Such a sad state our country is in. Jim’s work is awe inspiring. He tears his patients with respect and dignity. He makes sure the staff does too.

I am still absorbing what all this story was about. In this nation it really scares me how many homeless don’t get medical treatments. Such a sad state for the United States to be. And to treat our veterans so horribly.

I will carry Jim’s words and actions with me forever. Such an inspiring individual.

Rough Sleepers by Tracy Kidder is an astonishing in-depth look at the homeless population in Boston and one doctor leading the cause to support and treat those individuals. This is reminiscent of his past book, Mountains Beyond Mountains, by giving an up-close and personal look at a nation-wide issue that people have heard of but rarely take time to learn more. By giving both the homeless population and those who treat them an opportunity to share their story, Kidder opens new discussion on what can truly be done to help those in need. Wonderful book overall!

Rough Sleepers
By Tracy Kidder

Mr. Kidder tells the story of a program which, in conjunction with Mass General in Boston, was initiated to provide healthcare to the homeless of that city. The story is especially about Dr. Jim O'Connell, who went from wanting to be an oncologist to making medicine for the homeless his life's work. "Dr. Jim" wore many hats over the years, including as team leader for the Street Team, who rode the streets at night, trying to connect with the "Rough Sleepers" – those homeless who literally lived in the streets (many by choice).

Mr. Kidder spent a lot of time riding shotgun with Dr. Jim and his team learning about all the various causes of homelessness – abuse, addiction, mental illness just to name a few. The stories of patients presented here are at once horrifying and eye-opening. The task of helping the homeless is never-ending. Although in many ways a thankless job – Sisyphean as Dr. Jim would say – those who choose to take on this task have learned that homeless people no matter what their circumstances are people just like you or me. They need kindness and compassion, a helping hand and understanding.

This book should be a must read for all of us who have been fortunate enough to avoid this fate!

I was a little underwhelmed by this book. After reading Mountains Beyond Mountains, which had a really tight narrative focused on Dr. Paul Farmer, this book did not have the same narrative focus. While purportedly about one doctor providing medical care to the unhoused community in Boston, this book took a lot of detours into other people. I did not feel like I got to know Dr. Jim O'Connell very well or that he was the most interesting person in the story. I was more drawn to the stories of the Rough Sleepers. Overall, I am glad I read it but it did not have the same gripping story telling of Mountains Beyond Mountains.

A tender and illuminating account of our vulnerable neighbors and those that go to heroic lengths to serve them. These stories, brilliantly told by Tracy Kidder, should be read by everyone who has an influence on public policy.

The title of Rough Sleepers comes from a British term for people who sleep outside, but in this case it could also refer to the life that unhoused people endure. Kidder, a Pulitzer Prize winner for The Soul of a New Machine, takes a similar approach in this book of presenting an issue many of us know little about and illuminating it with superb storytelling and accessible information backed by solid research. The center of the story is Dr. Jim O’Connell, longtime director of a program serving Boston’s homeless community. Throughout, we learn much more about many of Dr. Jim’s patients and the patchwork network of support for these people than we do about Dr. Jim himself.

Quite a bit of the story outlines the very different ways people deal with being unhoused - including the fears and traumas that keep them on the streets. We see how unhoused people create community and care for each other’, and what compels them to return to the streets even when better options are available. One person pitched a tent in the living room of a new apartment because he felt more secure than sleeping in a bed. Another steals cigarettes to give away to his friends. Drugs are omnipresent but many don’t trust doctors or hospitals, even though they end up being hospitalized frequently.

Dr. Jim’s method is to go to where they are instead of making them come to him. Because of this, we learn much more than we would by taking the homeless out of their environment. We also are forced to confront some of the inconvenient realities about homelessness and the frustrating fact that there is no one size fits all solution. In fact, some of the “solutions” are literally impossible to implement. Take, for example, a shelter that requires no arrests in the previous thirty days, when the unhoused are routinely cited for sleeping on benches or under bridges. Or, a facility may insist on cleanliness when there are no public options for showering. Some of this made me uncomfortable but I’m so glad I had the opportunity to read this book.

