"Standing with them in the darkness, if need be"
January 7, 2023 11:34 AM Subscribe
You Have to Learn to Listen’: How a Doctor Cares for Boston’s Homeless [NYTimes Magazine Gift Link]
In the 1980s, Dr. Jim O’Connell was in his residency after med school at Harvard when he was asked to take a year to help Boston's homeless population. That year turned into a career.
"He had worked at Boston’s two largest shelter clinics for more than a year, and for a while he imagined that he knew most of the city’s homeless population. But when he began riding the van three nights a week, he realized that he’d never met most of the people who slept outside — the rough sleepers. ... the food and clothes and blankets they provided never failed to draw rough sleepers from their hiding spots to the back of the van, where O’Connell met them with a bartender’s patience and a student’s sincere interest."
"Once they got used to seeing O’Connell at their encampments, many rough sleepers would chat. ... Almost always, they would add that he shouldn’t think they chose to live outside. Offer them someplace else besides a shelter, and they’d gladly move in."
In the 1980s, Dr. Jim O’Connell was in his residency after med school at Harvard when he was asked to take a year to help Boston's homeless population. That year turned into a career.
"He had worked at Boston’s two largest shelter clinics for more than a year, and for a while he imagined that he knew most of the city’s homeless population. But when he began riding the van three nights a week, he realized that he’d never met most of the people who slept outside — the rough sleepers. ... the food and clothes and blankets they provided never failed to draw rough sleepers from their hiding spots to the back of the van, where O’Connell met them with a bartender’s patience and a student’s sincere interest."
"Once they got used to seeing O’Connell at their encampments, many rough sleepers would chat. ... Almost always, they would add that he shouldn’t think they chose to live outside. Offer them someplace else besides a shelter, and they’d gladly move in."
I highly recommend Dr. O'Connell's earlier memoir, Stories from the Shadows, which covers a lot of these stories. It sounds like this new book re-tells some of them, as I recognized a lot of the anecdotes in the article.
posted by allegedly at 1:19 PM on January 7, 2023 [3 favorites]
posted by allegedly at 1:19 PM on January 7, 2023 [3 favorites]
Jim O'Connell is great. Thank you for posting this.
This is in no way a negative on him or this article... just a riff from someone who works in homeless health services: The majority of service & healthcare providers for poor people are... other people from similar racial, class and social backgrounds. Mostly women. In areas that are mostly Black, the workers in these programs are mostly Black. In areas with a lot of LatinX folks, the workers are mostly LatinX. Med students, lefty mutual-aid folks, others are there too, and this is not an essentialist argument about who is better than anyone else. I'm most interested in who gets noticed for this work. It's kind of interesting that the NY Times would highlight Dr O'Connell because it sort of validates their priors - the idea of a heroic white man sacrificing status to work among the poor. Jim O'Connell famously credits a woman - Barbara McInnis - for teaching him humility among homeless folks - this is not a dig on him in any way - it's just a thought as we read, about who the majority of the heroic caregivers are in the world. Mostly folks who already lead lives of tremendous trauma and toil at home, then come to work and do again it for very little pay and often at their own physical peril. So many beautiful and inspiring people doing the work of Tikkun olam... I am grateful to all of them.
posted by latkes at 1:19 PM on January 7, 2023 [47 favorites]
This is in no way a negative on him or this article... just a riff from someone who works in homeless health services: The majority of service & healthcare providers for poor people are... other people from similar racial, class and social backgrounds. Mostly women. In areas that are mostly Black, the workers in these programs are mostly Black. In areas with a lot of LatinX folks, the workers are mostly LatinX. Med students, lefty mutual-aid folks, others are there too, and this is not an essentialist argument about who is better than anyone else. I'm most interested in who gets noticed for this work. It's kind of interesting that the NY Times would highlight Dr O'Connell because it sort of validates their priors - the idea of a heroic white man sacrificing status to work among the poor. Jim O'Connell famously credits a woman - Barbara McInnis - for teaching him humility among homeless folks - this is not a dig on him in any way - it's just a thought as we read, about who the majority of the heroic caregivers are in the world. Mostly folks who already lead lives of tremendous trauma and toil at home, then come to work and do again it for very little pay and often at their own physical peril. So many beautiful and inspiring people doing the work of Tikkun olam... I am grateful to all of them.
posted by latkes at 1:19 PM on January 7, 2023 [47 favorites]
This is a great article, thank you for posting it. I didn't realize until the end that the same author wrote Mountains Beyond Mountains, about Paul Farmer.
I liked this quote from O'Connell:
“This is a complicated problem. Homelessness is a prism held up to society, and what we see refracted are the weaknesses in not only our health care system, our public-health system, our housing system, but especially in our welfare system, our educational system, and our legal system — and our corrections system. If we’re going fix this problem, we have to work together to fix the weaknesses of all those sectors.”
posted by Dip Flash at 1:32 PM on January 7, 2023 [9 favorites]
I liked this quote from O'Connell:
“This is a complicated problem. Homelessness is a prism held up to society, and what we see refracted are the weaknesses in not only our health care system, our public-health system, our housing system, but especially in our welfare system, our educational system, and our legal system — and our corrections system. If we’re going fix this problem, we have to work together to fix the weaknesses of all those sectors.”
posted by Dip Flash at 1:32 PM on January 7, 2023 [9 favorites]
This is a good story about a good person. What’s exhausting is this that it is happening in the richest city, in one of the richest regions, of the richest country in the world. There should not be unhoused people in Boston.
