Lea DiRusso stared at the form in front of her, stuck on the words her doctor wrote to explain why she had to retire early from her career as a Philadelphia School District teacher: incurable mesothelioma.

“Incurable, incurable, incurable,” DiRusso said Tuesday. “It was echoing in my head.”

DiRusso, 51, spent her 28-year teaching career at two South Philadelphia elementary schools with known crumbling asbestos that the school system had largely papered over for decades. It’s been nearly nine months since she was diagnosed with an aggressive cancer caused by asbestos.

She became the public face of the school district’s failure to protect teachers and students from environmental hazards inside its aging buildings. DiRusso wants her death to mean something, her diagnosis to be an impetus for Philadelphia finally ridding its schools of the carcinogen.

But she worries that the district’s continued shoddy containment and removal work imperils that possibility.

“It’s like holding a grenade in your hand, and you’re pulling the pin out,” DiRusso said. “Do people not understand that this is deadly? Let me tell you, it is.”

“It’s like holding a grenade in your hand, and you’re pulling the pin out.”

Last month, workers began to remove asbestos fireproofing from steel beams that support the ceilings inside Bethune Elementary School. The North Philadelphia school is a city-designated site for families to pick up food once a week during the pandemic. On April 21, asbestos workers completed the first project area — the school’s gymnasium. And environmental staff with a district-hired firm and the Philadelphia Federation of Teachers collected air samples to make sure the gym was free of asbestos fibers.

Test results showed alarming levels of asbestos inside the gym. Worse, air samples taken outside the sealed work area, including in a hallway that leads to the school’s cafeteria and a food pickup spot, tested even higher — in fact, air samples ranged from five to 10 times higher than what city health officials deem safe, according to air-sampling logs and laboratory results.

The high results came back on April 22. The next day, parents and children picked up meals outside the school, said Jim Creedon, the district’s interim chief of facilities and capital projects.

But non-asbestos workers had moved freely throughout the building, including the contaminated hallway, with no protection.

“There are not enough controls in place,” said Jerry Roseman, the PFT’s environmental scientist. “It’s just too chaotic and risky.”

When Philadelphia schools closed March 13 because of coronavirus, DiRusso said she imagined a silver lining. She would get to spend more time with her husband and children, ages 16 and 19. And the district would be afforded time to carefully remove asbestos hazards from schools.

But since the shutdown, the district has grappled with high levels of airborne asbestos — caused by either a botched removal job or already existing contamination — at Bethune and another school, Gompers Elementary, in the city’s Overbrook neighborhood.

During a closer examination of how and when asbestos contaminated Bethune’s hallway, district officials also discovered additional asbestos not initially identified when the construction project began, Roseman said.

Creedon said it’s unclear what happened. “I think the challenge here is the high level of asbestos may not have been there for the last 20 years, like every single day — a lot of it may have occurred as a result of the work going on inside the building,” he said. “That’s why they went through the building to try to find various locations that may have been somehow disrupted, perhaps even during the testing process itself."

Under federal law, however, the district is required to identify the location of all asbestos material and remove it before any work that would disturb it.

The oversight mirrored mistakes made last fall, during a major renovation at the joint campus of Benjamin Franklin High and Science Leadership Academy. In that case, construction crews began dismantling the building’s old air ducts in the boiler room and first floor without adequate protection and spread asbestos fibers with students and staff in the building.

Last October, the district shut down Ben Franklin and SLA, relocating about 1,000 students.

One of those students was DiRusso’s son, Ashton. It was the first of nine schools that the district would close throughout the school year because of asbestos exposure since DiRusso’s cancer diagnosis last August. During that time, she sought a drastic medical treatment to prolong her life beyond one year — the median survival rate for mesothelioma patients.

On a bitter winter morning, DiRusso found herself on a gurney with her family inside a curtained-off hospital bay at the Hospital of the University of Pennsylvania, tears streaking down her face.

Her surgeon, Giorgos Karakousis, told them, “We’re going to take good care of her. This is going to be a long, long procedure. It may take seven to eight-plus hours. Whatever it takes, we are going to do what we need to do.”

Ashton, DiRusso’s son, nestled into his mother’s neck, a 16-year-old in a hoodie and sneakers with untied laces.

“Make sure you go to school after this, understand?” she said, shaking a finger at him. “That’s my last decree. I love you.”

She kissed her brother and her father. Her husband, Amr Osman, bent down, held her face, and wiped tears from her cheeks with his thumbs. She had dreaded this moment, but knew the surgery she was about to undergo was the best option for extending her life.

Still, she was determined; she had that DiRusso family grit.

DiRusso’s 75-year-old father, Carmen DiRusso Sr., was scheduled to have his sixth brain surgery at the same hospital in a few days. Doctors had given him only months to live when he was first diagnosed with stage-four melanoma. But there he was, six years later.

“He’s a bull,” Lea DiRusso said before being rolled off to the operating room. “I take after my father.”

DiRusso’s surgical team went to work, making an incision that ran from DiRusso’s chest to her pelvis. Biopsies and body scans were taken days earlier, but until they opened her up, surgeons wouldn’t know whether the cancer had spread to her bowels and require them to remove parts of her intestine.

Next, they cut out or burned away cancerous nodules in her abdomen. Doctors removed her ovaries and uterus, and excised diseased sections of her peritoneum, the lining around the abdomen.

