On December 27, 2006, Kushel and Miaskowski1 introduced Mr K, a 66-year-old African American man who has lived on the streets for nearly 50 years and for most of those years has used heroin and other illicit drugs daily. Mr K was diagnosed with advanced renal adenocarcinoma in February 2002 at a large urban hospital. For unclear reasons, resection was made contingent upon cessation of drug use and was not done. Thereafter, Mr K was lost to follow up for almost a year, until he presented to the emergency department with abdominal pain and heroin withdrawal. He was then referred for palliative care to Dr E, in the hospital's palliative care clinic.
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