I became a big fan of Tracy Kidder after reading “Mountains Beyond Mountains,” his inspiring story of a physician’s heroic efforts to provide care to people with tuberculosis from Peru to Russia. His latest book, “Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People,” once again provides a compelling story of an American doctor serving the poor.
Dr. Jim O’Connell has run a medical outreach program for Boston’s homeless population since the 1980s. The story is both inspiring and heartbreaking. Kidder’s writing allows the reader to get a sense of the experience of people living on the street, as well as the extraordinary challenges associated with bringing medical care to those “rough sleepers.”
O’Connell was recruited out of Harvard Medical School to develop a “Health Care for the Homeless” program. Under his leadership, the program has grown to more than 400 employees and serves more than 10 thousand homeless people a year. The edict of the program was “to seek out homeless patients wherever they lived in Boston and to follow their treatment consistently.” It evolved to include a hospital, street clinic, shelter and outreach van. Many tough lessons were learned along the way, including the difficulty in applying normal medical standards to treatment of those living unhoused. O’Connell describes their work as “practicing something like wartime or post-earthquake medicine.”
Kidder describes the historical “dismissive treatment of homeless people” by mainstream doctors and hospitals. Most if not all of the patients served have experienced severe trauma.
“The typical doctor’s approach often terrified them,” Kidder writes. Three-quarters of O’Connell’s efforts have to do with social work, not medicine. O’Connell describes his work as clearly not “addressing the many root causes of their patients’ misery” but rather “trying to figure out how to ameliorate some of the deepest suffering.”
Rough sleepers tend to have chronic health problems. O’Connell describes them as “broken people, often damaged from infancy.” O’Connell has found that “at least 75 percent had suffered the physical and psychological effects of severe childhood trauma.” Conditions treated by O’Connell include frostbite, tuberculosis, HIV/AIDS, schizophrenia, broken bones, addiction, mental illness and many more. One Street Team member stated “drugs and alcohol are your best friends, and then because they work, you get addicted.” He added “how can you live on the streets without self-medicating? I never could.” These circumstances often lead to premature death.
Kidder writes how, with time, O’Connell learned approaches that led to greater success with his patients, many of which violated the standard rules of medicine. O’Connell spends extensive time with each patient, actively listening, saying little and providing unwavering attention. Long ago, O’Connell began to break the medical school rule of “be friendly but not a friend.” O’Connell states that “if we tried to keep that boundary the way we were taught, we would get nowhere with this population.” He feels that he has “lucked into the best job I can imagine,” because when people have so little, there’s so much he can provide to them, but it’s clearly a difficult job.
“Most of the patients I’ve been close to over these thirty-two years are dead. So, there’s a certain sadness and moral outrage that I can’t get rid of,” he writes.
This sadness is amplified when some in Boston (and around the country) insist that the homeless should be ignored or imprisoned and get angry seeing tax dollars being spent providing services to the people experiencing homelessness.
In addition to medical care, O’Connell’s team helps patients navigate Social Security and state welfare systems, as well as find affordable housing. If a homeless person is lucky enough to get housing, they’re always at risk of losing it. Kidder tells story after story about desperate individuals being evicted and put back on the streets.
Kidder writes that “the modern era of American homelessness began in the 1980s” due to gentrification driving up housing prices and Ronald Reagan blaming the homeless for their plight. Reagan promoted many enduring misconceptions against the poor. According to O’Connell, homelessness represents weaknesses in “our health care system, our public health system, our housing system, but especially in our welfare system, our educational system, and our legal system — and our corrections system. If we’re going to fix this problem, we have to address the weaknesses of all those sectors.”
Remarkably, O’Connell states that “housing turns out to be more complicated than medicine. I wish I had a cocktail of drugs that would cure people of being homeless.”
Kidder spends extensive time telling the story of a “rough sleeper,” given the pseudonym of Tony Columbo. Growing up in Boston, Tony suffered extreme trauma as a child, including being repeatedly raped by a Catholic priest and by a neighbor. Tony was often beaten by his father, who also beat his mother and brothers. The trauma goes on and on. Tony quit school at 16 and proceeded to get into trouble with the law, culminating with his conviction of attempted sexual assault. For this crime, Tony served 18 years in prison.
Upon his release, Tony was required to register monthly as a sex offender, which also disqualified him for public housing support and effectively condemned him to homelessness. Even though Tony is a big guy, he is regularly robbed and suffers beatings on the street. Diagnosed with attention deficit disorder, possible schizophrenia and bipolar disorder, Tony survives through self-medication, imbibing tremendous amounts of drugs and alcohol.
But Tony is also an intelligent, caring person and becomes a favorite of O’Connell and his staff. Tony continuously invents roles for himself to help out at the street clinic and out on the streets and is always striving to protect the most vulnerable.
Tony considers O’Connell, his staff and other patients as his family, the only family he has. He soon becomes the unofficial street clinic “social director.” The stories Kidder tells about Tony are often humorous, as well as heartbreaking. Effectively, Tony is looking for a purpose to keep living. In the end, a life of trauma and living on the street proves too much for Tony, as it does for so many of O’Connell’s patients. After Tony dies, O’Connell reflects, “I just can’t help thinking what he could have been.”
This same reflection is fitting for the bulk of rough sleepers cared for by O’Connell. “Rough Sleepers” does a remarkable job of showing the humanity of individuals experiencing arguably the worst of American society. Readers of this book will likely find it more difficult to quickly ignore the rough sleepers they encounter in their own lives, and may also wonder “what could have been.”
Read more of the Mar. 15-21, 2023 issue.