No writer has chronicled this terrain more thoughtfully than the journalist Tracy Kidder. He is drawn to stories of brainy people who boldly take on sweeping social problems — most famously Paul Farmer, who revolutionized the delivery of medicine in an isolated region of Haiti and became the subject of Kidder’s acclaimed “Mountains Beyond Mountains” (2003).
Kidder’s excellent new book, “Rough Sleepers,” tells a story similar in some obvious respects. It chronicles the work of Jim O’Connell — like Farmer, a Harvard-educated, mission-driven empath — who for decades has led the Boston Health Care for the Homeless Program. With about 10,000 homeless patients annually, 600 staffers and numerous clinic sites, O’Connell’s initiative is sprawling and impressive. But he devotes much of his time to the program’s Street Team, which travels around Boston in vans providing medical services to “rough sleepers” — homeless people who opt to live outside rather than staying in shelters.
If you’ve read “Mountains Beyond Mountains,” you might be tempted to skip this book based on the surface similarities, 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, profane, arrogant, with a fully developed plan for changing the world by his 20s and a set of adamantly held ideas about medicine and morality that never seemed to change. O’Connell is a quieter, humbler presence. He came to medicine relatively late in life, and he accepted a position building a medical program for the homeless only after being “conscripted” by higher-ranking colleagues at Mass General. In “Rough Sleepers,” we watch as his patients and mentors — especially an extraordinary nurse named Barbara McInnis — gradually reshape 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 his patients as characters. “Rough Sleepers” veers in the opposite narrative direction. As Kidder relays the stories of the women and men whom O’Connell and his colleagues serve, “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 come to understand their decisions to avoid shelters and the factors that conspire to deny them apartments of their own.
By the last stages of the book, one patient in particular, the gregarious Tony (a pseudonym), has become nearly a coequal character to O’Connell. Kidder does not sanitize 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 prove more sympathetic than others. The one constant is that O’Connell offers treatment — and abundant kindness — to them all.
Kidder clearly admires O’Connell, yet he understands the limits of his work — as does the doctor himself. Homelessness, both writer and doctor seem to agree, is a structural problem that requires sweeping political solutions. O’Connell’s mission, by contrast, is smaller and more human. His aim is not to solve homelessness but simply to mitigate its effects. He sums up the ethos of his program this way: “This is what we do while we’re waiting for the world to change.” Or, as one of O’Connell’s friends — a leading advocate for the homeless — puts it: “Jim is doing exactly what he should.” The reforms that could really address homelessness go much deeper, she explains, than mere medicine. But “until that’s fixed, Jim is basically standing at the bottom of a cliff, trying to save people.”
This pragmatic call to action is a through-line connecting much of Kidder’s writing — not just “Rough Sleepers” and “Mountains” but also “Among Schoolchildren” (1989), about one teacher in 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, then back to Burundi to build a medical clinic. All of these books are, at some level, arguments about the meaning and worth of good works, and the moral value of small victories in a world of big problems.
They are also, in the end, implicit arguments about storytelling itself. You could certainly say that when journalists write about people seeking to make the world a better place, they risk softening for readers the complex injustices that underlie so much of contemporary life. But Kidder, to his credit, never gives short shrift to the larger context. He just asks us — correctly, I think — to consider that in a world of far too much cruelty, the compassionate person standing at the bottom of the cliff is part of the story too.
Richard Just is a former editor of The Washington Post Magazine, National Journal magazine and the New Republic.
Random House. 298 pp. $30
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