Rough Sleepers: Dr Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People

Book Title: Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People

Author: Tracy Kidder

Publication Details: Random House, 2023, 320 pp., $30, hardcover

More than 500,000 people in the United States are homeless. This number does not include housing insecure individuals who couch surf or are at risk of eviction. Tracy Kidder, in his latest book, Rough Sleepers, does for the homeless population what he did for global health in his landmark book Mountains Beyond Mountains, ² when he followed Paul Farmer around the world. This book is deeply experiential, too. Kidder spent 5 years intermittently shadowing Jim O’Connell, an internist who has dedicated his career to caring for homeless persons.

The term “rough sleepers” is borrowed from England and describes what happens when one sleeps in doorways, in makeshift tents, or on sidewalks. Kidder captures the traumas people face along the journey to living outside. Readers learn about substance use, mental health, and bad luck leading to homelessness and vice versa, homelessness contributing to this unfortunate triad. Kidder is a Pulitzer Prize winner, and it shows. He takes time to describe how even former professors can end up on the street. The book is not for the faint of heart as it contains many tragedies, yet it also contains moments of hope.

The book is an origin story. O’Connell stumbled into this work, committing to a 1-year postresidency placement before a planned fellowship. He spent months caring only for the feet of patients, a baptism the nurses insisted on to humble the heady Harvard graduate. The book is also an inspirational story. Readers witness O’Connell doing outreach, at night, squatting down doing what he does best: listening, joking, building relationships, and working hard to convince people with deep distrust of our systems to seek some assistance. He is everywhere—providing care, running Boston Health Care for the Homeless Program (BHCHP), ³ raising money, giving talks, and advocating for everything from keeping subway stations open at night for a dry place to sleep to creating more affordable housing.

As much as the book is about Dr Jim (as locals call him), it is also about his team, the creation of BHCHP, and other dedicated clinicians. Kidder is committed to his craft. Readers get statistics about poverty and homelessness, and details of the evolution of BHCHP from treating hundreds to now caring for 10,000 people. The organization serves as a national model with its hospital service, 30 clinics, respite, and outreach programs.

The most powerful moments include the regulars that Kidder meets. These are chronically homeless men and women. As a physician for people experiencing homelessness myself, I am in awe of how Kidder takes the time to make the frustrations of this work come alive. He follows a number of regulars throughout the book. BJ lost his leg to frostbite and gets around by scooter. Rocky is dying of cirrhosis. Others, unnamed, are suffering in the cold. Particular attention is given to Tony C, a tragic figure who cycles in and out of sobriety. Through his story, readers truly get a view of the intersectionality of self-inflicted injury, mental health issues, and substance use disorder contrasted with systemic shortcomings.

The author does not shy away from revealing the complexities of heroism. Just as readers learned the costs of Paul Farmer’s work on his personal life, they learn that when Dr Jim hands a few dollars to a patient in need, it undermines the boundaries his fellow clinicians are trying to maintain. So too, the hardships of unforgiving work are on display. As O’Connell puts it,

This book should be shared with premed students to illuminate the dedication within social medicine. Medical students and residents will cherish a copy, too. This generation wants to serve the underserved—refugees, prisoners, and addicted individuals. For learners and faculty, the book is a reminder to offer one’s sincerest care to those who receive the least attention. Dr Jim’s example may offer practicing physicians who are facing burnout an idea for career change. Readers will learn and benefit from the descriptive and thoughtful prose of Tracy Kidder. I listened to an audio version read by the author. Having met Kidder years ago, hearing his voice conjured his kind spirit and made the experience more personal. This book paired with O’Connell’s own Stories From the Shadows ⁴ would make a great gift for anyone interested in the underserved.