Many thanks to NetGalley and Random House for the opportunity to read and review this outstanding book.

“Rough Sleepers” was one of the most impactful books I read this year. Chronicling the work of Dr. Jim and the pioneering Boston Healthcare for the Homeless Program, this book details the brokenness & shortcomings of both health programs and social welfare programs in the United States while also highlighting the value, individuality and deeply personal stories of the rough sleepers in a way that leaves room for hope, joy and community. From the annual, grassroots candlelight vigils organized by the rough sleepers for the members of their community lost, to the way “Tony” protected others on the streets in ways that society failed to protect him, to the deep respect the patients hold for Dr. Jim, Tracy Kidder puts our shared humanity on display in a way that is both heartwarming and heartbreaking.

The book doesn’t shy away from the complexity— and more often than not, ineffectiveness— of one-size-fits-all solutions (just see the example of the man who, once housed, pitched a tent in the living room because rough sleeping was all he knew, or the story of the woman whose only mistake was doing everything right). Yet, it emphasizes the importance of empathy, community, friendship, and genuine care for the individual as a person worthy of dignity, respect and truth.

“For sleeping, they had favorite doorways, park benches, alleys, understories of bridges, ATM parlors. Rough sleepers were like homebodies without homes.”

The chapter on Foot Soaking also stood out: “Foot soaking in a homeless shelter—the biblical connotations were obvious. But for Jim, what counted most were the practical lessons, the way this simple therapy reversed the usual order—placing the doctor at the feet of the people he was trying to serve.” This role reversal, coupled with the ability— through the “van rides” and clinics— to spend time getting to know the rough sleeper patients in a way that commercial healthcare (where profits are made through RVUs and maximizing “efficiency”) doesn’t afford illustrated a clear positive impact on people and outcomes and underscores the “upside down” nature of modern medicine.

Policymakers, physicians and other medical providers, healthcare administrators, and all of us who encounter unhoused individuals / rough sleepers (yes, that means all of us) have much to gain from reading this book.

A rough sleeper is a person who spends nights outdoors. Dr Jim O’Connell has been treating these homeless people in a section of Boston for much of a long career. Tracy Kidder’s account of this work among the homeless is compelling and heartbreaking.

Rough Sleepers was a fantastic book that gives a look into what it's like to care for the homeless. He ties together poverty, mental health challenges, substance abuse, and how the cycle of homelessness is so hard to break out of. We get to follow Dr. Jim O'Connell unexpectedly finding the calling to into this work and through his career of starting "The Program". Tracy Kidder does a wonderful job humanizing the homeless and tells stories from Dr. Jim's perspective of his patients so well and you become attached to their wellbeing, especially with Tony Columbo. As a public health nurse myself, this book helped me think through my biases and how I can better approach care of my patients as humbly and kindly as Dr. Jim.

This book was heart breaking and heart warming. It brings awareness to one of our country's biggest problems. Homelessness. I love the dedication of Dr. Jim and everyone involved in this initiative. Can't wait to read more by Tracey Kidder.

I have loved everything I have read by this author. This was another compelling story. Though at times I had a hard time figuring out what he was trying to saying when relaying stories about the people in the book. It jumps around a lot which is kind of confusing. All in all this is a beautiful story of a man who devotes his life to those who are mostly forgotten and the stories behind those he serves.

