On a hot August day in 2005, I met with Marian Fontana in a little cafe across the road from her firefighter husband Dave’s firehouse in Park Slope, Brooklyn.

Marian and Dave should have been celebrating their eighth wedding anniversary on the afternoon of September 11, 2001 – the day of the 9/11 terrorist attacks. Dave had just completed a 24-hour shift at his Brooklyn firehouse with Squad 1 when Marian phoned him that morning to confirm their plans for the day. Aidan, five years old, had his first day at school and Marian and Dave had been looking forward to spending the day together. He was done he told her, and they organised to meet at a local cafe. “That was it” she said. “No profound discussions”. She can’t even remember if she told him she loved him. “We always did” she says, “but ingrained habits are forgotten sometimes”.

As she waited at the cafe, Marian noticed people taking animatedly around her, some staring up at the sky.  “I heard the words ‘airplane’ and ‘twin towers’” and then a friend approached her at the cafe and told her “a plane just crashed into the twin towers.” As Marian looked up, she saw a thick black cloud of smoke stretching across the perfectly blue sky from downtown Manhattan. She knew it was a big job, and she knew Dave would have gone.

She got home in time to turn on the television and witness the devastation – both towers of the World Trade Center were on fire. Marian watched as a man in a green shirt tucked his knees up, like a kid doing a cannonball into a pool, and jumped from one of the towers. “What’s happening?” she asked the television.

And then she heard it. A low, guttural rumbling sound coming from her television. The South Tower fell.  She knew, she said, in an instant that Dave was dead.

She couldn’t avert her eyes from the television – searching the ash-covered faces of those trying to flee the carnage, looking for the familiar features of Dave. The waiting for news was torturous. Grabbing the phone each time it rang, desperately hoping that it was Dave calling to say he was OK. Friends and neighbours called, some arrived with food. Although she hadn’t smoked in thirteen years, she lit a cigarette. Around lunch time, crying and pacing around the apartment she shared with Dave, Marian and her friends started to call the emergency departments of hospitals surrounding the World Trade Center. There are busy signals and confused nurses. They check their lists for Dave’s name.

Doctors and nurses in the hospitals near the towers were waiting, but the emergency rooms are virtually empty.

Around 1130pm, Firefighter Tony Edwards and Lieutenant Dennis Farrell from Squad 1 arrived, looking tired yet official. Marian had imagined this day, she says, ever since Dave started working as a firefighter. “I pictured myself perplexed as to why the fire company has arrived. A Captain steps forward and it suddenly dawns on me why they are there. I cry out, collapsing in the hall, my chest hurting and my stomach dropping”. “None of it comes close” she tells me “to the sonic blast” she feels when it happens in real life.

“We didn’t find any of the guys” Tony tells Marian. “The whole company is missing”.

David Fontana, a member of Park Slope’s elite Squad 1, died with his team as they climbed the stairs of the South Tower to rescue thousands of trapped civilians. Squad 1 lost half of its men at the World Trade Center – 12 brave “brothers” among the 413 first responders that died that day, desperately trying to help others.

As I sat across from Marian, I asked her how she was coping, especially with the fourth anniversary looming at the time.  She seemed surprisingly resilient, although I am sure moments of pure, raw grief are dealt with in private. But today, instead of talking about her own devastation, she is more worried about the plight of the surviving responders.  She tells me that she often thinks about how Dave would have coped with 9/11 if he had survived – how traumatised he would have been by what he witnessed at Ground Zero, by losing so many of his friends and colleagues. She wonders if their marriage would have survived 9/11.

“So there is nothing you can do for me” she tells me. “But it’s the guys that have been left behind. They are haunted by what they saw, what they had to do, how many guys were lost.  They are the ones we need to be worried about.”

And as it turns out, she was right.

Now, almost seventeen years after 9/11, the impact on the surviving responders is ongoing. Traumatised by 9/11 – because what they experienced has not ended.  New cases of 9/11-related illness are diagnosed regularly amongst the surviving responders. Cancer rates are around 15% higher in those who were exposed to Ground Zero compared to those who were not. More than 1000 responders have died in the years following 9/11 of causes directly related to the time they spent on “the pile” and over 7000 are currently being treated for 9/11-related illnesses. Nearly 2000 have had to retire due to 9/11-related injuries and illness.

The mental health impact is also staggering. Many responders still live with anxiety and PTSD, haunted by quirks of fate.  Why did they survive when so many others perished? Survivor guilt is persistent and nightmares still interupt their sleep. Many struggle to find the words to describe their experiences.

The reality is that the death toll from the terrorist attacks grows larger each year, and while the physical wounds may have healed, the emotional scars remain for many responders, even now. In many cases, the ongoing impact of 9/11 has shattered families and destroyed lives in a never-ending reverberation of pain and suffering.

This update was kindly provided by Dr Erin Smith, Course Coordinator, School of Medical and Health Sciences, Edith Cowan University; Member, Board of Directors, World Association for Disaster and Emergency Medicine.

Dr Smith presented at the 2017 Australian & New Zealand Disaster and Emergency Management Conference.

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