Rough Sleepers, page 1
Copyright © 2023 by John Tracy Kidder
All rights reserved.
Published in the United States by Random House, an imprint and division of Penguin Random House LLC, New York.
Random House and the House colophon are registered trademarks of Penguin Random House LLC.
Grateful acknowledgment is made to the following for permission to reprint previously published material:
Jim O’Connell, M.D.: “Prescription for Housing” by Jim O’Connell, M.D.
Reprinted by permission of Jim O’Connell, M.D.
Ben Tousley: Excerpt from “A Song for Barbara” by Ben Tousley.
Reprinted by permission of Ben Tousley.
Library of Congress Cataloging-in-Publication Data
Names: Kidder, Tracy, author.
Title: Rough sleepers: Dr. Jim O’Connell and his quest to create a community of care / Tracy Kidder.
Description: First edition. | New York: Random House, [2023]
Identifiers: LCCN 2022017445 (print) | LCCN 2022017446 (ebook) | ISBN 9781984801432 (hardcover) | ISBN 9781984801449 (ebook)
Subjects: LCSH: O’Connell, James J. (James Joseph), 1948– | Homeless persons—Services for—Massachusetts—Boston. | Homeless persons—Care—Massachusetts—Boston. | Homelessness—Massachusetts—Boston.
Classification: LCC HV4506.B67 K54 2023 (print) | LCC HV4506.B67 (ebook) | DDC 362.5/920974461—dc23/eng/20220420
LC record available at lccn.loc.gov/2022017445
LC ebook record available at lccn.loc.gov/2022017446
Ebook ISBN 9781984801449
randomhousebooks.com
Book design by Susan Turner, adapted for ebook
Cover design: Alex Merto
ep_prh_6.0_142395937_c0_r1
Contents
Cover
Title Page
Copyright
Epigraph
Author’s Note
Part I: The Van
Part II: The Art of Healing
Chapter 1: Conscripted
Chapter 2: Foot Soaking
Chapter 3: Disaster Medicine
Part III: The Pantheon
Chapter 1: Numbers
Chapter 2: A New Face
Chapter 3: The Street Team Meeting
Chapter 4: Angels Without Wings
Chapter 5: The Memorial Service
Part IV: Against Medical Advice
Chapter 1: No Loud Voices
Chapter 2: Upside-Down Medicine
Chapter 3: Death by Housing
Chapter 4: Eulogies for Barbara
Chapter 5: Living Life Backwards
Part V: Searching for Meaning
Chapter 1: A History of Tony
Chapter 2: Inventing a Purpose
Chapter 3: The Social Director
Chapter 4: Autumn Street Rounds
Chapter 5: Success
Part VI: A System of Friends
Chapter 1: Winter Comes
Chapter 2: Tony’s World
Chapter 3: The Beauty of Human Connection
Chapter 4: Sisyphus
Chapter 5: Boundaries and Limits
Chapter 6: The Gala
Chapter 7: The Prism
Part VII: The Night Watchman
Chapter 1: The Worry List
Chapter 2: Button-Down-Shirt Moments
Chapter 3: The Hug
Chapter 4: The Law of Pariahs
Chapter 5: In Boston Municipal Court
Chapter 6: Childhood
Chapter 7: A Free Man
Chapter 8: Confession
Chapter 9: The Night Watchman
Part VIII: The Portrait Gallery
Chapter 1: A Pandemic Season
Chapter 2: The Portrait Gallery
Dedication
Acknowledgments
Sources
By Tracy Kidder
About the Author
_142395937_
Keep watch, dear Lord, with those who watch or work or weep this night, and give your angels charge over those who sleep.
—Attributed to Saint Augustine
I Am
I am sometimes upfront
I am sometimes off-centered
I am sometimes concealed by myself
I am sometimes not even friggin’ there
I am strong as an oak and weak as an acorn
I am a child, love me
I am a boy, take my hand
I am a soldier, so please understand
I am peaceful and proud, humble yet arrogant
I am calm, yet violent
I am quiet, yet thunderous
So if we should meet for a moment on my life’s journey
Smile at me, talk to me, or simply be still
And know that I am.
—Michael Frada,
U.S. Army veteran and for many years a patient of the Street Team
Author’s Note
I have changed the names of many patients.
The following names are pseudonyms, listed under the headings of chapters in which they first appear:
The Van: Johnny, Charlie, Nick, Sandy, Jerry, Jane, Manny, Lou Anne, Allegra, Arnold, Caroline, Jacqueline, Jack
Foot Soaking: Mr. Carr
Disaster Medicine: Bill, Gary, Santo
A New Face: Tony Columbo
The Street Team Meeting: Bo, Mack, Joe Z
Angels Without Wings: Johnny Smith, Harrison, David
No Loud Voices: Art
Death by Housing: BJ
A History of Tony: Isaac
The Social Director: Sally, Timmy, Andy, Jackie, Jane
Winter Comes: Rocky, Angie
The Beauty of Human Connection: Harmony, Jake
Sisyphus: Ronnie, Rabbit, Leon
The Gala: Rebecca
The Hug: John Jones
The Portrait Gallery: Kay, Lena, James Smith, Jimmy Dagget, Jonah Daniel, Bob, Jack, Nat, Dawn, Phyllis, Matthew, Gretel
I
The Van
Around ten on a warm September night, the outreach van stopped in the kind of South Boston neighborhood said to be “in transition.” On one side of the street was a new apartment building, its windows glowing, its sidewalk lit by artful imitations of old-fashioned streetlamps. On the other side, in murky light, stood an abandoned loading dock. A heap of blankets lay on the concrete platform. Someone passing by wouldn’t have known they were anything but discarded blankets. But when the driver of the van walked up the steps and spoke to them, saying he was doing a wellness check, a muffled voice came back from underneath: “Fuck you. Get the fuck outa here.”
