For Tracy Kidder, stories create a road to empathy. Kidder, a Pulitzer Prize-winning nonfiction author and the keynote speaker on Thursday evening, March 9, at Health Journalism 2023 in St. Louis, explained why he decided to write his most recent book, “Rough Sleepers, Dr. Jim O’Connell’s urgent mission to bring healing to homeless people” (Penguin Random House, 2023).
In 1981, Kidder won the Pulitzer Prize for his book, “The Soul of a New Machine,” about computer engineers at the former Data General Corporation who were developing a new computer. Kidder also wrote, “Mountains Beyond Mountains” (published in 2003), his biography of Paul Farmer, M.D., a physician and anthropologist who died in 2022.
The author read from his book, and O’Connell joined him on stage to describe how he provides health care to homeless men and women on the streets of Boston.
Before Kidder read from “Rough Sleepers,” he shared his philosophy on writing. “I used to think the most important job for a writer of stories was to create life on the page,” he said. That was wrong, however, according to a former editor of his, who died recently, he added.
“The real trick was to get life off the page and into the reader’s imagination,” he said, quoting his former editor. When that happens, readers begin to imagine the lives and suffering of others, creating a road to empathy, he noted. “And true empathy, I think, is just one of the ingredients for relieving the suffering and cruelty in the world.”
Those words explained not only Kidder’s work as an author but also O’Connell’s efforts as a physician caring for the homeless. And those words are important for journalists, and everyone seeking to understand and end homelessness. One of the women in Kidder’s book was hideously abused as a child, as are so many homeless people in America, he said.
He returned to this point later, saying one of the root causes of homelessness is child abuse, which can lead to post-traumatic stress disorder and an array of other problems. “One way to end homelessness is to stop child abuse,” he said.
The two men met in 2014 when Kidder was doing research for an earlier book, “A Truck Full of Money,” about Paul English, an entrepreneur who founded the travel website Kayak and wanted to learn about homelessness in Boston, where he lived and worked. English was advised to ride with O’Connell in the van he used to serve his patients. Kidder went along as well.
The founder and president of the Boston Health Care for the Homeless Program, O’Connell earned his medical degree from Harvard University in 1982. After completing his residency in Internal Medicine at Massachusetts General Hospital, he started working with the homeless in 1985.
As Kidder read about his first night on the streets with O’Connell, the author said he got “a glimpse of a world hidden in plain sight.” He saw O’Connell’s patients and prospective patients sleeping in doorways and on park benches and arguing drunkenly with statues, he added. “I was left with a memory of vivid faces and voices and with a general impression of harsh survival leavened by the clear affection between a doctor and his patients.”
A few months later, he wanted to ride with O’Connell a second time. Again, he saw the affection O’Connell had for his patients and how they appreciated the care and friendship that O’Connell provided to them. That’s when he knew, he said: “I really wanted to write about this guy and about this whole enterprise.”
Then Kidder read from the first chapter of Rough Sleepers.
“Jim was like a 1950s doctor making house calls. Though the van rarely dispensed more than minor medicine. Rather, it was meant for bringing food and blankets and socks and underwear to rough sleepers and more urgently for finding people in distress and bringing them in if they would come to hospital emergency rooms or the city’s homeless shelters.”
AHCJ board member Marlene Harris-Taylor, who moderated the session, posed the first question. Do the homeless use the term rough sleepers to describe themselves?” she asked.
“The people who live on the streets of Boston, the ones who will not go into a shelter under almost any circumstance, are a fiercely proud group,” O’Connell said. Since he began his work on the streets, he learned they dislike the term “street person.” “They tend to use ‘rough sleeper,’” he explained. “So, we’ve always honored that.”
In Europe, the term is used often, and in London, a department of rough sleepers provides care for the unhoused, he added.
The challenging problem of homelessness
Cities often try to help the homeless by requiring them to qualify for housing before giving them rooms or apartments. When Boston did so, officials found the homeless almost never qualified for such housing, O’Connell noted. Before they could get housing, they needed to get sober and off drugs and take any medication they were prescribed.
But then federal studies showed a more effective approach is to provide housing first and then deliver the services the homeless need. “So, we were thrilled in the early two thousands of 2003 or 2004, when many of our street folks we had been following for all that time, got into housing,” he said. “That was like a miracle.”
Housing alone was insufficient, however. “You can’t stop caring for them,” O’Connell said. The formerly homeless often struggle with loneliness because they lack the community they had on the street and may feel isolated living in unfamiliar areas of the city. To the contrary, the care and support the homeless needed escalated, he added.
Getting the homeless off the street addresses only a symptom of larger issues in society, Kidder explained. “I don’t think of homelessness as a discreet problem. It’s really a symptom of many, many problems,” he said. “All of them are associated deeply with poverty, income inequality and racism.”
Homelessness is a complicated problem that doesn’t fit into a sound bite, Kidder concluded. “We’ve learned over these last years that you need what we now call a whole mosaic of different solutions. Cities will not solve the problem until housing policies change and until society ends racism and child abuse,” he added.