This book told of an amazing doctor, Jim O’Connell, who dedicated his life to helping the homeless in the Boston area. It is a straight, unblinking gaze into the lives of rough sleepers, those homeless who choose to sleep on the streets and how Dr. O'Connell made a difference in their lives. It is at times hard to read but there are triumphs as well as tragedies within the pages of this book. We could all learn a thing about compassion and not looking away. I highly recommend that everyone read this book and then pass it on to someone they know.
I received an advance reader copy from NetGalley for my unbiased review.

What an interesting book. I learned so much about not only the people who sleep on the streets but also the way knowledge combined with thoughtfulness, kindness and unconditional support can make a difference in the lives of ‘rough sleepers’. Along the way I also learned that the ‘rough sleepers’ are a community- they look after each other, they mourn the losses of one of them and yes, they also fight. The program was put in place by Boston Mass with Federal funds (initially) and continued thereafter because of the perseverance and community of its lead doctor.

I love Tracy Kidder's writing, and this is one of my favorite of his books. Mountains Beyond Mountains was the first book of his that I read. This is the story of a doctor with great compassion for his homeless patients. This is a book full of empathy. It is also a book filled with touching stories of people. This wasn't a topic that I knew a whole lot about, in spite of living in a city where I often pass homeless people on the street and wonder about their lives.

Rough Sleepers by Tracy Kidder begins with the words of an ancient nighttime prayer: “Keep watch, dear Lord, with those who work or watch or weep this night, and give your angels charge over those who sleep.” The prayer has startling relevance for those who sleep on the street, Boston’s “rough sleepers,” as homeless people were called in Britain in the 19th century.

Dr. James O’Connell has invested three decades in a concerted effort to “tend the sick, soothe the suffering, [and] pity the afflicted,” riding in the outreach van by night and building the Boston Healthcare for the Homeless Program by day. His services range from distributing food, blankets, socks, and underwear all the way to admitting patients to Mass General’s emergency room.

Tracy Kidder has a gift for humanizing large topics, and he employs it in his portrayal of Dr. O’Connell and his staff as he followed them around for five years, scribbling in his notebook as they made nighttime rounds in the city. Deadly opiates, harsh weather, insufficient nutrition, alcohol addiction, and an abundance of psychiatric maladies are perpetual opponents to medical care and basic healthful practices. For example, where does a homeless person store her insulin?

Hope wars against despair in the practice of “disaster medicine” where measurable success is infrequent. The book addresses the importance of housing and provides abundant evidence that housing alone is an insufficient factor in rehabilitating a vulnerable population.

Even tapping into the wisdom gained over three decades, Rough Sleepers is a message of awareness more than remedy. O’Connell’s assessment reveals a studied ambivalence: “I like to think of this problem of homelessness as a prism held up to society, and what we see refracted are the weaknesses in our health care system, our public health system, our housing system, but especially in our welfare system, our educational system, and our legal system–and our corrections system.”

Sadly, chief among these is the fatal weakness of the human heart that afflicts us all, even if we are housed and outwardly stable.

Readers sensitive to rough language should definitely give this book a pass.

Many thanks to Random House and NetGalley for providing a copy of this book to facilitate my review, which is, of course offered freely and with honesty.

Tracy Kidder presents the captivating story of a Boston doctor's work with the city's unhoused community.
Pulitzer Prize-winning author Tracy Kidder's Rough Sleepers follows the career of Dr. Jim O'Connell, a Harvard-educated physician who has spent over 30 years providing care to Boston's unsheltered community.

In 1985, as O'Connell was finishing his residency at Mass General, he was asked ("conscripted," in his words) to spend one year building a program called "Health Care for the Homeless." Sponsored by a grant from the Robert Wood Johnson Foundation, it was a trial to determine if the "poorest of the poor" could be integrated into the city's mainstream medical care system. He quickly realized that the program's patrons "seemed to believe that by 1990, when the grants ended, the big problems of health care for the homeless would be solved," but it was obvious to him that the root causes of his patients' misery weren't being addressed. "How do you treat HIV in a person who has no place to live?" he asks, "How do you treat diabetes in patients who can't even find their next meals?" After just one year working with this population O'Connell decided to spend his career addressing these issues to the best of his ability.

