Tracy Kidder tries to be a “good guest in the lives of the people he writes about.” He did this during years of research while he shadowed Dr. Jim O’Connell, who delivers health care to the rough sleepers (a 19th-century term for people who live in rough conditions on the street) in Boston.

Kidder's book, “Rough Sleepers,” tells the story of O’Connell, a Harvard graduate who turned down a fellowship at Mass General to serve homeless people in Boston. His dedication brought him to Boston’s poorest neighborhoods to treat patients suffering from untreated scurvy, lice, scabies and maggot-infested wounds.

The book peels away the layers of homelessness—mental health, abuse, eviction, incarceration and the public health crisis that homelessness has become. In this narrative, the policies made by out-of-touch bureaucracies fail to scratch the surface of this multifaceted issue.

In Kidder's description, O'Connell is "an intellectually gifted man." He gets to use his skills and invent a unique, well-organized group (Boston Center for the Homeless) that serves 11,000 to 12,000 homeless people a year. In the shadows of great medical institutions, O’Connell deals with the same health problems as those in the slums of Haiti, Peru and India.

"Some people call him a saint,” Kidder says, "but O’Connell is more than a saint or zealot.”

“No one knows more about homeless medicine than Jim,” Kidder said. “His patients were as human as you and me. Charming. People who had gotten a bad break or, more often, had horrifying childhoods.” 

Kidder brings people to life in the reader’s imagination. For example, he portrays the sheer unfairness of the world through Tony Columbo, a beguiling man from Boston’s North End who endured traumatic and horrific physical and sexual abuse. By 7, he had witnessed murder, and he and his brother once tried to kill their abusive father. At 15, Tony had attempted suicide and stayed in a mental hospital where they diagnosed him with schizophrenia and bipolar disorder. His 18 years in prison for sexual assault and rape made him ineligible for public housing. He also struggled with substance addiction and, at times, was violent.

Tony had a caring side and a deep appreciation for O’Connell. He kept his eyes on the street to find rough sleepers who disappeared, and he helped in the clinic to keep himself off the streets. Columbo died from an overdose.

Kidder told our group that “O’Connell’s team might light paths into the darkness. If you read about homelessness in the news, chaos and cruelty are in charge. If you get to know people working on these problems like O’Connell does, it makes the day go better to see people they need the most working with them.”

O’Connell describes his team and patients as a system of friends. Kidder explained our society’s obsession with the question of who deserves what. For instance, the deserving poor or the undeserving poor, the homeless vets or the homeless men? How can you separate the needs of these people? O'Connell rides around in a van to find the rough sleepers who need support because he believes they shouldn't be sidelined for not coming to the clinic. 

Kidder’s Zoom visit ended with Rebecca Enman, director of adult program and outreach at the library, questioning Kidder on how to tackle homelessness. Kidder responded, “Some want to give homeless people money and nothing is wrong with helping someone ease the pain of homelessness. Being homeless is lonely, so look them in the eye.”

Rebecca responded that when we see homeless people in the city, we look away. “Rough Sleepers” shows us what happens when someone takes the time to look them in the eye. 

With potential Medicaid cuts jeopardizing homeless health care, private donations become essential. You can help by contributing to programs like the Peterborough-based Monadnock Area Transitional Shelter.

Elizabeth Goodhue serves on the board of the Monadnock Area Transitional Shelter, which provides transitional housing, support and referral services to people who are experiencing homelessness, to educate the community on issues of homelessness and to advocate for solutions.