The blade scrapes across Mark Rine’s bare back, grating his cancerous skin like cheese, adding to the maze of scars and spots.
A small hole in his flesh quickly fills with blood. But if Rine feels pain, it's hidden behind his smirk. He and the doctor exchange recipes during the 10-minute procedure, and the physician scolds Rine for considering more tattoos, something that could mask more cancerous spots.
Then Rine glances toward the corner of the dermatologist's office.
His son Blake is sobbing. He's waiting for his own skin to be checked and worrying that his dad will die soon.
Rine is used to running into burning buildings. Blake, a high-school freshman quarterback, is sometimes blindsided by blitzing linebackers. But there is no manual or playbook for handling these moments.
“I don’t like it here, Dad,” Blake said, trembling while holding on to his dad’s arm. “I just want to go home.”
Rine doesn't know which of the 200 fires he responded to since he began his career with the Columbus Fire Division in December 2006 caused his terminal cancer.
It could have been the blaze at a large airport storage unit where, for seven hours, he fought the fire around exploding propane tanks and boxes of bathroom cleaning supplies.
Or was it when he smashed holes through a three-story apartment complex roof at the biggest fire of his career, again without wearing a mask to protect against inhaling dangerous chemicals.
After both of those fires, he crawled back into his bunk at the station house and went to sleep without showering.
The American Cancer Society states that multiple or repeated chemical exposures, whether big or small, can cause cancer.
“It’s impossible for a firefighter to know exactly what exposure was the one,” Rine said while chugging water to help combat the side effects of chemotherapy. “We don’t have those answers. But we do know what’s inside all those materials that were burning.”
Battling the heat
Firefighters are their own worst enemy when they don’t wear their gear, not only while fighting a fire but also when they go back into a smoldering structure to check for hidden flames or to gut the place.
Often, that work takes longer than the time spent dousing fires, which means longer exposures to toxins while unmasked.
They typically wear nearly 70 pounds of gear, including bulky pants, a thick coat, insulated boots, protective gloves, a bulky fabric hood and a rubber mask that’s part of a self-contained breathing apparatus with an air tank.
The main reason some don’t wear their gear at all times is obvious: It’s hot and uncomfortable.
A firefighter’s body temperature can rise to 105 degrees when in action. They often lug heavy hoses, axes and cutting equipment that can weigh more than 70 pounds.
“It can feel suffocating at times,” said Joel Rampe, a Findlay firefighter for the past 15 years. “I’m not making excuses for any of us, because the gear should stay on. But once the fire is out, you can still be at the scene for hours and hours, and you are exhausted.”
But the work they call the "overhaul" — when firefighters are opening walls, ceilings and partitions to check for fire lurking within them — is the most dangerous for contact with carcinogens. The smoldering ruins typically are at their most toxic levels then. Without a mask, firefighters inhale the gases.
Keeping the full gear on doesn’t eliminate the possibility of firefighters being exposed to the chemicals and toxins that can cause cancer. Small gaps between the hood, coat, pants, gloves and boots can allow smoke to snake up under the clothing and settle on skin.
And the more a firefighter’s body temperature rises, the greater the risk the toxins can be absorbed into the skin. With every 5 degrees that body temperature rises, skin absorption rates increase by as much as 400 percent, according to the Firefighter Cancer Support Network, a firefighter cancer nonprofit based in Burbank, Calif.
Toxins at home
Flame retardants can be a major threat to firefighters because when they burn, carcinogens are released into the air.
The chemical-based retardants are in many household and office items. They can be found in infant clothes, high chairs, mattresses, pillows and even Barbie dolls.
They are supposed to give the public and firefighters more escape time by causing smoldering before flames erupt. But study after study from the National Institute of Environmental Health Sciences and several universities has raised questions about their effectiveness.
The flame retardants don't have to ignite to be harmful, either. The Centers for Disease Control and Prevention found that 97 percent of Americans had traces of flame-retardant chemicals in their blood.
The seismic shift to flame retardants came in the late 1970s and is traced directly to big tobacco.
