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Rough Sleepers

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In Rough Sleepers, Tracy Kidder shows how one person can make a difference, as he tells the story of Dr. Jim O’Connell, a man who invented ways to create a community of care for a city’s unhoused population, including those who sleep on the streets—the “rough sleepers.”

When Jim O’Connell graduated from Harvard Medical School and was nearing the end of his residency at Massachusetts General Hospital, the chief of medicine made a proposal: Would he defer a prestigious fellowship and spend a year helping to create an organization to bring health care to homeless citizens? Jim took the job because he felt he couldn’t refuse. But that year turned into his life’s calling. Tracy Kidder spent five years following Dr. O’Connell and his colleagues as they served their thousands of homeless patients. In this book, we travel with O’Connell as he navigates the city, offering medical care, socks, soup, empathy, humor, and friendship to some of the city’s most vulnerable citizens. He emphasizes a style of medicine in which patients come first, joined with their providers in what he calls “a system of friends.”

320 pages, Hardcover

First published January 17, 2023

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About the author

Tracy Kidder

40 books993 followers
Tracy Kidder is an American author and Vietnam War veteran. Kidder may be best known, especially within the computing community, for his Pulitzer Prize-winning The Soul of a New Machine, an account of the development of Data General's Eclipse/MV minicomputer. The book typifies his distinctive style of research. He began following the project at its inception and, in addition to interviews, spent considerable time observing the engineers at work and outside of it. Using this perspective he was able to produce a more textured portrait of the development process than a purely retrospective study might.

Kidder followed up with House, in which he chronicles the design and construction of the award-winning Souweine House in Amherst, Massachusetts. House reads like a novel, but it is based on many hours of research with the architect, builders, clients, in-laws, and other interested parties.

In 2003, Kidder also published Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure The World after a chance encounter with Paul Farmer. The book was held to wide critical acclaim and became a New York Times bestseller. The actor Edward Norton has claimed it was one of the books which has had a profound influence on him.

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Displaying 1 - 30 of 432 reviews
Profile Image for Diane S ☔.
4,735 reviews14.1k followers
March 25, 2023
4.5 Unsung heroes. Life's better angels and people who care, people desperately needed. The homeless. The unhoused. Those people many turn away from, not seeing them as human. Another social problem that our great country cannot solve, like poverty, hunger, guns and the violence they wrought. In Boston, they are attempting to do something about it and this book introduces us to some of our better angels and those they try to help.

Kidder writes terrific narrative non fiction that pulls the reader in and makes them see and realize the scope of the problem. Dr. Jim O'Connell, became a physician later in life than many and finds the homeless his vocation. He is also rather funny and self deprecating, which is needed in this book where many of the people we meet tugged at my heart strings.
Profile Image for Nancy.
1,439 reviews333 followers
December 10, 2022
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.
Profile Image for Elyse Walters.
4,005 reviews36k followers
February 10, 2023
Audiobook….read by Tracy Kidder
….8 hours and 41 minutes

“There are some things that you do because it is simply the right thing to do”.

My heart cries for the homeless!!!

This story is deeply touching.
Anyone would be inspired by Dr. James O’Connell (Jim’s) journey- work - dedication working with the homeless in the Boston area.
The stories are grueling: blizzards- substance abuse- illness- extreme suffering - death - and a few miracles.

Jim once said:
“Most of the patients that I have worked with over the past 32 years are dead. But I tried to take care of people, see what they needed, provide what they needed.
He was drafted into the job of being a doctor for the homeless - he didn’t choose it”…..
But it transformed him as a doctor and a man!

A very powerful - inspiring book — heartbreaking heartfelt —
heart for the homeless >
heart to one man who rolled up his sleeves and did what was needed!!!

Kudos to Tracy Kidder …. once again, the remarkable humanitarian, author, has outdone himself by giving us the story of “Rough Sleepers”.

Highly recommended!!!
Profile Image for Collette.
79 reviews39 followers
January 17, 2023
Rough Sleepers by Tracy Kidder is a deep-dive into the world of the unhoused and a doctor who spent his career ministering to this population. Dr. Jim Connell, a Harvard Medical School graduate, had many options in the field of medicine, but his decision to lead a grant for homeless patients in the Boston area led to his life-long calling to serve this group and the myriad issues that accompany these circumstances.

