Peter S. Berger, MS
One random day of the year. One random shift at the station. One good torrential rain and storm. One cough. One bronchoscope. One grouping of molds, in my lungs. One diagnosis, COPD. How? Did someone miss something? Did no one complain about it before? Did it fall on deaf ears and was ignored? Was I not safe enough? How at 32 years old did I get COPD.
Chronic Obstructive Pulmonary Disorder, COPD, is a diagnosis that people receive when their lungs are exposed to contaminants [1]. Once the contaminants enter the lungs, they stick to the alveoli and cause air to be trapped. If air cannot be excreted through exhalation, carbon dioxide (CO2) becomes trapped inside the lungs. If too much CO2 remains, lung cells are damaged, the alveoli and bronchioles become scarred. Scarring can cause the lungs to work ineffectively leading to medical interventions including inhalers and medications.
At 32 years old, I thought it was just a bad cold or my allergies. I kept getting sick without any relief. I saw my regular doctor who ordered x-rays, scans, and blood work, but everything came back normal. My lungs were clear, but I was getting sicker. The doctor started me on 10 rounds of medication to treat bronchitis. The medication was detrimental to my stomach without correcting the cough. Why was that not going away?
Shift after shift, working at the same fire station, and I was getting sicker. It appears the medication, inhalers, and treatments weren’t helping at all. Nine shifts in one month, at the same station where it all began, and I was getting worse and so was the cough. I advised my supervisors and without batting an eyelash, the reply was it was my fault. I would get statements like, “You just don’t want to work at that station!” “No one else complains about the station, so what makes you believe there is a problem with the air quality in the station?” With all the negative responses, I had to take matters into my own hands. I had to know if the sickness was in my head or was there an issue?
After another shift and completely fed up, I purchased a $30.00 home mold/air quality test kit from a local hardware store. I thought if I can prove that there was a problem, maybe the administration would address it. Maybe I was crazy, a crazy firefighter, but I was determined to find the source of my illness. The $30.00 investment changed my life forever. That is when I knew I needed to be my own health advocate.
The next shift, I read the instructions and shared with the crew what I was doing. They didn’t seem to mind but were curious. I placed three trays of agar on three different air vents in the station. We ran calls all day, so upon return, I followed the instructions, taped up and labeled each sample, and went about my business the rest of the shift. The next morning was a true eye opener. What I saw was astounding. The mold was growing on the lid, the agar, and on practically everything. There was no spot on the plastic that wasn’t covered with something growing on it. I guess something with our air quality in the station was an issue. Even the crew was grossed out by what was growing! I packaged the samples and sent them to the recommended laboratory. What happened next was incredible.
The samples made it to the lab and then I received a phone call from the 404-area code (Atlanta, Georgia). The caller ID was the CDC. First thought was that it was a wrong number. Why was the Center for Disease Control calling me? I didn’t pick up the first time.
The second time, I did pick up. On the other end of the line, a person states, “Is this Peter S. Berger?” I answered that it was me. He continued, “I have an air quality sample that I received from our lab in Florida. Did you submit an air quality sample to the following address [omitted for protection]?”
I again say that the address provided was correct. Here is where the story takes a sideways turn. The next question was, “Where is this sample from?” How do I answer that? I went behind the back of my administration and didn’t talk to my union about the air quality test. But then I thought, the administration didn’t care to listen to my issue. Maybe they will if it is not a good report?
I told the person, “I am afraid that the company I work for will retaliate if the information is revealed,” to which the person said, “We are the government, we will protect you.” After I finished laughing, I decided to tell the person the truth. I said the following, “These are three air quality samples of a fire station that I work in. I have told the administration there was something wrong with the air, but they scoffed at me. Is there something wrong with the air quality?”
The CDC representative stated the following, “Mr. Berger you need to get your lungs checked. There are toxic levels of black mold, brown mold, and athletes’ foot in all three of the tests.” Huh? What? Check my lungs? Oh no!
