>> hello, i'm dr. sanjay gupta. few of us can forget what unfolded behind me ten years the shocking spectacle of the world trade center towers crumbling into dust against that new york city skyline and the what disappeared along with it. ten years later, the obvious signs of the dust are gone. yet in some waysit still looms over new york city. it still haunts the over new york city. thousands of responders who became sick after breathing it in. in washington, there is a large fire. >> move it! >> get out! >> the world trade center. >> back, back. >> what's going on? get out of here! >> let's go. >> and the president who is in florida today, >> within moments after the first tower disintegrated, an eerie silence fell over lower manhattan. >> there should be a sound when one of the largest skyscrapers in the world collapses. and we know that there must have been a sound. very few people, including myself, remember a sound. >> dr. david prizant, a pulmonologist and top doctor with the new york city fire department, rushed to ground zero to help. he was there when the first tower fell. >> they were talking about mid morning, 10:00 or so. it was a very sunny day that morning. and it was like it was a little bit darker than dusk. couldn't sire hand in front of your face. >> we were suffocating on large particles that were stuck in the back of your throat and your nose. >> and then there was this fine dust that you were constantly choking on. >> and as we walked a block or two away, we were still in that same dust. very short as you remember from the blast. >> 30 minutes later, the second tower turned to dust. >> what's happening? >> and there you could see the second tower, the front tower, the top portion of which was collapsing. good lord! >> do we know what is that dust? >> 40 years of life and work in those buildings, meaning all the furnishings, all of the computers, all of the personal notes on the desks, all of the extra pairs of sneakers that the women brought in so that they could run out at lunch time. 110 floors, each one of them the size of a football field, made of super hard concrete several inches thick turned into dust. >> most people will never forget those images of that dust. but if you walk around new york city today, there are very few reminders of it. so it may surprise you to know that so much of the dust was in fact collected. it's been studied and stored for the last ten years by dr. paul leoiy and for the first time ever, he's given us a look inside the cold room. leoiy is one of the leading experts on environmental toxins, a professor at robert wood johnson medical school. his cold room is a near freezing controlled environment where he has stored ground zero dust for almost a decade. >> here it is. this is the cold room. >> this is the cold room where we store it. >> is this it in this bin here? >> these, two yeah. >> each one has a manifest on it saying when it was sampled, who it was collected by, who analyzed it, where it was stored, what the initial weight was. >> there aren't a lot of reminders when you walk around the city of new york, thankfully. i mean, these are a few of the reminders that are left. >> sure. >> you see how high it went up. >> he watched from home as the plume of dust and smoke rose over manhattan. >> had you ever seen anything like this? >> no. >> had you ever read about anything like this? >> no. >> after his initial shock wore off, he began to wonder, what's in that dust? >> if i asked you to name how many different particles and what they were in the dust, could you do it? >> not without a sheet because we found so much stuff. you got fire retardants, combustion products, plastics and other parts of the periodic table. >> gold and mercury from tens of thousands of fluorescent light bulbs, lead from thousands of computer monitors, titanium from paint on the trade center walls, asbestos that coated lower beams of the trade center buildings. there was cement, glass, carpet fibers, ceiling tiles, even human hairs. in all, 1.5 million tons of the stuff. >> you had burning aircraft, you had burning furniture, you had burning buildings. that burning material included the jet fuel. we don't know what the gasses were in this initial complex mixture. that was inhaled by everyone. because no one could measure it. that's the great unknown for us. >> is it always going to be unknowable? >> yes. >> there will always be mysteries about the dust? >> yes. >> but over the next hour, you will learn shocking things about this dust. facts uncovered now for the first time. what is not a mystery is that for thousands of first responders breathing it in, the health effects were immediate. >> the dust was incredibly irritating. when you look at this dust under a microscope, the edges are incredibly rough. they're not smooth edges. and this was burning their nose, their tongue, the back of their throat, and their airways. every breath was a burning sensation. >> what did it do to the body? what did it look like? >> immense redness. normally the membranes of our airways from our nose all the way down into our lungs are almost white. they're not bright red. they're not looking like they've been all scratched. that's what these airways look when you put a scope down and you see it. >> so it was like sand paper literally in this case in the lung tissue? >> right. >> you'd