DiRusso’s brother, Carmen DiRusso Jr., sat anxiously in the family waiting area on the hospital’s second floor.

“Cumulatively, over decade after decade of being exposed to this, she now has a fatal disease,” he said. “The fact that there’s an injustice here has buoyed her spirits and given her something to fight for. She’s very angry about all of this.”

Under a federally mandated law, enacted in 1986, the district is required to routinely inspect buildings for asbestos and fix or remove any damage. District officials have long boasted of having one of the best asbestos monitoring programs in the country.

It wasn’t until Lea DiRusso got sick that parents and staff fully realized that the district hadn’t, in fact, stayed on top of asbestos hazards.

Just after 3 p.m. on Dec. 19, as DiRusso lay oblivious on the operating table, an angry crowd of teachers and students from Franklin Learning Center converged on district headquarters to demand to talk to Superintendent William R. Hite Jr. District officials had closed FLC two days earlier after they discovered asbestos debris inside a heating shaft. Rattled by news of DiRusso’s illness, teachers had pressed district officials to inspect their school and address long-standing environmental hazards.

It was not the first time that the FLC community had expressed public outrage over asbestos inside the school. Twenty-three years earlier, students staged a walkout, shouting and lying down in front of cars to protest conditions that led to the school’s auditorium being shut down and sealed off.

Jeanine C. Avery, a 1996 FLC graduate and walkout leader, said she always imagined their activism would have led to lasting change. Now 41 with two daughters, Avery heard about the recent spate of school closures because of asbestos contamination. “I don’t know if I should be shocked or should not be surprised at all,” she said.

By late afternoon, DiRusso’s doctors would reach the final step: bathing her abdomen for 90 minutes in a chemotherapy solution heated to 107 degrees. They hoped to “stun” the tiniest tumors and prevent them from growing for at least a year, longer if DiRusso was lucky.

At about 5:30 p.m., after the team had closed DiRusso’s incision with 40 staples, Karakousis, the lead surgeon, gathered DiRusso’s family in a small meeting room. He had a bit of good news. The cancer had so far spared her bowels, so he didn’t have to remove her intestine.

“All in all, she came through it really well,” he said. “The next step will be getting her healed up.”

On June 8, DiRusso’s oncologist will scan her body to check for cancer growth. If things are unchanged, she might not need more chemotherapy.

But for now, the focus is on her body’s recovery.

Earlier this year, the district reached a settlement agreement with DiRusso for $850,000, going above Pennsylvania’s $500,000 cap for personal injury cases against government agencies. In exchange, the district asked DiRusso to resign from her job, forgo a yearlong medical sabbatical, and waive her right to future district health benefits.

“Teaching has been my identity for 30 years and to not get up in the morning and have a focus or a routine has been really hard.”

“While I appreciate them going above the cap, it’s barely going to sustain me for medical coverage and things that I need for the remainder of my life, which is being cut short,” DiRusso said. “There’s no windfall here.”

The fact that she is no longer a teacher has shattered her, she said.

“Teaching has been my identity for 30 years and to not get up in the morning and have a focus or a routine has been really hard, mentally and emotionally, to try and come up with a new normal,” she said.

Her father — her rock, the bull — died Feb. 27.

“My father was a fighter and so having to take care of him, it made me not think of myself and it made me focus on someone else,” DiRusso said.

Would she have become a special-education teacher if she had known she would be exposed to asbestos and die early?

DiRusso thought of the scores of parents who have reached out to her to thank her for the way she changed their children’s lives — even the ones who she thought disliked her because of her plainspoken style and her high expectations for students, even the ones who struggled.

“I got these text messages and e-mails from parents, telling me that, ‘My kid really benefited from you and the love,' and, 'What you did for my kid, no one could have done,’” she said, “and it made me realize that I could not have chosen a different path because I needed to do this.”

These days, she’s holed up at home with her husband, her mother and her children. There are moments of joy in a pandemic, the mornings she FaceTimes with former students, at their parents’ request, to help them understand tough concepts or just to make a connection with a loved teacher.

And the times when everyone gathers for meals. DiRusso’s children requested breakfast for dinner, and despite her exhaustion and the chemo-induced neuropathy in her hands that causes constant pain up and down her arms, she rallied all her strength and produced it: pancakes, eggs, bacon, toast, biscuits.

“I’m happy that everybody is under one roof and that I get to spend time with them because I don’t know if I’ll be here next year …” she said. “I’m sure the plague or the quarantine wasn’t God’s purpose, but for me, it served a purpose of putting us all together.”

DiRusso’s daughter, Alysa, and Ashton are protective, fearful of their mother ever leaving the house and possibly contracting coronavirus. When food or packages get delivered, Alysa, 19, has a system, carefully wiping every square inch.

“They’re so afraid, it’s like, ‘If you catch it, you’re gone, Mom. You’re gone,’” said DiRusso. “Even though you already have the death sentence, they don’t want me going any earlier.”

But she’s also mindful of her legacy.

“Maybe something good will come out of this pandemic,” she said. “Now there’s an opportunity for this to be eradicated or handled appropriately in buildings, so that when kids do go back, it’s safer."

The Inquirer’s investigative reporting is supported in part by The Lenfest Institute’s Investigative News Fund. Editorial content is created independently of the Fund’s donors. A listing of Lenfest Institute donors can be found at lenfestinstitute.org. Gifts to support the Investigative News Fund can be made at www.inquirer.com/donate.