Every week during the school year, teacher Lea DiRusso climbed on a chair and hung her students’ best work on a clothesline strung between two old heating pipes. As she tugged the line down to clip on artwork or an essay, it tightened, rubbing against the insulation and often sending down fine white flakes.

Her 90-year-old school, Meredith Elementary, had leaking pipes, damaged asbestos insulation, and peeling paint, but DiRusso brightened every corner of Classroom 206.5: homey curtains, peel-and-stick stained-glass patterns on the windows, classical music playing low.

“When you come into a room on a Monday morning, and you’re starting to set up, and you see dust across your desk, or dust on the ground, or a ceiling tile fell, as a teacher, this is your pride and joy, it’s your room,” said DiRusso, a 28-year veteran of the Philadelphia School District. She would grab her school-issued broom. “You just scoop it up, you clean it up, and you move on."

Her fastidiousness, however, put her at greater risk of inhaling or ingesting cancer-causing asbestos fibers, according to medical experts. DiRusso’s classroom had a history of damaged, unrepaired asbestos pipe insulation, School District records show.

In late August, as she was settling her 18-year-old daughter into her freshman dorm room, DiRusso, 51, got an urgent phone call from her doctor: She had mesothelioma.

“I literally lost vision and hearing for a minute,” she said.

“I literally lost vision and hearing for a minute.”

Mesothelioma is a rare, aggressive cancer caused by asbestos. Roughly 3,000 people in the United States are newly diagnosed each year, and patients have a median survival of about one year, according to the Centers for Disease Control and Prevention. Elementary school teachers are at elevated risk, studies show. DiRusso has peritoneal mesothelioma, which invades the lining of the abdomen.

After completing three rounds of chemotherapy that began in September, DiRusso had a decision to make: Should she endure a risky, drastic surgery to remove her diseased organs, then get flushed with “hot chemo”?

“It’s terrifying to me,” she said at the time.

Mesothelioma is a cumulative disease. The level of risk increases based on the amount of exposure to asbestos and for how long, not unlike the link between chain-smoking cigarettes and lung cancer.

While DiRusso may have been exposed to asbestos from other sources at other times in her life, four doctors interviewed by The Inquirer said her three decades of teaching at Meredith and Nebinger — two old South Philadelphia elementary schools with environmental issues — were likely a “significant contributing factor” to her cancer.

Both Meredith and Nebinger are filled with asbestos building materials, and district documents show that environmental inspectors noted some of the asbestos as “newly friable,” or crumbling, and flagged it for repair. But the district didn’t get to it for months, or sometimes years, even though many of the spaces were occupied by students and staff. The Inquirer’s 2018 “Toxic City: Sick Schools” investigation revealed hazardous amounts of asbestos fibers in settled dust at seven elementary schools, including Nebinger, where DiRusso taught for 11 years before moving to Meredith in 2002.

“Her school exposure from materials that are in poor repair is likely to be one of the significant contributors. It isn’t the only contributor, but it would be significant, especially if she was a longtime teacher,” said Henry A. Anderson, former chief medical officer and state epidemiologist for the Wisconsin Division of Public Health. "A lot of risk really depends upon, were you in an area where there was an unusual amount of dust generated? Or did you personally generate that dust, like sweeping with a broom?”

Because asbestos was so widely used in building materials, construction workers remain at the highest risk for mesothelioma, according to the CDC. Other high-risk occupations include shipbuilders, refinery workers — and teachers.

Anderson, who specializes in occupational and environmental medicine, has conducted two studies, the more recent in 2018, that focused on mesothelioma cases by occupation in Wisconsin. Both studies found that teachers, particularly elementary and middle school teachers, are “at higher risk than the general population,” he said.

“I would say it’s a national phenomena,” said Anderson, an adjunct professor at the University of Wisconsin School of Medicine and Public Health. “What we’ve found is that there was a lot of asbestos used in the schools, and the schools have always been short of funds for maintenance.”

Mesothelioma can take 10 to 50 years or longer for symptoms to appear.

DiRusso first realized something was wrong this past spring.