The driver turned away and shrugged to Dr. Jim O’Connell, who was standing at the bottom of the steps. “Let me try,” the doctor said, and he climbed up to the platform and knelt by the gray mound. “Hey, Johnny. It’s Jim O’Connell. I haven’t seen you in a long time. I just want to make sure you’re all right.”
An earthquake in the blankets, then an eruption: Tangled hair and a bright red face and a loud voice, saying in a Boston accent, “Doctah Jim! How the fuck are ya!”
For the next half hour, Johnny reminisced—about the alcohol-fueled adventures of his past, about mutual old friends, mostly dead. The doctor listened, laughing now and then. He reminded Johnny that the Street Clinic was still open on Thursdays at Mass General. Johnny should come. That is, if he wanted to come.
Dr. Jim—James Joseph O’Connell—had been riding on the outreach van for three decades. During those years he had built, with many friends and colleagues, a large medical organization, which he called “the Program,” short for the Boston Health Care for the Homeless Program. It now had four hundred employees and looked after about eleven thousand homeless people a year. Jim was its president, and also captain of the Street Team, a small piece of the Program, with eight members serving several hundred homeless people who shunned the city’s many shelters and lived mainly outside or in makeshift quarters. About half of Jim’s administrative work now lay in managing the Street Team, and all of his clinical work went to doctoring its patients, Boston’s “rough sleepers,” as Jim liked to call them, borrowing the British term from the nineteenth century.
The van was a crucial tool for reaching those patients. It was financed in part by the state and managed by the Pine Street Inn—Boston’s largest homeless shelter. Nowadays two vans went out from the Inn each night. They had become an institution, which Jim had helped to foster in the late 1980s. Back then he used to ride three nights a week, usually until dawn. Now he went out only on Monday nights and got off around midnight.
When Jim had begun these tours on the van through Boston’s nighttime streets, he had imagined the world of rough sleepers as a chaos. But it turned out that most of them had territories where they hung around and panhandled during the day—“stemming” was the street term, its etymology obscure. For sleeping, they had favorite doorways, park b enches, alleys, understories of bridges, ATM parlors. Rough sleepers were like homebodies without homes. At the start of a ride, Jim and the driver and the driver’s assistant would trade the names of people they were worried about, and they could usually find each of them within an hour or two. Jim was like a 1950s doctor making house calls, though the van rarely dispensed more than minor medicine. Rather, it was meant for bringing food and blankets and socks and underwear to rough sleepers, and, more urgently, for finding people in distress and bringing them in, if they would come—to hospital emergency rooms or the city’s homeless shelters. The van was also a tool for keeping in touch with patients and their ailments and collecting the unpublished news of the streets.
Like all members of his Street Team, Jim carried a small knapsack, his doctor’s bag, its contents refined and miniaturized over the years. It consisted mostly of basic first aid gear and diagnostic equipment—a blood pressure cuff that wrapped around the wrist, a little pulse oximeter, an ear thermometer, a simple blood glucose meter, a stethoscope. Among the losses he regretted was the pint bottle of whiskey he once carried for the times when a patient was in alcohol withdrawal and on the verge of seizure. “You couldn’t do that now. It’s become a moral issue.”
He wore his cellphone in a holster on his hip, and he carried a small flashlight, thin enough to hold in his teeth if he needed both hands to examine a patient. A flashlight remained one of the Street Team’s essential tools for checking on rough sleepers. Some years back, one patient had asked how Dr. Jim would feel if his doctor came to his bedroom in the middle of the night and woke him up by shining a flashlight in his face. Jim took the issue to the Program’s board of directors, a group of about sixteen, which included experts in health and medicine and finance, and several formerly homeless people. The board convened a meeting of about thirty rough sleepers who issued this advice, long since become policy: The wellness checks should continue, but when they woke people up late at night, Jim and his Street Team should first shine their flashlights on their own faces so as not to startle the patients.
* * *
• • •
The van stops under streetlights on Bromfield Street not far from Boston Common. It’s like a small bus, with several rows of seats, mostly occupied by boxes of blankets, underwear, and socks. In the rear there’s a small canteen, with boxes of sandwiches and condiments, vats of hot chocolate, coffee, and soup. Jim gets out, opens the back doors, and looks around for customers. He has a ruddy face and silver hair that falls almost to his collar and over the tops of his ears. He wears light-colored corduroy pants, a collared shirt, and clogs. He’s six feet tall and trim and moves with an athlete’s self-assurance that makes a task look easy, and his voice is full of energy and cheer as he waits on the customers at the back of the van.
