I start this with a disclaimer that probably shapes what I write. I was born at St. Francis Hospital. My mother lives literally down the street in one direction and I live not much farther in the other. "Does St. Francis have to go away?" is now a rhetorical question. St. Francis has had a large role in my life and the lives of an innumerable number of my friends, relatives and neighbors. As I think about its demise, I find myself feeling angry that it must shut down yet at the same time hopeful about what Lawrenceville will be like after St. Francis is gone.

Chris Briem, who teaches urban economics at the University of Pittsburgh, lives in Bloomfield (cbriem@bellatlantic.net).

Why St. Francis must close says more about how our health-care system is changing than about the details of one more Pittsburgh hospital that will cease to exist.

That St. Francis was not going to be here for the long run has been clear for quite a while. Lawrenceville without St. Francis was not often talked about by those who lived and worked nearby, probably because it was too traumatic an eventuality to consider. But the writing was on the wall as its gradual decline accelerated in recent years.

Without disparaging the quality care that I am sure other hospitals will provide to its former patients, I doubt that St. Francis will ever be replaced. It is a testament to the care that St. Francis provided that even as other local hospitals received recognition as some of the best in the nation, many of the patients in St. Francis would refuse to be treated anywhere else.

A lasting footnote in Pittsburgh history is that the inconceivably wealthy Liberace was treated at St. Francis. More importantly, Abraham Twerski began his long distinguished career in mental health at St. Francis, helping convince the rest of the world that addiction is treatable and saving the lives of many.

These were just some of the more famous highlights of the history of St. Francis. The real history of St. Francis is that it provided service to generations of Pittsburghers regardless of whether they had the resources to pay for the quality health care they needed and received.

What did in St. Francis? It was a dogged persistence at doing what nonprofit hospitals did for years: Help people without trying to build a profit margin. If St. Francis had been a publicly held corporation, the shareholders would have forced it into another more profitable business altogether long ago.

Luckily, the Sisters of St. Francis were not in the business of medicine for profit, or even personal gain. The convent-motherhouse in Millvale has not seen a roof replaced, a repair made or any other renovation paid for from revenues generated at the hospital they built and supported. They will live in retirement under the same vow of poverty they maintained while serving the community.

Before I make the statement that I feel strongest about, I have to say that I am grateful Children's Hospital will fill the void that St. Francis could have left. Lawrenceville and much of the East End -- with a bankrupt and shuttered hospital site -- would have faced an unbearable future and a near-impossible redevelopment project. If I were to guess, the investment in a new Children's Hospital and research center will exceed the size and impact of St. Francis at its peak. The real estate speculation must have already begun.

What I can't fully reconcile is why St. Francis did not have any place in today's health-care system.

If it had filed for bankruptcy, St. Francis would seem to be placed in the category of Enron and WorldCom. Yet nothing would be further from the truth. No deception or theft occurred on the part of wayward CFOs or other executives. Its flaw was not that it could not provide a quality service to the community, just that it did so without a greater goal of building profit, efficiency, size or prestige. That its clientele did not always have the resources or insurance to pay was a reason to give them more care, not less. It didn't work as a business model, because it was not a business model; it was a vocation.

I suppose it does not make sense to have an emotional attachment to the hospital where one is born. Maybe I am strange for even knowing exactly when I was born: a little after 5 p.m., my mother tells me, although she cannot remember the specific room.

St. Francis is one less point of light that many Pittsburghers depended on in good times and bad, providing a service to the community that was needed, appreciated and will not be forgotten.