A Decade of Hope (6 page)

We know a fair amount about the radicalization process, where people start, how their ideas change, and when they decide to commit jihad. We are learning more and more about it, but it's no easy task, because we have also seen people who have just radicalized themselves. There are others who have been radicalized by a “sanctioner.” If you look at the case of eighteen young men in Toronto, their sanctioner was in essence a custodian in a mosque. Do we see it as a problem in the United States? Yes. But we don't know what we don't know.

When you search for the indicators to identify someone who is going to decide to kill other people, they don't jump out at you. Whom do we watch? What are the tipping points where people will decide to inflict violence ? They're not easy to see. We have thousands of people who come here on a student visa. It is probably a good thing overall for this country to have student exchange, but how do you vet them? There are thirty thousand students from Saudi Arabia going to school in Western countries, most of them here.

It is very, very hard to predict where we will be in the future, and no really thoughtful people have come out with anything definitive. A lot is based on economics. People want jobs, but there are no jobs at the end of jihad. If they change their government, that doesn't translate into jobs. So what does that mean? It means more frustration, more uncertainty. Is that an opportunity for the Muslim Brotherhood and other groups like that to come in and take over? Perhaps. We don't know.

One thing we have not seen in all the Middle East turmoil is American flags and Israeli flags being burned. So if you had to pick out one reason for upheavals in the Middle East and in Africa, it is that people want to advance economically. But there's no real structure in place to do this. The only country with the resources to make a difference in other Arab countries is Saudi Arabia, and they haven't really shown the propensity to do that sort of thing so far. Nobody knows the direction these countries will take. Look at Iran in 1979. They got rid of the shah, supposedly for all the right purposes, but the effort was subverted and was captured by radical Islamists. Could that happen today? Yes, it could happen. What do we do about it? It's going to take generations to change this jihadist thinking. My sense is, they are looking for the goods they see everywhere, but these are poor countries, and they are not able to change overnight. If a high-tech economy comes to them, it's going to be well down the road.

Let's assume democracy breaks out. It's a pretty messy process. The reality is that having somebody like Mubarak sit on the top of the Middle East and provide stability was a good thing for us. It's nice to espouse the virtues of democracy, but there are a lot of countries that aren't ready. George Will asked recently, “Would you want to see democracy in Pakistan?” If there's some semblance of democracy that breaks out in certain countries, it doesn't necessarily bode well for us at all. Why? Because the strongman model has worked reasonably well for stability in the Middle East. It's worked reasonably well for the United States. It's worked reasonably well for Israel. Getting away from that is just uncharted water; nobody knows what the result could be. And could these democratic efforts be subverted and negatively change the direction of a country? Absolutely. If it's going to change inevitably, what do we do? We can't necessarily change the tide of history.

I'm not saying everything depends on our military strength, but it's kind of the big guy you need standing behind you. Talk softly and carry a big stick. Our military is the big stick that we've depended on in the past. I think the world might sense the reluctance on our part to use justified, legitimate force, based on the reaction of the American people. The polls show that a majority want us out of Afghanistan, and there's no discernible benefit so far with what's happened in Iraq. Yes, there's some form of democracy, but who knows what that all means down the road? Do we have the will? It may have been undermined by what turned out to be the longest war in our history.

Dr. David Prezant is the chief medical officer of the New York City Fire Department. After the first plane went into the North Tower, he headed for the World Trade Center from his hospital in the Bronx. He soon helped set up a triage station on West and Liberty streets, less than a half block away from the South Tower, the first tower to fall. When it did fall, the building came down in eight seconds. He only remembers seeing people running before he was blown off his feet and thrown through the air.

