Thanks to NetGalley and Random House for the early reading copy in exchange for an honest review. This book, which basically tells the story of Dr. Jim O'Connell and his caring for the homeless in Boston, was moving, heart-wrenching and inspiring. While reading, I found myself often thinking that I need to do more and to give more. I'm not sure which Kidder shines a light on more: homelessness, as a broad issue; the individuals experiencing homelessness that he profiles; or Dr. O'Connell, and his optimism and selflessness in doing, what often seems, thankless work. I will be thinking about this book for months, if not years to come. My only criticism probably has more to do with me and feeling like it's not enough to lay out the problem--where's the solution? Of course there are no (easy) solutions, but I did feel this all ended rather abruptly and without any sort of resolution.

Rough Sleepers by Tracy Kidder
The first question long-time followers of Tracy Kidder will ask is, How does this book compare to Mountains Beyond Mountains, Kidder´s account of the work of Dr. Paul Farmer, co-founder of Partners in Health, which provides health care to the needy around the world? Both books are about self-sacrificing doctors who provide care to the hopeless and who believe that health care with dignity is a basic human right. If you haven´t read Mountains Beyond Mountains, I highly recommend it. Rough Sleepers is a worthy companion.

Dr. Jim O´Connell is the director of Boston Health Care for the Homeless Program. Kidder introduces him from the program´s van, out in the field making “house calls” on Boston´s rough sleepers, people who have no shelter at all, who sleep on the streets, in alleyways, in doorways. In addition to medical treatment – mostly focused on ameliorating the chronic health problems – the team distributes food, socks, underwear and other necessities of life on the street.

O´Connell and his team meet the homeless where they are – in shelters, half-way houses, on the streets, and for a lucky few, in newly acquired housing. He also meets them in the midst of their problems, delusions, and addictions. Most of the care he provides he characterizes as “good palliative care,” since their problems, exacerbated by a system that seems totally oblivious to the realities of life on the street, are largely intractable. Both Jim and Kidder call on the myth of Sisyphus to describe the work, while adding that they mean that myth in the sense it was reworked by Albert Camus, who wrote that Sisyphus´ task might have been endless, but he nonetheless found joy in it
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Kidder also follows the particular story of Tony, a homeless man who both benefits from and enhances the program´s work. Tony is selfless towards Jim and the residents of the streets, often to his own detriment, but is also an addict and a man with a prison record, which makes him difficult to help. The system fails Tony in many ways, and his story typifies the small victories and crushing frustrations of this work.

O´Connell is quoted as saying, “I like to think of the problem of homelessness as a prism held up to society. And what we see refracted are the weaknesses in our health care system…” The universal importance of this book lies not just in what it can tell us about our fellow human beings, but what it tells us about the problems facing health care for everyone in the United States. Kidder describes O´Connell as a kind of “country doctor for an urban population,” calling on patients on their turf, taking time to listen to their problems, acting as a kind of social worker at times. “Medicine is not supposed to be efficient,” O´Connell says. He has the human touch, which in an age of computerized medicine and insurance company middle managers is sorely missing.

This book is a joy to read, despite its often grim subject matter. Kidder´s prose never falters, and the image of Jim O´Connell serving the underserved is profoundly inspiring. Some have, inevitably, called O´Connell a saint. But he´s just a man, doing a job that needs to be done in the way it should be done for all.

I received a free ebook from NetGalley for my honest review.

This book was both uplifting and heartbreaking. Dr. Jim O'Connell has spent his entire medical career of over 40 years caring for Boston's homeless (unhoused) population. He doesn't do it alone, though. The Street Team is an in-the-trenches group that drive to the places where many of the "rough sleepers", those who are sleeping on the streets rather than couch-surfing or staying in shelters or cheap motels, can be found, and offers medical care, help with resources, or just a listening ear. Dr. O'Connell was also the head the Boston Health Care for the Homeless Program.
I will admit to finding this book pretty depressing. So many of Dr. Jim's patients never make it off the streets for good. There are uplifting stories of people getting clean and housed, but there are far more stories of backsliding, evictions, and early death due to substance use, weather, etc.

