I’ve been a fan of Tracy Kidder’s work since I first read The Soul of a New Machine in 1981. Kidder won a Pulitzer Prize and a National Book Award for that book about the process of building a new computer. My favorite Kidder book is House (1985) about a team of guys building a house. Kidder’s method is to embed himself in his subject, follow the principle characters around for a year or more, and then detail all that he has learned.
Rough Sleepers (2023) is a rough read. I taught at an inner city college for nearly 40 years so I saw and encountered plenty of homeless people on my way from the parking lot to the main College building. One time an agitated young man offered to sell me a gold wedding ring (it was obvious that he needed a fix badly). I told him I’d have to go to an ATM to get some cash to buy his ring and that I’d be back in a few minutes. Needless to say, I drove away and didn’t come back.
Tracy Kidder followed Dr. Jim O’Connell around for five years as O’Connell treated homeless people on the streets of Boston. O’Connell, who graduated from Harvard Medical School, was offered a position for a year to bring health care to homeless people. O’Connell did his year–and stayed for 30 more years. I have vast admiration for O’Connell and his team of nurses who try to care for wretched, homeless people society ignores.
“Jim was sometimes asked how he came to be a doctor to homeless people, and what kept him going. At one public lecture, he answer the question this way: ‘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.'” (p. 19).
The key factor in most of O’Connell’s homeless patients is mental problems. That, and abysmal family (or lack thereof) conditions. Sex abuse at early ages for both men and women, physical abuse, poor nutrition, little or no education, and no respect from American Society leads them to live on the streets or under bridges.
Despite Dr. O’Connell and his team’s amazing efforts, the homeless continue to struggle to stay alive in one of the most expensive cities in our country. I applaud O’Connell’s valiant efforts to help these poor people, but until America changes its attitudes towards mental health and poverty, the ranks of homeless people will continue to grow. Diane and I have made yearly donations to the Buffalo City Mission (who provides food and shelter for homeless people) and Friends of the Night People (who provides clothing and food for homeless people). But, the problem continues to grow. Do you help the homeless? GRADE: A
TABLE OF CONTENTS:
Author’s Note — xiii
I. The van — 1
II. The art of healing — 17
Conscripted — 19
Foot soaking — 25
Disaster medicine — 33
III. The pantheon — 49
Numbers — 51
A new face — 58
The street team meeting — 64
Angels without wings — 73
The memorial service — 79
IV. Against medical advice — 83
No loud voices — 85
Upside-down medicine — 89
Death by housing — 97
Eulogies for Barbara — 105
Living life backwards — 112
V. Searching for meaning — 117
A history of Tony — 119
Inventing a purpose — 130
The social director — 135
Autumn street rounds — 143
Success — 155
VI. A system of friends –163
Winter comes — 165
Tony’s world — 174
The beauty of human connection — 181
Sisyphus — 190
Boundaries and limits — 201
The gala — 204
The prism — 211
VII. The night watchman — 219
The worry list — 221
Button-down-shirt moments — 225
The hug — 228
The law of pariahs — 232
In Boston Municipal Court — 236
Childhood — 243
A free man — 248
Confession — 252
The night watchman — 257
VIII. The portrait gallery — 267
A pandemic season — 269
The portrait gallery — 273
Acknowledgements — 283
Sources — 287
It’s not only the USA …
Where we moved to in Hungary we often take a longer walk to our favourite supermarket LIDL since at almost 80 years my wife convinced me of selling my car.
And almost every time we see an “old” woman pushing an old baby carriage with all her stuff. We don’t know where she stays at night though.
My wife just asked around our neighbours whether they have clothes which they would (not …) throw way and on our next shopping trip we’ll give them to her or leave them on the bench where she often sits near the “feeding house” which gives kind of leftovers to poor people.
And of course she always gets some change.
What a sad, sad life.
Of course we don’t know how all this developed.
PS:
Talking with friends about our US trips we hear more and more that you should be very careful in the inner cities of San Francisco, New York etc because there are so many homeless and druggies around. It didn’t feel that bad on our holidays 12 – 15 years ago though of course I still feel the shock watching that guy who opened every Burger King package that was thrown into the garbage can – or even on the ground!
Wolf, I’m convinced a lot of homeless people suffer from mental illness. The problem of mental health (or lack thereof) in U.S. grows each year. A Senator from Pennsylvania just checked himself into a rehab center because of his depression. I consider that a brave move in this current political climate.
In a country where so many of us are just one illness away from homelessness, you’d think we’d be more willing to tackle this problem.
Jerry, exactly! Dr. Jim O’Cannell deserves all the praise he gets for focusing on a marginalized–though growing–segment of our population.
I was shocked at the number of homeless in San Diego. Tent cities abounded on what had recently been normal city streets. I donate to three Detroit charities but not enough. COTS-the Coalition on Temporary Shelter, Detroit Rescue Mission, Feeding America are three of my favorites because they are highly ranked on Charity Navigator for the amount of money that does to the cause rather than the administrators.
Patti, Diane and I saw a lot of homeless people on our last trip to New York City. Being homeless in a city like Buffalo results in illness and death because of the frigid cold. Although there are Warming Centers, many homeless people avoid them. Most of the victims who died in the December Blizzard were homeless people.
“principal characters’ not “principle”
I’ve always want to read more of Kidder but somehow never seem to get around to it.
Jeff, I’ve read Tracy Kidder since his first book. Each book is a Deep Dive into whatever topic Kidder is fascinated by at that time. You learn a lot and Kidder’s wonderful writing style makes his books a joy to read!