This is a book about the homeless in Boston, a dedicated (to say the least) doctor who stayed on years past his initial one year commitment, his stalwart compatriots who educated and supported him, and finally, the writer who put it all together in a highly readable, informative way. Kudos all around!!
Dr. Jim O'Connell began his supposed one year stint with Boston Medical Center's Street Van and homeless clinic. His team consisted of a variety nurses, PAs , other doctors and mental health professionals. He made assessments/referrals (to the clinic) and treated the issues he was able to on site. He and his team would have weekly team meetings to discuss who they were concerned about, be it physical, mental issues and or drug/alcohol addictions. The one recurring acknowledgement that the team had to make was that each person they came in contact with, "have the right to make their own decision even in the face of death," of whether they wanted any treatment or help.
Over time, burnout did affect the workers. The mental health worker on the team stressed that they had to stop trying to "be everything to everybody". and that boundaries and limits had to be set.(p. 2693). Dr. Jim's feelings on this, "I think one of the burnout issues is, most people get to the streets for way complicated reasons. The process of trying to fix those can be lifelong.
(p. 2693).
Successes were woven throughout the book, shortlived as some/many were. What I found exciting is that one of Dr. Jim's inner circle (a possible solution here?) felt that homelessness "...is really about accountability, system design, performance." (p. 2890).
This same person also felt "homelessness was a function of fragmentation, among social service agencies, both public and private." This "bureaucratic complexity" needed to be done away with and replaced with "...a system with a command center made up of all the relevant agencies in a city or region". (p. 2859) Each homeless person would be the responsibility of whatever jurisdiction they were in. "This system would rely on constantly updated data, keeping tract both of the community's overall homelessness problem and of each local homeless individual, with the causes of their homelessness diagnosed and appropriate solutions tailored to each,...described as a public health approach---science-based, data driven, collaborative, prevention-oriented". (p.2868).
The author described this approach as having "measurable success", such that by 2021 they were the recipient of 100 million dollars from the MacArthur Foundation "to accelerate their work".

Writing this review on a weekend when most of the country is experiencing record low temperatures, snow, and dangerous windchill conditions, I think of the nation’s homeless, especially those who sleep outdoors, the so-named rough sleepers of Tracy Kidder’s new book about Boston’s most vulnerable homeless people. Caring for them became the career work of Dr. Jim O’Connell, a Harvard-trained physician, but O’Connell didn’t mean for it to be. His job with the Boston Health Care for the Homeless program was meant to be a yearlong job right after O’Connell completed his medical residency.
As they say, life is what happens while you’re making other plans, and O’Connell became a fixture on the streets of Boston: a friend and counselor as well as a medical doctor. Pulitzer Prize winner Kidder accompanied Dr. Jim (as he was known) as O’Connell drove the Program’s van in search of those who needed help. This book is the result of those travels. Dr. Jim and his fellow workers at the program work tirelessly for their clients, treating their wounds and illnesses, helping with referrals to housing if wanted, working with substance abuse agencies, trying to cut through bureaucratic red tape to obtain whatever was needed. Readers will meet some unforgettable people from the streets and from Boston Health Care for the Homeless and will witness the successes, failures, frustrations, and friendships of the people on the cold streets and the extraordinary people who advocate for them.

Thank you to NetGalley and the publisher for an advance digital copy in exchange for this review. What I read will stay with me for a long time.

I found this book easy to read, but I didn’t like it enough to recommend it in our community. I wrestled with that decision, as I believe this narrative tells it very much like it is, but it has little to tie it to our area. It is how it is in cities, or in more populated areas, but not in our rural setting. So I tried to convince myself that I should promote it to show our community what the life of homeless people could be like, but while the book was easy to read, very conversational really, I didn’t love the rambling narrative. Read it all, cheered for the doctor who stuck with the program, knew someone would end up dead by the end, but didn’t love the wrap up. It left me unsatisfied, though maybe that is because there doesn’t seem to be any hint of a hope to eradicate homelessness. I feel like I need to apologize to the author for not liking it more. Maybe I will change my opinion as I read more news articles on the homeless in future days, looking for commonalities.

Thank you Netgalley and Random House for the ARC!

