“worth more than many sparrows” (Mt. 10:31)
How often I’ve seen unhoused people clumped under a bridge or hovered around a heating grate and dismissed them as anonymous, even slightly annoying. Never again. My attitude changed when I read Rough Sleepers by Tracy Kidder. The author’s work may be familiar to readers of Mountains beyond Mountains, describing the work of Dr. Paul Farmer in Haiti.
Here he profiles Dr. Jim O’Connell, whose career trajectory took an unexpected turn. After graduating from Harvard Medical School and being senior resident in the ICU at Mass General Hospital, he’d been awarded a prestigious fellowship in oncology at Memorial Sloan Kettering in New York. But the Boston hospital’s chief of medicine asked him to try—just for a year—working in their Health Care for the Homeless program. That was in 1985. When Covid hits the streets in 2020, he was still at it. By then, his program had 400 employees, caring for 11,000 unhoused people a year. Kidder spent five years following O’Connell around, tending what he called “a system of friends.”
One of the most poignant chapters describes his orientation to the Pine Street Inn, a shelter with a clinic. It had been run by nurses, who initiated the young doctor. They encouraged him to set aside his stethoscope and focus on foot washing, for more than a month. He was astonished that he recognized some of the elderly men from the Mass General ER, where they were sullen, angry, resisting treatment. With their feet soothed, soaking in buckets, they were docile, conversational, even asking for medications. It made sense—they’d been on their feet all day, they were tired and their feet were sore, itchy. “They’d let you look at their feet before they’d let you examine any other part of them” (p. 32) and their feet could reveal larger problems. Beyond the biblical connotations, it put the doctor at the feet of the patient, reversing the usual order of authority talking down.
He would soon discover and work around other reversals—like relying on friendly bartenders who’d insist that heavy drinkers needing medicine must take it before they could get a drink. Some people were reluctant to come to a hospital, shelter or clinic, so Jim and his team designed “The Overnight Rescue Van,” which would bring food, blankets and medical help to the “rough sleepers,” a term from British slang for people who sleep in rough conditions They navigated a mind-blowing labyrinth of regulations around what they could do, which Jim termed “the theater of the absurd.”
Jim would treat people who hadn’t seen a doctor, dentist or psychiatrist in years, with ailments he’d met only in textbooks—maggots in wounds, untreated cancers or hernias that had grown grotesquely large. At the low end of the prestige scale, Jim found this kind of health care “utterly fascinating” (p. 42). Perhaps it was because he could see the lovable person beneath an exterior that could be aggravating. As one of Jim’s assistants noted, an invisible barrier seems to block us from those slumped against a wall or begging at a corner. In the care of Jim and his team these people acquired identities—funny, quirky, caring for each other, and better understood knowing the trauma many had suffered. Or as Jim phrased it, “all that anger comes from a broken soul.” (p.189) A psychiatrist added, “How could you live on the streets without self-medicating? [with drugs and alcohol] I never could.” (p. 180)
Jim came to understand why so many unhoused people were averse to shelters–as one asked, “you ever try to sleep in a room with 100 people?” Kidder focuses on one character, Tony, and how his relationship with Jim, often erratic and frustrating, deepened into friendship. After decades of unconventional work, Jim still insisted, “it’s a privilege to be there. I love it.” His conversational manner was to say little, but remain unwaveringly attentive, “rarely ending a conversation himself, but allowing almost all of them to talk for as long as they wanted, as if he had all the time in the world.” (p. 272)
Over the years, Jim’s patients (or those who adamantly refused treatment) became characters with great stories that could make him laugh and irritate him at the same time. Jim transformed shadowy figures in doorways to lively characters and took photos of them that became a portrait gallery. Some, like the Judge, concocted fictional identities, but others like two former college professors were so brilliant and intriguing, Jim had a monthly lunch with them. Maybe Jim sees the unhoused as God does—not a heap of blankets beside the street, but precious children, with “every hair of [their] heads counted.” (Mt. 10: 30)
Kathy Coffey 