Kidder follows Dr. Jim and his community of doctors, nurses, addiction specialists, housing specialists and administrative support, showing us what it is like to be on both sides of this equation. The program that started with a grant expanded into a mobile Street Team that visited the homeless with needed supplies, a Thursday morning clinic housed at Boston's Mass General Hospital, and several facilities that offer temporary shelter and medical treatment for those in need of physical or mental health treatment and detox.

Also woven through this narrative are the stories of individuals Dr. Jim worked with, many of whom became part of his life. Extensively featured is Tony Colombo, a large Italian-American man with a heart for serving others, even when his own physical and mental needs loomed large and eventually took his life. Tony's story serves as a specimen under the microscope where we are safe to look from all angles and explore the question that so often comes to mind, "how does someone end up living on the streets?"

I was drawn to this book because of my empathy for the unhoused and my hope for solutions. However I discovered, as Dr. Jim did through years of dedication and service, that answers are elusive and what works for one does not work for all. He and his team saw the repeated cycle of addiction and self-destruction that comes with past trauma. One universal theme for the people he worked with was a dark and painful past. It would seem that all the dysfunction stored up inside these broken souls is too big to be contained in a place called home. Also, they found that housing isn't always "the solution." Many of the patients the team found housing for ended up getting evicted because they would have others over and continued their drug and alcohol abusing-lifestyle. Others did not know how to live in a home and needed training and coaching on the tasks of running a household. And then there were those who preferred to be outdoors in the harsh Boston winters, where their jobs consisted of staying out of trouble with the law and trying to survive. This group is a community, often helping one another, offering what protection they could, and even sleeping together for warmth. The mortality rate is high, but even those whose lives are disregarded hold their own yearly memorials for those they lose.

The administrative floor that houses Dr. Jim's office is lined with framed portraits of many of the lives he served. He found that most loved having their picture taken and hung on a wall as a reminder that they too existed and had a life, however troubled and transient it was. This book, while full of research and findings, is also full of stories and lives, including the life of an amazing person who made an exponential impact on a population so often pushed aside. My one wish was to see the portraits of those described in the book; to see them as Dr. Jim did, and recognize them not as a problem to be solved but as individuals who deserve health, healing, and, if not a home, a place in our communities.

I recommend this book to anyone who has ever passed by an unhoused person and wondered how they got there. It is a starting point to understanding, if not a solution tied up with a bow. Many thanks to NetGalley and Random House for an ARC of this important book.

Rough Sleepers hits the shelves, today January 17, 2023.
Profile Image for Traci Thomas.
544 reviews9,840 followers
January 29, 2023
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.
Profile Image for Brooklyn.
192 reviews52 followers
November 20, 2022
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.

Received pre publication copy from publisher and NetGaley. Should be coming out January 2023
Profile Image for Elizabeth McCullough.
9 reviews12 followers
December 14, 2022
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
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.
Profile Image for Jennifer.
1,114 reviews72 followers
February 27, 2023
American homelessness is mostly invisible to us. We’re uncomfortable and it’s unsettling to look at. I knew this would make me cry. The author Tracy Kidder wrote a compelling, sometimes hopeless look at the issues of a homeless person. I’ll be thinking about parts of this for the rest of my life.
If you want to see people love and care for others like Jesus, then you’ll find it here. Barbara was one my favorite person in this book. Small acts of kindness are unforgettable. I highly recommend this gem.
A few of my favorite quotes:
[Barbara would listen, and in her high but somehow calming voice would tell him, “Jim, you’re a doctor. You’re not God. There are things you can’t fix. You just have to do your work.” It was always the same general message…. “We don’t want saints and zealots. We want flawed human beings who do their jobs. Just make this an ordinary job that people like to do.”]