A thin Black man comes wandering into the light, out of an alley.
“You got soup?” he asks.
“Yes!” says Jim, grabbing a Styrofoam cup and filling it from one of the vats.
“You got crackers to go with it?”
“Sure!”
“Isn’t there a doctor who goes with you guys?”
“I’m a doctor,” says Jim. Then he introduces himself, offering his hand.
“I want to change my doctor,” says the man. “I hear good things about you.”
“We’d be happy to take care of you. We’d be thrilled.” The man should come to Street Clinic this Thursday, Jim says, adding that it’s held at “Mass General”—the gigantic Massachusetts General Hospital, not far away, near the banks of the Charles River.
The van makes many stops. It encounters a mixture of people. There seem to be about half as many women as men, and lone women are rare, almost certainly because the streets at night are especially dangerous for them. There are many Black faces, but far fewer than white ones, and this is surprising. Homelessness afflicts Black and Latino people disproportionately both in the United States and in Boston, and one might expect that the same would be true of the city’s rough sleepers. Jim has long worried that the van and other outreach efforts have consistently missed rough sleepers of color, and yet most of the van’s drivers and their helpers are themselves Black and Latino. Over the years they have often searched for their own in the nighttime city. Maybe, Jim thinks, the Black and Latino communities are more willing than Boston’s white world to harbor their homeless. In any case, once people have fallen to living on the streets, they have reached a certain horrible equality.
A young-looking white woman comes into the light on Washington Street, hopping on one foot and then the other, running her hands through matted, strawberry blond hair, all the while feverishly scratching her arms and neck and face. “That’s what people will do on K2,” Jim says softly, as the woman approaches. K2 is synthetic marijuana, which has notoriously unpredictable effects.
Her voice is loud and high: “Holy shit! I got lice! I was exposed to lice and I’m freaking out. I already got all the treatment and somebody stole it.”
“Where did you get the treatment?” Jim asks.
“I bought the shit at CVS, and somebody stole a hundred dollars’ worth of frigging lice removal shit, I got court tomorrow, my mother’s sick in the hospital, dying, and I need to go see her but I’m not gonna go there and expose people. A lot of chicks have ’em and don’t tell.”
He moves closer to her, glancing at her collar as she speaks, looking for lice. (“Scabies get under your skin,” he’ll explain later. “Lice feed on your skin but live in your clothing. If she had lice, they’d have been on her collar.”) He doesn’t see any bugs there, but he never argues in cases like this, where the patient seems delusional. Instead he makes her an offer, phrasing it provisionally, in an evenhanded tone: “Do you want to go to one of the shelters where they can do the treatment? Or no?”
She says she has to see about something else first, but adds, “Thank you, sir.”
“My name is Jim O’Connell. I’m a doctor, actually. So nice to meet you. Let us know if you want to come in.” He smiles. “How ’bout some nice hot soup?”
“No.”
“How ’bout some hot chocolate?”
“Yes! Hey, what kinda sandwiches do you guys have?”
His voice and attentions seem to have calmed her. She begins to tell him some of her life story. It includes an attempted rape, which has left her with a damaged shoulder. “Mind if I have a look?” She does not, and holding her shoulder with one hand, he gently moves her upper arm in several directions. It isn’t dislocated or separated, he tells her, but if she wants a better evaluation, she should come to the Mass General Street Clinic this Thursday. He writes down the phone number of the van, in case she decides to go to the shelter tonight.
“The pull of the streets” is a phrase that Jim and his team have used to explain to themselves why many of their patients leave detoxes and hospitals before their course of treatment is finished—leave “AMA,” Against Medical Advice. Jim says he still feels drawn to these rides partly because of the relative simplicity of the city’s nighttime streets—“When everything else has gone away, and it’s just you and the people there.” The van moves on. Jim stares out the window, at the woman sitting on cardboard under a streetlight, drinking her hot chocolate, eating her sandwich. He adds, “There’s something about the van that keeps you riding on it. It’s never quite the same, it’s always a little different.”
* * *
• • •
I first met Jim in 2014. A friend, a Boston entrepreneur, had wanted to learn about homelessness in the city, and Boston Health Care for the Homeless had offered him a van ride with Jim. I tagged along. I was struck by the relationships between this Harvard-educated “Doctor Jim” and the people the van encountered on the nighttime streets. His patients, and prospective patients, were sleeping in doorways, arguing drunkenly with statues in parks. I had rarely spoken to such people—and congratulated myself when I had. For me, the night’s tour was a glimpse of a world hidden in plain sight. I was left with a memory of vivid faces and voices, and with a general impression of harsh survival, leavened by affection between a doctor and his patients. Afterward, I wondered if I’d misunderstood, or misremembered what I’d seen. Some months later, I contacted Jim and asked for another van ride.