expect it to have gotten better once they stopped getting exposed. >> right. >> but in a lot of people it never did. >> never did. >> it's been ten years, and marty fullum, one of thousands of firefighters who responded, never did get better. on september 11th, while most people were running from ground zero, he was an indisputable hero, running toward the fires, the tragedy, and all that dust. >> what is it like right now for you? >> to walk? >> yeah. just walking down the hall? >> i mean, i feel okay. like i feel i'm getting a little winded but i'm okay. >> if you didn't have the oxygen? >> wouldn't be able to do it. i'd be back in bed now. >> four years after working at ground zero, fullum became gravely ill. >> you got sick. >> yes. >> and now at least some doctors have said this could have been due to inhaling those particles? down at ground zero? >> at first i thought how could this be 9/11? it's four years later. but the doctors said pretty much yeah, that's what it is. >> they told you that? >> they said this is 9/11. >> you believe what happened to you is because of the attack at ground zero? >> i believe so, yes. because just the number of us who got sick with stuff like this. >> does it make you angry? >> yeah, it does. i have some dark moments where i think about things, i'm alone, and it's not a good time of your life. believe me. naturals from purina cat chow. delicious, real ingredients with no artificial flavors or preservatives. naturals from purina cat chow. share a better life. just having some tender chicken and some tasty noodles. let's see...south western vegetables...60 calories. ya' know those jeans look nice. they do? 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what do you start doing? what do you do? >> it was all anyone could do. two brothers, both firefighters, both witnesses to the worst terrorist attack on u.s. soil, and all they could do was dig. >> we searched other surroundings buildings and the sidewalk to see if anybody was under anything. >> just looking for -- >> people. anybody who was stuck who was still alive. >> did you find anybody? >> no. nobody that was alive. we didn't find anybody that was alive. >> the situation was bleak and yet rescuers like the fullams, desperately raked the rubble, mindful of saving lives, mindless of the dust, the danger surrounding it. >> did you worry about your health? >> i knew it wasn't good for my health. but initially it was always a chance you were going to find somebody. and the risk seemed to outweigh the danger, you know? >> when's the first time you were offered a mask? >> probably three or four days after that. they had little paper ones they were giving out. that's what we used from then on. >> the paper masks would not have made a difference. they may have been worse than not wearing anything at all because you felt that you were protected and you weren't. >> the problem is there's no seal on these masks. so dust can enter from here, it can enter from here, even through the paper itself. a better option for marty and the other responders would have been a respirator like this. a lot of workers who did have access to these respirators say they were reluctant to use them because they were hot, they were uncomfortable. and responders worried they would hamper communication. >> were you ever offered a proper mask that can would have protected you? >> much later on. >> how long? >> probably at least a month and a half later they came down with these other masks. >> you guys were the frontline. >> yes. >> it took six weeks to get you a mask? >> yes. >> to protect yourself, give yourself the best chance at life? >> okay. >> that doesn't make sense to me. >> i wish i would have had it, you know? >> but here's where it gets complicated. for several days after 9/11, respirators for firefighters were located at a staging area offsite, nine miles from ground zero. marty's brother david got his respirator on his way in to ground zero. while marty, who lived on the other side of the city, went straight to the pile. >> well, if there's any good news out of all this, it's that everything we've tested for, which includes asbestos, lead, and vocs have been below any level of concern for the general public health. obviously, for those who are down here, these are very important. >> but that was part of the problem. respirators were not easily available, and no one was making sure workers wore them. also the testing required to make any statement about air quality had not been completed. so could anyone really say the air was truly safe? >> september 18th, the epa commissioner kind of waved the all clear sign. was that appropriate with what we know now? >> no, it was not. it definitely was not. she at that time did not have enough information to make that kind of statement. >> there was a great deal of responsibility. >> anthony depalma covered 9/11 for the "new york times." he's the author of of "city of dust." >> were people worried about the potential health impacts of this dust at that time, ten years ago? >> this was something that anyone who watched the videos from that day saw. they saw that thunder cloud of dust coming around the building like some sort of a science fiction monster. they knew that it was not safe. and yet the government was telling and continuing to tell them it was safe. they