Award-Winning Author Tracy Kidder’s Rough Sleepers Focuses on BU’s Jim O’Connell
Tracy Kidder, left, wrote his latest book about the work of Jim O’Connell, a BU doctor who has treated unhoused patients for almost 40 years. Photo by Robin Lubbock/WBUR
Award-Winning Author Tracy Kidder’s Rough Sleepers Focuses on BU’s Jim O’Connell
New book explores Chobanian & Avedisian School of Medicine associate professor’s decades-long career caring for the homeless
“Jim met an elderly man who looked fairly normal until he took off his hat at Jim’s request, revealing a grotesque-looking cancer that had invaded his head, paralyzing the left side of his face. That patient had been a professor at MIT, had suffered a psychotic break, and had been living on the streets for years, no one noticing or caring to notice what must have started as a small, easily treated basal cell carcinoma, now metastasized into an overspreading, fatal growth, which had reached his spine.”
Jim O’Connell, assistant professor of internal medicine at BU’s Chobanian & Avedisian School of Medicine, has spent almost 40 years caring for people living on Boston’s streets. His career is the subject of bestselling author Tracy Kidder’s new book, Rough Sleepers (Penguin Random House, 2023). O’Connell began his mission in 1985 as founding physician of the Boston Health Care for the Homeless Program (BHCHP). Today, he and BHCHP staff continue to make house calls on the unhoused, serving more than 11,000 people annually.
“Whenever I’ve met somebody on the streets, my first impression was inevitably completely wrong,” O’Connell tells BU Today. “As you got to know them, you started to see emerging these stories of real courage against unbelievable odds. And I don’t think we get a chance as members of society to see that very often because of the barriers between us.”
Kidder, a Pulitzer Prize and National Book Award-winning writer, shadowed O’Connell and his team for five years, including nocturnal van rides ministering to “rough sleepers” (the 19th-century Britishism for unhoused people). The book recounts O’Connell’s career shift in 1985 from an impending oncology fellowship at New York City’s prestigious Memorial Sloan Kettering Hospital to helping create the Program, of which he is president today.
BHCHP operates clinics at Boston Medical Center and Massachusetts General Hospital and in more than 45 shelters and sites in Boston. BU Today spoke with O’Connell, a Harvard Medical graduate, about the seemingly intractable crisis of homelessness. The interview has been edited for length and clarity.
Q&A
With Jim O’Connell
BU Today: How did you and your team spend that record arctic chill in Boston last month?
O’Connell: We were desperately worried. But the city and the state have been fantastic in situations like that. The Pine Street Inn [shelter] has outreach vans, which I think is the world’s most undersung and heroic venture. It goes out every night from 9 until 5 in the morning, every night of the year. During a cold time like that, they’re out most of the time.
Our teams were out during the daytime and part of the night. The EMS would stop and see people and offer them a way to come in, as did the police. The shelters just opened up—it was what they call amnesty; everybody could come in. For those tough, hardcore street folks, even South Station let people come in and stay. The train stations turn out to be, particularly for those with severe mental illness, places where people can feel comfortable, those who won’t go into the shelters. They’re big, open places; there are bathrooms [and] coffee shops. It was life-saving to have that all coordinated with a lot of help from the governor. I don’t think we had any bad outcomes that evening at all.
BU Today: Homelessness surged in the United States as a result of the Reagan Administration’s cut in poverty programs in the 1980s. Yet your team’s psychiatrist says in the book that most rough sleepers have experienced mental illness and/or substance addiction. Which do you believe is primarily responsible for homelessness?
O’Connell: I go down two paths.
How do you take care of the people who are currently homeless? There’s a bunch of people who, for complicated reasons—where they grew up, schooling, welfare problems, foster care issues, corrections issues–—they’re not there because of their own fault. It’s almost always due to a structural inequity—racial, poverty, all the things you can imagine. Shelters are absolutely life-saving. If you live in a shelter—basically in most cities around the world—you die at four times the rate of someone the same age in that city [who is not experiencing homelessness]. But if you’re living on the streets, you die at three times again that.
But [are shelters] solving homelessness? No. These are the people where the hurricane has already destroyed their lives, and we have to take care of them. The real issue is stopping the flow of people becoming homeless. That’s where we need to look at how we build housing in safe places with enough support for people to be taken care of. If you look at homelessness as a prism that you hold up to society, what you see refracted are the weaknesses in many sectors: our health sector, housing sector, corrections and justice sector, particularly our education sector, and in our social services sector. Those are the things we’re going to have to fix if we hope to stem the flow of people coming into homelessness.
