Susanna is an Indigenous woman who lives in the Six Nations of the Grand River Reserve. She is well-known to you. She first met you in the outpatient setting during your day in family medicine rotation two years ago at the beginning of medical school. At that time, Susanna had several issues with the management of diabetes, including regular blood glucose monitoring and appropriate medical management. Susanna has a complex medical history including type 2 diabetes, hypertension, obstructive sleep apnea, and a previous myocardial infarction and subsequent triple coronary bypass graft. After a lengthy stay in ICU six months ago due to pneumonia and septic shock, she developed end stage renal disease and is currently receiving in centre hemodialysis through a tunneled internal jugular catheter twice weekly. You are currently on your clerkship selective on nephrology with Susanna assigned to your team. Susanna has been admitted for a worsening chronic wound on her right heel. Susanna states she was attending the Grand River dialysis outpatient clinic on the Six Nations reserve 2 days ago, when one of the nurses there noticed increasing drainage from her right heel wound. Susanna’s vital signs there revealed she was febrile at 38.1 degrees and tachycardiac at 110 beats per minute with blood pressure 90/50 mmHg, respiratory rate 17 breaths per minute, and oxygen 100% on room air. Bloodwork was then taken, and a septic workup was also ordered.