were desperate for some kind of answer. >> the former epa commissioner says that answers were given, that in the weeks following the attacks, epa officials repeatedly warned of the risks to workers at ground zero and noted the difference between the air quality at the site and the air in the rest of new york city. >> we shouldn't seek a scapegoat, she adds, other than those who were indeed to blame for the lives lost that day, the terrorists who attacked our nation. >> chronic cough. >> all of this may have been confusing to responders. but something was becoming very clear to dr. david prezant, the fire department pulmonologist. firefighters, thousands of them, were getting sick. they filled his clinic, all complaining about the same thing, "i'm coughing and i can't stop." >> every one of them said, this doesn't smell like a fire. it doesn't taste like a fire. it's more irritating. >> one of those guys was marty fullam. >> you went to enough fires and you knew that what was in the air was no good. >> he had the world trade center cough initially. >> initially. >> that is the term you coined? >> yes. >> people think cough and they think, how bad could a cough be? >> right. >> how bad was it? >> in retrospect, we shouldn't have called it world trade center cough. we should have called it world trade center lung disease because it has a greater definition to it. >> and because coughs, well, they typically go away. but for many firefighters, the cough persisted. in fact, it got worse. and what would take its place was an inability to breathe. dr. prezant watched the tragedy unfold. >> in the three years before 9/11, their lung function was declining 30 milliliters per year, which is an infinitesimally small amount, typical of what middle-aged men have just due to aging. in the first six months after 9/11, on average they dropped 370 milliliters, 12 times what they themselves were decreasing just due to aging. that is unheard of. >> and in marty? >> marty over 1200 milliliters. >> so 40 times. >> 40 times, yes. >> at that time, did you know for sure that it was due to the dust that he had been breathing in after 9/11? >> knew for sure that it was due to 9/11. >> come in. >> knew for sure that the dust was effecting marty's lungs. but there was something else. his immune system was turning on his body, attacking his muscles and also his lungs. >> i went in the hospital, i weighed 220 pounds. after three weeks, i weighed 155 pounds. >> 65 pound weight loss in three weeks? >> yeah. i walked into the hospital. three weeks later i couldn't walk and i couldn't breathe. >> were you just weak? >> i couldn't eat, i couldn't walk, i couldn't go to the bathroom, i couldn't do anything at that point. >> and this is where the story of the fullam brothers takes a tragic turn. marty wore virtually no protection for most of his time on the pile. while for most of his time at ground zero, david wore a respirator. >> you were both there. you got sick. he didn't. >> yes. >> did the respirator make a difference? or breakfast? um... try the number one! 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>> it's like after about a minute or two, it's as though somebody is holding your head underwater. >> that feeling of slow suffocation started four years after marty's work at ground zero. >> in the spring of 2005, i failed a stress test. the technician giving me the test told me that my lungs weren't producing enough oxygen, and i never had anybody tell me that before. i started getting weaker every day and sleep more and more every night. muscle pain and difficulty breathing. >> and you had never had anything like this? >> no, never had anything. >> where was it coming from? >> i didn't know. >> but now we do know. marty's immune system was in overdrive, a destructive protein was spilling into his bloodstream. it all fit together like this. something was eating away at his muscles, and that same thing was also eating away at his lungs. all of it, his doctors believe, caused by dust. >> the body's immune system is literally attacking its own normal tissue. >> right. that's why we call this an autoimmune disease. >> how would breathing in dust cause an autoimmune problem? >> the chemicals that are coating that dust and the chemicals in the gasses released that day causes inflammation. and some of us, most of us, that inflammation occurs for awhile and goes away. in other people, for reasons we don't know, the inflammation continues. >> and this is martin fullam's chest x-ray. >> dr. david prezant is one of the doctors caring for marty. >> as you can see just right away, the lungs are black in a normal person and they're big. compared to marty's, which are small. normal people breathe about ten breaths per minute when they're at rest. but in marty, the lungs are much smaller. so he has to breathe 20, 30, 40 times a minute. and yet each time, he has to stretch a very stiff fibrotic, scarred lung. >> squeeze my hand, tight. >> by 2009, marty had been diagnosed with pulmonary fibrosis and a rare autoimmune disease called polymyositis. >> before 9/11 we were tracking our firefighters and we did not have a single case of polymyositis. since 9/11, including marty, we have about five cases of polymyositis. five cases, you would say, is a small number. but five cases compared to zero, compared to a population of