Kidder's portrait of O'Connell is vivid, painting his subject as a caring individual who is both frustrated and fascinated by his profession. He chronicles the doctor's journey from his first enthusiastic but naïve efforts to his becoming savvy about getting care to his patients, even if he has to use unconventional methods to do so (he decides, for example, to leave some patients' medications with a bartender who agreed to make them take their pills before giving them a drink). It's a finely-tuned portrayal that avoids the temptation of casting the physician as overly saintly or heroic; his flaws are evident, as are his strengths, and as a result, readers feel they know O'Connell well by the book's end.

The author also helps his audience understand how complicated the issue of homelessness truly is. He writes about a presentation he attended where a slide "displayed in sequence the forty-two different steps that six agencies and a landlord had to complete to get one homeless veteran housed." In another example, he quotes O'Connell as saying, "I like to think of this problem of homelessness as a prism held up to society, and what we see refracted are the weaknesses in our health care system, our public health system, our housing system, but especially in our welfare system, our educational system, and our legal system – and our corrections system." The author makes it clear that there's no easy solution. He does include statistics and demographic data, but the information is widely distributed throughout the narrative, keeping it from getting bogged down in facts and figures.

As the book progresses, Kidder gradually shifts focus from O'Connell to the individuals he has come to know through his profession, such as Santo, a man who'd been homeless for 40 years, and BJ, who lost both legs due to infections from frostbite. The author takes a deep dive into the life of Tony, another long-time resident of the streets who had been unable to find housing after serving 17 years in prison, and it's through Tony's experiences that we begin to understand the unrelenting trauma of homelessness. The book as a whole is fascinating, but it's these individuals' stories that make the narrative truly affecting and unforgettable.

Kidder spent many hours joining O'Connell in his clinic as well as on the "house calls" he made to his most vulnerable patients – van trips at night to the alleys and doorways where he knew they'd be sleeping. Toward the end of Rough Sleepers, he makes it clear these experiences left him a changed person. "[A] certain coffee shop," he writes, "was no longer just a place to get a good muffin, but also the shop across the street from where Harmony and Jake liked to camp, with their caravan of shopping carts and roller bags…Certain sights had acquired meaning—walking up Bromfield Street around dawn, I saw a man in a janitor's uniform sloshing a bucket of water across the pavement of a doorway, and I wondered if I knew the person who had spent last night on that patch of concrete." And I think that might encapsulate the main takeaway from this book; after reading it, I felt I had a better understanding of the issue and had developed more empathy for those experiencing homelessness – the "rough sleepers" in my own neighborhood. I think it should be required reading, and it's one of those books I find myself wanting to discuss with others, so it would make an excellent book group selection. I highly recommend it to all audiences, particularly those wishing to know more about this complex topic.

I used to assign Mountains beyond Mountains to my AP Environmental Science class as summer reading so I was familiar with Tracy Kidder. I grew up in the Boston area and my daughter works at MGH so I was interested in Kidder’s take on Jim O’Connell and his mission to help the homeless with medical care. I enjoyed the anecdotal aspect of the story. His writing was straightforward and clearly illustrated the major problems the homeless in the Boston area have today. I found the book both depressing and enlightening. O’Connell’s group provides one model for treating this public health issue. My takeaway was that even with resources and good staff, this ongoing issue is a long way from being solved. I thank NetGalley and the publisher for the opportunity to read this ARC.

This book clearly demonstrates that Dr. Jim O-Connell and his team went to great lengths to show humanity and provide care to unhoused people. The conditions people in this book live through are heartbreaking. The work the team did was beyond the scope of the job description and they refused to see themselves as heroes. It's admirable.