What I love about Tracy Kidder is how he finds a way to weave intimate, honest narratives of real people just trying to make things in their corner of the world a little better. In the case of Rough Sleepers, we follow Dr. Jim as he provides multifaceted care to the homeless population of Boston. It's not an easy read, but it is an excellent glimpse into the many challenges (legal, bureaucratic red tape, etc.) facing the caregiving teams as they try to support the individuals in their care.

Thank you to the publisher for providing the advanced reader copy via Netgalley in exchange for a fair and honest review.

A wonderful book about how Dr. Jim O’Connell has dedicated his life to helping the rough sleepers. This book follows his life working with the homeless and inspiring others to join him in caring for them. The best part for me is getting insight into the homeless people themselves, their lives, burdens, hopes and aspirations.

The book also covers the network of agencies, hospitals and institutions involved with the lives of the rough sleepers. Which will give you an idea of the scope of the issue and the challenges that it represents.

This book will inspire you with what can be done, enlighten you about the homeless situation and help you realize that all people have hopes and dreams.

Thank you to NetGalley and the publisher for this ARC.

Not only is this an excellent book, it will also be an exceptional movie . . . . or two.

The first movie should follow the book as it tells of the career path a young Harvard doctor elected to follow. Jim O'Connell intended to spend a couple of years in a low paying job as physician to the homeless. His short term plans became a fulfilling lifetime. "Rough Sleepers" tells the story of life on the street for the Boston homeless populace. The tale is both sad and heartwarming. Tracy Kidder weaves the individual stories of the homeless with Dr. Jim and what became his life's mission.

The second movie will be the story of Tony, a homeless character who is foundational to Jim's life. This sequel will tell the progress and relapse that Tony makes several times.

This book is so well written that I've already ordered an earlier Tracy Kidder book. His writing is that good. This one is five stars.

I wish to thank NetGalley and Random House Publishing Group for allowing me to read an advanced copy of this book. I have voluntarily read and reviewed it. All thoughts and opinions are my own.

This is a powerful book about the homeless in this country. The book reveals the life work of Dr. Jim O’Connell who when fresh out of Residency is tasked with working for one year with the homeless community in the Boston area. One year leads to two and then to a lifetime of commitment to understanding and meeting all the different needs of the homeless around him, Homeless people are largely forgotten or ignored. The book introduces the reader to life outside and the great lack of concern, for shelter, food, medical care and opportunities for these people. This book is not one that is quick to read but it informs everyone about the plight of being homeless in our land of plenty. It deals with health issues, mental illness, drug and alcohol abuse and troublesome past of the people who are now the Rough Sleepers. I am much more aware now and recommend this book to everyone. I applaud Tracy Kidder for writing such a book in such a sensitive manner and I look forward to other books by this author.

I think this topic is so important. I wanted to love this book, but the writing didn’t draw me in, and the story felt very drawn out. I had to force myself to keep coming back to read it. I would not recommend it.

Another brilliant book from Tracy Kidder! Rough Sleepers tells the story of Dr. Jim O'Connell and his work with unhoused people in Boston. This book reminded me a lot of Mountains Beyond Mountains (describing the late Paul Farmer's work in Haiti). Kidder does a masterful job of bringing Dr. O'Connell and the people he serves to life. This book should be required reading for those who complain about the homelessness crisis but don't actually interact with homeless people, and it shows a path forward for meeting the needs of homeless people with empathy and compassion. Thanks to NetGalley for the ARC!

As 2022 draws to a close, I look back at books I’ve read. Many fit the goal I set, which was to read more fiction and non-fiction of substance, books that would touch my heart and spirit. I read my share of my favorite mystery and thriller books as well and took a break for some light reading. Of course, I read a couple Christmas novellas. Recently, I was approved for a nonfiction book by award-winning author Tracy Kidder, Rough Sleepers: Dr. Jim O'Connell's Urgent Mission to Bring Healing to Homeless People. It sounded a bit heavy for Christmas reading, but since it comes out in January, I decided to dive in. It didn’t take long for me to realize that this book is really what the spirit of Christmas is all about.