[Almost always the criticism came indirectly, from friends of friends. This was convenient for a person who hated confrontations. Jim could reply forcefully but indirectly, to a friend of the critic,….Often he’d start by evoking Barbara: …I remember somebody coming into the clinic, and saying to Barbara who was working like hell, ‘What are we going to do to fix this problem of homelessness?’ And she looked up and said, ‘Are you kidding me? I’m too busy. Don’t ask me a question like that.’ That was her way of saying, ‘Stop torturing me with what society isn’t about to do. Let’s just do the best we can right now and take care of these folks.’ ” Jim paused, then wrapped up his case: ….‘This is what we do while we’re waiting for the world to change.’ ”]
Thanks Random House via NetGalley.
Profile Image for Helen.
608 reviews66 followers
December 23, 2022
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.
Profile Image for Katie Dillon.
272 reviews14 followers
February 9, 2023
Jim O'Connell really is as magical as he appears in these pages! He brings so much solace, gentleness and care to the people he treats. I worked for "The Program" that he founded in Boston for ~3 years and truly learned so much from his grace, wisdom and deep well of empathy for unhoused people. I want to be Jim when I grow up (whenever that may be!!).
Profile Image for Stef.
132 reviews
April 6, 2023
I could not put this down, and read it in just a couple of days. It's non fiction, following the life of Dr. Jim O'Connell as he dedicates his entire medical career to the care of the homeless in Boston, in particular, the "rough sleepers" who spend significant time sleeping on pavement. It's so well written and should be required reading of anyone in health care.... Or maybe just anyone everywhere.
Profile Image for LeeAnna Weaver.
152 reviews14 followers
February 14, 2023
Some sources say homelessness in America pre-dates the Revolutionary War. Others say it became a pressing social issue for the first time after the Civil War. Whenever it began, today the number of unhoused people in our country is growing exponentially, and finding solutions seems more daunting than ever. The title Rough Sleepers is a description of unhoused people who sleep outdoors, and for a variety of reasons, they rarely stay in a shelter. Kidder chronicles the work of Harvard-educated Dr. Jim O'Connell, the lead doctor tasked to care for Boston's unhoused people. He is beloved by his patients because he cares deeply about their well-being. He says his background as a bartender has sometimes been more helpful than his medical training. Listening is a primary part of the job which he describes as 75% social work. The book follows Tony, a charismatic man who has been unhoused for decades. Dr. Jim and the others on his care team are fully invested in caring for Tony. He is plagued with mental health issues, addictions, and the physical health ailments common to rough sleepers. As we come to know Tony, we see him as a compassionate protector of his community. We also learn he was traumatized at an early age by violence and abuse. In spite of circumstances and events he had no power to prevent or control, Tony treats others as he longs to be treated - with respect and dignity. In the end, Kidder says there are no simple answers to solve homelessness, but it is an issue we cannot ignore. One suggestion that makes sense to me is to consolidate care for the unhoused with a single agency that acts as an umbrella over all of the agencies that work with unhoused people. It is a herculean task, but we cannot see it as hopeless. Rough Sleepers should be required reading for everyone who creates or enforces legislation dealing with homelessness in our country.
Profile Image for Andrea.
1,000 reviews17 followers
March 13, 2023
Kidder has once again provided an amazing portrait of a person whose impact on the lives of others far outweighs that of most people. I was curious how this would read, more than 20 years after his book about Paul Farmer.

Farmer and Dr. Jim have a lot of similarities but I do think Kidder provides a little more overall community insight, profiling Jim, yes, but we learn especially there are many folks who enable the Street Team to work as well as it does and many of them are nurses and women.

One homeless man, Tony, is given a lot of space in the book and of course we learn that his life and conditions are so much more than the decisions he's made. Jim treats him (both as a patient and as a colleague) with dignity and respect.