Felt like Kidder could have done more to highlight the causes of inequality and poverty, and I felt that Dr. O'Connell's team could have tried harder to understand why they weren't serving more people of color. There was a missed opportunity to speak about mutual aid to counter unjust systems and to encourage us all to work cooperatively to meet the needs of everyone in the community, that no one person - even Dr. O'Connell - can solve homelessness by themselves. It will take a movement of people caring for one another at every level.

Many thanks to Penguin Random House, NetGalley, and Tracy Kidder for providing me with an advanced copy in exchange for an honest review.

Always in good hands with Tracy Kidder. Narrative non-fiction about Dr. Jim O'Connell and his30+ year career working to establish a health care system for people experiencing homelessness in the Boston area. Kidder followed O'Connell for five years learning how medicine is delivered to the homeless population and he also tells multiple stories of people he experienced along the way. Beautifully written.

I read and listened to audiobook narrated by Kidder.

Enjoyed is perhaps not quite the right word- but I benefited from reading this book and learned a lot. Tracy Kidder is so gifted at opening unfamiliar worlds to his readers, and he has done it again here. Dr. Jim O'Connell is remarkable and this is a great portrait of both him and his work on the streets of Boston. I especially appreciate the nuance here- the issues around the unhoused are complex and I feel Kidder does them justice.

Tracy Kidder can always be counted on to present a little known subject to his audience in such a way that by the time they come to the last page, they will care almost as deeply as he does. He combines exhaustive research with deep compassion and enlivens his clear reporting with vivid dialogue.
This particular effort is the story of the homeless population of Boston, the “rough sleepers” who prefer to stay away from shelters and hospitals. We see this group through the eyes of the stalwart band of doctors and counselors who with ingenuity and sensitivity try to make the lives of these souls easier. We come especially to respect the work of Dr. Jim O’Connell who works doggedly to serve this population, gaining their trust by listening to their stories without judgment.
We read their stories as well and come to understand how badly these men and women have been served beginning in childhood. Some will respond to the medical care and housing offered.. Other never have a chance to escape from the alcohol and drugs that have taken the place of the security that society provides. Kidder makes us care for these deeply wounded individuals.
At the end of the book are extensive notes, including surveys, statistics, and research, which may encourage the reader to dig deeper and perhaps work toward solutions for Rough Sleepers, not just in Boston, but throughout the United States.

The book by Tracy Kidder describes the life experience and life cycle of "rough sleepers", the homeless who live their lives completely outside without support of shelters. The story specifically focuses on rough sleepers in Boston.
Dr. Jim O'Connell is a physician and Harvard medical school grad who chooses an entire medical career focused on providing medical care for homeless citizens and patients in Boston. His story truly expands the concept of medical care to include health care, empathy, a listening ear, and developing a friendship with his many patients. In my opinion, what true medical care should look like.
But the real connection in this story is found in hearing the stories of some of his patients. The most time is spent on a patient names Tony Colombo, a homeless patient whose story went from a traumatic and abused childhood, to a prison term for rape, followed by a post prison lifetime where he was unable to be homed or live a normal life due to a lifetime sentence from his original imprisonment.
What Tony's story, and many others, show is a narrative that should make us question our legal system, our medical system, our national construct around compassion, and the worth of every individual life. Dr. O'Connell and Tony are great examples of people who used their opportunities to care for others in need. And hopefully in reading this book, most of us can consider what we can do for our local community and some people in our lives to make their experience better.

A well written and researched story by Tracy Kidder after 5 years observing the homeless clinic, Dr. O'Connell's medical practice, and the lives of the homeless in Boston. Written in a way that captured my attention and gave me a new perspective and desire to make a difference.
I believe if you give this book a chance, you will have a similar experience.