Kidder opens this saga by taking us along on a van ride through the streets of Boston. It’s nighttime. Mid-1980s. Dr. Jim O’Connell and his Street Team are distributing food, blankets, and comfort to homeless people on the streets of Boston. “Rough sleepers”, O’Connell calls them, which is a term from 19th century Britain. The team doesn’t deliver just physical comfort. O’Connell chats with folks, most of whom he knows by name. He examines them, encourages them, invites them to come to Mass General – the Street Clinic at Massachusetts General – on Thursdays. It’s an impressive scene. This was in the era when HIV-AIDS first came on the scene. The book concludes with COVID.

Jim O’Connell didn’t set out to do this work. He did have a way with people. He tended bar while working his way through med school. Perhaps that’s why, when he was about to head off to New York City’s prestigious Sloan Kettering for an oncology fellowship, he was asked to postpone it to work for the Boston Health Care for the Homeless program for one year. At age 37, he wasn’t sure he wanted to do that, but he said yes. The rest was history, as he is still with the program, although not on the Street Team.

His initiation? The nurses put him to work washing feet! Imagine that! It seemed to be a humbling experience, but it struck me – it reminded me so much of Jesus washing the feet of his apostles. The nurses explained to him that the most important thing in the clinic was to listen to the patients, and this was the best opportunity to do that, to get to know the people. Jim was excellent listener.

As he spent more time getting to know the people and their way of life, he became familiar with the immensity of the problem of homelessness. People are affected by diabetes, narcotics, alcohol abuse, histories of sexual abuse, criminal backgrounds, lack of education, and many untreated illnesses. Many avoided shelters, preferring to sleep outdoors. The goal was to get them off the streets, but people sex offense and/or criminal backgrounds were usually ineligible. Those who did receive housing were evicted because they broke the rules, or they didn’t know how to cope with living indoors. But there were success stories. One staffer, the recovery coach, said that his way to avoid despair was to redefine success. He measured sobriety in hours, he said. So, he rejoiced when his folks could achieve that.

There are some marvelous people in this book. Jim and the other team members always tried to overlook the past, the reasons people became homeless. Their concern was for the person they were trying to help in the here and now. One man, Tony, is highlighted because he was a favorite of staff and street people alike. He struggled mightily, but he was also a generous soul who helped others and fought for those who were weak and helpless.

Jim often thought of the work in terms of Camus’ essay, The Myth of Sisyphus: The gods had condemned Sisyphus to endlessly rolling a rock to the top of a mountain. The rock would fall back of its own weight. This seemed a horrible punishment, a futile, hopeless labor. Camus’ argument is that the work itself is rewarding. It is the struggle that gives happiness. Homelessness is a multi-faceted condition, according to O’Connell. That must be what keeps Jim and his wonderful team members going. The problem is not just with our housing system or our health care system, but also welfare, education, legal, and corrections systems as well. The people living on the streets of Boston in Kidder’s book are evidence of this. And Boston is just one city in America.

I’m so glad I had the opportunity to read this book. Thanks to NetGalley, Random House, and Mr. Tracy Kidder for this ARC copy. My thoughts and opinions are my own.

5 stars

Well written wonderful book about a segment of society we too often dismiss. I couldn't put it down.

I am always impressed with the way Tracy Kidder gets inside peoples' lives. Kidder's narration is so intimate that it makes nonfiction read like fiction, but with the right amount of facts and statistics woven in to remind me <i>this is all real. Rough Sleepers</i> is hard reading. While it is relatively short, it took me longer than expected to finish. I found myself distracted as I read, my mind drifting to other things, despite thinking the writing was good and being interested in the story. I'm not sure if it's a result of the writing, the painful narrative, or simply what's happening in my own brain.

<i>Rough Sleepers</i> follows employees and patients at Boston Health Care for the Homeless. The focus is on Dr. Jim O'Connell and one of his patients, Tony Colombo. Jim starts at BHCH fresh out of residency. His plan is to work there one year before starting a more prestigious fellowship program. It's been decades and Jim's still there. He was drawn into the lives and stories of his patients and community; along with so many of BHCH, Jim feels his calling is to work with the unhoused population.

Kidder helps the reader get to know each of the people in <i>Rough Sleepers</i> on a personal level. The lives of staff and patients are both challenging (of course in different ways). What struck me most were the logistical and bureaucratic obstacles unhoused people face at every turn. It seems nearly impossible to escape the vicious cycle--and for most, that is exactly how it plays out. For example, reading about BHCH staff trying to secure housing for Tony and others is shockingly difficult. In most circumstances, they fail. The intermittent successes seem to be enough to help them continue battling an arcane and complex system. Their patience is saintly.

