Cancer. Is there a word that scares us more? We are inundated with stories of firefighters being diagnosed with cancer – not surprising considering that cancer is the leading killer of firefighters. So, why do so many of us ignore the warnings for so long? And why do we skip our annual physicals?
If you’re preemptively asking, “What gives you the right to lecture me on getting a physical? Well, here’s what gives me the right: I am a cancer survivor. My cancer was the result of poor decision-making on the job over 40-plus years of service. Quite honestly, I was being stupid, not wearing PPE or SCBA and skipping my annual physicals. Sins from my past came back to haunt me, but today, I can use my experience to make a tough love appeal to you about health and wellness, not only for yourself but also your members. My experience underscores the power of an annual physical. It saved my life, not once but twice.
Avoidance first, many tests later
My first cancer diagnosis came in 2018. The results from a fire department physical revealed an abnormal prostrate-specific antigen (PSA) level, so the department physician said I should get a second opinion, which I did, but not right away. In fact, it was almost a year before I did anything.
Hutto Fire Rescue provides an NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments physical for all of our personnel. We implemented these physicals many years ago to help ensure that our firefighters are in the best health possible so they can serve our citizens when they need us most. And while the level of testing has changed over the years, what has not changed is our concern for the health and wellness for our personnel.
Here I was, responsible for ensuring that our members got their physicals, but I wasn’t taking action for my own health. My wife insisted that I get a second opinion, but I still waited a few months. She continued to ask whether I had gotten a second opinion, so I finally went to a clinic where, sure enough, they confirmed the abnormal PSA score.
The next step was an appointment with my urologist, who reviewed my previous results and ordered yet another PSA test. By this point, I was beginning to wonder if this whole process was worth it or just a false alarm. But once again, the doctor confirmed the abnormal PSA level, so additional tests were ordered.
The doctor did a biopsy of my prostrate (11 samples) to definitively determine if there was cancer present in my prostrate.
I was not ready for what came next.
Official diagnosis, shock and questions
The news came on Aug. 17, 2018. My Gleason Score – a number used to describe the severity of cancer – was 8 out of 10. That means high-grade cancer. Cancer was detected in three different locations inside my prostate.
No matter your age or occupation, when you hear the words “you have cancer,” you are really never as prepared as you think you might be. We can all say, “I can handle it, doc, just tell me straight,” but when they do, it really changes you.
My doctor talked to me about the many different treatment options, but I wasn’t really hearing him. My mind was swimming with this new information – cancer. Countless questions ran through my mind: Is this a career-ending illness? What am I going to do if I can’t be a firefighter? That is all I have known for 40 years. Is this a death sentence? Who is going to take care of my wife? Will my insurance cover everything and take care of my wife? How am I going to tell my son and his newlywed wife? How am I going to tell my aging parents?
My doctor must have recognized that I was checked out, trying to process everything, so he instructed me to go home, think about everything over the weekend and set up an appointment for the following week to come back. He encouraged me to write down any questions that came to mind.
Sharing the news with my team
My wife and I walked out of that appointment with the world crashing down around us. We went home, held each other tight, said our prayers, and proceeded to write down as many questions as we could think of. But I did something else, too. I went to the fire station. I had a duty to tell my employer and my employees about my diagnosis and the potential consequences.
In meetings with my bosses, the fire department executive staff and the firefighters, I informed them of my diagnosis and what the future might hold. I also advised them that it was the NFPA 1582 physical that first detected the anomaly and the follow-up consultation with our fire department physician that started my path to a diagnosis. I also advised them that we would always be getting our annual physicals at Hutto Fire Rescue.
The first two phone calls
After the diagnosis, my first two calls were to the Firefighter Cancer Support Network (FCSN) and the Texas Workers Compensation Commission (TWCC).
The FCSN team members are quite simply a group of cancer survivor angels. The information they provide, the support they give, and the piece of mind that they bring while going through this process is priceless. I have actually been involved with this group for many years. As the chair of the International Association of Fire Chiefs (IAFC) Safety, Health and Survival (SHS) Section, I have participated in several events and programs with the FCSN. But I never thought I would be on the receiving end of their offerings. So when I first made the phone call, it was hard to talk to them as a person in need of their services instead of helping them provide their services. Nonetheless, they provided comfort and reassurance that I would not be going down this road by myself.
The call to the TWCC started a more complex part of my journey. At that time in Texas, there were three cancers covered by presumption legislation: prostate, testicular and non-Hodgkin lymphoma, so I assumed this was going to be considered an occupational-related cancer. I believed this because the TWCC had come out in some very high-profile fire department cancer cases across the state where insurance was denying claims. However, the insurance forgot to tell their front-line adjusters that these cancers were covered by TWCC.
My initial experience with workers’ compensation can be summed up as hitting roadblock after roadblock. Within four weeks, I went through four different insurance adjusters before anyone was able to confirm that, yes, my cancer was considered an occupational illness that was covered by TWCC. My adjuster advised me that I was now part of the “catastrophic loss” category due to the potential expenses and medical treatment that would be required for this diagnosis.
