotoluidine, and arsenic, to name a few. Alone, any one of these may be harmful; mixed together they could make a potent cocktail of carcinogens with the capacity to do untold damage to the body’s organs, cells, and DNA.

    It might seem odd that flame-retardants—ostensibly a firefighter’s best friend—would be a problem. They are, after all, designed to help slow the spread of fires or prevent them from starting in the first place. For decades, chemical mixtures were added to couches, mattresses, drapes, highchairs, cribs, televisions, computers, and countless other household items. But these chemical mixtures are not foolproof. They become ineffective at high temperatures, and when they go up in smoke they can take on the form of carcinogenic particles that are easy to inhale and capable of seeping through skin and into the bloodstream.

    Throughout the years, many states, including Massachusetts, mandated flame-retardants in hopes of preventing destructive infernos. In 2012, however, a series of investigations revealed that the chemical industry misrepresented scientific research in an attempt to sway legislators by downplaying the known health risks that these chemicals pose to humans. The alarming revelations led to immediate legislative changes across the country. California rewrote its flammability standards so that foam cushions no longer needed to be laced with toxic and ineffective retardants. Other states soon followed. In no time, retailers such as Crate & Barrel, Ashley Furniture, and Williams-Sonoma took steps to eliminate the chemicals from their products.

    Finally, in 2014, the Massachusetts Board of Fire Prevention Regulations and the Department of Fire Services revised their rules and rolled back flame-retardant requirements for public spaces, noting that less-flammable fabrics and sprinkler systems appeared to be equally as effective and less dangerous. But Boston decided to continue to allow the retardants. It was troubling, says Elizabeth Saunders, state director of the Massachusetts office of Clean Water Action, an environmental group that has worked on the issue, but also understandable: From the perspective of the fire department and city council, Boston had one of the lowest national rates of firefighters killed in action, so changing the fire code to eliminate flame-retardants didn’t seem to make sense.

    The decision, however, turned Boston into one of the biggest markets in the country for flame-retardant-treated products, with devastating consequences. At the time, a member survey from the Business and Institutional Furniture Manufacturers Association showed that a staggering 40 percent of all furniture that was pretreated with flame-retardants ended up in our city. Not only were these products banned in nearly every other major metropolis, but they were feared by firefighters, who knew that potentially poisonous particles wafted off these things when alight.

    Another problem is that these noxious particles tend to linger long after the flames are out. As Saunders notes, a firefighter doesn’t have to be in a raging hellfire to be exposed to the harmful effects. “When the fire has gone out and they’re still on site cleaning up without their masks on,” she says, “all those fumes are still around. The soot gets onto their uniforms and protective gear, and then it gets into the fire trucks and firehouse. The exposure just follows them.”

    For the unfortunate ones, this endless cycle of exposure can lead to an early grave.

    The problem isn’t limited to Boston. Just north of the Mystic River, in the heart of Chelsea, sits one of the busiest fire stations in the United States. Engine 2 responds to more than 4,000 calls each year, or roughly 11 a day. It’s a firehouse full of seasoned first responders who also know the pain of burying a colleague. It was here that Pete Kannler spent years doing the job he loved.

    Broad-shouldered with dark facial hair, Pete was born in Melrose and raised in Wakefield. At age 28, he married the love of his life, Michelle, had two daughters, and settled down in Townsend, a quiet blue-collar suburb that straddles the border with New Hampshire. Pete relished working at the firehouse until one day in July 2015, when he went to the bathroom and noticed blood in his stool. He said he felt fine, but Michelle, a nurse, knew that this was cause for concern. It was probably an ulcer, she told him, but she wanted him to visit the hospital to make sure. Several hours later, doctors at Lowell General Hospital routed a scope down his throat and found a tumor at the junction of his esophagus and stomach. The next morning, a CAT scan revealed that his liver and lymph nodes were overrun with cancerous cells—he was diagnosed at Stage 4. When doctors delivered the news, Pete didn’t wallow in self-pity. Instead, he asked, “What do we do now?” His wife sat next to him, knowing that this was not a battle he could easily win.

    When Pete first met with a team of specialists at the Dana-Farber Cancer Institute, they wasted little time reaching a consensus on the cause of his disease: His advanced cancer was courtesy of his career. An instructor at the fire academy—where, ironically, he helped launch a cancer-awareness-and-prevention program—Pete was cut to his core. He couldn’t help but wonder whether the hundreds of young men and women he had trained over the years would suffer a similar fate.

    Pete knew he was in bad shape, but he was far from ready to surrender. He and his wife read reams of dense medical texts and scrutinized alternative therapies on the Internet, determined to learn everything they could about his illness and the risks of being a firefighter. Michelle recalled the dozens of “Salty Jake” tales she’d heard throughout the years from her husband and his buddies, and she dwelled on the culture that so enamored them. “There was a time when all of the firefighters wanted that seasoned, ashy look on their faces after leaving a fire,” she says. “They would put their masks on when they were directly by the fire, but when they weren’t, they would leave off the masks.”