At that time, there was concern among firefighters and state fire marshals about the number of people falling asleep with lit cigarettes. Lawmakers across the country began pressuring tobacco companies to produce a cigarette that would extinguish after a short period if it was not being smoked.
Fearing that such an idea could tamper with their product, the tobacco companies balked. Instead, they hatched a well-funded plan to put flame-retardant chemicals into things found inside the home, according to court documents released after tobacco companies settled unrelated lawsuits to smokers getting sick.
The records show the industry spent millions and offered grants to fire organizations to get buy-in for the plan. They hired lobbyists to persuade fire officials that this was the path to better fire safety.
The linchpin in the whole scheme was to start with the National Association of State Fire Marshals and ply the group with grant money. The marshals even put the tobacco lobbyist on their governing board, according to court records.
Tom Brace, one of the founding members of the Fire Marshals Association and once fire marshal for the states of Minnesota and Washington, said the group was unaware of tobacco’s influence on flame retardants.
Brace said the group would have done things differently if that was fully known at the time.
“Cancer wasn’t talked about at the time either, not that I recall,” Brace said. “Since then, we’ve learned a lot more about flame retardants, and some of the bad ones have been eliminated.”
In late September, the Consumer Product Safety Commission voted to warn the public about dangerous chemicals in baby and toddler products, mattresses, upholstered furniture and electronics enclosures. The federal group for the first time ever said it plans to discuss banning a whole class of flame retardants that have been found to be harmful.
'I can't do this anymore'
Mark Rine kneels down in the street, almost gasping for air. He can’t muster the energy to remove his air tank.
His body is betraying him.
It is summer 2014, about two years into Rine's fight with melanoma. He has been growing weaker every day, but doesn’t want to admit it. The chemo injections have brought with them insomnia, vomiting, night sweats and constant exhaustion.
Forty pounds have dropped off his once-powerful 225-pound frame in a year.
Rine sits on the fire truck as it turns the corner. “I can’t do this anymore,” he says softly.
Rine realizes not enough is being done to warn fellow firefighters about the dangerous chemicals and flame retardants in burning materials that they immerse themselves in. He decides to dedicate himself to sharing that message.
Adding more chemicals
Columbus Fire Chief Kevin O’Connor has no doubt that flame retardants have, at times, saved his firefighters from a brutal fire.
“Not having fires has saved my guys from exposures for sure,” O’Connor said. “The problem is, there is not enough research out there, and when you add more chemicals such as flame retardants, it’s just more chemical we are being exposed to.”
Heather M. Stapleton is a chemist and associate professor at Duke University whose work focuses on environmental risks from chemicals such as flame retardants.
Some of her research, which was funded by the National Institutes of Health, found that manufacturers' tests showing that flame retardants increase escape time for firefighters were misleading. The furniture in those tests, Stapleton said, was saturated with more flame-retardant chemical than what is actually sold to consumers.
“There is not good data out there suggesting they are providing a true benefit,” Stapleton said.
Stapleton's research is clear though, that chemicals in flame retardants are linked to cancer.
In 2013, California lawmakers changed rules around flame retardants, saying they had to be able to smolder if exposed to a small open flame for a short period of time. This allowed manufacturers to line furniture with a fire prevention shield material instead of soaking the foam cushions with flame retardants.
The law is aimed at eliminating the most harmful flame retardants. But it will take years to phase the bad stuff out of homes and offices across the country, including Ohio.
Ohio's law on flame retardants largely mirror national standards set by the National Fire Prevention Association, which vary depending on fabric material but allow numerous chemicals to be used to keep flames at bay.
The city of Boston was able to amend its fire code that same year allowing hospitals, schools and campuses with sprinkler systems to use furniture free of toxic flame retardants.
And despite tobacco companies' efforts to keep lawmakers from tampering with their product, every state has passed laws requiring fire-safe cigarettes since 2011.
— Reach Mike Wagner at firstname.lastname@example.org; reach Lucas Sullivan at email@example.com.