GRANITEVILLE - In the early morning hours of Jan. 6, 2005, Robert Wayne Williams was awakened by a loud crash near his home on Hard Street.
"I thought Stevens Steam Plant had blown," he said of the Avondale Mills Inc. textile facility.
Mr. Williams said he walked out onto his front porch, saw that the mill was still standing and went back to bed - unaware of the deadly disaster that was unfolding in his backyard.
When he awoke at about 9:30 a.m., he noticed the strong smell of chlorine. Helicopters hovered overhead, and people in hazardous-materials suits patrolled the small mill town.
"My street was deserted. Everyone else had left," said Mr. Williams, 53, who worked as the industrial housekeeping supervisor at Avondale Mills for 10 years.
The former textile worker - a smoker who suffers from asthma, emphysema and hypertension - has been out of work on disability since March 1998.
He also was among the hundreds of people injured after deadly chlorine gas seeped from the wreckage of a moving Norfolk Southern freight train that slammed into a parked train on a rail spur. The chlorine exposure killed nine people and hospitalized 72 others. Mr. Williams and other survivors say they continue to suffer from the gas's debilitating effects, which range from skin irritation to memory loss.
Seated in his kitchen by a glass cabinet-turned-pharmacy because of "all the dope they got me on," Mr. Williams described how his health has worsened since he was exposed to some of the estimated 60 tons of chlorine released a year ago.
He said physicians have told him his respiratory illnesses have gone from mild to moderate. In addition, Mr. Williams said, his doctors increased to maximum levels the dosage of medicines that help him breathe.
Mr. Williams took 13 prescriptions before the accident and was put on four more afterward. Two of them are now a permanent part of his pill regimen.
One drug "tricks your lungs into thinking you don't have to cough," he said, and the other is a steroid that prevents lung infections.
From his kitchen, Mr. Williams pointed to the spot about 75 yards away where three punctured chlorine tankers unleashed the toxic fumes. His 16-year-old cat, Goldenrod, who survived alone in the house for 15 days after the crash, lay curled up on a blanket nearby.
He originally planned to stay at his house after the accident. But about two hours after he woke up that Thursday he became one of an estimated 5,400 who were forced to leave home.
He was taken by ambulance to the University of South Carolina Aiken and to Aiken Regional Medical Centers.
By the time he left his house, his voice was gone, his eyes were red and he was coughing up phlegm, Mr. Williams said.
During the next seven to 10 days, which he spent at a friend's house in Aiken, he said, "I'd cough till I passed out."
The effects of the accident have not been limited to physical difficulties.
In a study done five months after the train crash, almost half of the 94 participants had positive screenings for post-traumatic stress disorder, said Mary Anne Wenck, an epidemic intelligence service officer for the South Carolina Department of Health and Environmental Control. She added that "a positive screening does not mean a person has post-traumatic stress disorder."
In fact, said Dr. James Gibson, the state epidemiologist and the DHEC chief of disease control, these people, who sought treatment at hospitals or from private physicians after the crash, might not recognize the signs as the onset of a medical condition.
"It presents itself as not functioning very well," he said. "People think, 'I just can't get things going. I just can't get things done. I can't remember very well. I just can't get organized.'"
Patricia Courtney, 65, of Main Street, said her memory has faltered since the chlorine spill. The train accident, however, is never far from her mind.
"I've been sleeping in my clothes ever since this happened because I want to be ready to get out if anything else happens," she said.
Once, when she heard a helicopter hovering overhead, she called 911 to report another train wreck.
"I never did hear the trains before. You can get used to them," she said. "But I hear them now."
Mrs. Courtney, who said she had no health problems before the accident, now says she has suffered from numerous ailments, including chronic bronchitis.
"I've got one thing, if I don't take it every day, I get to where I can't breathe," she said.
Mr. Williams has also experienced memory problems.
"It messed up my short-term memory. It messed it up a lot," he said. "That bothered me more than the lung problems.
"It was mid-November before I stopped walking into a room 10 times a day and wondering why I was in there."
Dr. Kaye Kilburn, a University of Southern California professor of internal medicine, said Mr. Williams' signs of improvement more likely indicate that he has adapted to his neurological disability.
"(Post-traumatic stress disorder) is an invention. It has no reality," he said. "It's a poor excuse for a diagnosis. It takes you nowhere. It's a label."
Dr. Kilburn, who studies how chemicals affect the brain, tracked residents of Alberton, Mont., after a 1996 train derailment released 65 tons of chlorine into their community. One person died; 350 were treated for chlorine inhalation; and 1,000 people were evacuated.
He initially found that these people suffered from a number of problems, including memory loss. Three years later, he said, their conditions had grown worse.
Questions linger about the health of Graniteville's most severely affected victims, said Dr. Erik Svendsen, the DHEC's environmental epidemiologist for the Bureau of Disease Control.
DHEC continued its efforts from mid-August until the end of October, when it offered free health screenings at three Aiken County locations to people who were within a mile of the crash. Health officials performed breathing tests on these people and had them answer a questionnaire.
The department created a registry of 555 people from the screenings funded with environmental cleanup fees. Fifty-one percent of the respondents sought medical treatment after the accident, and 72 percent had new or worsened health problems immediately after the chlorine spill, Dr. Svendsen said.
Symptoms associated with chlorine exposure include skin rashes, coughing and respiratory illnesses, Dr. Gibson said.
Dr. Kilburn, who visited Graniteville in July, said he believes the accident victims deserve more aid than they have received.
"These people have been so badly damaged and so little helped," he said. "There's been no effort to find out how badly damaged their brains are. ... The problem is they've not been able to raise money to get help."
Reach Betsy Gilliland at (803) 648-1395, ext. 113, or firstname.lastname@example.org.