A Decade of Hope

by Dennis Smith

  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, a
nd 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.

  Our life or our job is made more joyful or sweet because it’s not without risks. You can only achieve positive things if you are true to your basic vision and philosophy. But that is not without risks. It was a risky thing to do to take that patient out of a protective environment; he was intubated and in critical condition. If he passed away in that environment, it would have had no consequence to me or the Fire Department, except that we would have lost a soul. If he passed away during transport, it would have had damning consequences to me and to the department’s Bureau of Health Services, because he would have passed away under our responsibility. These are very tough experiences to live through, but you become stronger because of them. And they just magnify your life.

  On the morning of 9/11 I was doing what I do, and Dr. Kelly and everyone else were doing exactly as always—which was to be aware of the department’s health needs. We immediately saw this is a huge event, with the potential for mass casualties that we might be able to triage or treat. It would be incredibly likely that there would be near fatal or fatal firefighter or EMT [emergency medical technician] events that we would interact with, as liaison or whatever. I cannot tell you that I looked at the towers and said, Oh, 343 firefighters and nearly 3,000 people were going to die that day. In fact, it didn’t occur to me at all, and interestingly, it didn’t occur to me that this was a terrorist event. I only thought, when the first plane hit, that it was an accident, but I knew it’s where I belonged, and so I got in the car. On the way my wife called me, saying she had seen on TV that a second plane had hit. You knew then that something crazy was going on here.

  Dr. Kelly responded from Staten Island; I responded from the Bronx. She got there a little earlier than I did, but both of us arrived after the second plane had hit and before the first tower collapsed. I parked a few blocks north of the command center, which was on West Street. I went down to the command center and reported there, as I’m supposed to. I saw Chief [Peter] Ganci and spoke to him but did not see Dan Nigro [see page 1] until later on.

  In 1993, when the first bombing at the Trade Center occurred, I was not in a position where I could respond. Dr. Jones was then head, and I was really a one-day-a-week lung specialist. I had heard, whether it was correct or not, that there was a doctor who was already in the towers—not a Fire Department doctor, but a regular doctor who had helped a pregnant woman and had set up a little treatment area on one of the floors. I always felt that’s what I would have liked to have done in similar circumstances. You were there to help people, not to watch. So now I kept bothering Chief Ganci, whom I knew: “What can I do?” I realized that he had his job to do, and I couldn’t really bother him too much, because he couldn’t concentrate. To give me something to do, and possibly get me out of his way, he said, “Why don’t you go over to West Street and the South Tower, on the corner, and just stay there, and when victims come out you can triage them and decide what they need? We’ll send one or two ambulances to meet you.”

  As I was walking the few blocks there, I saw what I originally thought was debris and then realized was people jumping off of the towers. When I got there I was met by several EMS—I think two—ambulances, maybe three, and by an EMS chief. He looked around, saw where we were, and said, within minutes of my arriving, “This is not the place where we need to be. There’s stuff falling. We should not be on the sidewalk here. We should walk into the middle of West Street.” Obviously there was no traffic—it had all been cordoned off—so we set up our triage evaluation area there. I, along with the few EMTs and paramedics who were there, followed the EMS chief.

  That single decision saved our lives, because within a minute of our turning around and walking toward the Hudson River, somebody realized that the South Tower was collapsing, or that stuff was falling. I was looking away from the tower, and when all of a sudden people in front of me started running toward the water, I said to myself, What are these cowards running for? What’s going on here? We’re going to start the triage center, so why are they running? But you get this sort of herd mentality, and so I started running too, toward the water. It was surreal—I’d never been in war, I’d never been attacked, I’d never experienced a tsunami or hurricane or earthquake or a volcano eruption. So this was a first for me. You hear about experiences in which your life flashes by you in an instant. It is so true. As I was running across West Street I was going over in my head several things, again and again. Number one, I was saying to myself—and I can remember it like it was yesterday—was though I had not seen the tower collapse, I hadn’t heard anything either. I have no auditory memory of this at all. I remember the sheer silence afterward, but I don’t remember whether the collapse was loud or silent. All I have is people in front of me, and alongside of me, running, and stuff falling all over me and, literally, beams to the left of me and to the right of me. And I said to myself, over and over again, I have shown up here, and I’m going to get killed, and I have helped no one. This isn’t fair. In the short period of time getting across West Street, I must—at least in my memory—have said that to myself a million times. The other thing I said to myself was that my wife knows I’m here, but she is not going to be able to survive without me. My wife had some medical problems, and I just felt that I was now dying, I had helped no one, and I was hurting my wife in ways that no one could imagine. And this just seemed unfair. And then, before I knew it, I didn’t actively jump, but I was blown what felt like halfway across West Street. I became engulfed in debris that was falling and falling and falling, and I thought it was never going to stop.