Rough Sleepers
4 Stars. Dr. Jim O’Connell has spent 35 years providing medical care and support to Boston’s “rough sleepers,” people who are unhoused, some of whom struggle with drug or alcohol addiction. The author, Tracy Kidder, (best known for Mountains beyond Mountains) has followed Dr Jim and tells his story and that of those he has devoted himself to helping along with other medical personnel and others engaged in agencies that play a role.

The book lays out Dr. Jim’s journey, the state of the unhoused and home insecure in Boston, and offers a window in to what life is like for the unhoused in the USA. Kidder is gifted in weaving together the story.

It is clear that working with mentally ill folks that live on the streets is not easy, particularly since there is a lack of funding for this work and many systemic barriers . But Dr. Jim admirably treats his patients with respect. He leads a team that go out at night seeking home insecure people with medical needs and helps them any way he can. He's friendly, nonjudgmental, and a great listener. His help extends beyond medical care too.

One person he encounters that is a focal point in the book, is Tony Columbo. Born in the Italian part of town, the North End, Columbo is a big, bulky, caring guy who has mental health and addiction issues but despite living on the streets himself tries to care for others.

There is much to do to improve this situation in Boston and elsewhere and it clearly takes a village. This story will sadden you, inspire you but will also stay with you.

Many thanks to Netgalley for this ARC. #RoughSleepers #NetGalley

I really enjoyed this book. I love of Kidder tells stories. This book makes you so mad at the system and the way humans are discarded. Jim O’Connell is clearly a good dude with a great time. There’s something missing from this book though. It’s hard to tell why Kidder told this story, aside from it being interesting. It’s also hard to tell what the takeaways should be. I enjoyed it a lot but feel unresolved upon finishing it.

Many thanks to Netgalley for this inspiring and well-written book that I hope will reach a large audience. People studying homelessness for the first time along with seasoned professionals will all learn something from Dr O'Connells long and inspiring career trying novel solutions to help improve the plight of Boston's homelessness. I highly recommend this title to professionals and the general population, this is a. topic that bears much discussion.

In Rough Sleepers, Tracy Kidder follows the career of Dr. Jim O’Connell who devoted his life to homeless people who frequently slept on the street. Dr. Jim’s career began with an early choice as he neared the end of his residency and was challenged by the chief of medicine to postpone an impressive fellowship to spend a year creating a health organization for homeless citizens. The year turned into a life’s work.

The author spent five years following Dr. Jim, his colleagues, and his patients through the ups and downs of life on the street and the effects on the health of these people. The complexities of serving this population seemed to multiply. Quality time with the patient was imperative since these patients were suspicious of a doctor in a hurry. A saying the medical personnel learned to follow was, “You just have to be there and be present and, if need be, stand with them in the darkness.”

Often the medical personnel defined their tasks as Sisyphean since they worked to get a patient off of substance abuse or over a habitual health issue only to have them revert to original destructive habits and start over again. Kidder pictured a community inhabited by caregivers and patients who become supportive of each other as they slip and slide in and out of wellness and safety. The reader gets to know these people as portrayed by the author and keeps alive a hope for each of them.

This very readable book is a mix of humor, red tape, warm socks, medicine, addictions, and friendship. It puts a human face on those who live by turns under the bridge, in makeshift tents, or in low-rent housing,

I received a complimentary ARC of this book from Netgalley, author Tracy Kidder, and Random House Publishing. Thank y0u for letting me read it in advance! As always, Kidder's research and storytelling is superb. He has turned his focus to homelessness, specifically a program and an individual in Boston who is making a difference one life by one, yet his impact is far-reaching and has changed and improved many lives.

