What patients have taught me about addiction, homelessness, and society’s obligation to those living in the shadows

The BASIS

Dr. James O’Connell, President of the Boston Health Care for the Homeless Program (BHCHP) and Assistant Professor of Medicine at Harvard Medical School, contributed this op-ed as part of our Special Series on Addiction and Homelessness. Dr. O’Connell is the author of Stories from the Shadows: Reflections of a Street Doctor.

Serendipity has wreaked havoc in my career, often trumping carefully conceived plans.  Four-year grants from the Robert Wood Johnson Foundation were given to the City of Boston and 18 other cities in 1985 in an effort to integrate the care of homeless individuals and families into the mainstream of each city’s health care system.  I was asked by Dr. John Potts, my Chief of Medicine at MGH, and Dr. Tom Durant, a longtime mentor, to delay a planned fellowship in oncology and accept a role as the physician with the new Boston Health Care for the Homeless Program.  I was truly an accidental tourist with no experience in homelessness and ill-prepared for the burden of co-occurring medical, psychiatric, and substance use problems borne by this eclectic and vulnerable population struggling to survive without homes in the midst of abject and persistent poverty.  My one-year diversion from my planned career path ignited my passion as the sheer complexity of caring for homeless persons challenged all of my clinical skills.  I am still learning in that same role thirty-three years later.

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