Rough Sleepers is a great snapshot of Dr. O'Connell's work with Boston Healthcare for the Homeless and some of the people he cares for. It provides an overview of both the program's history and Dr. O'Connell's role within it. There's also a focus on the stories and lives of a few notable 'rough sleepers' that Dr. O'Connell provides longitudinal care for. Drawing on the experiences of those working to help and Boston's homeless, Kidder provides an overarching critique of the ways homelessness can be politically created, from the dizzying amount of bureaucracy that keeps people from receiving housing to the lack of support homeless people receive once in housing. And Kidder also shows the way in which medicine is practiced differently when working with the homeless, which may be a larger critique of how medicine is practiced now, with its focus on efficiency and financial/insurance-related constraints. Nevertheless, Kidder also highlights the agency of both physicians and those they care for within these systems of disenfranchisement. A major focus of this book is the difference between caring and curing: while we may think of physicians as people who cure, the root problems of homelessness are not necessarily something that can be fixed by a physician, and instead the role of the physician is to care, showing how they can still do their best to mitigate the challenges faced by those without housing.

All in all, much like Mountains Beyond Mountains, Kidder shows the ways people are working to fill in (some of) the gaps within the healthcare and social systems.

I hope this book shoots to the top of the New York Times, and every other book list. It needs to be read, especially by people in the public arena—-policy makers, hospital administrators, professors, even retired people like me.
Kidder has done it again: taken a subject that seems distasteful, and made it into some both impactful and fascinating. He had to have spent countless hours, days, even years with Dr. Jim O’Connell, who works with Boston’s unhoused, especially those he calls “rough sleepers”. These are the people who, for a variety of reasons cannot or will not even come into the shelters. If you want to help them, you have to find them first.
Kidder starts right at the beginning, exploring why a skilled physician, coming out of Harvard Medical School, would choose to begin and remain working with the poorest of the poor. In some ways, this is also the story of Barbara McGinnis, the Pine Street Shelter nurse who taught O’Connell how to be not just compassionate but also effective in her world. Together, and with many others, they were the architects of Boston Healthcare for the Homeless.
Many of us have no idea what other people suffer: growing up in abusive homes, because of military service, because of illness or for so many other sad reasons. We see a small number of the homeless on the streets, and mostly we ignore them, walk past, or in some other way pretend we don’t see them. Kidder reminds us that each of those people, and thousands more we never see, is human and has a back story, a history.
Kidder’s story is about the one man who could really see them, the people that others considered lost. This is a two-part gift: the gift of the man who does this work, and the gift of the man who tells his story. It is worthwhile on both counts.

Rough Sleepers refers to the homeless population of Boston who sleep outside in all types of weather. Boston has a large amount of rough sleepers who often suffer from drug addiction and mental illness. Dr. Jim O’Connell has spent his entire career providing medical care, support and a listening ear to the homeless. This book is about his decades of caring for the homeless. The author, Tracy Kidder, has followed Dr Jim and has captured the doctor’s selfless devotion to Boston’s Rough Sleepers. The book also introduces the reader to many of the individual homeless and to the many of the other medical personnel who work with Dr. Jim.
I was very moved by this wonderful tribute to Dr. Jim and to all of the people who work with the homeless.

What an incredible story of one man's quest to aid the homeless in Boston! Tracy Kidder spent time riding with the people who helped keep the homeless healthy enough to survive the conditions in which they lived. This is a well written and documented tale of an under-served community which is spreading across our nation. Kudos to Mr. Kidder.

Tracy Kidder addresses a very real problem in American society, and that's homelessness. He focuses on a physician working in a Boston clinic for the homeless. Kidder addresses the political issues that impacted public health and closed many mental health facilities going back to Reagan administration. He also addresses that many of the homeless are victims of childhood trauma, resulting in problems with addiction. A failing child protective system contributes to homelessness, yet the homeless are blamed for their circumstance. Kidder relates of many of them are so sick by the time they get housing, they either are not mentally able to live in housing or they die from chronic illness. In large cities, there are programs to aid the homeless, but not enough funding. In smaller cities, it's left up to individuals to start a nonprofit. Nothing much changes.

Throughly helpful and enjoyable! Bravo in the concepts of sleep realm needed for a completely restful sleep.

I would highly recommend this book for parents and grandparents alike.