“Rough to Sleep” by Tracy Kidder


Kidder’s newest non-fiction work follows Dr. Jim O’Connell, founding father of Boston Well being Take care of the Homeless, in his work to supply medical care to 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. Printed by Random Home, an imprint and division of Penguin Random Home LLC. All rights reserved.



At about 10 o’clock on a heat September night time, the outreach van pulled up in a type of South Boston neighborhood that was stated to be “in transition.” On one aspect of the road was a brand new house constructing, its home windows alighted, its sidewalk lit in inventive imitations of previous avenue 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 identified that they have 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 strive,” 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 not 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 previous mates who’re largely lifeless. The physician listened, laughing from time to time. Johnny talked about that the road clinic was nonetheless open on Thursdays at Mass Normal. Johnny should come. That’s, if he wished to come back.

Dr. Jim – James Joseph O’Connell – has been driving the outreach truck for 3 a long time. Throughout these years he created, with a number of mates and colleagues, a big medical group which he known 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 Road Staff, a small a part of this system, with eight members serving a number of hundred homeless individuals who prevented town’s many shelters and lived primarily outdoors or in short-term lodging. About half of Jim’s administrative work now lay in working the Road Staff, and all of his scientific work went into treating his sufferers, the “Boston sleepers,” as Jim preferred to name them, borrowing the Nineteenth-century British time period.

The truck was an vital software for reaching these sufferers. It was funded by the state and operated by the Pine Road Inn – Boston’s largest homeless shelter. These days, two pickup vehicles come out of the pub each night time. They turned an establishment, which Jim helped solidify within the late Nineteen 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 night time streets of Boston, he imagines the world of sleepers in shambles. However it seems that the majority of them had areas to hang around and roam through the day — “pop” was a avenue time period, and its origin is obscure. For sleeping, they’d most popular driveways, park benches, alleys, underpasses, and ATM lounges. The tough sleepers have been like homebodies with out houses. In the beginning of the journey, Jim, the driving force, and the co-driver would commerce names of individuals they have been nervous about, they usually may normally discover every of them inside an hour or two. Jim was like a Fifties physician making home calls, although the van not often distributed greater than easy treatment. Relatively, its objective was to deliver meals, blankets, socks, and underwear to tough sleepers, and, extra urgently, to seek out and convey folks in misery, in the event that they have been to come back—to hospital emergency rooms or to homeless shelters within the metropolis. . The van was additionally a software for holding in contact with the sick, their diseases, and gathering unpublished information on the streets.

Like all of Road’s crew, Jim carried a briefcase, his physician’s bag, and its contents polished and miniaturized through the years. It consisted largely of primary first support 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 try this now. It turns into an ethical difficulty.”

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 fingers to look at a affected person. The flashlight remained one of many Road Staff’s major instruments for checking tough sleepers. A couple of 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 midst of the night time and woke him up by shining a flashlight in his face. Jim took the case to this system board, a bunch 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 develop into coverage: Well being checks ought to go on, however once they wake folks up late at night time, Jim and his staff ought to shine flashlights on their faces. . In order to not startle sufferers.


The bus stops underneath avenue lights on Broomfield Road not removed from Boston Frequent. It is like a minibus, with a number of rows of seats, largely occupied by bins of blankets, underwear, and socks. Within the again is a small canteen with bins of sandwiches, condiments, and bowls of scorching 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 straightforward, his voice is stuffed with power and cheerfulness as he waits for purchasers at the back of the truck.

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

“Do you might have soup?” Requested.

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

“Do you might have 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 comfortable to deal with you. We’ll be comfortable.” The person ought to come to the Road Clinic on Thursdays, says Jim, including that it takes place at Mass Normal—the large Massachusetts Normal Hospital, close to the banks of the Charles River.

The truck stops a number of occasions. Meets a mix of individuals. Girls appear to be about half as quite a few as males, and lone girls are a rarity, and the streets at night time are virtually definitely particularly harmful for them. There are lots of 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 would possibly count on the identical to be true of tough metropolis sleepers. Jim has lengthy nervous that the truck and different outreach efforts have persistently missed sleepers of colour, but many of the truck drivers and their assistants are themselves Black and Latino. Over time, they’ve typically looked for their very own locations within the night time metropolis. Maybe Jim believes that the black and Latino communities are extra keen than the white world in Boston to deal with the homeless. Nonetheless, as soon as folks hit the streets, they’ve reached some horrible equality.

A younger white lady comes into the sunshine on Washington Road, hopping on one foot after which the opposite, working her fingers 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 surprising 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 therapy and somebody stole it.”

“The place did you get the therapy?” 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 plenty of chicks have ’em and no inform them.”

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