This is a book that should be read by every American. If you think you know all about homelessness, think again and take a closer look at the people you meet in this book. Dr. Jim O'Connell is just completing his residency at Massachusetts General and on his way to a fellowship in oncology at Sloan Kettering when one of his mentors waylaid him. He was looking for someone to help a program called Health Care for the Homeless that had been established by a group of nurses years ago, and was up for a grant, but the terms required a doctor. It would only be for one year, so Jim postponed his fellowship and went to help-in his mind thinking that they'd be delighted to see him, but that wasn't quite the case. His first task was to soak the patients' feet. Which he did for quite some time. Of course, he does eventually get to doctor, and he wins the nurses' over, along with the patients who are suspicious of him at first too.

What makes this book, aside from the inherently important and interesting topic, are the many people we come to know. Dr. McConnell, of course, but also Barbara McInnis, the nurse who first pulled him aside asking him to let them "retrain him" because he's been "trained all wrong." And then there are the homeless people we meet. The final chapters we see Dr. McConnell's "portrait gallery" of some he has met over the years and we hear more of their stories. The book focuses on a few of them in more depth, helping the reader come to understand the person's background (although in some cases, no one really knows), and perhaps how they came to be homeless and why so many continue to choose to stay there when other options are made available to them.

In the end, you'll be left with greater empathy, but also with some frustration and great sadness at this seemingly never ending problem.

Homeless is a health crisis in America. No other way around it. Multiple studies have shown that if you have a home, you are inherently healthier. Even though I participate in groups that try and help the unhoused in my area and even though I am involved in providing affordable housing and have been to Skid Row and know exactly the scenes Dr. Jim and Mr. Kidder describe, I still found new things to consider and avenues I hadn't explored while reading this book. I particularly liked the reference to those who have been incarcerated and how they are excluded from specific policies intended to help those who are homeless. They can't get housing, they can't get jobs, therefore they can't afford to pay for housing. And we wonder why they are angry or drunk or using drugs or sleeping in doorways. I imagine for anyone not as familiar with the plight of our many homeless and residentially challenged (pick your euphemism), this book could provide an amazing eye opener. Who out there that might read this might be able to aid another person? Like is stated in the book, what these people are doing isn't going to solve homelessness but it will help those who are in the position. I am recommending this book to several of my coworkers and friends. I think it will add a bit more compassion to what we do and how we think.

A wonderful, hopeful book about a doctor who began an outreach to the homeless in Boston. Kidder writes about the doctor, Jim O'Connell as well as the patients he finds on the streets

Tracy Kidder is one of the preeminent non-fiction writers of his generation, and in this book he uses his prodigious gifts to shine a light on the plight of the homeless. This book should be required reading for everyone so that they can get some insight into a painful problem in American society, and the author's skill for storytelling makes it a compelling page-turner of a book.

Tracy Kidder just keeps delivering again and again!  Lyrical, pragmatic, and full of humanity and grace, this portrayal of Dr. Jim O’Connell’s quest to love and care for people experiencing homelessness in Boston transports the reader to another reality.  Because that’s what life for this unhoused population is—a totally different reality that requires different skills, different coping mechanisms, expectations, and desires.  Yet it is still fully human and fully relatable.  O’Connell and his team, as communicated through Kidder’s unflinching account, provide a compassionate look at the subject as a social issue within systemic constraints.  Each individual has a story which, when taken together, are a recipe for a sour cocktail of bad luck, bad choices, and bad systems.  The reader emerges with a tempered admiration for O’Connell’s seemingly endless mission to make vital connections with these affected individuals and provide truly patient-centered care.  The book tackles difficult questions of cause and effect, a cost-benefit analysis of the work, and what a realistic outcome could look like (rather than a purely idealistic one). I found Kidder’s prose to be like a closely-woven tapestry:  separate and interconnected human-centered stories loosely weaving across and around a timeline of the evolution of O’Connell’s work.  One leaves with the impression that we could all be in this together—that this work is approachable and doable, if we would but pull together to see it to its completion.  I highly recommend this book (and all Kidder’s work, if I’m being honest) to anyone who is interested in ideals lived out through actions, and anyone interested in the complex work of healing individuals experiencing homelessness.