Yes, I give to half a dozen charities every couple of months, mostly for feeding kids and the homeless. I agree on the mental health problems, which seem to be getting worse every year. Sometimes when leaving a concert late at night in the summer, we see people lined up down the street just trying to sleep, including outside the Cardinal’s residence attached to St. Patrick’s Cathedral.
I give the doctor enormous credit and respect for his work. Sadly, in this country we just don’t seem to care much as a society, which is disgusting considering that mental issues touch probably every family.
Jeff, I totally agree with you. The U.S. Mental Health problems don’t get much attention or funding…while the problem grows. All of these mass shootings have roots in people with severe mental health issues.
Yes, we donate to various charities that help the homeless. We’ve also given money and food to individuals who were obviously hungry and (as the English say) living rough. Homelessness is a massive problem with many root causes (untreated mental illness, lack of affordable housing, unemployment, underemployment, stagnant wages that can’t keep up with even the lowest rents). Since I can’t see the oh-so-devoutly-Christian-Jesus-is-my-poster-boy members of the GOP willing to take even the tiniest steps in the direction of addressing the “unhoused” crisis (too busy banning books, suppressing voters, and screaming about drag queens), it’s up to the rest of us to act on a case-by-case basis, alas!
Deb, I despise politicians who seek to “blame the victim” for problems. As you point out so eloquently, the GOP and others refuse to address the problems of mental illness, housing shortages, lack of job training programs, and food insecurity. And, of course, “The rent is too damn high!”
Well put, Deb!
Never enough. I’ve done not enough work with the Community for Creative Non-Violence in DC, that was running some of the most high-profile shelters there, and Food Not Bombs, which tends to feed anyone who seeks out their meals, and other bits and pieces along the way.
Of course, Deb, since Jesus of Nazareth “gets us”, and the current reactionaries’ campaign goes, it’s clearly his problem. And such folks want everything to devolve to private charity. Just keep Rick Scott away from the till.
Mental illness isn’t required for homelessness, btw, in times of reactionary support for eviction protocols , ridiculous rents and speculation in the housing market, and still, even with Record Employment, no lack of job insecurity. All the factors are simply in place. I don’t own any part of the deed to Alice’s house, although I’ve paid a share of the bills and put work into it, so, officially, I could be considered homeless, and it wouldn’t be too hard for both of us become so with only a few bad turns of fate that, again, wouldn’t require mental illness at all (physical illness of other sorts can certainly help concentrate the mind/distract from keeping the rent or loans or property taxes paid…that last a Real Bite in NJ, and not here alone).
Todd, the Number One reason people go bankrupt in the U.S. is medical bills. Our healthcare system is broken…and nobody seems able to fix it. Mental Health in the U.S. devolves as the shortage of therapists keep troubled people waiting months for attention. And what medical insurance will cover (or won’t cover) enters into the problem, too.
Not so much unable as unwilling. RomneyCare was not the answer, even if it was a stopgap better than the void it didn’t fill.
I keep water bottles, dog treats and granola bars in my car to give to homeless with dogs. I see many fewer dogs in the last year or two.
Our stupid mayor is pushing pay toilets downtown to help stop public urination, etc. Homeless people might be given tokens, but I’d bet against our idiot mayor going in that direction.
You will need to be careful if coming to Bouchercon in San Diego. Most areas of the city and neighboring cities have large homeless encampments. Many are filled with agressive people. The problem started when Reagan shut the mental health hospitals to save money when he was governor
When I first moved to Southern California (in 1980), it was astonishing (to naive me, at least) how many obviously mentally-ill (and, in many cases, quite violent) people were living & sleeping on the streets. I mentioned this to a long-time Angelino who said it all started with Reagan closing down state mental institutions in the late 1960s—and, within a decade, things were already extremely dire. Institutionalization isn’t always the best choice, but there has to be somewhere for those who are violent and have completely broken with reality.
Deb, like you I’ve seen the deterioration of mental health in America. State governments turned their backs (and closed their wallets) to the mental hospitals. Trying to solve homelessness and depression and paranoid schizophrenia with pills is a fool’s errand. More research into helping people with delusions and hallucinations needs to be done. And actual buildings for homeless people to be treated and counseled should be on the National Agenda.
Maggie, the closing of mental institutions in New York State followed the same pattern. The Governor just decided not to fund the state-wide mental hospitals forcing patients out on the street with just a jar of psychotropic drugs to keep them sane. Diane and I don’t go to Buffalo at night any more. Every day, violent incidents find their way on our local newscasts. Some of it is caused by drug gangs, but a lot of the violence is just random shootings.
From your comments I realize that there are really problems – the US health system gets very bad critics from here.
In European media you also often read remarks on the gigantic abuse of “legal” drugs in the USA like Fentanyl etc – and there seem to be more coming up.
Re helping the homeless:
In Germany many cities now have a “Tafel” (table) where volunteers are cooking every day and many supermarkets deliver there those vegetables beyond their “date of use” etc which are still good – just no longer good looking.
I have to admit that we also often buy products which are sold cheap at the end of their “best before”.
On the other hand statistics say that an unbelievable amount of food is still thrown away – I don’t understand it!
Wolf, like many aspects of American Life, it depends on whether you have money or not. Wealthy people get a whole different level of healthcare than poor people do.
And at least some similar programs of making available potentially wasted food are arising in the US (beyond the volunteer efforts of Food Not Bombs and its comrades stretching back decades). That they are needed as much need as ever, if not more (at very least since the depths of the Great Depression), says little good about this Shining Beacon to the Expensive World.