The community we serve has significant issues in terms of social determinants of health. It is home to one of the largest open air drug markets in the country where many people live on the streets and are far away from their home.

One patient was a young man who frequented our hospital’s acute unit often because he was in active addiction, unhoused, and without a chronic dialysis unit due to these circumstances. I will never forget the day I asked him where he was from.

I meant where he grew up before he landed in this situation; instead, he told me, “Outside.” He was living in a terrible world, but our acute unit was a constant in his life. He trusted us.

Occasionally, he would come in somnolent, in active withdrawal from whatever substances he was using. I knew his baseline and advocated for his care. I made sure he was physically clean. Once, he was so dirty I had to soak his hands to get the dirt out from under his fingernails. I would send him upstairs washed up, with clean sheets and food after dialysis.

When his time was up, I met his family in the ICU when he was on CRRT. His mother and brother told me he was a Veteran, and that after serving, he came back a different person. His brother saved his life and took him to rehab, but he just couldn’t win the fight against his own demons.

His mother was upset that he was alone on the streets for the last months of his young life. I was able to talk to her about his dialysis family—the team that saw him every time he came through the hospital, spent time with him, and cared for him. That he knew us and trusted us. This knowledge gave his family some peace. Knowing that her son was treated with dignity and compassion helped her make the tough decisions she faced. She knew that he was cared for, and that despite his demons, his dialysis team knew he was someone’s son.