I was working as a doctor in a Kentucky clinic when I first met Mr. Stroud. The year was 2013. Mr. Stroud was memorable for several reasons. The first reason? He was blue.

He was a 45-year-old stocky guy, pleasant in demeanor, with blue eyes and red hair. His skin was also blue. His lips especially. He did not seem to be unduly distressed, however. He was pleasant in demeanor, although he was a bit short of breath when he spoke in sentences longer than five words.

His wife was with him in the clinic. She was a pretty blonde woman also in her 40s, somewhat generously proportioned, She would fill in his sentences when he ran out of steam. Between the two of them, I learn that Mr. Stroud has had lung disease for some years now. He was a coal miner in Tennessee for ten years. He then became a firefighter. He was one of the first responders when the Twin Towers fell in New York on 9/11/2001.

He is obviously having a flare-up of his lung disease. He says, “When I get blue like this, my legs swell up.” So it is not my imagination that this patient is blue. And indeed, his legs are quite swollen.

The wife says he needs to be hospitalized. Whenever he gets to this stage, he apparently comes into the hospital for a reworking of his diuretics and for breathing treatments. They seem pretty calm about all this. They apparently have dealt with these blue spells for some time now.

I check his blood oxygen saturation. It is low, at 80 percent. He is breathing fast. His respiratory rate is 30 breaths per minute. I call his cardiologist. She is treating him for right heart failure secondary to lung disease. She will see him for a consult in the hospital. He gets a comfortable room in the hospital. And, after a cocktail of diuretics, the swelling in his legs goes down. After three days of breathing treatments and supplemental oxygen, his sats go up, and he is less blue. He is discharged home.

He returns to visit me every month or two when his daily regimen of meds needs to be tweaked. And I make arrangements with his cardiologist.

At some point, the treatments no longer help. He dies at age 47, leaving behind his wife and two daughters.

What this patient taught me: Mr. Stroud had lung damage from coal dust. He had further lung damage from exposure to the toxins in the debris at the site of the collapsed towers. He was a good man. He taught me about the price the first responders and their families paid after the events of 9/11/2001.

Janet Tamaren is a family physician and author of Yankee Doctor in the Bible Belt: A Memoir. She can be reached at her self-titled site, Dr. Janet Tamaren, and on Twitter @jtamaren.

Image credit: Shutterstock.com