Taking It to the Streets

Physician-author brings the lives of Boston’s homeless out of the shadows

For the past three decades, James O’Connell ’82 has spent his days, and often his nights, bringing health care to Boston’s homeless population. As the founding physician of the Boston Health Care for the Homeless Program, O’Connell practices medicine among those who are often overlooked. He was seeking such a purpose when, at age 30, he arrived at HMS, eager to learn and to find his place in medicine.

“I wanted to figure out how could I make a difference and what would fuel my passion,” O’Connell says. “I thought about medicine because I’d always had great admiration for what doctors did. There’s something about the practice of medicine that invites you into the lives of people through sharing stories while treating illnesses.”

Some of those stories have now been gathered together. Stories from the Shadows is a compilation of tales O’Connell has collected over his years with the program, each illuminating the struggle of living on the edges of society and each shedding light on the difficulty of delivering health care to the city’s homeless.

“When I first walked into the program, I thought the nursing staff would be pleased to have a full-time doctor. But they knew I was coming from a world that didn’t understand homeless patients,” O’Connell says. “One of the nurses instructed me to soak the feet of the patients; I was befuddled. But I quickly came to understand the effectiveness of such simple and humble service. Working at the feet reversed the usual power structure of the doctor-patient relationship and indelibly changed the way I approached the health care of homeless individuals.”

Although he often worked more than 100 hours a week, O’Connell ended each day by recalling his interactions with patients and either writing or typing out their stories. He kept the stories in a box.

“I was spellbound,” O’Connell says. “I cherished these remarkable characters and didn’t want to forget them—or their stories.”

“Caring for the homeless,” he adds, “quickly unveils the weaknesses in our mainstream systems. We’ve had to learn how to shape and mold the health care system, including sending our clinicians into the shelters and onto the streets to reach people who are struggling with the immediacy of daily survival. You have to be willing to change and willing to take a risk.”

Established in 1985, the Boston Health Care for the Homeless Program now provides acute and subacute, pre- and postoperative, and palliative and end-of-life care in its freestanding 104-bed medical respite facility, the Barbara McInnis House. The program serves more than 12,000 patients annually in more than sixty shelters and outreach sites in Boston.

Photo: Rick Friedman