I'm grateful Kidder is still writing these profiles. This is a favorite book of the year.
December 12, 2022
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.
Profile Image for Bob Brown.
31 reviews58 followers
December 13, 2022
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.
Profile Image for Emily.
66 reviews
February 5, 2023
This book is so meaningful and sentimental to me. I worked at Boston Healthcare for the Homeless during the summer of 2017 and it was a completely transformative experience for me that laid the foundation for the kind of medicine I want to practice. It completely changed my worldview of unhoused individuals; getting to know people as individual humans rather than invisible beings on the side of the street. Working here really helped me to define my “why” for wanting to be a doctor and pursue my MPH. Reading this book at the end of my medical school journey is really full circle for me. Parts of this book were written from the summer of 2017 when I was there, and re-instills the “why” for me. The system is so broken and fixing it feels like an impossibly enormous feat that can really weigh you down. Resilience-building and preventing burnout are huge problems in this line of work. While maybe not the perfect answer/solution, Dr. O’Connell teaches that if we can’t fix the problem right now, we at least have to do what we can with the skills we have to help people who are suffering. Books like these are here to remind and show us the humanity in people that our society has completely ignored. I would highly recommend anyone read this book to get a glimpse into the stories and struggles of a few unhoused individuals and to better understand the societal factors that allow for homelessness. This book isn’t perfect in describing solutions, but surely paints a picture of the humanity and life experiences of those who are unhoused. I am forever grateful for the patients I got to know at Boston Healthcare for the Homeless, the experiences we shared here, and the impact they have had on my career and personal life.
Profile Image for Vidya.
189 reviews
April 14, 2023
Tracy Kidder doing what he does best - profiling a ��saint among us”. Was fascinating to learn about the rough sleeper life and also get intimately familiar with a couple homeless people who he chose to profile as main characters in the book rather than viewing them as a “population” or set of statistics. Was interesting to think about the work of providing medical care and how helpless/ineffective that can feel yet how important it is. I found that admirable and simultaneously don’t understand how that career would not feel super frustrating and hopeless over time. Highlighted my strong (and incorrect) bias of wanting to “solve problems” of inequality when so much of the necessary work to ensure humanity of the disenfranchised is bearing witness, meeting people with dignity, recognizing an individual’s right to make their own choices and giving up any notion that you know a better way and thus a solution. That was the lesson I took from this book more than how to provide effective or efficient care and/or how to address the epidemic of homelessness in America.
Profile Image for Cari Allen.
217 reviews19 followers
January 22, 2023
An exceptional look into the life of Dr. Jim O’Connell and the dedication he put forth into bringing not only medical care to the homeless of Boston, but humanity as well.

Kidder paints a compelling portrait of the difficulties in caring for the “Rough Sleepers” or chronically homeless of Boston. Dr. Jim and the Street Team have spent their professional medical careers providing check ups and preventative care to the city’s most hardened and yet most vulnerable population.

Written with both grace and compassion, Kidder focuses on several “old classics” as they navigate the struggles of finding permanent housing, managing mental health crises, and simply struggle with the stress of previous life choices that led them to a life of sleeping on the streets.

Highly recommended for anyone in the medical field or anyone who has compassion for lesser seen and highlighted populations of our cities.

Huge thank you to Netgalley, Random House, and Tracy Kidder fir an advanced reader’s copy in exchange for an honest review.
Profile Image for Robyn.
1,779 reviews118 followers
March 10, 2023
Tracy Kidder

WOW! I was amazed by this book about Jim O'Connell's contribution to making the world a better place. I was a police officer as the homeless population began to be more visible in our modern world. It was only a drop but by the time I left the department, it was a puddle of great size. Now when I drive into Houston the signs of this community are everywhere.

I think the story told here won't make a huge difference in the world, but it might make some difference, change the opinion of the population that walks by another human in such dire need they hold up a sign that asks for help. I rarely pass one without giving what I have in my pocket or truck. I don't know many police officers who don't care, it is just such a huge problem that it is difficult to deal with. This is another group that people have such hard conceptions of and know so little about.

i appreciate that Dr. O'Connell dedicated his life to ending some of the sufferings of this group. His graduation from Harvard could have provided such a different life for him, yet he held true to what he started.

From the book's jacket:

Tracy Kidder spent five years following Dr. O’Connell and his colleagues as they served thousands of homeless patients. In this book, we travel with O’Connell as he navigates the city, offering medical care, socks, soup, empathy, humor, and friendship to some of the city’s most vulnerable citizens. He emphasizes a style of medicine in which patients come first, joined by their providers in what he calls “a system of friends.”

Oh, but for the grace of God, go this group and not us.

5 Stars

Happy Reading!
Profile Image for Molly Firth.
101 reviews1 follower
March 26, 2023
This was excellent. A great read to better understand the challenges facing unhoused individuals, and how compassion can go a long way.
Profile Image for Sage.
509 reviews39 followers
December 15, 2022
This book was a real kick in the teeth, and equal parts inspiring, sad, hopeful, heartbreaking. Dr. Jim O’Connell has cared for the homeless population in Boston since the 1980s. His first task while on a one-year stint backed by Mass Gen was not to dispense medical advice, it was to wash the feet of the homeless. Stirring and biblical. He then learned that traditional medicine isn’t a fit for many rough sleepers, and instead doctors and nurses etc need to take a much more holistic approach rather than see as many patients/bill as many hours as possible.

Rough Sleepers is an incredible and infuriating reminder that the health care/mental health system is incredibly broken, and yet there are people called to this kind of service all the time, hoping to catch people as they fall off a cliff, as the book puts it.