 

 

 

I
was born, according to my parents, at Bronx-Lebanon Hospital, which is on the Grand Concourse. And I lived in that area around the Grand Concourse for the first six years of my life, roughly. We then moved closer to Montefiore Medical Center on Mosholu Parkway, and I started school at PS 80. I had always hoped to go to Bronx Science, but when I was going into fifth grade we moved to Yonkers. There I finished grade school, and then went to Lincoln High School, a normal high school with no science specialization. From there my parents told me that I could go to the college of my choice, but they had only a limited amount of money. I didn't want to burden myself with loans, so I had to think about whether I wanted to go to a state school or a private school. I got into all of the state schools in New York, but I also got into Columbia, which is where I decided to go.

To be closer to campus, I moved to my grandmother's apartment on the Upper West Side. And it was a great experience because (a) I didn't really have a commute, only a five-minute subway ride, and (b) I was able to have the full college experience, with everything right there. Also, I got very close with my grandmother, which was just a very big benefit. Most of us don't live in an extended-family world anymore, and I'm glad I got the chance to do so, because my grandmother was a great person.

I didn't always know that I was going to become a physician. I knew that I was going to do something in science but was not quite certain what. I majored in biochemistry, and originally I thought I was going to become a PhD scientist in biochemistry or organic chemistry—what a mistake that would have been. But I was convinced that chemistry was my calling. I was incredibly wrong.

Many people think parents want you to become a physician, and I can tell you with 100 percent honesty that in the beginning that was not the interest of my parents at all. They did not care what I chose to do, but based on their own life experiences, they did feel that happiness required a certain amount of security—not money, but security, the ability to control your own destiny and make your own decisions. My dad had always wanted to do certain things but was impoverished growing up, and he did not want the same thing to happen to me. He felt that if I went into chemistry that I would become an automaton, and pharmaceutical companies would just use me and spit me out. And he was probably right. Only a few very brilliant people can really control their own destiny in that industry. And so after a while he lobbied very hard, in a way I found distasteful at times, for me to go to medical school. I hated what he said at the time, but as usual with parents, he was absolutely correct.

So I went to the Albert Einstein College of Medicine in the Bronx. It's a great medical school, but I was completely uninterested for the first two years, at best an average student. However, when I got onto the wards and started seeing patients, I realized how great this field could be, and how you could change things for both individuals and, through teaching and research, for large numbers of people as well. I realized that I wanted to specialize in internal medicine, and did my internship and residency at Harlem Hospital, because I wanted a place where I could learn a lot, and where I really could make a difference. I wanted to be in an impoverished area, where interns and residents were used as physicians, something that is not too commonly practiced in this day and age. At that time, although we had supervision, we were really doing it all ourselves. I was there for three years, and then I went back to Einstein–Montefiore Medical Center to do a pulmonary fellowship to become a pulmonary critical care specialist.

While at Montefiore, the main teaching hospital for Einstein, I ended up meeting two physicians who worked for the Fire Department. One was Dr. Fell, who was a chest surgeon, and the other one was Dr. Rosenbloom, who was a cardiologist. I was not part of their sphere, being a pulmonary doctor, but we'd interact, and we seemed to get along well. By the time I finished my fellowship I was married to a woman who already had two children, so I had substantial financial responsibilities. But I did not want to go into private practice; I wanted to continue doing research and teaching and taking care of patients in a way that did not involve worrying about how much time I spent with them, or billing, and all of those things. I graduated in 1986, a pulmonary physician, and was offered by Einstein the standard rate for an academic pulmonary physician, which is fifty thousand dollars. That is not a lot of money today, and was not even a lot of money in 1986, especially if you have a wife and two children. So I was thinking about what other side jobs I could take, and I remembered that I knew these two Fire Department physicians. Wouldn't that be interesting? The Fire Department must need a lung specialist, with all that smoke inhalation. So my FDNY doctor friends called up Dr. Cyril Jones, who ran the [FDNY's] Bureau of Health Services at that time, and it seemed like [he had] the perfect job for me. I could see all of their pulmonary patients in one day. I could choose a weekend day, so it wouldn't interfere with my work at Montefiore. It would supplement my income and allow me to provide some important service back to the city. And finally, it would enable me to help people in such a noble position as firefighting, where they get smoke inhalation, asthma, and other maladies in order to save lives.

