“Rough to Sleep” by Tracy Kidder


Kidder’s newest non-fiction work follows Dr. Jim O’Connell, founding father of Boston Well being Look after the Homeless, in his work to offer medical care to the town’s homeless.

Dr. Jim O’Connell helps distribute soup to a member of the Boston homeless neighborhood in entrance of South Station in Boston, Massachusetts, on January 11, 2023. Carlin Steil for The Boston Globe

From the e book ROUGH SLEEPERS: Dr. Jim O’Connell’s Pressing Mission to Convey Therapeutic to the Homeless by Tracy Kidder. Copyright © 2023 by John Tracy Kidder. Revealed by Random Home, an imprint and division of Penguin Random Home LLC. All rights reserved.



At about 10 o’clock on a heat September evening, the outreach van pulled up in a sort of South Boston neighborhood that was stated to be “in transition.” On one aspect of the road was a brand new condominium constructing, its home windows alighted, its sidewalk lit in inventive imitations of outdated road lamps. On the opposite aspect, in a mysterious mild, was a abandoned loading dock. A pile of blankets was positioned on a concrete platform. Nobody would have recognized that they had been something however discarded blankets. However when the truck driver got here up the steps and spoke to them, saying he was doing a well being examine, a muffled voice got here from under: “F*you. Get a f*outa right here.”

The motive force turned away and shrugged at Dr. Jim O’Connell, who was standing on the backside of the steps. “Let me attempt,” stated the physician, and went as much as the sidewalk and knelt beside the grey mound. “Hello, Johnny. It is Jim O’Connell. I have never seen you in a very long time. I simply need to be sure you’re okay.”

An earthquake within the blankets, then an eruption: tangled hair, a vivid purple face, and a loud voice, saying in a Boston accent, “Doctah Jim! How are you ya!”

For the subsequent half hour, Johnny reminisced about his previous alcoholic adventures, about outdated pals who’re principally useless. The physician listened, laughing every now and then. Johnny talked about that the road clinic was nonetheless open on Thursdays at Mass Normal. Johnny should come. That’s, if he wished to return.

Dr. Jim – James Joseph O’Connell – has been using the outreach truck for 3 a long time. Throughout these years he created, with a number of pals and colleagues, a big medical group which he referred to as “The Program,” quick for Boston Well being Care Program for the Homeless. It now had 4 hundred staff and took care of about 11,000 homeless folks a 12 months. Jim was its president, in addition to the chief of the Avenue Group, a small a part of this system, with eight members serving a number of hundred homeless individuals who prevented the town’s many shelters and lived primarily exterior or in short-term lodging. About half of Jim’s administrative work now lay in working the Avenue Group, and all of his scientific work went into treating his sufferers, the “Boston sleepers,” as Jim appreciated to name them, borrowing the Nineteenth-century British time period.

The truck was an necessary instrument for reaching these sufferers. It was funded by the state and operated by the Pine Avenue Inn – Boston’s largest homeless shelter. These days, two pickup vehicles come out of the pub each evening. They turned an establishment, which Jim helped solidify within the late Eighties. On the time, he rode three nights every week, normally till daybreak. Now he solely went out on Monday nights and got here down round midnight.

When Jim begins these van rides by means of the evening streets of Boston, he imagines the world of sleepers in shambles. But it surely seems that the majority of them had areas to hang around and roam through the day — “pop” was a road time period, and its origin is obscure. For sleeping, that they had most well-liked driveways, park benches, alleys, underpasses, and ATM lounges. The tough sleepers had been like homebodies with out properties. Initially of the journey, Jim, the motive force, and the co-driver would commerce names of individuals they had been apprehensive about, and so they might normally discover every of them inside an hour or two. Jim was like a Fifties physician making home calls, although the van not often disbursed greater than easy remedy. Slightly, its function was to deliver meals, blankets, socks, and underwear to tough sleepers, and, extra urgently, to search out and produce folks in misery, in the event that they had been to return—to hospital emergency rooms or to homeless shelters within the metropolis. . The van was additionally a instrument for protecting in contact with the sick, their diseases, and gathering unpublished information on the streets.

