In medical school, after I’d broken the news to Charlie McCabe that I’d chosen internal medicine over surgery, he’d grimaced and said, “Let me introduce you to someone.” I followed him across the Mass General lobby to another set of offices where a man named Jim O’Connell was embracing a middle-aged woman in pink tights, a pink sweater, and bright red lipstick that had been haphazardly applied far beyond her lips. O’Connell was about the same age as Charlie McCabe and looked like a dad on a network television show: neatly parted gray hair, kind eyes, cardigan sweater, and a broad, welcoming smile. He immediately put me at ease.
“Jim!” McCabe exclaimed as we caught sight of him. McCabe turned to me and threw a thumb at Jim. “Someone should write a book about this guy.” Jim O’Connell waved McCabe’s suggestion away and extended a hand.
Both men had done their residencies at Massachusetts General Hospital, and like it had with McCabe, life had thrown Jim a curveball when he finished his training. He had planned to begin an oncology fellowship at the Memorial Sloan-Kettering Cancer Center in Manhattan, but at the conclusion of his three-year internal medicine residency, Jim had been asked by an MGH administrator if he’d consider spending a year assisting with a new program bringing health care to the homeless. He agreed, and his one-year stint with the homeless turned into twenty-five. And in the process, he cofounded Boston’s Health Care for the Homeless Program and revolutionized the way health care was delivered to the indigent.
“Until next week, Jimmy,” the patient said as she leaned in to hug him.
“Wouldn’t miss it, Sheryl.”
After the woman in pink stepped aside, McCabe asked Jim to explain his work to me. O’Connell summarized his career in the way one learns to do when soliciting donors is a way of life: after receiving a master’s degree in theology from Cambridge, O’Connell came to a crossroads; he joked that his liberal arts education had left him “uniquely prepared for bartending and driving cabs.” After bouncing around the country—teaching high school in Hawaii, waiting tables in Rhode Island, baking bread and reading in a barn in Vermont—he did the improbable and went to medical school. He arrived at Harvard Med at age thirty, around the time that Charles McCabe developed that first tingling sensation in his hands.
“Come out in the van with me,” Jim said as I scanned his spartan office and he prepared to see his next patient. “Come out tonight and meet our patients.”
It wasn’t clear why he was making the offer, and I wasn’t sure, as a medical student, what I could bring to his program. Perhaps he had a deal with McCabe—maybe guys who turned their backs on surgery had to pay penance by riding in the van with Jim. I turned to McCabe, who was smiling. “Do it.”
Later that evening, I met Jim at one of Boston’s well-known homeless shelters, the Pine Street Inn, wearing a crisp white button-down shirt, khakis, and a new Calvin Klein tie. Taking a seat in the corner, I looked on as Jim, dressed like Jerry Seinfeld in jeans, white sneakers, and a navy blue polo shirt, tended to a long line of men and women who were there to get their routine checkups. His unique skill, I soon discovered, was that he never cut anyone off. He let his patients ramble on about anything they wanted, mostly issues wholly unrelated to their health, while he poked and prodded, quickly and quietly looking into ears, noses, throats, and any other orifices in need of inspection. He was able to time the cadence of a story, applying his stethoscope when someone paused to catch his or her breath and removing it when the story resumed.
I wanted to take notes but there was nothing to write; he simply knew how to interact with each and every patient. And he was especially adept at interacting with people who clearly had mental illness. He knew the names of distant family members and the details of obscure conspiracy theories. His method was remarkable—there was something almost religious to it—like he was the priest and his patients were the confessors.
Hours later, after the last patient had been seen, Jim went behind the counter of the soup kitchen and loaded up two dozen Styrofoam containers with chicken noodle soup. From there, I tagged along as he hopped in a van and began seeking out Boston’s homeless who, in Jim’s words, were “temporarily off the grid.”
Our driver, a Haitian man named Pierre, followed his normal route, stopping at ATM branches, abandoned subway stops, and indeterminate New England wastelands searching for people who might appreciate a warm meal, a pair of socks, or their blood pressure medication. We were seeking out the people I actively avoided in everyday life, the ones wearing rags who hadn’t bathed in months. I couldn’t believe there was a man—a Harvard Medical School faculty member, no less—who was on a first-name basis with the scores of otherwise nameless people we encountered. And without fail, they were glad to see him.
“Tell them something about yourself,” Jim advised that first night as we walked with flashlights, searching for a man known to sleep near a riverbank. “Tell ’em anything. Just be yourself and be honest.” Jim cut a solitary figure as he forged ahead to where water met land, waving his flashlight back and forth like a tiny lighthouse. He spotted a pile of blankets next to the Charles River and motioned me over. There was a shine on the water from distant construction lights, and I could feel my heart thumping with every anxious exhalation. Lifting his index finger to his lips, Jim whispered “All yours” and disappeared in search of others.