middle-aged men that you would expect none in, five cases is a lot. >> something stirred up a full-on revolt in marty's body, and he was dying. the only option doctors had to offer, a lung transplant. >> marty was on constant oxygen. he couldn't go to the bathroom without turning up his oxygen because he couldn't -- wouldn't be able to make it from his bed to his bathroom. that's how short of breath he was. marty got a lung transplant, and that changed his life. >> did the lung transplant make you feel better? >> yes, it did. initially, it did. >> but what was different? >> i could breathe without supplemental oxygen initially. >> there's a picture of you i think surrounded by family and a bunch of firefighters. everyone looks pretty elated. do you remember that picture? >> yes. >> how are you feeling? >> i felt good i was going home. >> that feeling of being home, of breathing easy, would be short-lived. the worst possible outcome in just a few months time, marty's body began rejecting his new lung. >> after a lung replacement you have such hope. now he's back. he's attached to an oxygen tube. he can't separate himself, he can't go away from this for two hours and take a break and feel okay. so it's there night and day, night and day. >> for marty's brother david, night and day are a persistent reminder that even though he and marty were both at ground zero, both exposed to dust, his brother is ill and he is not. >> you have two brothers. they were exposed to the same things. one walked away without any physical problems, the other one has been racked by a series of ailments, required a lung transplant, maybe another. the questions that they ask each other are the questions that many of us in the city ask. and they ask, why him and not me? and why me and not him? >> now, one brother, marty, would need another lung transplant. >> we had boy scout camp right at the top of that mountain up there. >> why him and not me? >> that question often crosses the minds of these two friends, ernie vallebuona and bernie kelly, former vice cops with the new york city police department. partners, they arrived at ground zero within hours of the collapse. >> we were watching the teams of firemen go in with their tools and scout packs and they would disappear right before our eyes. >> like the distance i am to you? >> yeah. pretty much your hand would be like where your partner would disappear as you walked into that dust. as we were walking in, i had to hold onto the hood of his jacket. and he would disappear and i would lose him. i wouldn't even know where i was going. >> nobody had any kind of respirators. in the police department, anyway. we didn't have any kind of respirators. so we were trying to wrap bandannas around our faces. >> in a statement, the city of new york said emergency management experts and contractors quickly implemented safety protocols, including the requirement that respirators be worn and that despite overwhelming logistical challenges, several hundred thousand respirators were made available to workers within a week. but the reality for vallebuona and his partner is that they never got one. three years after 9/11, vallebuona was sick. >> you're pretty convinced that your partner got sick because of what he saw and what he went through at ground zero? >> i'm not a scientist. i'm not a doctor. but there were too many of my friends, including ernie, who were getting these strange diseases that nobody could say where they came from. >> do you wonder why you didn't get sick? >> yeah, all the time. you know, ernie's standing here, another guy's standing here. both these guys got sick and i didn't. >> there was that question again. why him and not me? and another mystery that lingers as persistently as the memories of the dust that enveloped them ten years ago, could that dust cause cancer? >> called from the hospital and i said, i'm not going to be coming back to work. they found a 11-centimeter mass inside my abdominal area, and they believe it's cancer. the authentic, the rare, the hard to define. to those always searching for what's pure and what's real from we who believe we know just how you feel. haagen-dazs. workers are inspecting tons of debris from the world trade center tower. >> trying to locate anyone who might still be alive. >> continuing hope that survivors might be found. >> in the days and weeks after the towers fell, ernie vallebuona worked through rubble. he was on the overnight shift. most of the time, he was coated in dust. >> i was like a raccoon. you know, you had smoke and dust like caked onto your eyes. you could see like where your eyes would tear, there were like little trickles of clean skin where your tears went down your face. >> his only protection from breathing in the toxic air, a bandanna that hung loosely to cover his nose and his mouth. >> maybe after a couple of weeks when they realized there was no more people to rescue, they could have backed off and said, okay, this is kind of disgusting. it's definitely not healthy. why don't we look a little closer at it before we put all these detectives and cops and firemen in there? >> september 11th, rudy giuliani, then the mayor of new york city. >> put your mask on. >> and then this, two days later. >> but there are no dangerous substances in the air, at least according to the tests that have been taken