Pre-admiration on the Streets of Boston

Crestfallen over the passing of Dr. Paul Farmer, I asked my physician for any professional anecdotes about the man. She had only limited personal experience to speak to, so she instead prescribed the biography of Jim O’Connell, another hero of hers.

O’Connell bears a striking resemblance to Farmer in both his career and demeanor. Both Boston-based medical doctors, they found their calling for service to marginalized groups, starting a program from scratch and even fighting some of the same ailments (namely multidrug-resistant tuberculosis). Both famously selfless even among physicians, their struggles with professional boundaries has sometimes bordered on unsustainable. They both developed a personal vernacular–Farmer with terms like “white liberals” and “pragmatic solidarity”, O’Connell with “old crusties” and “pre-admiration.” Both beyond modest, they’ve rejected the status traditionally awarded to doctors and instead insisted on partnership with their patients.

These parallels make it difficult to imagine O’Connell and Farmer as anything less than close friends. It turns out they were pals, but you wouldn’t know it from reading the book; Kidder makes no mention of Farmer throughout Rough Sleepers. That omission feels odd given the time he’s spent with both doctors.

In light of those similarities, Rough Sleepers and Mountains Beyond Mountains feel surprisingly distinctive. Kidder maintains a greater emotional distance from O’Connell than he did from Farmer. His reluctance to criticise remains (with subjects like these, who could blame him?), but his personal take on the issues are largely limited to rhetorical choices. Without the “mold-breaking” reflection of Mountains, Sleepers makes for a much more conventional biography.

Kidder embraces the relatively small area of O’Connell’s practice with frequent references to specific streets, squares, and bridges¹. While this is obviously helpful to a native Bostonian such as yours truly, it also fits thematically as a subtle but persistent reminder that these peoples’ lives play out in public spaces. Kidder tells many more of those stories than he did for Farmer’s patients. Most are are brief vignettes–short tales of loss and triumph that support the urgency felt by O’Connell and his Street Team. Other folks make multiple appearances, and Kidder finds something of a supporting character in a rough sleeper referred to as “Tony.” Tony’s tragic struggle substantiates O’Connell’s rumination on the wider homelessness epidemic. It also drives home the emotional toll of an entire career spent caring for the unhoused. This is never more clear than when O’Connell reflects on his gallery of former patients at the book’s conclusion. It’d be impossible to understand the plight of every rough sleeper, but for this American class of untouchables, Kidder excels at making empathy feel like an essential pursuit.