Rough Sleepers

by Tracy Kidder

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.”

Genres: Nonfiction, Biography, Audiobook, Medicine, Social Justice, Book Club, Sociology

320 pages, Kindle Edition

First published January 17, 2023

About the author

John Tracy Kidder is an acclaimed American nonfiction writer best known for combining literary narrative with journalistic precision. He gained national prominence with The Soul of a New Machine (1981), a Pulitzer Prize-winning account of computer engineers at Data General, noted for its insight into the emerging tech industry and the human stories behind innovation. He later earned widespread praise for Mountains Beyond Mountains (2003), a biography of physician and humanitarian Paul Farmer, which further solidified his reputation for blending compelling storytelling with social relevance.
Kidder studied English at Harvard and earned his MFA from the Iowa Writers’ Workshop. Though his first book, The Road to Yuba City, was a critical failure, he rebounded with a series of successful works exploring diverse topics: home construction (House), elementary education (Among Schoolchildren), and aging (Old Friends). He also served in Vietnam, though he says the war did not significantly shape his writing, despite authoring several well-regarded essays on the topic.
In 2010, Kidder became the first A. M. Rosenthal Writer-in-Residence at Harvard’s Shorenstein Center. There, he co-wrote Good Prose, a book on nonfiction writing. His work continues to be recognized for its empathy, narrative strength, and commitment to truth.

Reviews

[Nancy · Rating 5 out of 5]

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.

[Diane S ☔ · Rating 4 out of 5]

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.

[Elyse Walters · Rating 5 out of 5]

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 >
and
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!!!

[Collette · Rating 4 out of 5]

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.

[Maureen · Rating 5 out of 5]

“ Dr. Jim O’Connell‘s urgent mission to bring healing to the homeless people.”

This is an inspirational story of Dr. Jim O’Connell‘s life‘s work helping the homeless in Boston. Traveling by van accompanied by Tracey Kidder through the streets of Boston. Cardboard boxes, alleyways and under bridges were their homes. Dr. O’Connell offered medical care, socks,soup and friendship. Tracy Kidder spent five years documenting Dr Jim’s journey.
After graduation from Harvard the hospital Chief of Medicine at Massachusetts General made a proposal. Would O’Connell defer a prestigious, fellowship, and spend a year helping the homeless. Doctor O’Connell couldn’t refuse.
“ The modern era of American homeless began in the late 1980’s when the size of the visibility of the problem began to rise.”
In this book we also meet the patients of Dr. O’Connell who suffer from various ailments including substance abuse and mental illness. These are real people who for one reason or another have no place to go.
The system failed them and continues to do so.
This is a book not to be missed. Take your blinders off and read how these people live.

[Sue · Rating 5 out of 5]

As I live in a suburb of Boston, I knew I would read this book on Rough Sleepers, about the health care program for the homeless in the city led by Dr. Jim O’Connell.
Like all of Kidder’s books, this is an immersive study of Healthcare for the Homeless, Dr. James O’Connell, the program’s evolving staff and development, and the homeless of the city. As is his method, Kidder spent five years with Jim: in the clinic, in shelters, in the van driving through the streets at night checking on Jim’s people, in staff meetings, in hospital rooms.

With Kidder’s technique, the reader can learn so much about this program, the people who work in it, with its difficulties and rewards. Perhaps most importantly, we get a view of many individuals who are chronically homeless. We have the opportunity to see their struggles over time as well as their attempts to work with Jim and his excellent staff as best they can. I was reminded of the saying…”there but for the grace of God go I.”

Highly recommended to all

[Traci Thomas · Rating 4 out of 5]

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.

