1917 Fire

February 18, 2013, 7:53 p.m.  When I clicked my cell phone to take the call from Jim Raper, the first words I heard were, “The house next door is on fire!”  I’d not yet gotten out “Oh no, Jim, are you and Scott okay?” when Jim continued:  “I’ve been telling them for years, Mike.  They wouldn’t listen.  And now it’s in flames and the clinic is in jeopardy.”

Then I got it:  Jim wasn’t at home.  He was at the clinic.  He was referring to the dilapidated, two-story wooden tinderbox building adjacent to the 1917 Clinic building.  For more than 10 years, Jim had pleaded with city officials to condemn the building so it could be torn down.  No response.  Repeatedly.  He went to UAB officials who said there was nothing they could do.  We joked that it proved health care wasn’t the only screwed up system in America.

“It’s gonna burn down, Mike, and it will take the clinic with it.  It’s only a matter of time.”

The building wasn’t just adjacent to the 1917 Clinic building; it virtually abutted the clinic building, less than a foot of space between its rotting wood wall and the brick exterior of our clinic.

During the 20-minute drive to the clinic, all I could think was, “Jim’s prophecy came true.”  I envisioned the clinic engulfed in flames.  I began a mental inventory.  The clinical data was safe because it was stored off site.  Many of the office contents could be replaced—the equipment, the computers, the furniture.  But science depended on the 400,000-plus specimens in the repository, which I began collecting in 1986. I thought about the letters and keepsakes from patients and families. The artwork created by patients and donated to the clinic, including the chalk pictures Brian had drawn for me while he was blind. Gone. Irreplaceable. Senseless, preventable, foreseeable loss – all of it.  No one had cared enough to do what had to be done.  Including me.

As I drove up, the streets surrounding the clinic were blocked off.  The air stank of smoke, and I could see it billowing into the night sky, illuminated by the orange flames below.  I got out of the car and headed at a trot toward the building.  When a policeman blocked my path, I told him, “I work here, I need to meet with the UAB officials on the scene,” and he waved me through.

As I rounded the corner I saw Jim, staring at the scene in disbelief.  Firefighters were on all sides of the burning building, pouring enormous amounts of water on it—and, to my great relief, an equal number of firefighters were on the roof of the clinic building, hosing it down to keep it from catching on fire. The clinic building was mostly unharmed.  We had dodged the bullet.

When I went by Jim’s office the next day to see how the clean-up of the clinic was going, he turned toward me with an anguished look.

“They found three bodies in the rubble, Mike.”

Squatters had moved into the building. To escape the 25-degree, wind-chilled night, they’d probably started a fire to keep warm and it went out of control.

 “These people are dead because we couldn’t get the job done,” he said.  “They were seeking shelter they couldn’t get elsewhere.  And now they’re gone.”

Our nation’s healthcare system is like the abandoned building that until recently stood next to our clinic.

In the 1950s, the building housed the office of a family physician, Dr. Rhett Barnes, who also lived in the house.  I bet Dr. Barnes provided compassionate care to his patients.  In the custom of the day, he probably accepted whatever payment his regular patients could provide—and if they couldn’t pay, he’d see them anyway.  That was the way physicians practiced in those not-so-long-ago simpler times.  There was less they could do technically—fewer drugs, simple X-rays, no CAT scans or PET scans or monoclonal antibody therapeutics.  But they were their community’s healers, public servants who took pride in making house calls on stormy or freezing nights.

That bygone approach to health care has been abandoned as surely as the tinderbox Dr. Barnes left behind.  In comparison with what once existed, the structure that remains is barely recognizable.  We can see it is a building.  But it is a building in serious disrepair, ready to burst into flames at any moment, taking with it all the unfortunates who seek shelter there.  Is this “the finest in the world,” the pride of America? Can we even say this is consistent with our political, moral or religious principles?

In the days after the fire, the local newspaper identified the men who died. As county residents, they would have sought care at the county indigent hospital, Cooper Green Mercy Hospital. But two and a half weeks earlier – February 1, 2013 –Cooper Green had closed.   Among other displaced persons were all 800 HIV patients being seen at its outpatient clinic, all of whom were transferred en masse to the 1917 Clinic patient rolls.  We absorbed them into our clinic as best we could, stretching staffing and resources that were near the breaking point already.

When asked about the fire, Birmingham’s mayor was quoted as saying, “Condemning that building was on our short list in the short term.”

I suppose lawmakers in Washington will say the same thing if asked about the nation’s health care infrastructure when it goes up in smoke. Like the tinderbox next to our clinic, it’s a disaster waiting to happen. When it does, who will we blame for the truth: no one had cared enough to do what had to be done, including us?


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