as recently as about three to four hours ago. >> giuliani went on to say the dust could burn the eyes and throat, exacerbate asthma symptoms. >> this is one of the largest debris removal operations. >> but again responders like vallebuona say they were confused, was the air safe or wasn't it? we tried asking the former mayor to explain and did not receive a response. >> the message seemed to be, let's save the city. let's get the city back on its feet. is that what was going on? >> absolutely. it was a triumph of politics over common sense. but make no mistake about it, it was absolutely essential that the city get back on its feet. that wall street reopen quickly. the question in terms of policy is, how do you make that happen without exposing people unnecessarily to danger. >> danger that responders like vallebuona couldn't even concede until years after working on the pile. a few years after the attack, 9/11 was slowly receding into the background of vallebuona's life. he went back on vice, undercover. then, in 2004, he got sick. >> i got very sick. i was getting cold sweats. i was a little hunched over. i thought it was definitely food poisoning. >> an emergency room doctor agreed and sent him home. but four months later, vallebuona was doubled over again with a stabbing pain in his abdomen. >> one of the doctors came in and told me, mr. vallebuona, it looks to me like you have a very large mass inside your abdomen. could very well possibly be cancer. i was diagnosed there with stage three lymphoma. and i believe i only had about a 30% chance of survival. >> ernie's cancer was aggressive. by the time doctors discovered it, an 11-centimeter tumor, the size of a small grapefruit, had formed in his abdomen. lymphoma is not often diagnosed in someone so young, and rarely do doctors know what causes it. but they do think environmental toxins may play a role. >> we know that asbestos and benzine cause cancer. but in most instances, there's a latency period from exposure to the environmental hazard to the development of cancer that's anywhere from 10 to 20 to 30 years or longer. >> if there was a study that came out tomorrow, ernie, that said, we now know that people getting sick at ground zero had nothing to do with the environment, how would that make you feel? >> well, i would have to say it would be a total lie. any doctors i've spoken to, even nurses, they all say the same thing. oh, it's definitely related. we get so many rescue workers in, especially cops and firemen. >> how's everything going with your treatment? >> i finished the last treatment. i've just got to go back and see if i'm done. >> there are so many rescue workers in vallebuona's situation, mostly cops, all responders, that they have formed what they call a cancer club. >> one of our friends, he's a captain. he had multiple myeloma. another lieutenant who worked in vice with me has the same lymphoma i have. >> one member of the club is reggie hilaire. >> in 2001, hilaire was a rookie cop. he worked at ground zero for 11 days in november, and later staten island. but like so many others, when he was at the world trade center complex, he had no mask. >> i remember one person just pointed at me like, you, you should be getting a mask. you should wear a mask. i'm thinking to myself, all right, give me one. >> he never got one. >> in may of 2005, he was diagnosed with thyroid cancer. just months after his diagnosis, hilaire was in remission. and he went in to see his doctor for a follow-up. >> he started saying, okay, the biopsy came back. but i'm having a disagreement with the pathology because they're saying multiple myeloma. i didn't hear anything else. i was what? another one? >> a second, completely different cancer, multiple myeloma, a blood cancer that typically strikes much later in life. hilaire was diagnosed at 34. only 1% of patients who develop multi-myeloma are hilaire's age. his biggest fear right now, that his cancer will progress. dr. jacqueline moline authored after study about multiple myeloma among responders. in a population of 28,000, she found eight cases, including hilaire. >> we found that there were four people under the age of 45 in our group of people that we were following. and a population that size you would expect less than one. so we said, something might be going on here. >> something was going on. but what? >> we do know that there were carcinogens in there, even in the dust there were carcinogens. the question is, how long does it take for people to develop cancers after they've been exposed to these compounds? >> it's a question that science has struggled to answer. but ernie vallebuona has no doubt. he believes there is a connection between his cancer and the dust. >> i firmly believe that. >> it's a tough thing to prove, isn't it? >> oh, sure. >> and now, almost ten years after 9/11, vallebuona is reeling again. after years of aggressive therapy, he thought he was cancer free. >> they were ready to pin the little cured button on me. but my last visit to the doctor, they actually detected something inside of me and they're not too sure what it is. i'm being told now that my cancer could possibly be back. starting my progresso soup for lunch plan, huh. nope, just having some tender chicken and some tasty noodles. let's see...south western vegetables...60 calories. ya' know those jeans look nice. they do? yup. so you were checking me out? yup. [ male announcer ] progresso. 