Stories from the Shadows: Reflections of a Street Doctor

by James J. O'Connell, Howard K. Koh (Foreword)

Dr. O'Connell’s collection of stories and essays, written during thirty years of caring for homeless persons in Boston, gently illuminates the humanity and raw courage of those who struggle to survive and find meaning and hope while living on the streets.

Genres: Nonfiction, Medicine, Memoir, Medical, Health Care, Social Justice, Biography

186 pages, Paperback

First published January 1, 2015

Reviews

[Susanne · Rating 5 out of 5]

Oh my. I am humbled and impressed. This is a book of memories and reflections written by an extraordinary individual who graduated from Notre Dame in 1970, received a Masters in Theology in 1972 and an MD from Harvard in 1982, and then proceeded to devote the rest of his life to providing medical care to the homeless people of Boston. If this isn't a recipe for sainthood I don't know what is. You will never look at a homeless person again in the same way after reading about the people O'Connell came to know and love.

[Lina Fang · Rating 4 out of 5]

I want to meet Jim!!!! But also the whole world does and he is a busy man! This made me think a lot and I feel lucky to work my jobbbb

[Jennifer Welsh · Rating 5 out of 5]

As a family physician, this book reconnected me with the importance of seeing the divine spark in each person I come in contact with. The personal stories of triumph amidst tragedy are a call to action for all of us.

[Margaux Miller · Rating 5 out of 5]

A guy from the NYT said that nobody has done a better job at humanizing the homeless than Dr Jim O’Connell and he is 100% right. I was recently introduced to the term street medicine and this book really solidified it as a potential career choice for me. His writing is beautiful (and honestly a bit hard sometimes, he uses big, purposeful words) and you can tell he cares deeply about those that he heals. This is a must read- its ability to humanize the most ignored and marginalized is inspiring and I hope to carry that voice and empathy with me into my medical career. Sorry. Sappy. But it was just so beautifully inspirational ❤️ thank you Haley for this!

[Noah · Rating 5 out of 5]

A beautiful compilation of stories of real people, medicine, and the challenges and opportunities of the health care and folks-who-are-homeless-care systems.

[Liv · Rating 4 out of 5]

“We are not in the business of changing people; our purpose is to gently offer hope and options.”

[Rita Graham · Rating 5 out of 5]

The shadows refer to the places in the Boston streets that we ordinarily never see. These stories are written by a doctor who has spent 30 years caring for the individuals in the shadows, the faceless and nameless, the defiant and addicted, the human beings most of us (including their families in many cases) would rather not acknowledge even exist. Dr. O'Connell worked with many special service providers over the years and has helped develop some desperately needed links in a chain to bring dignity and continuity to the care that is required. A great reminder in this Lenten season to "love your neighbor as you love yourself."

[David Newton · Rating 4 out of 5]

Books like this are great boosts of empathy while working in the hospital. Honestly it helped right away on my first residency rotation in the emergency department. The ED becomes the final common pathway of illness and poverty, and people experiencing homelessness face this same intersection but unfortunately at higher speeds. Diseases present earlier and at more advanced stages in these folks than their housed counterparts, and Nashville was no exception.

Dr. O’Connell does a remarkable job humanizing these friends and provides a clearer glimpse into a world I know very little about. Psychiatric illness and early childhood trauma become (far too) common refrains, but this engenders a sympathy that covers a multitude of sins. O’Connell finds something beautiful in each personality and helps the reader see it too.

Homelessness can make modern medicine feel so powerless. I'm thankful that most hospitals including mine employ a cadre of professionals (e.g. social workers, case managers) that have broader reach than the pills and procedures at my disposal. Simultaneously I've experienced a gradual shift in attitude that looks to care more than cure. This is partly because of what I think is feasible after years of unmet social needs and partly because of books like this that highlight the importance of engaging humanity.

I think homelessness will be one of society’s most complex problems to solve and that its roots run far deeper than material deprivation alone. But there’s something profound in these essays about the power of authentic, committed relationships and the washing of feet that gives me hope for doing some good in the present.

I’m thankful to have a few friends who care deeply for this population, including Erik Olsen who recommended this book specifically.

[Roxanna · Rating 4 out of 5]

Healthcare for patients who rely on shelters or housing instability is defined by harm reduction. I appreciated this book because I continually find it a challenge to rethink traditional solutions for this particular patient population. His stories were insightful but also contained important and real practical advice

[Colin · Rating 5 out of 5]

This short yet powerful book uses sparse and direct prose to unflinchingly describe the circumstances and conditions of the homeless of Boston and the work of the author for 30 years. The author originally intended to work in the field of oncology but during volunteer was lead to spending a career providing medical care to some of the neediest and most vulnerable members of our society. The author's description of the people he meets on Boston's streets is respectful and a reminder to us all of the old cliche, "there but for the grace of God go I."

