Review | ‘Rough Sleepers’ follows a doctor devoted to the homeless

No writer has described this terrain as thoughtfully as journalist Tracy Kidder. He is drawn to stories of smart people bravely tackling profound social problems – most notably Paul Farmer, who revolutionized the delivery of medicine in a remote region of Haiti and became the subject of Kidder’s critically acclaimed “Mountains Beyond Mountains” (2003 ).

Kidder’s excellent new book, “Rough Sleepers,” tells a story that is similar in a number of obvious ways. It chronicles the work of Jim O’Connell — like Farmer, a Harvard-educated, mission-driven empath — who has led the Boston Health Care for the Homeless Program for decades. With approximately 10,000 homeless patients a year, 600 staff members and countless clinics, O’Connell’s initiative is vast and impressive. But he devotes much of his time to the program’s Street Team, which travels around Boston in vans to provide medical attention to “sleepers” — homeless people who choose to live outdoors rather than stay in shelters.

If you’ve read “Mountains Beyond Mountains,” you might be tempted to skip this book because of the similarities in appearance, but that would be a mistake. Jim O’Connell is a different type of hero than Paul Farmer, in ways that make this a very different work of journalism. Farmer, who died last year, was a big personality – determined, blasphemous, arrogant, with a fully developed plan to change the world by the age of 20 and a set of adamant ideas about medicine and morality that never seemed to change. O’Connell is a quieter, more humble presence. He came into medicine relatively late in life, and he did not accept a position such as establishing a medical program for the homeless until after he was “conscripted” by senior colleagues at Mass General. In “Rough Sleepers,” we see how his patients and mentors – especially an extraordinary nurse named Barbara McInnis – gradually change his view of what it means to be a doctor.

Perhaps because the larger-than-life farmer figuratively and literally took up all the space in “Mountains Beyond Mountains,” the book never found much room to develop its patients as characters. “Rough Sleepers” goes in the opposite direction of the story. As Kidder tells the stories of the women and men who serve O’Connell and his colleagues, “Rough Sleepers” becomes a detailed portrait of the lives of homeless Americans. We hear about their backstories, their struggles, their hopes for the future. We understand their decisions to avoid shelters and the factors that conspire to refuse their own apartments.

In the latter stages of the book, one patient in particular, the gregarious Tony (a pseudonym), has become almost an equivalent character to O’Connell. Kidder doesn’t purge Tony – a convicted sex offender who is both a victim and perpetrator of horrific abuse – or the lives and choices of any of the other homeless people he profiles. Some are more sympathetic than others. The one constant is that O’Connell offers them all treatment – and abundant kindness.

Kidder clearly admires O’Connell, but he understands the limits of his job – just like the doctor himself. Homelessness, writer and doctor seem to agree, is a structural problem that requires far-reaching political solutions. O’Connell’s mission, on the other hand, is smaller and more human. His goal is not to solve homelessness, but simply to mitigate its consequences. He summarizes his program’s ethos as follows: “This is what we do while we wait for the world to change.” Or, as one of O’Connell’s friends—a leading homeless advocate—puts it, “Jim is doing exactly what he’s supposed to be doing.” The reforms that can really do something about homelessness go much deeper, she explains, than mere medicines. But “until that is sorted out, Jim is basically at the bottom of a cliff trying to save people.”

This pragmatic call to action is a running thread that connects much of Kidder’s writing—not just “Rough Sleepers” and “Mountains” but also “Among Schoolchildren” (1989), about a teacher at a low-income school, and ” Strength in What Remains’ (2009), the moving account of a Burundian refugee’s journey from genocide to homelessness to the Ivy League and then back to Burundi to build a medical clinic. All of these books are, at some level, arguments about the meaning and value of good works, and the moral value of small victories in a world full of big problems.

They are ultimately also implicit arguments about the storytelling itself. You could certainly say that when journalists write about people who want to make the world a better place, they risk softening for readers the complex injustices that underlie so much of contemporary life. But to Kidder’s credit, he never makes short shrift of the larger context. He just asks us – rightly so, I think – to consider that in a world with far too much cruelty, the compassionate person standing at the bottom of the cliff is also part of the story.

Richard Just is a former editor of The Washington Post Magazine, National Journal magazine, and the New Republic.

Random house. 298pp $30