[Jenna · Rating 5 out of 5]

Working in mental health and human services for my whole career, I love when I find a book that seems to capture the complex roots of social and public health problems as well as the complexity and the inherent dignity and worth of the human beings who are most impacted by them. Some recent examples of such books would be This Is All I Got, Invisible Child, the now-classic Evicted, and I’d add this book to the pile. This is an inspiring book about an interdisciplinary team of amazing medical professionals, originally led by Dr. Jim O’Connell, who have dedicated their lives to helping address the physical and behavioral health and other most fundamental human needs of unhoused individuals in Boston. But even more importantly, the book reflects, appreciates, and respects the beautiful individuality, value, and personhood of these “rough sleepers” as the team and their leader have built relationships and trust with them over the years. It doesn’t hurt that Tracy Kidder is also exactly the right reporter to relay this story. A great book for anyone with a heart.

[Katie Dillon · Rating 5 out of 5]

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!!).

[Octavia · Rating 5 out of 5]

“Maybe Housing would prevent the slaughter.”

To like, Love, or have such an appreciation for this Memoir, One can not chase the Fantasy World. Readers will find this memoir as a very strong glimpse of Reality for many people’s lives in this world.

Homelessness has been an epidemic for decades and seems to be worsening the situation, sadly.
The title of this memoir is the reason I was so interestingly drawn and curious of what these pages held inside. This author takes readers on a true Journey; sharing the Life of Dr. Jim O’Connell. He felt like it was the “Right” thing to do … Taking care of people (without homes) who lived on the streets aka the “rough sleepers.”

“They Trusted him.”

The audiobook version was my choice this time. Honestly, it was not easy at all. Tracy Kidder does a wonder with this memoir because I’m sure it was not easy. He does share stories regarding the “unhoused” people as well. These stories include drug cocktails, sexual abuse, mental illness, disorders, etc, I was not at all prepared for Everything covered within these pages. It was so hard listening to these real issues and real life traumas they had endured and getting through them. But, at the same time… I’m so Grateful for this memoir as an Encouragement to continue the Good Works because It’s Always For The Greater
Good ✨.

Highly Recommended

[Elizabeth McCullough · Rating 5 out of 5]

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.

[Brooklyn · Rating 5 out of 5]

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

[Diana Miller · Rating 5 out of 5]

This is one of the most beautiful and inspiring books I have ever read! I was so moved to see Dr. Jim’s Christlike love, care, and service to Boston’s homeless population. Please read this!! I think of this book and his friends often, especially Tony.

My big takeaway from this book is that there is joy and beauty in Sisyphean tasks, and that love and care can’t be “wasted” on people. Our job is not to weigh every outcome; it is to serve those around us!

[Robert Sheard · Rating 5 out of 5]

Absolutely devastating, but so wonderfully rendered. I've read two of the best nonfiction books this week. C'mon fiction, you've got some work to do in 2024 to reach this standard.

Read this book. Full stop.

[Reagan Styrt · Rating 5 out of 5]

Wow. This would be a great book club read because it brings up many important questions about what we value as a society and what we are willing to tolerate. Some takeaways:

- The main message of the book seemed to be: there is no one solution to homelessness, and even exceptional attention and medical care cannot fix that. Even cities who radically expand affordable housing cannot match the inexorable rising levels of homelessness. The best we can do is to serve people while they are unhoused. Kind of a dismal take, but probably right.
- I was struck by Jim O'Connell's "pre-admiration" attitude. His presumption is, ‘Oh, I’m eventually going to like this person. I will probably find some reason… I just happen not to know it yet.”
- If you are a homeless sex offender you will have a hard time ever getting housed, and if you don't check in monthly with the authorities you will go back to jail.
- Some concessions have to be made (i.e. allowing cigarette smoking) to convince the rough sleepers to see the doctor. These tradeoffs might hurt them in the long run but may prevent more urgent visits to the ER.
- In both of the Tracy Kidder books I have read so far, doctors are able to really make a difference in the lives of patients because they are operating outside of the medical system and can spend unlimited time with patients. Not sure how one adapts their model to the average clinic or hospital that is (unfortunately) a business.

P.S. Love how the author used the terms "practitioners" and "providers" throughout the book to reflect that it was PAs, NPs AND doctors serving the rough sleepers!

