NEW YORK - Even before the mournful sounds of the bagpipes, it's clear this morning will be a somber one.

Packets of tissues are placed on chairs. A single jacket hangs from a hook. And firefighters adjust each other's uniforms.

It is an event that has sadly become routine: a plaque unveiling ceremony for a firefighter who died from an illness thought to be linked to the toxic air and debris created by the World Trade Center's collapse on 9/11.

"It is painfully clear that the sacrifices by our department and our department's families did not end 17 years ago," said FDNY Commissioner Daniel Nigro.

This ceremony is for Robert Alexander, on the first anniversary of his death from a brain tumor. He was just 43 years old. 

After 9/11 he was assigned to the Fresh Kills landfill, searching for human remains and personal effects amid the rubble taken there. At the time, he was a police officer. In 2002, he joined the FDNY.

Robert's brother, Raymond Alexander, is all too familiar with these rituals of grief. Their father, also named Raymond, was a firefighter too. He responded on 9/11 and died of a 9/11-related cancer just months before his son.

"It's just a sad reminder of a lot of stuff that took place last summer and then the two and a half years leading up to that was just tragedy after tragedy," Alexander said.

It has been that way for the fire department, too. While the city and country have in many ways moved on from the horror of that day, the FDNY cannot.

The growing toll of firefighters and other personnel who have become sick and died from diseases believed to be the result of 9/11 is just too great.

Since he became commissioner more than four years ago, Nigro has attended more than a hundred funerals and plaque dedications for the second wave of victims that still has not crested after the FDNY's staggering loss 17 years ago.

"I think we all believed that the 343 was a number nobody could have imagined. But that was it. As bad as it was, that was it for the funerals and the grieving in this department but we were proven wrong," Nigro said.

So far, 182 members of the fire department have died of illnesses believed to be caused by World Trade Center dust, including 17 this year - more than a hundred due to cancer.

Another 11,000 FDNY members have been certified as sick - more than 2,000 of them with cancer. 

"I think that it's a guarantee that this department will lose more than 343 members post 9/11 due to the illnesses that they contracted due to their work there," Nigro said.

Which means there will be more and more ceremonies like this one. For a department suffering the aftershocks of 9/11 now and in the months and years to come.