My favorite description of Jim:
"Pre-admiration was something like the opposite of prejudice, a quality the doctor tried to emulate: 'I think that Jim has an attitude of pre-admiration for the people he doesn't yet know. His presumption is, "Oh, I'm eventually going to like this person. I will probably find some reason over time to like them. I just happen to not know it yet.""

Overall, important topic, well-written, and definitely recommend.

I was one. When we lived in Philadelphia and I worked downtown, I got used to seeing them. People sleeping on cardboard boxes over the subway vents. The man who sold pencils on the street corner. The young man who came to the house and asked my husband to hold his money, giving over a fist of change, fearful it would get stolen in the shelter. He would return when he needed it, and went into the store next door to buy a soda and a bag of chips. There was the woman with all her belongings in a shopping cart who once threw empty soda cans at me when I came out of the public library.

One time a man stopped me and asked for money. I took him into the McDonalds we were in front of and bought him whatever he wanted: a cup of coffee.

Reading Rough Sleepers, moved by the stories of the homeless who sleep outside, I wondered why I didn’t give the homeless I had encountered more thought. I was young, we didn’t have money, I was ignorant. Or was acceptance just plain easier?

Tracy Kidder’s story of the Harvard trained doctor who dedicated his life to serving the most needy is inspirational, disturbing, eye-opening. The position he accepted for a year before he went onto to a fellowship in cancer research became his life’s work. His background as a bar tender taught him how to listen. His childhood taught him how to stay calm and controlled.

His first duty was to wash the feet of the homeless. It was a medical necessity, but also a lesson in servitude. Dr. Jim learned that traditional medicine, based on profit and treating patients not people, didn’t work with this population. He needed to get to know them, earn their trust before he could treat them. Dr. Jim delayed the fellowship another year, then gave it up. He had found his life’s calling. He worked long hours, traveling the streets at night to check on patients. He gave up wealth and rank and a private life. He made a difference, forming decades long relationships with his patients.

It’s not just the good doctor that we come to know; we get deep into the stories of his patients like Tony. He was a good person, a peace maker, a volunteer. Like 90% of the homeless, he was also an addict. And a felon whose conviction for attempted rape barred him from obtaining housing or employment. He had mental health issues. Like 75% of the homeless, his childhood was filled with violence. Dr. Jim wondered what Tony could have been–if only. We come to care about Tony.

The book presents the complicated bureaucratic system that has failed the homeless. How low income housing disappears when building are upscaled, the tenants unable to find affordable alternatives. How for profit medical system fails this population. And how government’s cutback on spending and the closure of psychiatric hospitals, the lack of treatment for PTSD in veterans, all contributed to an increase in homelessness. As a society, we want to blame the poor and homeless for their situation. We don’t want our tax money to fund programs for people who are addicts and unemployed. We don’t want to know who the homeless are because its easier that way.

Rough Sleepers shows how a few people can make a huge impact, even in a flawed system. Dr. Jim treated the homeless as individuals of worth, ministered to their needs as he could. Its up to the rest of us to urge politicians to address the systemic issues behind homelessness.

I received a free egalley from the publisher through NetGalley. My review is fair and unbiased.

Heartwarming story of people who are helping the homeless but also heart wrenching to hear of so many people who are suffering day in and day out.

Tracy Kidder has written other non-fiction books about special people, and this book is about Dr. James O'Connell and his program in Boston which is an outstanding help to the many people there living in shelters or outside. These people are called Rough Sleepers, and O'Connell group not only medically treats them, but takes a Street Van out in the city to provide food and other necessities. Some of the rough sleepers he describes are unforgettable, such as BJ, Tony Colombo, and Joanne. This book gives the reader an understanding of this disadvantaged group and why O'Connell has worked with them 30 years.

This was an excellent book but not an easy read. What I appreciated most was the author's willingness to present the problem of homelessness in an honest and complex way. The book follows Dr. O'Connell as he works among the homeless of Boston. The focus of the book was really on the doctor's patients who were unhoused over many years or in some cases decades. This book looks at what that means for the person's health, delving into issues of abuse, addiction, and other struggles. No neat and tidy solution to these people's problems is offered. This is an excellent book to read if you are at all interested in learning about the complexities that surround homelessness.

