Rough Sleepers Quotes

“Just give love,” it read in part. “The soul will take that love / and put it where it can best be used.”
― Tracy Kidder, Rough Sleepers

“Medicine is not efficient,” I heard Jim say to a group of interns many years after Taube had retired. “It’s not supposed to be efficient. It has nothing to do with efficiency.”
― Tracy Kidder, Rough Sleepers

“There are some things you just do because it’s the right thing to do. And the outcome is out of my hands or in somebody else’s hands. I want to believe there’s value in that. You’re doing everything you can for the patient, but you’re not deluding yourself into thinking that what you do isn’t worth doing because the person is going to die anyway.”
― Tracy Kidder, Rough Sleepers

“Most of the patients I’ve been close to over these thirty-two years are dead. So there’s a certain sadness and moral outrage that I can’t get rid of. But when you work with people who’ve had so little chance in life, there’s a lot you can do. You try to take care of people, meet them where they are, figure out who they are, figure out what they need, how you can ease their suffering. I was drafted into this job, I didn’t pick it, but I lucked into the best job I can imagine.”
― Tracy Kidder, Rough Sleepers

“the Program,” short for the Boston Health Care for the Homeless Program.”
― Tracy Kidder, Rough Sleepers

“For Rosanne, much of the overall problem lay with fragmentation among social service agencies, both public and private. Her favorite slide displayed in sequence the forty-two different steps that six agencies and a landlord had to complete to get one homeless veteran housed in Long Beach, California. Part of the cure, Rosanne believed, lay in creating systems dedicated to solving each community’s issues. All the relevant agencies in a city or region would be represented in a single command center.”
― Tracy Kidder, Rough Sleepers

“A troubling philosophical issue also loomed. He served on a panel that was compiling a study of studies for the National Academies of Sciences. The aim was to show that housing for homeless people improved their health and saved the public money, and yet no studies fully supported those widely held claims, none at least that met the standards of the academics on the committee. Some of Jim’s old allies refused to give up the cost-savings argument. He wrote me privately: “Housing homeless people is mandatory. A human right. But I have long been skeptical of the drive to show that it saves money, because that leaves housing dependent on whether it saves money. Ridiculous. Who would ever say that Mass General exists to save money?”
― Tracy Kidder, Rough Sleepers

“Listening to the man’s story, Jim felt he’d been granted a privilege. This was intimate contact with life, the very thing he had missed during all those years of reading philosophy.”
― Tracy Kidder, Rough Sleepers

“Jim was sometimes asked what single thing he’d do to end homelessness. On one of those occasions, he cited large population studies about the tight connection between health and educational status. If he had the power, he said, he’d pay public school teachers $200,000 a year and maybe thirty years later homelessness would become a rarity. Maybe what he called “the faucet” would be turned off. More often, he spoke of a more general solution—“What we need is a new war on poverty.”
― Tracy Kidder, Rough Sleepers

“On a recent trip to Southern California, Jim had been given a tour of the fifty-square-block section of Los Angeles known as Skid Row, where about two thousand people were living on pavement in terrible squalor. Tens of thousands more were living under freeways and beside riverbeds in the greater Los Angeles area. When he returned, Jim told the Street Team: “L.A. makes me feel like we’re playing in a bathtub here in Boston. The dimension of the problem is beyond all imagination. Tents and encampments all over the place. L.A. would have to create housing for at least sixty-six thousand.”
― Tracy Kidder, Rough Sleepers

“At the gala, before he made his exit, Jim told the audience, “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 of all those sectors.” 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.”
― Tracy Kidder, Rough Sleepers

“As with all social service projects, a lexicon of terms accumulated around the Housing First movement. Permanent Supportive Housing (PSH) described the movement’s general aim and means, and a model program conducted in the 1990s in New York had shown that housing for chronically homeless people could indeed be long-lasting and beneficial, provided they received adequate support. This trial—The Consumer Preference Supported Housing Model (CPSH)—had involved 242 people who suffered from either mental illness or substance abuse or both. The model had housed them, via various grants and public subsidies, in apartments situated in “affordable locations throughout the city’s low-income neighborhoods.” And they had been supported by Assertive Community Treatment (ACT) teams, somewhat modified from the general prototype, but substantial. These included nurses, social workers, drug counselors, administrative assistants, and “peer counselors,” who directed the support services with the advice and consent of the tenants. Each team had access to psychiatrists and other professionals, and each stood ready to help the tenants every night and day of the week. After five years, 88 percent remained housed—a remarkable result.”
― Tracy Kidder, Rough Sleepers

“We’re making up for what wasn’t done for our patients. What you didn’t provide—schools, jobs, safety.” In truth, though, over the first ten years he and his colleagues rarely had occasion to question the worthiness of what they were doing, simply because they were so busy doing it.”
― Tracy Kidder, Rough Sleepers

“In graduate school, Jim had studied Albert Camus’ essay The Myth of Sisyphus. (Camus begins: “The gods had condemned Sisyphus to ceaselessly rolling a rock to the top of a mountain, whence the stone would fall back of its own weight. They had thought with some reason that there is no more dreadful punishment than futile and hopeless labor.” At the end of the essay, Camus refutes its beginning: “The struggle itself toward the heights is enough to fill a man’s heart. One must imagine Sisyphus happy.”)”
― Tracy Kidder, Rough Sleepers

“Maybe this is true more generally, a magnification of a common problem: If we knew everything that everyone had said and done, we might not enjoy anyone’s company.”
― Tracy Kidder, Rough Sleepers

“rare psychiatric malady that actually defines the idea—Cotard’s delusion, the belief that one is already dead, or doesn’t exist, or is putrefying, or has lost one’s blood and inner organs.”
― Tracy Kidder, Rough Sleepers

