During my fellowship in palliative medicine, I have learned the value of home visits. I learn more about my patients’ lives in two minutes of seeing their homes than I could in a lifetime of clinic visits. During home visits, I get to pet dogs, touch quilts, study photos, and admire charming heirlooms that would fetch only a few dollars in a garage sale, but that in these homes are priceless mementos. Just as often, I bear witness to the mess, the filth, the foul smells, the poverty, and even the loneliness and despair. Regardless of whether I like what I find in a home, at least it’s honest, and it always helps me understand how to best care for a patient.

Driving out to Jerry’s place west of town for a home visit was an ordeal. We wove along roads that progressively narrowed—paved, then gravel, then dirt—dodging dogs and loose livestock all along the way. Jerry’s friend met us and walked us down a path to the old aluminum shell of a trailer where Jerry was staying as he battled lung cancer. I’ll be honest, I wasn’t too surprised to see an old Confederate flag on the wall in this sad, stuffy space. Confederate flags are still fairly common in small-town Texas. Mixed in with the flag, I saw some more artful tapestries, but the faded colors of Dixie still popped.

As my eyes further adjusted to the dark inside of his hot trailer, I scanned the clutter and found jumbles of pill bottles, half-consumed bottles of Ensure, flies feasting on food that Jerry hadn’t touched. Then I saw Jerry himself, a specter lying in the dark, and his body revealed instant clues to the severity of his disease—labored breathing, gaunt features, the exaggerated convexity of his chest, each rib so distinct with no muscle or fat left to cover them. Sweat dripped off his pale body as he cried in pain.

We got him some of his pain medication and quickly made the decision to call 9-1-1. He clearly needed immediate attention and was not yet ready to embrace the finality of hospice at home. He was among the sickest patients I’ve ever seen outside of a hospital. I caught myself staring.

After some long spellbound moments, I forced my gaze away. As my eyes drifted up from his ribcage, I saw something equally as sick as Jerry’s lungs—a full-size swastika flag on the wall right above his bed. I had missed it at first, but there it was. Crisp and clean. A freshly made, recently purchased SS swastika flag. This was no historical artifact—this was an endorsement. Now I started to feel sick.

In 2023, we still hear some who defend flying the Confederacy’s Stars and Bars, as hurtful as the flag is to so many, but there’s no debate that a swastika represents hate, antisemitism, evil, and white supremacy. The ceiling of this nasty old trailer had just gotten a whole lot lower; I felt as if the walls were closing in.

A question has echoed in my head ever since that day. How should I handle the tears of a Nazi? I had recently been reading some of the essays of the Trappist monk Thomas Merton, who dealt regularly with questions like this. Merton wrote that, for him, empathy came from an understanding that his own faults and shortcomings were as great as anyone else’s. He believed that, deep down, he was capable of any of the monstrous depravities he saw in his society and in the world at large. To Merton, the fact that he had not traveled down certain dark paths was merely a reflection of God’s grace, not his own superiority. He must, therefore, extend love to all persons.

Beyond that, Merton felt a responsibility to engage with the societal problems of his times. He didn’t like that he had to deal with the realities of Auschwitz, Hiroshima, and Vietnam—all of which happened during his lifetime—but he felt he had no choice. These were the times into which he was born. He didn’t get a pass, and neither do I. I have to find my role in the midst of this messy society. On that particular day, in my capacity as this man’s physician, my role was easing the pain of a neo-Nazi.

EMS arrived, and we escaped from this rectangle of sadness back into the bright Central Texas sunlight. How should I handle the tears of a Nazi? As his physician, I should handle them the same way I handle the tears of anyone else. I should wipe them, and I should do my best to alleviate his suffering, even when I’d rather keep my distance.

Tyler Jorgensen is an emergency medicine and palliative care physician.