Mark Rine points to the family photo of his five young children and beautiful wife projected on the wide screen above the stage. Then he tells the crowd of Newark firefighters that terminal cancer likely will kill him soon.
“Let me be the one who dies for you,” Mark Rine exclaims, throwing his hands into the air. “I can’t go back and do the right things to protect myself. All I can do is convince you to do the right things so you don’t lose everything and your family doesn’t suffer.”
Rine thunders away at his latest group of firefighters for more than the usual 90 minutes.
He implores them to wear all their gear until they are completely finished at a fire scene, then to shower immediately afterward before they encounter their family or anyone else.
He rattles off statistics of how firefighters are far more susceptible to some cancers than the general public.
How nearly every burning home is filled with products containing carcinogens and chemicals that can cause cancer if the lungs or skin are exposed to them. And he tells them: If they haven’t been screened for cancer yet, they'd better make an appointment.
Some firefighters, even the older guys known as "old heads," roll up their shirt sleeves or raise their pants leg to check their skin for spots. Others scribble notes, nod their heads or whisper to one another that this presentation is scarier than running into a burning building.
Even in Rine’s own department, there is no formal operating procedure to protect firefighters from cancer. There is no mandate to take a shower or clean their gear and equipment at the scene.
Columbus Fire Chief Kevin O’Connor said there are unwritten rules that his firefighters follow when cleaning themselves after a fire. O’Connor said he is constantly monitoring best practices and implementing cancer-prevention measures within his operating budget.
“There’s no national best practice on some of these things,” O’Connor said. “So we try to make changes where we can based on what we know works.”
Until recently the National Fire Protection Association, which sets standards for departments such as Columbus, had no guidelines on cancer prevention. The agency released standards aimed at cancer prevention for the first time this summer. They do not mention the word cancer specifically, but they lay out increased training and education on chemical exposures and how to decontaminate after an exposure.
Another significant new standard mandates that firefighters across the country wear their breathing apparatus and air tank during overhaul.
Money is another obstacle to better cancer prevention for firefighters.
Many departments operate on flat or reduced budgets that have kept manpower at the same level as in the 1990s.
Cleveland's budget was reduced by $2 million to about $86 million from 2015 to 2016, according to city budget documents. Cincinnati had to rely on about $8.5 million in one-time federal grants to fund its recruit classes for the past two years to maintain its ranks of 850. And it's far worse for volunteer fire departments that have less support than professional units.
Burying too many
Frank Szabo can see the bodies of firefighter brothers in their coffins as he says their names.
The Cleveland Division of Fire, which has about 750 firefighters, doesn’t track how many have cancer.
Szabo’s roles as a battalion chief for Cleveland and as pension and benefits coordinator for the union have put him on the front lines. It’s his job to protect firefighters on a fire scene and, if necessary, help them when they’re dying of cancer.
He’s fighting an uphill battle against a few million dollars in budget cuts in recent years and an eroded relationship between the union and the fire administration. The division promotes cancer awareness with signs in fire stations and periodic announcements from the chief’s office.
“We don’t get the chance much to talk about cancer and what to do about it,” said union President Tim Corcoran.
Unlike similar large urban departments in Columbus and Cincinnati — and shunning national standards set by the National Fire Protection Association — Cleveland doesn’t have firefighters fitted for their own masks that connect to the oxygen tanks.
Instead, the firefighters share the breathing masks they do have, cleaning and passing them from one shift to the next.
Each firefighter depends on the firefighter before to inspect the mask. If firefighters want their own face piece, they must pay $400 out of their own pocket.
And it’s common in many departments that once oxygen tanks are emptied, firefighters simply remove their masks and keep working rather than fetching new tanks.
“Guys don’t want to be seen leaving a structure while their buddies are still inside working and busting their ass,” said Cleveland fire Lt. Sam DeVito. “It’s something in our culture that has to change.”
Earlier this year, Cleveland Fire Chief Angelo Calvillo verbally altered a decontamination plan that allowed firefighters to be out of service for 30 minutes after fighting a fire so they could change and shower. Instead, he ordered firefighters to remain in service to better serve the public and not tax crews in other areas of the city.
Union officials filed a grievance, and both sides are still trying to work out a solution.
Calvillo did not return calls seeking comment.
Awareness of the cancer threat is increasing. According to a Dispatch survey of Ohio firefighters, 50 percent are concerned that cancer could lead to their death. Ten years ago, only 5 percent considered cancer a threat.
Still, 37 percent do not shower within 60 minutes of leaving a fire scene. And about 50 percent said they have only one set of gear to wear to a fire. Firefighters across the state said a second set of gear would help prevent cancer because they wouldn't be wearing dirty gear.
On a gloomy February day, the Newark Fire Department welcomed five new members at a graduation ceremony inside its downtown station. It was the largest graduating class for the city of about 49,000 in decades.
Newark doesn’t provide a second hood for firefighters to wear under their helmets. The hoods protect the neck and jawline, but they also soak up cancer-causing particles. Members of the National Fire Protection Association's safety committee say swapping those hoods out immediately for clean ones after extinguishing a fire can dramatically reduce cancer risks.
The city has done some things to help prevent cancer in firefighters, such as adding wipes to firetrucks and issuing directives for firefighters to clean themselves after a fire. Equipment is stored safely inside fire stations to try and prevent contamination.
Firefighter Jarrad Tracy watched the graduation ceremony from the back of the room.
Tracy, a Central Ohio native, is one of three firefighters out of a 2006 rookie class of 10 in Concord, North Carolina, who were diagnosed with cancer. Doctors found a football-sized tumor in 2007 in his chest after Tracy passed out during a training exercise. Tracy went through treatment for a year. He returned to Ohio in 2012 and was soon hired by Newark Fire.
Concord has since implemented some of the most proactive cancer-prevention measures in the country. The 250 firefighters there are now required to wipe down before they leave the scene. They must shower after every fire. The firefighters change into coveralls at the scene. Their turnout gear is immediately bagged up on the scene and transported for decontamination.
“In Concord I was up in the attic on a small kitchen fire and it was smoldering in the attic, and I’m shoveling stuff through a hole we cut and I’m coughing, my nose is running and my eyes filled with,” Tracy tells them. “All the while, I have an air pack on my back and a mask hooked to the air pack that’s not on my face.”
Would he do that today?
'Something is going to kill me'
It’s 39 degrees just after dawn one April morning, and Mark Rine is the only one walking into Ohio State University's Martha Morehouse Medical Plaza wearing shorts and flip-flops.
He always feels warm, like he has an eternal fever. And it's worse today, when Rine will learn whether the cancer inside him is getting worse.
Rine has blood taken before heading up to the fourth floor to see his oncologist, Dr. Kari Kendra.
Kendra tells him the cancer in his lungs has grown since his last appointment a few months ago. She tells Rine there is no reason to panic.
Rine doesn’t, but Kendra’s second announcement is far more alarming. She is taking him off the chemo drug that has helped keep him alive for several years. There are concerns that the drug is no longer effective because his body has become immune to it.
The hope is that the side effects will lessen, but that is of no comfort to Rine, whose mind wanders to the fear of leaving behind a wife and their children.
He walks out of the hospital taking a cancer inventory in his body.
There are tumors in his spine. Those tumors cause constant throbbing pain in his left leg and occasional pain in his right leg. There are spots in his lungs. And there’s the potential for more cancerous spots on his skin. Each is potentially lethal.
“Something is going to kill me; it’s just a matter of what and how long it will take,” Rine says. “No reason to worry about what I can’t control.”
— Reach Mike Wagner at firstname.lastname@example.org; reach Lucas Sullivan at email@example.com.