[Jennifer · Rating 5 out of 5]

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.

[Tracy Telle · Rating 5 out of 5]

Highly recommend. This book totally humanizes all of the homeless people that seem to be multiplying.. I have thought for years that I wish I had used my excellent memory and test taking skills to go to Med School so that I could help all of these people in need...(too bad I never would have applied back then because I didn't want to dissect a cat! Hindsight...and nothing at all to do with the cost of med school, of course! Or the work...)

[Lauren · Rating 3 out of 5]

I read this book since I had liked “Mountains Beyond Mountains.” For me, this book didn’t reach the same level as “Mountains Beyond Mountains.” I commend the author for tackling a tough subject. In addressing homelessness and substance abuse, Kidder offered multiple perspectives to make readers think. Where this book fell short for me was that it felt pieced together. The story of Tony, a homeless man, was intermingled with information about Jim, the doctor, and stories of other people. There became too many characters to keep track of. I learned more about Tony than about Jim who faded to the background in light of the other characters’ stories. The part about the pandemic at the end also seemed thrown in there. While a nonfiction story can never have a true conclusion, we never learned the program’s plans for the future or about Jim’s concluding thoughts. Overall, the subject is very interesting, but the book itself is more a collection of short stories.

[Helen · Rating 4 out of 5]

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.

[Jill]

My fault for not reading the book’s subtitle, but the narrative framing of the doctor is frustrating because it’s disingenuous (book really isn’t about the one doctor) and distancing (comes off like author is reluctant to engage with the people whose stories he’s telling). The actual stories are strongest part, particularly Tony’s. Not obvious to me why author wrote this (doesn’t seem passionate about topic or even that academically interested) or what takeaway author intends.

[Lauren Zanders · Rating 5 out of 5]

absolutely incredible. I am a part-time crisis counselor at the Boston Medical Center and I work very closely with the Boston Healthcare for the Homeless program, and recognizing all the program names was so cool! they truly do incredible work for the community.

I don't think many people can recognize that the average American is much closer to homelessness than being a billionaire. you can be a couple of mistakes or misfortunes away from being in a precarious situation. we are all looking to be connected to someone and to be cared for. Jim's story is one of the most inspiring I've read in a while. giving care and support not because that's what he was trained to do as a doctor, but as someone who is innately human, and wants to connect and care for other humans.

[Aubrey · Rating 5 out of 5]

I appreciate very much the compassion that this account brings to the lives of people who experience homelessness. In my work in the mental health field I have had the privilege of meeting and working with a number of people who have experienced homelessness and other forms of transience (foster care). Without fail there is a story of unimaginable trauma, usually beginning at a very young age. I cannot say that I wouldn't be in the same situation had I not been so fortunate to escape some of the extreme hardships born by these individuals. Considering all of this leaves me feeling humbled, grateful, guilty, desirous to contribute to positive change.

I have to agree with Dr. Jim's approach to meet people where they are at and give them the care they need. Regardless of how many times. (Remembering an important tenant from the faith of our protestant-formed nation: grace.) All humans deserve to be treated with dignity; these lives are precious no matter how they appear to the outsider. And the healing process is so much more than detox, housing, medication and physical care. I don't know what the solution is but it does seem there are some large systemic issues at play and it would require large systemic changes to alter the trajectory of poverty, addiction, homelessness...No, it is not financially sensible. Maybe all decisions should not hinge on our capitalistic notions of profit and on statistical measures of success. I think most of us know deep down that human life is not measurable in those ways.

[LeeAnna Weaver · Rating 4 out of 5]

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.

[Nick Hansen · Rating 5 out of 5]

As I started this book around the same time as the first GOP presidential debate of the 2024 election cycle, I wanted to shove it in the hands of everyone on that stage, as well as every other politician in America.

The title is slightly misleading as it’s not just about Dr. Jim O’Connell, but also a picture of homelessness in Boston and America in the 21st century.