The next day I called my doctor and shared the air test results. This was the day my COPD journey officially began. I met my first of seven pulmonologists who would become part of my story. The doctor was briefed on the situation and ordered an immediate bronchoscope to determine if mold was living in my lungs and the source of my illness.
The answer would come 30 minutes later. I awoke breathing fire and asked if the doctor found anything. He told me he found a cluster of molds at the base of both my lungs [2]. Emotion rushed over me, and I broke down and cried. It was the first time I showed emotion during this process, because the truth was coming to light. I had been living with mold in my lungs and it was the reason I was sick for so long. The doctor told me that he had removed all the mold and that he wouldn’t be surprised if in “two weeks you’re going to call telling me it is difficult to breathe.”
Well, he was right on the money. Two weeks to the day, 19 years ago, I was officially diagnosed with COPD at the age of 32. I looked at the doctor and told him that I am too young to have COPD. “It is a disorder for people who smoke their entire life.” He told me that mold infiltration in the lungs is a way to get COPD, especially as a young person.
The U.S. economic cost from COPD is 49.9 billion per year [3]. Well, that was me and that was what happened to my lungs. However, my firefighter health took another turn 15 years after the COPD diagnosis.
One random day. One random shift. One room and contents fire. One small bump on my neck. One small pimple that wouldn’t pop. One dermatology appointment. One random sample from my neck. One diagnosis, Cancer. How? Did I miss something? Was I not safe enough? When did that happen? Did I not wear enough sunscreen? How could I have cancer? There was no way.
Seven years ago, my unit was dispatched to a room and contents fire. We extinguished the fire as we normally do, nothing out of the ordinary. Our crews cycled through rehab, we washed our hands and made sure we did not contaminate each other or ourselves. We returned to the station, showered, and returned to service.
Fast forward two months, when this weird bump appeared on the side of my neck. I didn’t think much of it, but I am a picker, so I tried popping it, thinking it was a pimple. I tried massaging it, thinking it would just go away. I tried having my wife pop it, but it kept getting bigger and eventually was so painful I didn’t even want it touched. My wife said, “You should get that checked out.” I said it was nothing, but it was still painful a week later. I made the decision to see a dermatologist, which was my saving grace.
I received the phone call on September 19, 2017, at 1400 hours. It was the call that I didn’t want to hear but needed to hear. The words from the doctor sent chills down my spine and I turned pale, according to my wife. The doctor said, “You have cancer, but we are going to get rid of it quickly.” It was squamous cell carcinoma, and I was floored. I am now 44 years old, and I have cancer.
Every question flooded my brain, and I couldn’t keep up. I needed to process the statement and I couldn’t. I was not doing well with the information, but I know I uttered, “Get it out of me now!” The doctor agreed.
The Mohs surgery was the following week, and the cancer was removed with clear margins remaining. Basically, that means the doctor got everything. It was out, but I couldn’t understand how I got it in the first place. I was on my way to New York to speak at the New York State Health and Safety Conference in front of 500 firefighters and I had the firefighter cancer statistics on my mind. I was now a statistic. It was mind blowing. I asked the doctor to give me the sample, I know that sounds weird, but I wanted the sample analyzed, a true analysis. I was so careful with sun exposure that something was amiss. And then the answers showed up.
I took the sample and sent it to Stockholm, Sweden to have it analyzed at the International Cancer Initiative. This company has over 3 million tissue samples that have been analyzed, including a section that is dedicated just to firefighters. I took another piece, and had it analyzed in a private lab which handles cancer samples to see what the cells showed. The answers were astounding. Both samples revealed I had the following contaminants in my tissue sample: hydrogen chloride, formaldehyde, polyaromatic hydrocarbons, PFAS, benzene, and other chemicals not recognizable. I thought about the results and said that I knew how those chemicals entered my body, a room and contents fire.