Highly recommend.

[Savannah Dziadzio · Rating 5 out of 5]

Dr. O’Connell is my personal hero, he is an incredible example of how medicine should be practiced. These stories are so vivid and humbling. As a medical student I can only hope to have an ounce of the grace of Dr. O’Connell as a practicing physician. These stories are so incredibly truthful and human and I have loved everyone minute of them

[Megan · Rating 4 out of 5]

Dr. O'Connell is an inspiring physician who has spent 30+ years caring for the homeless in Boston.
This compilation of essays puts a face to homelessness. The accounts are sometimes humorous, sometimes heartwarming, and often tragic.
It's obvious in the reading that the homeless problem is a complex one without easy answers. The compassion and humanity that Dr. O'Connell and his staff share with the homeless population is impressive and worthy of emulation.
It's impossible to read this and wonder if you could remain judgement free as you help addicts get clean, only to see them on the streets addicted again. Could you/I clean maggots from a homeless person's body, only to see them develop a blood or bone infection without the maggots to clean up their necrotic flesh? Could I wash their feet and avoid holding my nose when they come in for care covered in urine and feces? This is a segment of society so difficult to care for, so marginalized, but also so in need of love and compassion and the help they hopefully will accept.
O'Connell pioneered some of the methods their ministry uses now to help the homeless, including medical vans that distribute blankets and food to the "rough sleepers" who prefer not to sleep in shelters, as well as medical care right on the streets. He was taught by the nurses how to win the trust and confidence of the homeless population. He is a doctor who takes time and listens. Kudos to him and his staff for their amazing work. It would be very difficult to do. And very disheartening to continue to do.
Read this for Funner Book Group.
My biggest grievances about this book is that it is not on audible or an ebook.
Addendum, now that we have had book group and talked about this book.
Quote roughly from the book: "In January 2000 the team began following a cohort of 119 people who had been living on the streets of Boston for 6 consecutive months or more. Most had lived on the streets of Boston for six consecutive months or more. Most had lived on the streets for 5 years or longer. Despite an average age of only 45 when the subject first began this study, a third of these individuals were dead within five years. The leading causes of death were cancer, heart disease, and liver disease. Our hypothesis that these individuals had fallen through the holes in our safety net and had avoided our health care system proved resoundingly wrong. In a scathing rebuke...Medicaid reported that these 119 individuals had an aggregate 18, 384 emergency room visits in the five years between 1999 and 2003. " This shows the scope of financial strain for treating the homeless population.
Present at our book group was a woman who is an advocate for the homeless in Dallas. She has met and worked with Dr. O'Connell multiple times. Every time she is in Boston she rides out on his van with him to minister to the homeless. She told us that Boston is the exemplar city of how to take care of the homeless. Because we have so many shelters and beds available we have only 3% of our homeless sleeping in the streets. Seattle, by contrast has 60% of their homeless sleeping in the streets. Our success is partly due to innovative programs like the van which distributes food, blankets, clothing, and medical care on the streets, and helps the sick and infirm get to the hospitals. And it is partly due to large donations from pharmaceutical companies and other donors to fund these programs, as well as to build shelters with so many beds. So hooray Boston! We all left book group wanting to get more involved in sharing love and compassion with the homeless in our area.
I always love reading books about things going on in the Boston area. This was a good one!

[Karen · Rating 3 out of 5]

As the first few chapters unfold, you can't help but be drawn into the humble stories and all you can imagine is the satisfaction of choosing a career like this, the emotional and physical pain you've relieved, that would otherwise be ignored or ridiculed. As you continue, the stories, though different... are also the same: drugs, mental instability, hopelessness and doubt comes in. How many were actually lifted out of this street life, to live productive lives themselves, or is it only to make them more comfortable with the choices they've made that have led them here? What is a productive life? Did they make choices or was it inevitable, out of their hands - out of ours? What choices are each of us making, living side by side but not as equals? What is equal? Who is deserving, of what? Why?

Is there a home for the homeless, is there hope for the hopeless? (Brett Dennen)

[Sapir Englard · Rating 3 out of 5]

I have to admit, I skimmed the last 40 pages or so. I just couldn't. The writing is heavy, and while the content is genuinely interesting, the writing style is just not for me. It dragged on, and I felt kind of insulted that it took me so long to finish such a small book.