Like all of Avenue’s crew, Jim carried a briefcase, his physician’s bag, and its contents polished and miniaturized over time. It consisted principally of fundamental first help and diagnostic tools—a blood stress cuff, a small pulse oximeter, an ear thermometer, a easy blood glucose meter, and a stethoscope. Among the many losses he regretted was a pint bottle of whiskey he as soon as carried for occasions when a affected person was experiencing alcohol withdrawal and on the verge of a seizure. “You may’t do this now. It turns into an ethical subject.”

He wore his cell phone in a pouch on his hip, and carried a small flashlight, skinny sufficient to carry in his tooth if he wanted each arms to look at a affected person. The flashlight remained one of many Avenue Group’s major instruments for checking tough sleepers. Just a few years in the past, a affected person requested how Dr. Jim would really feel if his physician got here into his bed room in the course of the evening and woke him up by shining a flashlight in his face. Jim took the case to this system board, a gaggle of about sixteen, which incorporates specialists in well being, medication, and finance, and a number of other previously homeless folks. The board convened a gathering of about three dozen tough sleepers who issued this recommendation, lengthy since grow to be coverage: Well being checks ought to go on, however after they wake folks up late at evening, Jim and his crew ought to shine flashlights on their faces. . In order to not startle sufferers.


The bus stops beneath road lights on Broomfield Avenue not removed from Boston Frequent. It is like a minibus, with a number of rows of seats, principally occupied by bins of blankets, underwear, and socks. Within the again is a small canteen with bins of sandwiches, condiments, and bowls of sizzling chocolate, espresso, and soup. Jim will get out, opens the again doorways, and appears round for purchasers. His face is pale purple, with silver hair falling on the collar of his head and over his ears. He wears mild coloured shorts, a collared shirt, and clogs. Six-foot-tall, well-mannered and strikes with an athletic aplomb that makes the job look simple, his voice is filled with vitality and cheerfulness as he waits for purchasers behind the truck.

A thin black man strolling into the sunshine comes from an alley.

“Do you’ve soup?” Requested.

“sure!” Jim says, taking a styrofoam cup and filling it from one of many bowls.

“Do you’ve crackers to go together with it?”


“Is not there a health care provider who goes with you guys?”

“I am a health care provider,” Jim says. Then he introduces himself and extends his hand.

The person says, “I need to change my physician.” “I hear good issues about you.”

“We’ll be glad to handle you. We’ll be glad.” The person ought to come to the Avenue Clinic on Thursdays, says Jim, including that it takes place at Mass Normal—the enormous Massachusetts Normal Hospital, close to the banks of the Charles River.

The truck stops a number of occasions. Meets a combination of individuals. Girls appear to be about half as quite a few as males, and lone ladies are a rarity, and the streets at evening are nearly definitely particularly harmful for them. There are various black faces, however a lot much less white ones, which is shocking. Homelessness disproportionately impacts blacks and Latinos in each the US and Boston, and one may count on the identical to be true of tough metropolis sleepers. Jim has lengthy apprehensive that the truck and different outreach efforts have persistently missed sleepers of shade, but many of the truck drivers and their assistants are themselves Black and Latino. Through the years, they’ve typically looked for their very own locations within the evening metropolis. Maybe Jim believes that the black and Latino communities are extra prepared than the white world in Boston to deal with the homeless. Nevertheless, as soon as folks hit the streets, they’ve reached some horrible equality.

A younger white lady comes into the sunshine on Washington Avenue, hopping on one foot after which the opposite, working her arms by means of matted strawberry-blonde hair, whereas furiously rubbing her arms, neck, and face. “That is what folks at K2 would do,” Jim says softly, as the lady approaches. K2 is artificial marijuana, which is understood for its sudden results.

Her voice is loud and loud: “Rattling it! I’ve lice! I used to be uncovered to lice and I am panicking. I already had all of the remedy and somebody stole it.”

“The place did you get the remedy?” Jim asks.

“I purchased shit at CVS and somebody stole 100 {dollars} value of lice removing shit I am in courtroom tomorrow my mother is sick within the hospital she’s dying I have to go see her however I am not going on the market and shaming folks quite a lot of chicks have ’em and no inform them.”

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