Nurse, BHCHP board member, former President of the American Nurses Association and longtime provider of and advocate for homeless medicine Barbara Blakeney sat down with BHCHP founding physician and president Dr. Jim O’Connell and Pulitzer Prize-winning author Tracy Kidder, whose newest book is Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People. Their full conversation took place on Our City Streets, Blakeney’s show about homelessness on Waltham’s community access channel. The below excerpt has been condensed and edited for clarity.
BB: Tracy, I would love to know how you got interested in following Jim.
TK: I went out on the Pine Street Inn van. I was astonished by what I saw: the very warm relations between Jim and the patients and the people operating the van. They weren’t searching for patients; they knew where they were. It was homebodies without homes, and a doctor making house calls. But it was more than just a usual doctor patient relationship.
So I got interested in that—and that there was a problem out there in plain sight that in my own life I had failed to pay attention to, in the usual way of committing some sleight of mind where you don’t see need and distress, partly because you don’t know what you can do about it and partly because you just don’t want to be bothered. To be fair, I didn’t set out to do a good deed. I just wanted to tell a radical story.
BB: You embedded yourself in the program (Boston Health Care for the Homeless Program)for five years. Is that your normal approach?
TK: I’ve done it with a lot of different people. I become interested in a person and then I want to get interested in the things that preoccupy them. And then of course I get into the bigger subject, in this case homelessness, particularly of the rough sleeper variety. It’s one way of humanizing things that can be seen just as statistics. I need stories to understand the world. And there were plenty for me to latch onto.
BB: There’s a scene at the end of the book where Jim, you realize that the group of people you had cared for for years was thinning out. There was a new group of people showing up, and you were not going to have the same amount of time to build relationships with this younger population. Can you talk about this a little more?
JOC: I remember that very clearly. It was at a memorial to remember the people who had died on the street in the year before. It was a moment of vulnerability, of realizing, ‘Shoot, I wish I was beginning all over again.’ But this has always been shared work, and I felt a sense of pride that we have set up something that guarantees to each patient that when one person has to walk away, they will still know the rest of the team and not feel deserted. There was something about that day that made me realize what had been going on for the last 35 years was evolving, and that our commitment really is—as we’d been asked to do by the homeless community—to provide continuity of care.
BB: There’s a lot of death on the street—rarely from strange or unusual diagnoses. Jim, how do you manage that?
JOC: Very few, if any, of our patients are experiencing homelessness because of something they did. Most of it has been structural: bad foster care; physical, sexual, emotional abuse; mental health issues; racism; poverty; all the other societal things that funnel into homelessness. Frequently, we don’t have the ability to change the fact that they die from neglect that happened a long time ago. I think it’s the greatest challenge to anyone who wants to do this work and stick with it. But one important thing is we work in a team. I would urge anyone who wants to do this job to try as best they can to work in a team, to share the grief—and also share the joy.
BB: Was the experience of Tracy writing this book what you thought it was going to be?
JOC: Tracy got to know so many of our patients over such a long and measured time. His magic with spinning a story was applied to people we have known and loved. We were more than happy to share that, and hopefully for the rest of the world it will shine light on the courage and nobility and real resilience of people on the street.