And so that is how I got the job with the FDNY. It was a phenomenal way to give something back to this great city.

In the midnineties, Dr. Jones retired, and the Fire Department began looking for a more state-of-the-art facility, one that would be more actively monitoring and treating—things that I had been doing on my own but that most of the Bureau of Health Services was not doing. Dr. Kerry Kelly then became the chief medical officer, in 1994, and I became the deputy chief medical officer. Today . . . Dr. Kelly is chief medical officer of the Bureau of Health Services. I'm chief medical officer for EMS [Emergency Medical Services] and special adviser to the [fire] commissioner on all health matters. Both Dr. Kelly and I are codirectors of the World Trade Center Medical Monitoring and Treatment Program.

Dr. Kelly's specialty was family practice, and we formed a great partnership. She lives and breathes the Fire Department. Her grandfather was a fire chief, her father was a lieutenant, and she has many cousins on the job. I think of her almost as a Mother Teresa for the Fire Department. She really wants the best medical care for the firefighters, and she's allowed me great latitude in my work. Sometimes a leader is really only interested in leading, but Dr. Kelly is interested in taking people along and allowing them to become the best they can be.

I have a lot of interests, and she has encouraged all of them. Together we developed a medical group practice in an occupational health setting so that we could offer our firefighters state-of-the-art medical care. As a doctor in a large organization, you can easily be labeled the company doctor, and the only way to avoid that label is to constantly practice state-of-the-art medicine. We do not make duty-status decisions in favor of the patient or the department, but medical decisions, and then the duty-status decisions just follow.

I got interested in protective equipment to reduce burns, because the major injury among firefighters was various degrees of burns. We did fascinating studies with bunker gear [outer protective clothing], showing that it reduced burns. These studies got me to know [both] management and [the labor unions] better and develop credibility with them. We did medical studies, and the union leaders, who were very savvy about safety, realized that if you practiced the best medicine it would benefit everyone in the long run.

It was not a question whether I would respond to the World Trade Center on 9/11—it was just a fact. I'm a lung specialist, but when Dr. Kelly and I took over the leadership of the Bureau of Health Services, one of the responsibilities that was unique to the chief medical officer and the deputy chief medical officer was trying to help out when firefighters and EMS workers who worked for the FDNY were perilously injured. So since the midnineties I have been responding to any life-threatening emergency for firefighters. I could go to all the major-alarm fires, because I'm a leader and I have a command presence, but that's not my interest. I love firefighters, and my mom always told me that my two favorite places to visit as a kid were the Bronx Zoo and the local firehouse. I don't like to just stand around fires, but I do go whenever there is a life-threatening injury or the significant potential for life-threatening injuries, or whenever I think I might be of help in a mass disaster. My job gives me that freedom and responsibility. The toughest moments, but the best ones, for Dr. Kelly and me have always been when a firefighter is fatally or near fatally injured, because we are really able to help that family and that person. Anybody who has seen us do that realizes the immense benefit that we bring to them, to that situation.

Before 9/11 there was a fire chief who had a very serious smoke inhalation event, and he went into respiratory distress. He was intubated at the scene and was taken to a small hospital. I arrived shortly afterward, and the medical care was excellent, but it rapidly became evident to me that their ability to provide the same high-level medical care throughout his hospital admission, especially at nighttime, was not going to be what this patient needed. And therefore I went into the waiting room, and I introduced myself for the first time to his wife. It's a situation in which I had not been that patient's physician, I'd never met the family, and I was now asking that his wife trust me and my advice that, despite the potential for additional new life-threatening consequences, we should take this patient and move him to a different hospital. As I was trying to explain to her why she should trust someone she had never met, she interrupted me and said, “You can stop talking now, I know who you are, and we're going to do whatever you say.” To this day, that is the greatest moment of my life, because it just sums up everything. It sums up the sense of a career in which you're trying to do nothing but help people. Luckily God was watching over me then, and the chief had a great outcome, and is now living a completely normal life.