I know that there were a lot of folks that made the presumption legislation happen in Texas, but it was spearheaded by the International Association of Fire Fighters (IAFF). For that I am grateful because it was one less thing I needed to worry about during my process. With the TWCC handling the bills, I was able to focus on treatment.
Treatment, recovery and return to work
Follow-up tests determined that the prostate cancer had not spread to other parts of my body – cause for celebration! With this information, we could now address the treatment options: 1. Do nothing, 2. have surgery to removal the prostate or 3. have surgery to remove just the cancer followed with radiation. After talking with my wife, friends who had been through prostate cancer, the urologist and an oncologist, I chose option 2. I would undergo a radical prostatectomy, the surgical removal of the prostate gland and surrounding tissue.
The surgery was on Dec. 6, 2018. Again, I thought I was prepared. My doctor and friends had all told me about the difficulties that recovery would bring – but I could handle those, right? The truth is that the recovery was a very dark period for me. From wearing a catheter for two weeks to the physical therapy, it was a long climb to be able to return to work.
My doctor declared me cancer free on Jan. 17, 2019, and I returned on a four-hour routine on Jan. 21, 2019. I maintained this for only a couple of weeks because you really can’t get anything done in just four hours, but that is all my body would allow me to do. I did this routine, went home and went to sleep. I gradually increased my hours and eventually resumed full-time work on Feb. 18, 2019.
Today, I am still going through routine checkups.
Déjà vu: Annual physical and initial denial
It happened again in 2024 – my annual NFPA 1582 physical saved me.
Just like all members of Hutto Fire Rescue, I took my physical at the start of the calendar year. I failed it miserably! I could not reach the levels required by our healthcare provider. I was not too concerned. I had been fighting a sinus infection and allergies since the 2023 holidays.
My healthcare provider noted that there were irregularities in the EKG results. Again, I dismissed their concern because I have had a mitral valve prolapse since I was a child. It is something that I would regularly get looked at by my primary care physician and my cardiologist.
I prepared to take my fire department physical again, assuming it would show our fire department doctors that they were wrong, and I was right about it just being allergies. And while there were some signs that something was in fact wrong, I ignored them. For one, stairs were becoming an issue, so I would just find an elevator.
Something was wrong
I did not follow up on the doctor’s concern for over 9 months, but then one of those significant events happened that told me I could not ignore the signs any longer.
I was at the IAFC’s Fire-Rescue International conference in Dallas. As a member of the IAFC board of directors as the representative for the SHS Section, we were met with a full agenda for the week – meetings, talking to the membership and attending social events. Walking the exhibit floor to thank the vendors for attending and staffing the SHS booth were also important. The problem: I could not do all of this. I struggled to walk from one end of the exhibit floor to the other without finding a place to sit down to catch my breath. What’s more, I had to sleep in a chair in my hotel room for seven nights because every time I laid down, I felt like I was drowning.
When I returned home from the conference, I decided that maybe I should follow up with my cardiologist. And again, just like the cancer diagnosis, I was not ready for what came next.
Diagnosis: Heart failure
After conducting a battery of tests, the doctor told me that I was in the middle of congestive heart failure – and had been for a while. I needed to have a valve repaired or replaced as soon as possible. The doctor scheduled an appointment for me with a leading heart surgeon in central Texas.
When I met with the surgeon, he shared that I was now on the edge of having acute heart failure.
However, unlike my cancer diagnosis, this was not an occupational issue. This was a genetic issue that I would be required to pay for. This brought about many questions and concerns that needed to be addressed.
The surgery occurred about a week later, and I was in the hospital for seven days to make sure that my healing was going in the right direction. I was hooked up to machines and pumps that sustained my life for the first few days.
I am home now, recovering and following the directions of all my doctors, including cardiac rehab.
Set the example
Why am I telling this story? Because I can. I almost didn’t have the chance to share this critical lesson with anyone.
We can get wrapped up so tight taking care of everything in the fire department that we forget ourselves. But believe it or not, your organization will manage without you, at least for the time necessary for you to look out for yourself.
Remember, enforcing your PPE standard operating procedures (SOPs), conducting gross decontamination following every fire, getting an annual physical, all contribute to the health and wellness of your members. But it starts with you. Set the example. Get your physical. Follow the advice of the medial professionals because they know more than you do. Isn’t that what you are paying them for?
A final word on annual physicals
Fire Chief I. David Daniels once said to me that you can gauge what is important to fire department leadership by watching where they put their money. Some department leaders opt to purchase new fire apparatus every year or design Taj Mahal-like stations. While these flashy expenditures look great and can certainly support the organizational mission, it is often the smaller, less obvious investments in safety, health and wellness programs and equipment that underscore a strong and genuine commitment to the people at the heart of the organization. Such investments could include PPE, training and, yes, annual physicals.
Annual physicals may not always be popular among members, but as a fire chief, you have only one job – protect your personnel so they can protect the public. Do not accept the argument from anyone – your membership, your city or district management, anyone – that you cannot afford annual physicals or do not need them. We do need them. Insisting on annual physicals is the right thing for the betterment of your personnel – and yourself.
No more excuses. That will not fly today. Stay safe!
