Susan Gnora, known by most as Susie, got up that morning and ironed. What she ironed is unknown, though most likely she ironed her husband’s white work shirts. Perhaps she ironed shirts most mornings, like other Donora wives whose husbands worked at one of the mills along the Monongahela River. That particular morning, Friday, October 29, 1948, was extremely foggy. Looking back we recognize the 29th as the fourth day of what we now call the Donora Death Fog, but at the time it was just another foggy day in Donora.

Susan was having trouble breathing that morning, but she kept ironing nonetheless. She also had a headache that wouldn’t go away. She had never had a health problem before, aside from a twisted ankle when she was young, and she had no history of asthma or other lung disease. Yet on this foggy day a woman who had survived the births of 14 children struggled for breath. Her family gathered at her home throughout the day. Susan’s husband John worked all day at a coal mine in Monessen and didn’t get home until about five o’clock. He found his wife painfully short of breath. She told him, “I no feel good.”

Neither Susan nor John spoke English well. John couldn’t read nor write, and in all likelihood Susan couldn’t either. John depended on his energetic wife for everything, from fixing his lunch everyday to using his every-two-week paycheck to manage the family’s finances. She paid all the bills, and when one of her children needed cash, she gave them whatever the couple could afford.

Throughout the day Friday Susan had found herself so weak that she couldn’t complete even the simplest tasks. Her alarming weakness stemmed partly from the lack of oxygen in the air and partly from the dangerous effects of pollutants she had been breathing. The air in Donora that week had become increasingly thick with noxious gases, including carbon monoxide, ozone, and sulfur dioxide, all menacing gases in high concentrations.

The air also contained tiny particles, or nanoparticles, of such metals as zinc, lead, and cadmium. Those nanoparticles had been blown into the air from the steel and zinc mills along the river, particles that joined the coal dust already in Susan’s home from the family’s coal-fired Heatrola. The coal dust, plus the various types of nanoparticles in the Donora air, were breathed in not just by Susan but by everyone else who entered the house or who lived in Donora. The nanoparticles found their way into the deepest parts of the lungs and then into the tiny air sacs, or alveoli, there. Alveoli allow inhaled oxygen to pass into the bloodstream and carbon dioxide in the bloodstream to be exhaled.

When a person is at rest, about ten ounces of oxygen, and about the same amount of carbon dioxide, pass into and out of the bloodstream through the alveoli every minute. During exercise that amount can double. In Donora that horrible weekend, those ten ounces or so contained an unhealthy amount of noxious gases and harmful nanoparticles. On entering the lungs, all those pollutants caused an inflammation of the alveoli, which prevented the normal amount of oxygen from passing into the bloodstream and the normal amount of carbon dioxide from passing out through the lungs.

The lack of oxygen in the blood is most likely what caused Susan to become weak, and a buildup of carbon dioxide in the blood most likely prompted her headache. Other cells in the body also became inflamed and couldn’t perform their own particular functions as well as they should have. As a result Susan’s heart rate increased, trying to push more oxygen to the brain and other organs that needed it most. Her kidneys couldn’t get rid of as much waste as they should have, and so poisons began building up in her bloodstream. All of her body’s energy was being used to keep her heart, brain, and lungs working, and unless Susan was taken to a smog-free area right then, and given oxygen, she would die.

Her family had no idea how serious her condition was, though, until it was too late. Her son, George, said, “I didn’t realize it was that bad. I thought it was just one of those things that would blow over.”

Susan spent most of Friday night sitting on the edge of the bed, her head bent to her chest, her breathing becoming ever more labored. Speaking became too difficult, and sleep was out of the question. Her daughter, Elizabeth, called every Donora physician in the phone book, but they were all busy, out on house calls. She was finally able to reach Dr. William Rongaus, who arrived sometime between 9:30 PM and midnight. Rongaus drove to the Gnora home in extraordinarily thick, black fog. He gave Susan “a hypodermic,” probably epinephrine, to help open Susan’s airways and improve her breathing. He also left a few pills, most likely theophylline, a drug used to treat asthma and other breathing conditions. Susan didn’t want any of the pills, and the prescription Rongaus left behind was never filled.

When Rongaus left the Gnora home, Susan’s son-in-law, Rudolph Crafton, told him, “Any man who would drive a car [in that fog] would have to be a magician.” To which Rongaus replied, “I’ll manage somehow.”

Susan’s condition worsened overnight, and by 8:30 the following morning, Susan Gnora, a 62-year-old, five-foot, previously healthy, hard-working, Hungarian housewife “a little on the plump side,” with only a fourth-grade education, was dead. Susan became the ninth person to die from the smog. At least ten more souls would perish before rain and a bit of wind arrived that Sunday morning to clear away the fog and let the people of Donora breathe again.