Thanks to the author and NetGalley for providing me with an ARC copy of this book. The review above is my honest opinion.

documentary, biography, street-people, Boston, medical-doctor, medical-caring, nonfiction, narrative, new-skills, addiction, addictive-behaviors, homelessness, memories, memoir, documented*****

One man CAN make a difference (with a lot of help from others).
In Boston town a different sort of revolution happened and is still way ahead of most others. It is in the recognition and care of the people who have no address and are ignored by the masses. It is in providing health care (and where possible, housing) for those who have fallen through the cracks in The System. Through these pages we meet some of the individuals, nurses and doctors, and even some of the bureaucrats who either made it all work or became obstacles. There continues to be a great need out there and we need to face it and overcome. Take a lesson from Dr. Jim and the Street Team.
Couldn't be totally clueless about the matters exposed in this book as I am a retired RN (class of 1968) who worked the inner city in hospital and jails until 2011.
Everyone needs to experience this book!
I requested and received an EARC from Random House Publishing Group/ Random House via NetGalley. Thank you!

Rough Sleepers is a thorough, inside look at the life of medical professionals who serve the homeless . Dr. Jim is the main character in the book, and he is truly an astonishing person. He gives to his patients literally and figuratively, and will do just about anything to make them a little more comfortable, and a little less alone. This book will reinforce the idea that each of us should be doing something to help others - whether it's a donation of our time, talents, or service.

Heartbreaking moving story of homelessness in Boston though it’s implications are universal.. Award winning author Tracy Kidder (Strength In What Remains, Mountains Beyond Mountains, Among Schoolchildren, House, The Soul of a New Machine) now documents homelessness in Boston in Rough Sleepers - euphemism for the sleep the homeless get. He focuses primarily on Dr Jim O'Connell - Harvard medical educated - who decided after deferring Sloane Kettering for a year to dedicate his life to ministering to the Boston homeless.

He led a Street Team who went out every night to seek the nooks and crannies that he knew the homeless favored to tend to their medical needs - to help them yet not try to change them or force them off the streets - sometimes to provide overnights at the Barbara McInnis House. Also he ran the Boston Health Care for the Homeless Program. Part documentation- part oral history - part social history- this is the story of one man’s journey to solve an insoluble problem.

A big focus is one homeless man Tony Columbo- born in Bostons Italian North Emd - bruiser - alcoholic/ addict - mental health issues - charming big bustling man who was loved and took care of so many others - but could never get his own act together and remained on the streets. His story is harrowing and ultimately heartbreaking. Kidder devotes a lot of the book to Tony’s story giving the issues a human filter - and you want to cheer him on yourself. No saint - he is the epitome of the message of the book- to help as best you can without judgment or force to the broken toys of the world.

These are real people that Dt Jim helps by befriending them - listening- working with them on their treatments and housing - but never forcing anything. if a patient decides to leave the shelter to go back to the streets - no questions were asked - with the offer that they keep in touch and keep up their medical treatments as best they could. A humane if not difficult at times approach.

A wonderful book - uplifting and devastating at the same time - of this Sisyphean problem as labeled in the. book. Kidder as observer goes on rounds with Dr Jim and tries to record and not to interfer in order to create a rich human tapestry of a problem exasperated in recent times with no ultimate solutions offered.

Very readable - in fact somehow a page turner - beautifully written with sober eyes - highly recommended for its humanity - tact - insights - empathy.

Kidder has written a deeply felt book for the soul full of joys and pains and subtle observations. Everyone tells their story here in their own words . A beautiful achievement.

Thanks to NetGalley and the publisher for this ARC.
I am always excited at the prospect of another Tracy Kidder bio, and this did not disappoint. Kidder knows how to take the time to make a really complex portrait of his subjects, many of whom would be easy to oversentimentalize, like this Boston doctor who has spent decades caring for the homeless who sleep mostly outside, the "rough sleepers." A side highlight in this one was the sad story of a homeless man who got close to both the doctor and the author. Well written as expected, heartbreaking, inspiring, and realistic in due measure as well.