“Sir?” I said, staring at the pile of blankets that was gently oscillating like an accordion. “Hello? Hello there? Anybody?” I looked out over the river and frowned. “My name is Matt,” I said, rubbing my hands together. “Just here to check in.” I inched closer and placed my right hand on the pile of blankets. “I’m working with Jim O’Connell and Health Care for the, uh, do you know Jim?”
At that point in medical school, I was several months removed from the banana peel; there was no chance that Axel ever had to seek out patients like this. I began grinding my teeth as McCabe’s voice trickled into my head: Ask yourself a deceptively simple question: Can I imagine myself being happy as anything other than a surgeon? Like a sine wave, the blankets bounced up and down as I considered my words. “Hello? Anyone?”
I was preparing to turn around when a voice emerged. Soon a pair of eyeballs was staring back at me.
“Hey,” I said, “I’m Matt.”
“You work with Jim? Is he here?”
I leaned in, trying to make out a face. “He is. Would you like me to get him?”
“Who are you?”
“I work with Jim,” I said tentatively. “I’m a student. I brought socks and soup.”
“Can I…can I talk to Jim?”
“Yes, I’ll get him.”
“Can he take a look at this?” The man emerged from under the blankets and pointed to an open sore on his left shin. The skin was dark and mottled, with pus weeping from the borders. The stench was overpowering and unforgettable; I fought the urge to turn my head away. “Let me get Jim,” I said softly.
As I headed back to the van, I thought of the material I’d been stuffing in my brain during medical school and compared it with what was floating through Jim’s head. He held in his mind an intricate map of the city’s homeless, a human atlas that few, if any, possessed. Jim O’Connell was undoubtedly the only physician who could tell you why one overpass was preferable to another for a good night’s sleep or why Copley Square was better than Faneuil Hall for panhandling.
And like Axel, Jim was happy to dispense wisdom. “The key,” he said later that night as we walked with flashlights under a condemned bridge, “is to build a relationship. It’s easy to condescend. Resist that urge.” And after a challenging interaction, “The problem is us, not them.” Between stops, Jim and I talked about Whitey Bulger, Boston’s enigmatic criminal, and baseball. “Dennis Eckersley,” Jim said, referring to the former Red Sox pitcher, “his brother was homeless. Who knew?”
I found myself coming back to my apartment in Brookline raving about the experiences. I wanted to be like Jim. I wanted to be Jim: an unconventional, understated, brilliant doctor who played by his own set of rules, engaging patients in ways I’d never seen or considered. His method tapped powerfully into my own self-image as an outsider—the pre-med who was a ballplayer, the Ivy Leaguer in the minor leagues. In medicine, too, I knew I wanted to be something different but I wasn’t sure what that something was until I met Jim.
More than a few times, my roommates were subjected to my theory that Jim O’Connell was doing for Boston’s poor what Paul Farmer, the subject of Tracy Kidder’s book Mountains Beyond Mountains was doing for Haiti. “Do you know what he’s building?” I’d ask Heather, referring to the centerpiece of O’Connell’s oeuvre, a massive medical complex that included a 104-bed inpatient clinic and dental clinic designed for the homeless. “Do you realize,” I’d say, time and again, “just how incredible that is?” My friends quickly tired of hearing about it, but I never tired of telling them.
One morning, I found myself in the corner of Jim O’Connell’s small office at Mass General, looking on as he examined the middle-aged woman with smeared lipstick, the one he’d been speaking with when McCabe introduced us. This time Sheryl was wearing dirty gray sweatpants and a blue Tasmanian Devil sweatshirt. Neon lipstick was smudged across her lips and cheeks.
After removing his stethoscope from her chest, O’Connell sat down in a black plastic chair a few inches from Sheryl and took one of her hands in his. “Everything looks good,” he said. “Very good. Things are trending in the right direction.”
She looked over at me and in a stage whisper said, “I was hoping for great.”
“Everything looks great,” Jim added warmly. “Blood tests, urine test, heart and lungs. I couldn’t be happier.”
I had seen Sheryl at the Pine Street Inn several times and learned from Jim that she’d been living on the streets of Boston for nearly a decade. Sheryl tended to ramble about her ex-husband and occasionally burst into fits of laughter for no apparent reason. She once shouted at me about the television show Designing Women.
Jim gently pulled Sheryl’s hand in his direction to regain her attention. “You know what I’m going to bring up next,” he said. “And just because you say no doesn’t mean I’m ever going to stop asking.”
She leaned toward him and their knees almost touched. “Lay it on me, Jimmy.”
