‘Rough Sleepers’ follows a doctor’s relentless efforts to treat homeless patients

The art of storytelling is all about details. That is, how you structure your story and what details to emphasize or omit. Each of these choices shapes the story, its contours, and tone. In the field of non-fiction, few writers are more veteran than Pulitzer Prize-winning author Tracy Kidder. His latest book is Models for Storytelling. “Rough Sleepers” chronicles the pioneering work of Jim O’Connell, a physician who coordinated medical care for Boston’s homeless citizens.

As O’Connell soon realized, practicing medicine with so-called rough sleepers (the British term for homeless people) ran counter to any model he had studied at Harvard Medical School. . No efficiency, no quick fixes, no short patient visits with lasting results. Working with this collective relies on time and trust and requires a “system of friends,” his O’Connell acronym for the teamwork involved. Crucially, he found that his medical degree was often less important than the bartending skills he acquired in medical school. Indeed, taking care of the bar has made him a better listener.

The Boston Health Care for Homeless Program opened its doors in 1985 with O’Connell at the helm. It was a year of posting that made a career. Nicknamed Dr. Jim, he was particularly drawn to working with Raf his Sleeppers, who are only a small fraction of the homeless population. He loved running with his team three days a week on the street program, and Kidder often joined them when the van toured downtown Boston. So O’Connell handed out hot cocoa, socks, and blankets to sleepers in the city. This was an invitation for them to show up at his weekly clinic at Mas General Hospital.

“How do you treat HIV in homeless people? How do you treat diabetes in patients who can’t even find their next meal?” Kidder asks. “In medical school, those questions didn’t come up.[Jim]had discovered the role of the homeless doctor.”

As the book unfolds, we meet some of the regulars Dr. Jim has dealt with. Among them is Joao Guarino, who has been homeless on and off for 30 years. She is one of her stories of success. Now a member of her program’s board of directors, she colorfully tells her story to freshmen at Harvard Medical School each year.

Then there’s Tony Colombo, a product of Boston’s North End, the old Italian neighborhood of Boston. One of his seven children, Tony dropped out of school at the age of sixteen. He slashes a tire, blows up his car, and burns down a restaurant for insurance money. Tony, who was a victim of sexual abuse, attempted rape which landed him in prison for 18 years.

Still, Tony has become one of Dr. Jim’s “pantheon of vivid, mysterious patients for years,” Kidder writes. He had the undeniable great personality of a leader who knew and protected everyone around him. He took on equal roles of enforcer, counselor, and his director of social. Before long, he became the eyes and ears of Dr. Jim on the front lines.

But like many of his allies, Tony has been in and out of hospitals, on rest programs, and often left the AMAs against the advice of his doctors. Alcohol and cocaine were one of his addictions. Among his illnesses, hepatitis and bipolar disorder. As Kidder explains, Tony’s Streets of His Life’s revolving door was, like so many of the program’s other revolving doors, a dizzying, relentless cycle of illness and recovery. You may feel whiplash and fatigue just reading it.

This is how Dr. Jim and his team have maintained the course for nearly 40 years, employing 400 people and programming it into a $50 million medical alliance serving about 11,000 homeless people annually. This raises the question of whether or not you built the .

“The housing wasn’t just complicated,” says Kidder. “(Jim) has found that if you think too much about the problem, you will starve yourself into a system of friends—clinics, co-workers, patients, etc., where forces go against great advances and disagreements between allies.” Don’t despair,” he told me. “But it’s much easier to take care of people.”

Kidder deftly threads this needle, navigating the tangle of bureaucratic rules that keep homeless people out of their homes and Dr. Jim’s call for down-to-earth, one-on-one ministry. interweave.

“Just enjoy the good days and embrace the bad days,” says O’Connell. “That’s kind of the theme of our work. Sisyphus. If you don’t like rolling rocks up hills, this job isn’t for you.”

For Kidder, who lives part-time in Maine, the book was the result of five years of loving work and deeply embedded research. Payback is a book that celebrates the great good one man and his program have done in the face of unimaginably grim odds. It humanized a serious problem. Having someone like Jim O’Connell, an official mensch, at the center of the story isn’t bad either.

Joan Silverman writes editorials, essays and book reviews. Her work has appeared in numerous publications, including Christian Science Her Monitor, Chicago Her Tribune, Dallas Her Morning Her News. She is the author of “Someday This Will Fit,” a collection of linked essays.