  And then I remembered—this is how stupid you can be, or how stupid I was, because I never try to play firefighter, but I do listen to patients—one guy who came to me maybe twenty years before, and he had a knife on his belt. Firefighters don’t come in uniform when they see you unless they are injured on the job. He was not uniformed, but I was wondering why he had such a large knife on his belt. And he told me that a firefighter always needs a knife, because if you got caught in a building collapse, what you needed to do is to get down on all fours, cut a hole in the carpet, pull up the carpet, stick your head under the carpet, and suck out whatever air you could until somebody came and found you. I have no idea whether this is true or not, but I remembered it as I was being engulfed with all this stuff. A firefighter would know how humorous this is. I had no knife, and below me appeared to be asphalt, so I wasn’t going to be cutting a hole in anything to get air. But this story came back to me, and I said to myself, I need to create an air pocket so I can survive. Somebody will find me. The Fire Department will rescue me. They don’t know where the hell I am, but they rescue everybody else, so they’re going to rescue me. I was 100 percent convinced of this. I’m telling this because I find it unimaginable that a person could have these thoughts during this event. I am amazed at how these thoughts occur.

  So—stuff was falling, I had no idea where I am, and I was wearing everything that I preached a first responder should not wear
in a disaster: a sports jacket, a tie, pants, and regular shoes, along with a stethoscope. I had no hard hat—no hat at all—no gloves, no respirator, no SCBA [self-contained breathing apparatus], nothing. I was doing exactly what you should never do in a disaster, which is to take an asset and convert it into a liability. My training made me an asset, but now, caught in this disaster, I was a liability.

  I had no idea where I was except that I was somewhere on West Street. I could barely breathe with so much dust, and I couldn’t see anything at all. I knew there was stuff above me that I couldn’t seem to get out from under, because it just kept coming down, and I ended up lying prone, facedown on a hard surface, which I later found out was actually the asphalt on West Street. But at that time I didn’t know. And I got it into my head that no matter how hard it was going to be, I was going to get on all fours. I was going to lift myself up. Obviously I could not stand up to run away, but that’s what I would have loved to have done. I was caught in all of this debris, but I was going to get on all fours, because then there would be an air hole underneath me that I could live off of until somebody came and rescued me. Now, the stupidity of this notion did not occur to me at the time.

  I was now suffering greater injury, with more stuff getting at my head, because I was not protecting it, and this air pocket that I tried to create just got filled in with dust and debris. But I survived. Everything stopped suddenly, and I was able to crawl out from between crevasses. It seemed that Sheetrock or plywood or beams of some sort must have fallen in a way that created a sort of roof for me. In addition, I was lucky enough to have been blown, or almost catapulted, to the end of West Street, directly under where the pedestrian bridge meets the ground, so there was a sort of natural crevasse that also must have protected me. When you hear on the radio that they had spent, like, $12 million to build a narrow pedestrian bridge over a highway, and you say to yourself, How could that possibly have cost $12 million?, I now look at it as money well spent. Build those things as strong as you can. Again, I didn’t figure this out in advance; I didn’t purposefully aim to be shielded by the bridge. I just ran across the street and got blown under the bridge. I was just lucky.