She had remarried two years earlier, and her new husband, Amr Osman, encouraged her to eat healthy. DiRusso was happy when she began to drop pounds. But even as she lost weight, her stomach began to swell.

“I’m 51 years old and I actually took a pregnancy test, because that’s how hard my stomach was,” DiRusso said.

She went to a gastroenterologist, who ruled out cancer after ordering a colonoscopy and endoscopy. He suggested her stomach bloating and indigestion were related to menopause and gastritis. He told her to take Prilosec for heartburn, she said, then come back in a month.

In August, when pants that DiRusso wore on a Friday didn’t fit her by Sunday, Osman took DiRusso to the emergency room. At the time, they were staying at Osman’s house in Absecon, N.J. Doctors admitted her to AtlantiCare Regional Medical Center in Atlantic City. She spent 11 days there while doctors ran tests and drained four liters of fluid from her abdomen.

Doctors also performed surgery, inserting a thin tube with a camera to explore her abdomen and do a biopsy. They sent her tissue samples to Johns Hopkins for analysis.

» READ MORE: Hidden Peril: Cancer-causing asbestos lurks in Philadelphia district schools. Tests find alarming levels, even after repair work is done

DiRusso tried to remain upbeat, but she was growing increasingly scared. She confided in a nurse, whom she had befriended, that one doctor had told her that fluid in her abdomen could be a sign of cancer. The nurse took a peek at DiRusso’s medical records and began to cry.

“I’ll say a prayer for you,” the nurse told her new friend.

"I knew I was in big trouble,” DiRusso would later say.

Asbestos, a durable fireproofing material, was slathered throughout schools constructed before 1980, in part as a way to protect children in case of fire. Builders sprayed asbestos on auditorium and gymnasium ceilings, troweled it on walls, and wrapped it around heating pipes.

Under federal law, school districts must document the location and condition of all asbestos in each building every three years, and make a plan for removing or repairing any damaged material. Districts must do a visual inspection every six months.

Kept in good condition, asbestos is not considered hazardous. But when damaged, the tiny fibers, invisible to the eye and so light they can drift in the air for hours, pose a health risk.

DiRusso said she knows she can’t definitively say she got mesothelioma solely from her school exposure. She is a nonsmoker but lived in homes with popcorn ceilings — textured paint that, until 1977, may have contained asbestos. Asbestos also can be found in baby powder and some talc-based makeup, and blown-in attic insulation in older homes.

Still, she said she is angry that district officials, who flood teachers with directives about everything from how to talk to children about 9/11 to scripting lessons, never shared a word about how to take precautions around the asbestos in their classrooms.

“You think to yourself, ‘If something dangerous is in my midst, someone, somewhere, would have said something to me,’ ” DiRusso said.

After learning DiRusso had asbestos-caused cancer, district officials assessed Meredith for damaged asbestos and gave staff “do’s and dont’s” of working in a building with asbestos. Meredith’s gym was shut down for about a month as workers removed asbestos around pipes, including a damaged section behind the basketball backstop.

DiRusso’s own classroom had damaged asbestos insulation marked as a “high priority” for repairs in 2015, 2016, and 2017, records show.

Doctors interviewed by The Inquirer said the exposure that caused DiRusso’s mesothelioma most likely occurred long before 2015. The district maintains asbestos inspection reports from Meredith and Nebinger from the early 1990s, as required by federal law, but failed to make them available to The Inquirer despite at least five requests.

DiRusso didn’t always want to be a teacher. She comes from an old South Philadelphia Italian family — large and boisterous, with aunts and uncles and grandparents all crowded into redbrick rowhouses a few blocks from one another. She attended St. Monica’s grade school and St. Maria Goretti High School, working part-time at the IRS to help pay her high school tuition.

DiRusso entered La Salle University as a journalism major but switched to education a year later. A cousin with Down syndrome inspired her to become a special-education teacher, and in 1991, DiRusso started at Nebinger, in the city’s Bella Vista neighborhood. She married in 1997 and divorced about eight years later when her daughter was about to start kindergarten.