Dr. Jim used his past as a bartender (then attending Harvard Medical school in his mid-30s) to get to know his patients and meet them as they were, and the trust that he was given in return was remarkable. I’m not sure how he dedicated his entire career to this monumental Sisyphus-like task. The tales of the whole Street Team through the years and how the program grew from bare bones in the 1980s to a full fledged operation was incredible to watch unfold.

In the gala chapter (sorry my ARC didn’t have page numbers), Dr. Jim says at a gala: “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. If we’re going to fix this problem, we have to address the weaknesses in all of those sectors.” (Quote from the book continues) “It was a bleak assessment, implying that the only cure for homelessness would be an end to many of the country’s deep, abiding flaws.”

It’s also interesting to think about the decrease of SROs/boarding houses that populated cities in the 1800s and early 1900s. Hearing about some of the street team’s patients who wanted housing and couldn’t find anything they could afford even with housing vouchers, OR people who lived in their apartments for years after being homeless for a period of time only to then be priced out of their HOMES was just absolutely disgusting and heartbreaking to read.

Overall, I read this in two nights and couldn’t put it down - it was compelling and eye opening and elicited many feelings.
This entire review has been hidden because of spoilers.
Profile Image for Misha.
736 reviews8 followers
January 21, 2023
You might know Tracy Kidder from his bestselling book Mountains Beyond Mountains. This book is about Dr. Jim O’Connell, a man who along with a stellar team of nurses has served the homeless and insecurely housed in Boston for more than 35 years. You learn about Dr. Jim’s journey but also hear the stories of the people he meets on the street—some of whom he gets to know over decades of his career. It’s a sobering and inspiring look at the issues of homelessness in our country and the very real people at the heart of it.
Profile Image for Bonnye Reed.
4,088 reviews69 followers
January 30, 2023
I received a complimentary ARC of this excellent Memoir/Biography from Netgalley, author Tracy Kidder, and Random House Publishing. Thank you all for sharing your hard work with me. I have read Rough Sleeping of my own volition, and this review reflects my honest opinion of this work. I am always pleased to recommend Tracy Kidder to friends and family. He writes in-depth, deeply researched depictions of life in our world.

Rough Sleepers follows Dr. Jim O'Connell and his cohorts as they work out a system of bringing medical care to the many homeless souls in Boston, Massachusetts. It is a road map to assist the homeless that most cities of any size can follow to provide basic medical care to those who have fallen through the cracks of American life. It is a map we are compelled to follow.
pub date January 17, 2023
Random House Publisher

Reviewed on January 11, 2023, at Goodreads and Netgalley. Reviewed on January 17, 2023, on AmazonSmile, Barnes&Noble, BookBub, Kobo, and GooglePlay.
812 reviews18 followers
December 22, 2022
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.
Profile Image for John Stepper.
510 reviews19 followers
February 1, 2023
I devoured this book, as it gave me insights into a world of suffering I dared not look at too closely.

Having been so inspired by Mountains beyond Mountains and the story of Paul Farmer, I wanted a booster shot. But I closed the book feeling…hopeless.

That’s not meant as a criticism of the storytelling and certainly not of the heroic work of the protagonists. It’s that the multiple references to Sisyphus doomed to forever push a boulder up a mountain, only to have it fall again, seemed all too apt.

Yet they also refer to an essay by Camus, “The Myth of Sisyphus”, in which he argues that the work itself can be the goal. You may not fix homelessness or cure people, but you can see and listen to them, support and encourage and, yes, befriend them. And that can be enough. That can be a very good life’s work indeed.

Maybe there’s hope after all.
Profile Image for Michelle.
2,290 reviews57 followers
November 15, 2022
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.
Profile Image for sarah  morgan.
242 reviews11 followers
January 19, 2023
Thank you Net Galley for the opportunity to read and review.

We’ve all seen them. Some of us have given them clothes or food or money. Dr. Jim gave them his entire career. Tracy Kidder (Mountains Beyond Mountains) followed Dr. Jim for five years watching and learning about caring for the rough sleepers- those homeless people who don’t use shelters. Amazing book. Five big stars!
Profile Image for Heidi Burkhart.
2,071 reviews30 followers
February 12, 2023
I love Kidder’s books! When I noticed that this book had been published I couldn’t wait to read it.
Sensitive, insightful, and impressive.

Highly recommended.
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