It’s clear how to solve homelessness (give people a home!) and it’s even cost effective! As a society, we choose not to, and that sucks.
posted by rockindata at 4:53 PM on January 7, 2023 [5 favorites]
It’s clear how to solve homelessness (give people a home!) and it’s even cost effective! As a society, we choose not to, and that sucks.
posted by rockindata at 4:53 PM on January 7, 2023 [5 favorites]
Here's a relevant article. From Wapo about Seattle. This is a co-worker and I have issues with the article, but it speaks to your point latkes. Its brutal work, and I'm only on the operations side not the clinical side.
posted by kittensofthenight at 8:20 PM on January 7, 2023 [4 favorites]
posted by kittensofthenight at 8:20 PM on January 7, 2023 [4 favorites]
I know a guy who treats homeless people and one of his patients complained that for years he heard ticking in his head. Everyone else had chalked this up to mental illness and dismissed the complaint. But when he put his ear next to the patient’s head he could hear it too. It turned out it was a loose piece of skull that clicked when a vein pushed against it. Taking patients seriously is important!
posted by vorpal bunny at 8:37 PM on January 7, 2023 [9 favorites]
posted by vorpal bunny at 8:37 PM on January 7, 2023 [9 favorites]
There should not be unhoused people in Boston.
There shouldn't, but the problem is more intractable than the Times article really had space to discuss.
Boston Medical Center, Boston Health Care for the Homeless, the Pine Street Inn, which are mentioned in the article, and other programs (such as Rosie's Place, which is for women specifically, and a city shelter on Southampton Street) are all clustered in a relatively small area called Mass and Cass (or less charitably, Methadone Mile).
Ever since 2014, Mass and Cass has become the place to congregate and even try to live, and people have flocked to Boston from across the state and the rest of New England and many wind up there at least part of the time.
Boston's a big city, yes, but the state could be doing more to provide housing and rehab services where people are coming from, not just leaving it mostly up to Boston, but that runs the risk of offending suburban communities (one of the few significant state efforts to do anything in 2021, when things were really spiraling out of control, involved buying some modular micro-units as "low threshold" housing and installing them on a state hospital campus in another Boston neighborhood).
A couple weeks ago, Mayor Wu said that in her year in office, the city has gotten 80 people who used to live in tents at Mass and Cass into permanent housing with case workers and services to help them stay there, so that's a start.
What happened in 2014? The long neglected bridge to the city's treatment facilities and shelters on an island in Boston Harbor had to be shut before it collapsed into the harbor., so a lot of services expanded in Mass and Cass. All the facilities on Long Island have sat empty since then in part because the city of Quincy, through which the road to the bridge would pass, just keeps fighting its reconstruction, no matter how many times it loses in court or before state regulators.
posted by adamg at 9:36 PM on January 7, 2023 [5 favorites]
There shouldn't, but the problem is more intractable than the Times article really had space to discuss.
Boston Medical Center, Boston Health Care for the Homeless, the Pine Street Inn, which are mentioned in the article, and other programs (such as Rosie's Place, which is for women specifically, and a city shelter on Southampton Street) are all clustered in a relatively small area called Mass and Cass (or less charitably, Methadone Mile).
Ever since 2014, Mass and Cass has become the place to congregate and even try to live, and people have flocked to Boston from across the state and the rest of New England and many wind up there at least part of the time.
Boston's a big city, yes, but the state could be doing more to provide housing and rehab services where people are coming from, not just leaving it mostly up to Boston, but that runs the risk of offending suburban communities (one of the few significant state efforts to do anything in 2021, when things were really spiraling out of control, involved buying some modular micro-units as "low threshold" housing and installing them on a state hospital campus in another Boston neighborhood).
A couple weeks ago, Mayor Wu said that in her year in office, the city has gotten 80 people who used to live in tents at Mass and Cass into permanent housing with case workers and services to help them stay there, so that's a start.
What happened in 2014? The long neglected bridge to the city's treatment facilities and shelters on an island in Boston Harbor had to be shut before it collapsed into the harbor., so a lot of services expanded in Mass and Cass. All the facilities on Long Island have sat empty since then in part because the city of Quincy, through which the road to the bridge would pass, just keeps fighting its reconstruction, no matter how many times it loses in court or before state regulators.
posted by adamg at 9:36 PM on January 7, 2023 [5 favorites]
Reminder to all that you can get trained in naloxone use in ~20 mins. and your state or locality probably offers free kits.
posted by praemunire at 1:12 AM on January 8, 2023 [4 favorites]
posted by praemunire at 1:12 AM on January 8, 2023 [4 favorites]
It's a small thing, but I appreciated how the photo captions in the article were written to emphasize people's humanity (rather than, say, pathologies). A couple were a bit clumsy but the effort and intentions were good, and I wish that was more common practice in all of these kinds of articles.
posted by Dip Flash at 6:49 AM on January 8, 2023 [4 favorites]
posted by Dip Flash at 6:49 AM on January 8, 2023 [4 favorites]
Here's a relevant article. From Wapo about Seattle. This is a co-worker and I have issues with the article, but it speaks to your point latkes. Its brutal work, and I'm only on the operations side not the clinical side.
posted by kittensofthenight 3 days ago [4 favorites −] [!]
This is really good. I mean, agreed, the framing is not perfect, but this is how I experience this work and it resonates extremely strongly. If folks want a picture of what working with the most vulnerable patients really is like, I would recommend this as a starting place.
posted by latkes at 10:35 AM on January 10, 2023
posted by kittensofthenight 3 days ago [4 favorites −] [!]
This is really good. I mean, agreed, the framing is not perfect, but this is how I experience this work and it resonates extremely strongly. If folks want a picture of what working with the most vulnerable patients really is like, I would recommend this as a starting place.
posted by latkes at 10:35 AM on January 10, 2023
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