About Dr. Jim - the author does a fantastic job of painting a portrait of his life (though I wanted more on how his work affected his family life), without venturing into hagiography or nominating Jim for sainthood. He is a man who is dedicated to his work, humble about his role, and willing to listen and build something. It really isn’t about him.

The book’s reporting on Boston’s homeless community is compassionate and dignified. You can tell Tracy Kidder took the time to gain the trust of many subjects, including one of the most memorable characters in the book, Tony Columbo.

I can’t help but think of what disservice people like Ronald Reagan did to this country by painting poverty as some sort of moral failing. What a crock of bull. Yes, the “rough sleepers” of the book make some choices that confound those who are trying to help, but when you read about the ravages of addiction, the psychological damages of childhood abuse, the maddening inefficiency of the housing bureaucracy, and willingness of many to just write people off, I can see how people make the choices they make.

In the end, Dr. Jim, as well as many people he learned from and work with, are the type of people you need in this world. Humble, dedicated, and willing to do whatever it takes to help. I wish we had more leaders like him.

[Linda Anderson · Rating 4 out of 5]

Book club selection- wonderful book about homelessness mainly in Boston and a doctor’s life work in treating the homeless medically, psychologically and his deep caring. I learned a lot reading this. I realized how deep of an American and world issue this is and reasons why people end up living on the streets. The author tells many stories of the patients Dr Jim O’Connell treats.

[Janice · Rating 3 out of 5]

The topic of this book is compelling. I learned a lot about the patient, compassionate, dedicated, wise Dr. O’Connell and the similarly devoted staff of his clinic. I learned about the many social, physical and psychological problems of people without long term housing. Dr. O’Connell’s program is impressive, creative and inspirational. Unfortunately, Tracy Kidder seemed to be all over the place with this book. He would skip around within the same chapter between politics, the health care system, this particular program, Jim’s story and some brief and more in depth biographies of particular people served by the program. One of the major characters was Tony, a beloved patient of Dr. O’Connell. While Tony was a sympathetic and complex character, it interrupted the flow of the book to suddenly be focused on one character across several chapters. It seemed like Kidder lost focus and needed to fill up another 100 pages, so switched the narrative to one character’s story in the latter part of the book. There would have been a better flow to the book if it had focused certain chapters on the development of the Program, some chapters on the staff, and some chapters on their patients/clients. Mixing them all together made for a disjointed book. Very informative, despite the structural problems.

[Jocelyn Chin · Rating 4 out of 5]

a quote from chapter 7 that stuck out to me: “I like to think of this problem of homelessness as a prism held up to society. And what we see refracted are the weaknesses on our healthcare system, our public health system, our housing system, but especially in our welfare system, and our educational system, and our legal system, and our correctional system. If you’re going to address this problem, you have to address the weaknesses of all those sectors.” — Jim, the doctor who spent his career administering care to the homeless population in Boston.

I liked how this book dedicated a great deal of real estate to humanizing each of the patients, especially Tony. These people weren’t necessarily likable, but their stories were shared, and a legacy of sorts has been left behind. It feels important that a book about ‘rough sleepers’ would portray them with as much dignity as possible when most of society strips their dignity away.

This book was definitely reminiscent of Mountains Beyond Mountains. So this is Tracy Kidder’s niche genre — journalistic/narrative nonfiction following one man’s journey to improve healthcare/care among an underserved population.

[David Pfanschmidt · Rating 5 out of 5]

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.

[Pamela M · Rating 3 out of 5]

A readable account of some of the homeless and those who provide care to them. The strength of this book is that it doesn’t give simple answers or platitudes to the homeless problem. And it paints vivid portraits of all involved in the community. I kept waiting to get lectured on what I should or should not be doing to help. That didn’t happen. What did happen is I was inspired to think a little more deeply about the issue. There, but for the grace of God go I. Goes all of us. A weakness of this book is that it’s really disorganized in my opinion. But worth the read.

[Stef · Rating 5 out of 5]

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.