All happy families are alike; each unhappy family is unhappy in its own way.
-Leo Tolstoy
“He’s out junking.”
This term is unfamiliar to me. My patient did not come to his clinic visit today because he’s “junking?”
His sister has arrived alone to what-was-supposed-to-be my patient’s follow-up appointment. There is nothing else she can do. Her brother’s mouth has been sore for months and the pain is worsening. He can no longer eat solid foods, a couple of his remaining teeth have fallen out, and his lower lip is now numb. Lumps have developed under his chin.
A couple of weeks ago, he had called the one sibling he thought might help.
And she did. A few days later, he was in my office and she was there with him, attentively taking notes and asking questions. He chuckled as he acknowledged that he has “a few” other issues. He talked about his drug use. He smokes whenever he can afford cigarettes. He drinks all day long. Cancer has destroyed part of his tongue, lower jaw, and lip. He has big lymph nodes under his chin. He is skin-and-bones – nutritionally, a wreck.
At that first appointment, we had scheduled testing. He failed to show up for some of the scans. Before today’s office visit, I had looked at the available results; the treatment guidelines told me that his best chance for cancer cure would involve surgery, chemotherapy, and radiation. I wondered how he would get through the rugged treatment and months of supportive care.
Today, his sister sits alone in the office, near tears. She tells us that her brother rents mattress space in the basement of a house. Yesterday, he refused to come to the door when she had stopped in to remind him of today’s appointment. Today, when she arrived to pick him up, he was gone. His mattress was empty. One of the other men told her that he was out.
She knows what he is doing. He spends his days digging through garbage and wandering through empty lots looking for cans and bottles that he can sell. “He uses the money to buy alcohol,” she says. “He says he has to keep junking. It’s the only way he can keep on living. I tried to be firm with him and told him he needs to see the doctor. He wouldn’t listen to me.”
She wrings her hands. “What am I supposed to do?”
There are no easy answers. We offer support to her, we talk about social service agency referrals. We spend an hour together. She is devastated.
Before she leaves, we assure her we will care for him when he decides to return. We all realize, however, that he will not come back until he finds he needs cancer treatment more than he needs his junking.
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