40 soups 100 calories or less. thank you, sir. >> thank you. >> for the past two months, ernie vallebuona has lived in a state of emotional paralysis, anxiously awaiting test results to find out if his cancer is back. >> i received some bad news on my scan. there was some activity that looked a lot like cancer. they weren't 100% sure. >> vallebuona, a former nypd detective and responder to ground zero, was first diagnosed with late stage lymphoma three years after 9/11. >> my older son had done a poem when he was in class about his dad, 9/11. i don't want my son to have to deal with that. i just want him to be a happy little kid, not having to worry about his dad dying from his exposure to 9/11 dust. >> it is true that exposure to chemicals in the dust has made many responders sick. most have serious respiratory problems. but questions about cancer have eluded scientists until now. dr. david prezant, chief medical officer of the new york city fire department, authored a study just published in the lancet medical journal suggesting something that may change this whole debate, answering the question that many believed would never be answered, that firefighters working ground zero are in fact at increased risk of cancer. >> we found a 19% increase in all cancers in our exposed firefighters as compared to our non-exposed firefighters. >> 19% increase in cancer rates. that's a significant increase. >> that's a significant increase. we excluded cancers that might have been diagnosed early. we still see this 19% increase. when we put those cancers back in, we see a 32% increase. >> to be clear, prezant's findings were specific to firefighters, many of whom were there when the dust first rained over lower manhattan. but they raise questions about what may be found later, in other responders. >> the firefighters watching the world trade center and developed cancer over the last ten years, they have the lingering question, why did i get this cancer and was it related to the dust. and you would say what? >> for most instances, it was world trade center related. >> to be sure, these are early findings. and in july of this year, before dr. prezant's study was released, the national institute for occupational safety and health found no connection between exposure to dust and cancer. dr. prezant's study may change our understanding. vallebuona a study doesn't address his most urgent concern. is his cancer back? >> if it's more bad news i'm going to faint. >> hello. >> hi. >> how are you? >> okay, very good. >> i've got good news for you. >> what's that? >> looks good. >> oh, great. >> i might actually have to spring you. can you stand it? will you miss me? i'll miss you. i will. >> that's five points on a star. for one year every year cancer free. >> nice. >> wear that with pride, all right? >> thank you. >> i've gotten my life back. i feel like a feather floating in the wind right now. i just feel great. >> emma. >> yeah? >> i love you, hon. >> i love you too, daddy. >> give me a kiss. >> how many more of those you got? >> marty fullum is also trying to get his life back. >> how are you feeling today? >> doing well today. >> keeping fit. taking a regimen of pills. >> it's about 40 pills a day, yeah. >> and undergoing painful treatments. all in the hopes of qualifying for another transplant. and yet despite all that effort, marty's lungs are slowly failing him. >> how sick is marty? >> marty is as sick as can be. marty is still alive because of his ability to persevere. >> but that may not be enough to help him to breathe again. and just recently, he found out whether he will get the transplant that could save his life. >> i was being considered to be listed again for a second transplant. and then a month ago they told me no, i wouldn't be considered. >> with columbia not wanting to do the second lung transplant because of your inflammatory lung disease from the polymyocytis. >> yes. >> a new lung was his only option, his only hope. >> breathe in and out. >> without a transplant, marty has one, maybe two years. >> at some point i would get sick where i'd have to be in the hospital on a respirator, probably. and that would be it, which isn't what i wanted to hear. >> meanwhile, his brother david, who like marty worked tirelessly on the pile ten years ago, is physically well. but emotionally wrecked. >> i'm blessed with each day to watch my kids grow. then all of a sudden you're drawn back by that guilt because someone else can't watch his kids grow up. sometimes the person who is healthy feels more guilty. >> yeah. it's not his fault i'm sick, you know? even if i die, it's not his fault i die. it was my choice to be there. you know? >> you have three daughters. >> yes. they're not happy. i could tell them, they get upset and they cry the fact that i might die. and i realize i'm not going to get old with them. it's very unlikely that i'll live to older age. but right now i have my time with them, which is good. >> and marty fullum says he won't stop fighting, petitioning other hospitals to get that transplant. >> 5 1/2 years ago they told me i had two years to live. here it is 5 1/2 years later. i'm still alive. so i must be doing something right, you know? 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