He took a deep breath. “I would like you to speak with one of our mental health professionals.” Sheryl pulled back slightly but left her hand resting in his. “This is not a judgment against you,” he said. “I just think you’d benefit from talking to someone. Someone with more expertise than me.” She closed her eyes as he continued to speak. “We’ve been talking about this a long time and I think it would really help. And the clinic actually has an opening today. You could be seen this afternoon.”
I stared at Sheryl, wondering what was going through her head, as my eyes fixated on the lipstick. Why not talk to someone? What’s the harm? I straightened my freshly starched white coat and folded my arms.
“I understand why you don’t want to go,” Jim said, edging closer to her. “Really. But this is important, and I’m not going to stop bringing it up.”
She shook her head. “I’m not crazy.”
“I know that. I know you’re not crazy. But I still think this could help.”
Sheryl looked down at the floor, and my eyes drifted in the direction of her gaze. What was she thinking? Was she crazy? In our brief interactions, it had kinda seemed like it.
“It’s important,” Jim added. “Really important.”
Sheryl looked over at me, and I gave a gentle nod.
“Please consider it,” he said.
She gave him an exaggerated smile and softly said, “Fine.”
My eyebrows raised, and so did Jim’s.
“I’ll do it, Jimmy. Whatever you want.”
“You will?” he asked.
“I will.” Sheryl looked at me, grinning. “He has been a pain in my ass about this for years. Years! Never shuts up about it. Go see someone. Go talk to someone. Well, I’m talking to you, Jim! I’ll talk all you want.”
I wanted to respond but wasn’t sure what to say. “Is that right?” I muttered.
“I’ll make the referral now,” Jim said, flashing a flicker of a smile. “Right now.”
A moment later the appointment was over. Sheryl grabbed her belongings, gave Jim a hug, and said, “To be continued,” as she sauntered out of his office toward the mental health clinic. When the door closed, I noticed that O’Connell was staring at a blank sheet of paper on his desk.
“Interesting lady,” I said, approaching him. “Really interesting.” I took a seat where Sheryl had been. “Lot going on there.”
Jim sighed and looked at me. “That woman has had her life ruined because of mental illness,” he said. “Her marriage, her job, every interpersonal relationship. All destroyed.” His eyes became moist and his voice soft. “I have been trying for six years to get her to see a psychiatrist and she has always refused. Every single office visit for six years. Always said no.”
I studied his face, trying to think of something significant to say. But I could only offer a single sound. “Huh.”
“She has never given herself a chance.” Jim pounded his right hand on his thigh and smiled. “Until today.”
“Incredible.” His eyes bounced from left to right, and I tried to follow them. I could hear voices just outside of the office discussing a new coffeemaker. “Why today?” I took out a pen and a small notebook from the front pocket of my white coat and started to jot down the details of the exchange. “Wonder what changed,” I said.
I waited for Jim to say something about persistence or tact, but he didn’t say anything. He just stared at the blank sheet of paper. As we sat in silence, I tried to imagine what the last six years of encounters with Sheryl had been like. Had she yelled at him? Politely declined his suggestions? Did he ever get frustrated or upset with her?
“Matt,” he finally said, putting a warm hand on my shoulder, “sometimes things that on the surface can seem like small victories, very small victories…”
His voice trailed off, but I wanted him to continue. I put down my pen. “Yes?”
He stood up and shook his head. “Sometimes those things can actually be tremendous victories.”
I was so taken with Jim and his philosophy that I convinced Harvard Med to give me course credit for schlepping around with him. Instead of making me learn how to efficiently manage a complex primary care visit with a guy like Sam, the school gave me primary care credit for assisting Health Care for the Homeless one night each week. That’s part of the reason I felt so overwhelmed when I started working in Columbia’s primary care office; I had watched Jim provide primary care out on the streets, but I hadn’t done much of it myself.
Sure, I dispensed clean socks and foot ointment and listened when people wanted to chat, but Jim was the one examining and treating people. He was the one making tough decisions, convincing a reluctant recluse to go to an emergency room or providing reassurance. But it was during those late-night rides that I discovered how important it is to connect with patients. He was the reason, I realized later, that I first went to Benny’s room when Baio asked me to introduce myself to the patients in the CCU. I didn’t gravitate to the most medically complex patients, I went to the guy on the stationary bike—the guy I could talk to and potentially connect with.
From Jim I learned that through medicine it is possible to reach the unreachable—even the ones who most of us forget about or actively try to ignore. This is the power and beauty of our profession. He spent his evenings with Boston’s homeless so they would trust him, so they would come to his clinic when illness struck. And this, I discovered, was no small task for people who lived under bridges or in large boxes near abandoned warehouses—people who were embarrassed by the sores on their legs or the smell of their skin. To walk into a hospital’s lobby in shambles and sit in a waiting room was not something most would even consider. But they did it for Jim.
And I wanted them to do it for me.