Still, the parts I forced myself to invest in were good. The stories are intriguing as much as they're heavy.

3 Stars for effort and for the cause.

[Kati · Rating 3 out of 5]

The three-star review is not so much for the content, but rather for the presentation. The book is basically a collection of opening statements from President's Reports to the BHCHP and from public health task force meetings. Their original purpose was to be a brief, superficial reminder that there were unique human beings behind the statistics that were about to be discussed, before diving into those statistics. As a result, each 'chapter' is 50% poignant but frustratingly shallow story about one or more people who were homeless, followed by equal amount of airtime for whatever the focus of the original meeting or report was going to be.

There are any number of better books this could have been. Even simply editing out the old 'meeting minutes' portions so the focus could be on the people helped would have been a great improvement. Better yet would have been to expand the brief episodes into longer narratives. Some of the patients, Dr. O'Connell apparently knew a life story for; it would have been nice to see those covered in more than a paragraph.

The boctor's work on the streets is wonderful, the book was hopefully a decent little fundraiser for the Boston Health Care for the Homeless Program, but as a book among all others in a library, I'm afraid it was kind of phoned in.

[John Fredrickson · Rating 4 out of 5]

It is hard to adequately characterize this book. O'Connell received a Masters Degree in Theology, then graduated from Harvard Medical school with the eventual goal of being an oncology specialist. He ends up getting diverted into a career that he would never have anticipated - he becomes a doctor to the homeless population of Boston. The (very short) stories in this book variously relate the personalities, histories, medical issues, and other aspects of many of the homeless people he has encountered in his work at BHCHP (Boston Health Care for the Homeless Program).

All of the stories depict the patients with respect and dignity. The nurses and doctors exhibit immense fortitude and caring in the attention and treatments they provide to a very difficult population. Even some of the homeless in the stories exhibit this care, not only to each other, but also to the medical staff they learn to trust.

The stories O'Connell tells are uplifting in multiple dimensions. There is a deep humanity in all these stories that makes one not only feel humbled by these caregivers, but also makes one a bit more reluctant to treat the homeless people on the streets as invisible.

[Meir Brooks · Rating 5 out of 5]

A must-read, albeit a difficult one. The book is short and simple: it describes the experiences of Jim O'Connell, a doctor and leader of the Boston Health Care for the Homeless Program. The book is just 185 pages and an extremely quick read, as it is composed almost entirely of brief (2-3 pages mostly) vignettes of patients from 1985 to 2015. The stories are mostly repetitive and overwhelmingly sad, as homeless patients suffer through difficult lives and often sudden ends. But the book brings out the voices of these individuals in their own words, even if through the prism of O'Connell's eye, and humanizes them, preventing them from being pure victims or stereotypes or mere backdrops. Their angers, loves, hopes, brilliance, mistakes, dreams, friendships and families, all are described beautifully. O'Connell's example and those of his coworkers are a beacon of light. It is the kind of book that should change us, and even if it doesn't, we should have its stories and voices in our hearts and minds.

[David Holoman · Rating 3 out of 5]

Let's be clear: Author Dr. O'Connell is heroic and inspirational, truly. The work (healthcare for the homeless) is important beyond measure, and demonstrably frustrating.

The book, however, is not that great, mostly in a missed-opportunity sense. It is composed of maybe two dozen vignettes that read for all in the world like text extracted from an annual financial report. The vignettes often make coarse, abrupt transitions to other subjects that leave the reader looking for context, or breath. They are peppered with person-mentions like a book-long acknowledgement section, or the make-good of a promise to mention these folks in a book someday.

In thirty years, could not four stories be identified as the best and most emblematic, and be worked up in more detail?

Back to inspirational, however: the accounts are touching, and they do make me want to get involved locally. So that's certainly worth something.

I can save you some trouble: if you aren't in Boston, you'll have to order this book.

[Nicholas Morley · Rating 3 out of 5]

Parables from Boston's overlooked. The doctor clearly got that 8th grade English lesson on writing a hook to pull in the reader, because it's used to start every chapter. The case reports are laced with philosophical musings on the nature of medicine and care in a society that permits-- perhaps manufactures-- crushing poverty, but they don't go so far as to critique the caretaker, the cared-for, or their wider society in any systematic way. It is a rosy view of the profession, and at times borders on exotifying the homeless population to the wannabe doctors and possible philanthropists the collection is obviously pitched to. Good PR for an important subsection of medicine, but not much else.

