NEW YORK — There is no voice left in Manuel Checo's voice. He speaks in a granular rasp that fades, occasionally, to whispery puffs of air. Sometimes, for periods as long as two days, he is unable to speak at all.
When that happens, Checo carries a pad of paper with him so he can scribble down notes if he needs something. But for the most part, he will simply disappear into his rented room, ignoring his cellphone when it rings.
Checo, a janitor, spent six months cleaning dust from office buildings around ground zero after the World Trade Center attack. Five years later, the lining of his lungs is pocked with scars and densities that do not belong there -- possibly a sign of a disease that can cause lung tissue to become so stiff that it can no longer carry oxygen, wrote a radiologist who examined a scan of his lungs last year.
The son of a general in the Dominican Republic, Checo, 54, irons his shirts with military precision. When he meets a woman on the street, he kisses her hand. But the truth is that when he discovered that he was too weak to work again, his life veered terribly off course. He was evicted from his apartment and slept in his car for six months. Acquaintances didn't understand his racking cough and thought he had tuberculosis or AIDS.
Whoever he was before Sept. 12, 2001 -- when a supervisor from his company called to tell him there was work near ground zero -- he is a different man now. Sometimes he is overwhelmed by the feeling that he has lost his way.
"I get up, I get dressed," he said, in Spanish, through a translator. "And then I say to myself, 'Where am I going?' "
The dust around ground zero, we now know, contained caustic, finely pulverized concrete, trillions of microscopic fibers of glass, and particles of lead, mercury and arsenic, as well as carcinogens like asbestos and dioxin. Five years out, the "World Trade Center cough" has started to look like a persistent -- and in some cases disabling -- respiratory condition.
An ever-growing number of New Yorkers is coming forward to describe symptoms: the first responders who plunged into the tangled wreckage to find survivors; the volunteers who hauled diesel fuel and doled out cigarettes; the students at Stuyvesant High School who returned to classes while acrid fires burned nearby.
Less visible is the army of cleaning workers who were sent to the area to clean office buildings. Those were the cases that were shocking to Scottie Hill, a social worker, when the Mount Sinai Medical Center opened its WTC health clinic in 2002. The cleaners, mostly Polish and Latino immigrants, were already living close to the edge when the job began; by the following year, many were in crisis because of lost wages and poor health.
Three out of four lacked health insurance. Forget workers' compensation -- many of them could not even contact their employers by phone. Hill frequently saw clients who were facing eviction or had lost their homes. Some couldn't afford the $4 it cost to ride the subway to the clinic and back.
A few of the immigrant workers, too sick to support themselves in the U.S. anymore, have returned to their home countries. But that decision is fraught, too, because relatives back home -- or doctors, for that matter -- may not know what is wrong with them. Jaime Carcamo, a psychologist who treats 50 Latino workers who cleaned around ground zero, said some of them, finding that they were unable to work, simply withdrew from society.
"They just remain like nomads," he said. "Some of these people just fell into the cracks. People don't know about them, but they're out there still."
It is ironic, then, that Checo remembers the job so fondly. He had been a U.S. citizen for almost a decade by then, and working around ground zero gave him "so much sense of brotherhood," as if he were descending into the pit every day with police and firefighters. It was an environment stripped of class, of racism. What he says about the experience is this: "Something so bad created something so beautiful."
He worked a night shift as part of a two-man team with Alex Sanchez, a fellow Dominican 15 years his junior. Using a handsaw, they would cut two holes, each large enough for a man's torso, in a building's air vents. Peering into the dark passageway with a flashlight, all they could see was dust, glittering in the dark. Then one of them would hold up a hand vacuum, and the other would switch on an air hose, and both would disappear in a cloud of dust.
Tons of material had settled in the buildings. When terrorists crashed two planes into the World Trade Center on Sept. 11, its two towers collapsed with such force that dust and debris poured in and upward through the ventilation systems of the buildings around them. It was up to landlords to decide who would clear the buildings, and many chose cheaper labor: men and women who days before had been emptying trash cans and dusting computers.