We have to do both.
BU Today: The book offers personal portraits of many of your patients, especially Tony Columbo. Can you tell us about him?
O’Connell: Tony had a particular charm that you couldn’t ignore. He had spent a long time in prison and was now homeless. I remember being at the Mass General street clinic; he came in late in the afternoon and needed like a hundred different things. Eventually, I had to walk him to a pharmacy and get his medication ’cause he had no identification. During all that, he really got under our skin. He just was a wonderful, lively human being, really bright, and really determined to make his life better.
He was living on the streets. He came into (Barbara) McInnis House, our respite program, where people who have been in the hospital and are ready for discharge but are too sick for the streets or shelters can receive 24-hour medical care. He would animate the entire place. Helping everybody out. The kitchen staff, nurses loved him. He would be letting us know what could be fixed and what couldn’t. He could also be a little bit of a pain in the neck; sometimes, you don’t want to hear all these criticisms.
When he was outside—he was a big, tough guy, but a gentle soul—nobody messed with him. He took it on himself to protect the weak outside, particularly the women. The women called him their “night watchman.” The role he had was touching and profound and really sad, because you kept thinking, if we could just get him into the right setting, he could be really productive. But all the long time in prison and the limitations to housing when you have those charges meant that he was kind of doomed to be on the streets.
BU Today: I have heard advocates for unhoused people differ on whether you should give pocket money to those who ask for it on the street. What are your thoughts?
O’Connell: For me, it’s an important but nerve-wracking ethical decision. When I started, I was trained by Barbara McInnis, this amazing nurse, and Kip Tiernan, founder of Rosie’s Place , and the first thing Kip ever said to me was, “Give me five bucks. I’ve got to give it to this guy. He needs to get a pack of cigarettes.” Barbara would give money to people to go get a cup of coffee. Then I was close to Paul Farmer [the late co-founder of Partners in Health]. Paul used to say, “Are you kidding? If people are poor and have nothing, give ’em a chance.”
It’s arguable whether that’s a good thing or a bad thing. We’re trying to get [people] to come to McInnis House. That’s where I became acutely aware that these are people who have literally no money in their lives, nothing. They couldn’t even get a candy bar out of the machine. I used to give them a handful of quarters so they could, like everybody else, use the machine, get a sandwich.
I have never given enough money so that somebody’s going to hurt themselves with it. We’re careful about who we do and don’t give money to. The issue gets down to the core of who we are. In our program, we actually ask our staff not to give money out, because it sets up a difficult dynamic.
BU Today: To steal Jesus’s phrase, will we always have unhoused people with us?
O’Connell: The longer I’ve been in homelessness, which is getting near 40 years, I know less about it than what I thought I knew about it back in the beginning. It is incredibly complicated, a collision of so many forces. I do know that we’ll never solve the problem without adequate housing. But do I think just adequate housing alone is going to solve the problem? I don’t think so. These people have lived through inordinate challenges. About 25 percent of men on the streets could not read or write. What went wrong in their lives? It always goes back to trauma when they were kids, neglect in schools, ADD and learning disabilities that were not recognized, and then they get funneled through the system and get spit out of the other end with no skills, no ability to fit in.
We, as a society, have to either fix that or acknowledge we have to take care of those folks. We have a vibrant, good society, but part of our own duties is to take care of those who are less fortunate. We are going to have people who struggle always, but it doesn’t mean we can’t take care of them.
BU Today: What’s it like to have a writer of Kidder’s stature tell the story of you and your life’s work?
O’Connell: Tracy’s a fabulous writer. I was devoted to his Mountains Bend Mountains, which was about Paul Farmer. Paul lived this magnificent, off-the-charts life. When Tracy said he wanted to write about us, I kept thinking, this is going to be so boring, compared to what you’re used to. When I would be on a panel with Paul, he would introduce me as this poor doctor who never got more than a mile from medical school. But he would always come back and say, “They’re finding, a mile from medical school, exactly the disparities we’re finding in Haiti and Peru.”
Tracy became part of our team for five years. Within weeks or months, we didn’t realize he was there writing. I will say, though, if you’re going to let somebody hang out with you for five years, just remember that in five years, you could say a lot of really stupid stuff. And you don’t know if it’s going to show up in a book or not.
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