“Reagan administration had used a study of mental health problems among homeless mothers to argue against housing subsidies—to say in effect that families were homeless because of mental illness, not a lack of housing.”
― Tracy Kidder, Rough Sleepers

“Among the losses he regretted was the pint bottle of whiskey he once carried for the times when a patient was in alcohol withdrawal and on the verge of seizure. “You couldn’t do that now. It’s become a moral issue.”
― Tracy Kidder, Rough Sleepers

“Homelessness was fed by racism, income inequality, and a cascade of other related forces. These included insufficient investments in public housing, as well as tax and zoning codes that had spurred widespread gentrification and driven up rents. Many poor and moderately poor Americans lived with the fear of losing housing, which can itself harm bodies and minds as well as social relations in families. One recent study had found that “unstable housing” was accompanied by a twofold increase in diabetic emergencies. Illnesses such as diabetes, and all sorts of accidents and injuries, could lead to homelessness, which itself bred other illnesses, such as PTSD—redefined by one practitioner of street medicine as “persistent traumatic stress disorder.”
― Tracy Kidder, Rough Sleepers

“Over the years Jim had heard, and more often overheard, objections to the Program’s expanding practice: Many people who worked and paid taxes struggled to pay for health insurance. Why should their money go to providing what some would consider concierge medicine for these people who lived at public expense? For people who produced nothing except indecent public spectacles, and didn’t even try to take care of themselves? Heard from inside a shelter clinic or McInnis House or out on the van, such protests seemed irrelevant. What was the alternative? Ignore chronically homeless people, as the city used to do, or imitate draconian regimes and imprison all rough sleepers in a stadium? In fact, the Program lightened the burdens that homeless people placed on other medical organizations, and did so while providing good care at lower cost than in hospital emergency departments.”
― Tracy Kidder, Rough Sleepers

“A severe recession in 1980 had inaugurated the era of rising homelessness. But the problem was driven and sustained by many long-brewing problems: the shabby treatment of Vietnam veterans; the grossly inadequate provisions that had been made for mentally ill people since the nation began to close its psychiatric hospitals; the decline in jobs and wages for unskilled workers; the continuation of racist housing policies such as redlining and racially disproportionate evictions; the AIDS epidemic and the drug epidemics that fed it. Also the arcana of applying for Social Security disability—a process so complex that anyone who could figure out how to get assistance probably didn’t need it.”
― Tracy Kidder, Rough Sleepers

“Jim told the audience, “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 of all those sectors.” 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.”
― Tracy Kidder, Rough Sleepers

“In America, lengths of hospital stays had greatly diminished. Patients were sent home to recuperate after procedures that once would have meant a week or more in a hospital bed. But for people without homes this change meant recuperating in the shelters or on the streets.”
― Tracy Kidder, Rough Sleepers

“Charity is scraps from the table, social justice is a seat at the table, and remember, we want a seat.”
― Tracy Kidder, Rough Sleepers

“they could do a lot for patients from day to day but not much to fix the real causes of their misery. When he had felt near despair, both exhausted and awake to how ineffective his efforts were on the grand scale, he’d had Barbara McInnis to counsel him, to tell him, “Who are you? God? Your job is to take care of that broken foot.”
― Tracy Kidder, Rough Sleepers

“was reminded of the time, one of many, when Jim was musing about the ups and downs of lives like Tony’s, and how they could insinuate themselves into the lives of the Street Team’s members. He had said: “We just have to enjoy the good days and accept the bad days. It’s sort of the theme of our work. Sisyphus. If you don’t enjoy rolling the rock up the hill, this is not the job for you.” Then he had paused and revised his interpretation of the myth: “Or I guess you have to enjoy the walk down. I used to think that a beer with Barbara McInnis at Doyle’s on Friday night was the walk down the hill.”
― Tracy Kidder, Rough Sleepers

“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: “But do I want to hold that up as a gold standard? No. I want to hold it up as, ‘This is what we do while we’re waiting for the world to change.’ ” • • •”
― Tracy Kidder, Rough Sleepers

“The most common answer began with a question. Had Dr. Jim ever tried to sleep in a shelter, with a hundred other people in the same room? Well, they just couldn’t do it. Almost always, they would add that he shouldn’t think they chose to live outside. Offer them someplace else besides a shelter and they’d gladly move in. The most striking explanation came from a man who slept under one of the Storrow Drive bridges—a sweet, soft-spoken fellow who suffered from schizophrenia. Jim had met him half a dozen times and given him coffee and blankets and socks and treated him for a few minor ailments. In the middle of a very cold night, afraid the man might die of hypothermia, Jim begged him to come back in the van to the Pine Street shelter. But the man demurred. “Look, Doc, if I’m at Pine Street, I can’t tell which voices are mine and which are somebody else’s,” he said. “When I stay out here, I know the voices are mine, and I can control them a little.”
― Tracy Kidder, Rough Sleepers

“People who worked and proselytized on behalf of homeless people formed a loose confederation, with one shared interest and many differing opinions. In recent years Jim had heard that some in the alliance claimed that the Program belonged to "the homelessness industry," which misspent resources that should be used for creating permanent supportive housing. Also that the Program was an insidious part of that status quo: It propped up an unjust system by successfully treating homeless people with diseases like AIDS, weakening one of the housing movement's chief arguments— "housing is health."

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, or sometimes to me in the privacy of his office or car. Often he'd start by invoking Barbara, "The older I get, the more I realize how wise she was. 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.”
― Tracy Kidder, Rough Sleepers

“Jim was sometimes asked what single thing he’d do to end homelessness. On one of those occasions, he cited large population studies about the tight connection between health and educational status. If he had the power, he said, he’d pay public school teachers $200,000 a year and maybe thirty years later homelessness would become a rarity.”
― Tracy Kidder, Rough Sleepers