    Other issues trouble Michelle as well. At Engine 2, she knew firefighters often responded to back-to-back emergencies with little or no break. Many times, Pete didn’t have time to shower between fires, and he consistently wore the same turnout clothing and safety equipment, even if it was still slathered in soot and chemicals from the previous call. “The gear was so dirty,” Michelle recalls. “They had no choice but to be surrounded by it, even long after the fire.”

    Like her husband, the cancer was stubborn and resilient. Pete endured round after round of intensive chemotherapy, with devastating side effects including memory loss and painful rashes. Simple tasks such as sending a text message became a grueling physical feat. There was also the psychological toll of going from being a man who rescued others to someone who could no longer get cold milk from the fridge for his daughter. By the end of September 2016, his liver was obliterated and the cancer had taken over. “He finally said to me, ‘If this is it, you need to tell me,’’’ Michelle says. Less than a week later, her husband died at age 37. “From diagnosis to death,” she says, “it took 13 months.”

    Michelle is grateful for the flowers and expressions of concern from firefighters and activists following her husband’s death, but worries that conditions for firefighters will never improve. “People say they’ll never forget or that this won’t happen to others,” she says. But she knows that the very same people in Engine 2 who worked alongside her husband and champion his legacy are still pulling off their masks at fire scenes and needlessly exposing themselves to the same risks that ultimately killed her husband. “Wearing your mask,” she says with frustration, “is still not considered cool.”

    Today, Michelle is working with young recruits at the Massachusetts Firefighting Academy, where she shares her husband’s story. She is also a force on social media, calling out firefighters who in photographs aren’t properly wearing their safety gear. “Where is your mask?” she’ll write in the comments. Still, Michelle knows that raising awareness can only go so far. Protecting the area’s firefighters requires political will and lots of money, and it feels like firefighters are constantly playing catch-up.

    As of now, there is no silver bullet to stop firefighters from getting cancer. So much of protecting them comes down to ensuring that they have the right equipment to do the job, and that hasn’t always been easy in Boston. For years, firefighters had a single set of gear and were stuck with oxygen tanks that provided a mere half-hour’s worth of air. Commissioner Finn doesn’t mince words when it comes to why: “The past administration didn’t care.” Under Mayor Thomas Menino, the Boston Fire Department was largely viewed as resistant to change, and the relationship between the fire union and department leadership was strained, especially when it came to the issue of safety equipment. “The fire union,” Finn says, “was always pushing the last administration to look at this.”

    Then Mayor Marty Walsh took office, the gridlock let up, and results began to show. Last October, Walsh announced $4.5 million worth of new oxygen tanks that give first responders 50 percent more air than the previous tanks. The department also struck up a partnership with Dana-Farber to screen firefighters earlier and more frequently for cancer. The fact remains, however, that firefighters in Boston are still contending with the unintended consequences of lingering flame-retardants—which the city refused to ban for so many years.

    At least earlier in the spring, the city finally acted on reducing new flame-retardants. Under growing pressure from firefighter groups, the city council voted to modify Boston’s fire prevention codes so that they fall in line with the rest of the state. That means hospitals, schools, colleges, and other public buildings equipped with sprinklers are no longer beholden to flame-retardant mandates. Saunders says it’s a step in the right direction, but there’s still work to be done, particularly when it comes to homes and apartment buildings, where flame-retardants make their way into living rooms and bedrooms in any number of items. In response, state Representative Marjorie Decker has introduced legislation aimed at cracking down on flame-retardants in household furniture and children’s products. The chemical industry has been vocal in its criticisms of the proposal, but to cancer patients such as Preston, it seems like an easy choice.

    Fighting fires is an inherently risky job, and there is no way to completely safeguard the men and women who devote their lives to saving others from the invisible threats lurking in the smoke. Nobody knows this better than Preston. The tumor in his chest has made life for him, his wife, and his four children a living hell. Over the past year, he’s gone through six rounds of chemotherapy, each so intense that he had to be admitted to the hospital for a full week to safely receive and recover from the treatment. “This cancer is so advanced,” Preston says. “It messes with your mind.”

    Ever the optimist, though, Preston sees a silver lining. He praises Walsh for supporting the fire department and appreciates Finn remaining by his side. Volumes have been written on the special bonds that firefighters share with one another, and it is clear to Preston that these bonds hold steady whether the enemy is a five-alarm inferno in Southie or a potentially fatal malignancy.

    Like the flames of a house fire, cancer has a way of being unpredictable. It changes course,flares up, tapers off, and remains a threat long after you think it’s been extinguished. Whether Preston lives or dies, he hopes his experiences will serve as a cautionary tale to every firefighter out there. “We’re trained to put out fires and save people,” he says. “We were never taught about cancer.”


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