“Firefighters are exposed to a variety of hazardous substances including carcinogens such as polycyclic aromatic hydrocarbons (PAH) during firefighting. To minimize the uptake of such substances into the body, firefighters wear personal protective equipment.”[4]
The position of the bump was where my suspenders, jacket, SCBA tank straps and radio strap were all on top of each other. The friction and high temperatures caused my skin to abrade and open, giving the carcinogens the opportunity and the means to enter my dermis. I immediately contacted the International Cancer Initiative and had my sample registered in their tissue bank. I was my own health advocate, and I was grateful for pursuing more answers.
“Cancer is the leading cause of death among firefighters… Firefighters’ greater risk of cancer is likely due to their exposure to smoke and hazardous chemicals on the fireground. Fire settings contain various hazardous substances, including:
- Combustion byproducts known or suspected to cause cancer.
- Persistent compounds that, if absorbed, can remain in the body for long periods.
- Particulate and other hazards released from burning materials or in fire debris
Firefighters can encounter these substances by being near burning materials or wearing dirty or improperly stored turnout gear.”[5] Organizations such as NIST, NFPA, FSRI, NC State, ATF, and more continue to conduct research into the chemical profiles of fire smoke and particulates contributing to firefighter cancer. Questions remain as to the time, route, and dose of chemical exposures and the diagnosis of various cancers. Medical institutions are also trying to answer the how and why cancer is so prevalent in the trade.
“The Firefighter Cancer Initiative (FCI) was launched in 2015 through a state of Florida appropriation.”[6] The FCI not only advanced a variety of cancer and exposure work, but it has also driven new scientific and medical partnerships nationally. This program is one to follow and share.
How can you participate to make a difference? Join the National Firefighter Registry (NFR) for Cancer[7] and Science to the Station: A Health & Wellness Alliance (aka The Science Alliance) “A community of scientists, health care, and fire service professionals dedicated to providing critical information needed to improve the safety and health of firefighters and other first responders.”[8]
My health experiences have translated into two program affiliations. I serve as the educational coordinator for the Fire Fighter Cancer Foundation [9], a clearinghouse for a variety of resources and programs in its 19th year of non-profit work, research, technology, and innovation exploration to reduce the impacts of cancer upon the members of the fire service, their families, and communities.
For five years, I have been affiliated with the American Lung Association’s “Fight For Air Climb,” where firefighters, first responders, and other participants climb some of the country’s most iconic buildings to raise funds and awareness for people with lung disease[10]. The American Lung Association [11] has recently appointed me to a position on their Executive Board for South Florida.
At 51 years of age, 20 years in the fire service, I live with COPD and am a Cancer survivor. But what about the rest of us? What are we breathing every day? Is the air quality in your fire stations comparable to what happened to me? Who is your advocate? Have you said something to someone, but nothing was done? Does your fire department offer annual health screenings? Are you visiting a dermatologist annually to check your skin? Be your own health advocate. Reach out to the right experts to consult. One random day. One random shift on duty can change the course of your life.
On a personal note, I want to thank the sheriff and fire chief of my current fire department. The sheriff and the fire chief are committed to the health and safety of all their employees. I thank you for your dedication.
BIO:
Peter S. Berger is a 20 year veteran of the fire service. Mr. Berger is a Firefighter/Paramedic and Fire Inspector for a fire department in South Florida. Mr. Berger has been an advocate for firefighter health for over 15 years. Mr. Berger is on the South Florida Executive Board for the American Lung Association as well as on the Executive Board as the National Education Coordinator for the Fire Fighter Cancer Foundation. Mr. Berger received five degrees, four of which are in the fire service, including a Masters Degree that he received when he wrote and got published a Risk Assessment of Cancer in the Fire Service. Mr. Berger is married with three young children.
[2] Aspergillosis – https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis
[3] National Heart Lung and Blood Institute. Morbidity and Mortality: 2009 Chart Book on Cardiovascular,Lung and Blood Diseases.
[4] https://www.sciencedirect.com/science/article/pii/S1438463923000019
[5] https://cdc.gov/niosh/enews
[6] https://umiamihealth.org/sylvester-comprehensive-cancer-center/research/firefighter-cancer-initiative