As a single mom, money was tight. In 2007, DiRusso borrowed from her 401(k) to put a down payment on a home deep in South Philadelphia on 17th Street, a dead-end block up against the Schuylkill Expressway.

Colleagues describe her as a skilled, caring educator and problem-solver, able to work with any child. “Kids just wanted to sit in her room — they just wanted to be with her,” said Jessica Tilli, a teacher who worked with DiRusso at Meredith for 12 years. "Her students struggle, and she’s always been their cheerleader.”

» READ MORE: Danger, Learn at Your Own Risk – How environmental hazards in Philly schools endanger students and hinder learning

Peers at both schools elected DiRusso shop steward. Teachers came to her for help with everything from personnel issues to the heat not working to mold in the gym.

Asbestos never came up, she said.

Now too sick to work, DiRusso misses her students and colleagues, even as they text her encouragement and call to see if she needs anything. She keeps a card one little boy painstakingly wrote out for her on a dining-room buffet table.

"Dear Ms. DiRusso, I have been thinking of you so so much lately. I know you are in a lot of pain but I just miss you so much. Just please come back,” it reads. The boy’s words tore her up.

“When you go to eat that last piece of pie, you know that it’s that last piece of pie and you enjoy it a little bit more," DiRusso said. Her eyes welled up. "Was that my last year of teaching? I don’t know. Will I be too sick? I didn’t get to wrap it up in a bow. It was kind of stolen.”

Asbestos is now all she thinks about, she said.

DiRusso’s 16-year-old son, Ashton, a sophomore at Science Leadership Academy, was displaced from his school this fall after construction workers inadvertently exposed parts of the building to asbestos debris. District officials closed the school. Both Ashton and his 18-year-old sister, Alysa, attended Meredith elementary school, in Queen Village. DiRusso said she finds herself worrying about whether they’ll get cancer.

She said she tries not to “ugly girl cry” in front of her children. When Ashton wanted to stay home from school to be with her, struck by the fact that their time together was fading, she was firm.

“We’re going to work through this, and we’re going to make the most of the time we have, and you know Mommy’s a fighter, and while I’m here, we’re just going to keep on moving,” DiRusso said she told him. “Mommy has no choice and you have no choice.”

But some days she can’t even open her mail or get out of her pajamas.

Then there are days when she packs in as much life as she can. She swings by her son’s school and takes him to lunch. She takes time to admire her favorite sculptures at the Rodin Museum. She talks to Alysa on the phone at least twice a day.

Ashton said he tries to come up with questions “Future Ash" won’t be able to ask his mom, such as how much money to spend on an engagement ring, when the time comes. (Three months’ salary, she told him.)

Her son came out as transgender in sixth grade, DiRusso said, and she’s glad that she helped him transition, both legally and physically, before she got sick.

“I’m proud of him,” she said. “He’s an amazing example for a lot of people.”

After several tough discussions with her children this fall, DiRusso made a decision:

She was going to fight on. She would do the “hot chemo."

People diagnosed with mesothelioma typically live six months to a year. Having exhausted her options with conventional chemotherapy and seeking to extend her life, DiRusso will undergo a procedure called HIPEC — hyperthermic intraperitoneal chemotherapy — on Dec. 10.

Her cancer has already spread to her ovaries, uterus, and small bowel. To remove the tumors, surgeons will make a long incision in her abdomen, and then give her a full hysterectomy and perhaps remove part of her bowel. After the organs are removed, doctors will bathe her abdomen in a chemotherapy agent heated to 107 degrees for 90 minutes. All told, the surgery could take 10 hours.

Unlike most mesothelioma patients, DiRusso was diagnosed at an early age, so her chances of recovering from the HIPEC are better. “Lucky people get a few more years," she said, “but that’s not good enough.”

DiRusso badly wants to maintain family traditions this Thanksgiving, which included her cooking a huge holiday feast at her house. But she can’t. She’ll be too tired. So for the first time, the family will have the meal catered.

"I hope I make it to the next one, because I’m not going to get a chance to do it this year,” she said.