[Jacqueline Kawate · Rating 5 out of 5]

After finishing his medical training, Dr. O'Connell postponed his fellowship in oncology to work, for what he though would be one year, in a new program providing medical care to the homeless in Boston. 30 years later he is still treating the homeless, on the street and in shelters. It is officially called the Boston Health Care Program for the Homeless. He ventures out into the streets at night to seek out those in need. He understands the peccadilloes and fears of the homeless and he seems to not judge them. He visits his patients in jail and he goes to court on their behalf when necessary. He attends their funerals, even when it is a pauper's grave. He is a medical hero and a true humanitarian. Great book.

[MJ · Rating 5 out of 5]

Dr. O'Connell has spent most of his life as a doctor helping those many of us try to ignore - the homeless, in this case, the Boston homeless. In this book he tells the stories of some of those folks - how they came to be in that situation and how he learned to help them. Over the years, he and his fellow "angels" learned some surprising things - many are functionally illiterate, had rough childhoods in the foster care system, and have a much higher rate of cancer than the general population (likely due to the early ages at which they started smoking and drinking).

It's not a long book, but took me a few days to read through it because I had to keep taking breaks from the subject matter. But I finished it and highly recommend other do also; it will change your view of the homeless.

[Benjamin · Rating 4 out of 5]

"The true measure of any society can be found in how it treats its most vulnerable members."
-Gandhi.

Dr. James O'Connell guides us through 40 years of patient stories that are as devastating then as they are today. The healthcare inequalities, and disparities continue to exist despite our efforts to make meaningful changes. Dr. O'Connell astutely calls out the system both healthcare and governmental as a broken machine casting these fragile souls to the frayed edges of society. Poverty is the greatest social determinant of health and much is still needed to address our homeless crisis and the medical conditions unique to this population.

This book is a bullseye to what FQHC medical providers see and experience daily. 10/10 Recommend.

[Teresa · Rating 5 out of 5]

I read this book several years ago, and it was one of those incredibly impactful books that never leave you. I appreciated the rawness of it, and it changed my perceptions of both homelessness and our role in “curing” it. My biggest takeaway from the book: the nurse who ran the clinic was constantly telling the doctors and nurses that they were not there to change anyone’s life. Their job was simply to offer hope and options. I would say that in addition to hope and options, they gave them a healthy dose of dignity too. Without that perspective, I think it would be impossible to continue in that line of work without completely burning out. Beautiful book full of humanity.

[Erin Rody · Rating 5 out of 5]

This book will leave you tenderhearted and with deep gratitude and respect for the extraordinary work done by Dr. O’Connell and his team. Many a train ride found me weepy eyed from the remarkable stories that Dr. O’Connell tells of his patients, his “rough sleepers” out on the streets of Boston. For any urban dweller curious and seeking understanding about those on the fringe of society – I would highly recommend this book. Dr. O’Connell is the embodiment of humility, devotion, kindness, and grace.

[Brooke Long · Rating 5 out of 5]

I would highly recommend this quick read for anyone curious about the true trials and tribulations of serving those experiencing homelessness. Boston Healthcare for the Homeless Program has incredible insight into the stories of those who have firsthand experience living on the streets and in shelters, and this book is a humbling collection of just a few of those stories. If you like this book, definitely check out Rough Sleepers by Tracy Kidder!

[Annie · Rating 5 out of 5]

Incredibly moving and masterfully written. I’m glad to have read this book while rotating with Dr. Bossie as I saw many parallels between the themes highlighted in this book and Bossie’s practice. This book emphasizes the importance of meeting patients where they are, centering their needs, and working to restore the dignity that has been so callously stripped from the most marginalized.

[jane · Rating 5 out of 5]

it would be a dream to work for bhchp in some capacity so i greatly enjoyed this read, i think he is a very good writer and his vignettes were charming, though it is sad that a lot of them are very similar — the individuals are very unique but their fates are quite similar. also thank you eda for letting me borrow this book

[David · Rating 5 out of 5]

This book opened for me a whole new world and sub-culture within our society. I marveled at O'Connell's ability to care for these people and to write about them without judging them. It is evident that he came to love them as friends and saw their worth and value. I am not sure I could ever do that. I would just want to fix them.

[Julie Brown · Rating 3 out of 5]

I was deeply touched and inspired by Dr. O’Connell, for the humanity in this collection of stories from his years as a street doctor for the homeless. I do wish each story had been fleshed out more, they were pretty brief.

[Joe · Rating 4 out of 5]

It reads like a series of journal entries, but the anecdotes are piercing and impactful, these are lives we don’t care to notice but I’m glad for the work Dr. O’Connell and his colleagues are doing to place a light on this major social determinants of health.