Stories from the Shadows: Reflections of a Street Doctor by James J. O’Connell (BHCHP Press, 2015)
Stories from the Shadows is slight in length and humbly self-published. It may, as author James J. O’Connell ’82 confesses, be “uneven, bumpy, written all too hastily, and dusty from too much time in drawers and boxes.” But it recounts formidably the details of homeless lives and insists formidably that these lives be known.
Here are biographical and autobiographical stories from thirty years of street medicine, starting with the first days of the nurse-led clinic at Pine Street Inn, a shelter for Boston’s homeless. The medical care is given in shelters, hospitals, respites, and vans that travel the streets at midnight; over conversations about Willa Cather or Aristotle, while tactful physical exams are deftly being conducted; against steady conditions of intoxication and mental illness; and, perhaps most imperatively, during foot soaks.
Some patients are in a constant state of disappearance; others are unable to leave the cardboard house they’ve built under a loading dock. They care for themselves as they can; one proudly reused a single syringe for insulin over the course of months. They identify themselves (diagnostically) as Tom Collins and Rob Roy. They refuse, accept, then re-refuse, then re-accept care.
Of course, there is no undifferentiated “they” here. The homeless are not a species that can be identified by femur length or tooth. If there’s common ground, it’s that “the journey toward homelessness is sinuous and treacherous.” Medically, as with people in any socioeconomic class, the homeless contract heart disease and cancer, only the courses of their diseases are complicated by resistant infections, by the sequelae of street life (maggot-infested wounds, for one), and by a reluctance to allow workups. One patient refused theophylline levels for her asthma but agreed to re-evaluate the dosage every few weeks, based on the number of detectable wheezes.
They speak in hard-won ways. “When Elise asked me if I’ve ever heard any voices,” says a World War II veteran diagnosed with schizophrenia, “I had to honestly tell her no. I know what she’s driving at, and she means mental voices. I told her no, because I hear real voices.”
A hundred forms of tender care are described, each with some crystalline detail that embeds it in the mind. The photograph of one patient shows “a wandering right eye [that] glances eerily past the camera into some cosmic distance.” This is like a stanza from a late-night poem, written by someone for whom late nights have become a way of life.
And, for the dying, there is a final kind of tender care. When O’Connell describes nurses sitting beside their patient, scenting his pillow with lavender, isn’t this what anyone would want?
Does it matter whether my real name is known, or whether it’s not?
Elissa Ely ’87 is a Massachusetts-based psychiatrist.