It sounds like your nephew is lucky to have you take him in and try to help him. It probably doesn't make it any easier to cope with, but your nephew's behavior is not that uncommon for someone his age with kidney failure. Delayed maturation is common and people on dialysis of any age may have problems thinking clearly and remembering. Denial is a very common coping mechanism for people with chronic illness and depression is very common, especially for someone like him who has faced all the losses he has faced. It's also likely that he is anxious about his future which he may see as uncertain. Here is an article that may help you understand more about how to help people his age cope with dialysis:
If he's getting dialysis in an adult clinic, which is most likely given his age, the adult dialysis system and healthcare providers in it are often ill prepared to handle adolescents and young adults with kidney disease who often are not as mature as others their age and they may expect him to grow up and act his age and he may feel like they're bullying him. That said, every dialysis clinic must have a social worker who has a masters degree and counseling training and is responsible for helping patients and their families cope with kidney disease and achieve the patient's desired level of functioning. The social worker is also responsible for helping the dialysis team understand patients' emotional needs. The social worker in the adult clinic may be less experienced dealing with patients your nephew's age than with those who are middle aged or older and may refer him to someone in the community who has more experience with chronically ill young people. You should talk with the dialysis social worker about what you know about your nephew's emotional state and how that affects his behavior. He/she may have some ideas for you. Be aware that because of his age unless you're his legal guardian, staff are limited in what they can tell you about his specific case because of patient privacy laws. If your nephew is willing and gives permission, they can talk with you and include you in planning for his care as much as he wishes.
So far as resources for counseling or support in the Houston/Galveston area, talk with the dialysis social worker or contact the National Kidney Foundation of Southeast Texas which is located in Houston. NKF's phone numbers there are (720) 748-9991 or toll free at (800) 961-5683. Other resources for support:
- American Association of Kidney Patients' support groups in Texas, including one in Houston: http://www.aakp.org/outreach/List/texas/
- Renal Support Network was founded by a woman who had kidney failure as a child, includes KidneyTalk recordings: (800) 579-1970; http://www.rsnhope.org
- Dialysis-Support, an online support group for people on dialysis and their loved ones: http://health.groups.yahoo.com/group/dialysis-support/
The dialysis social worker can explain federal, state, and local resources for financial assistance and help you and him develop future goals, which hopefully will include school and/or work. People on dialysis often feel like they're too sick to work, staying active and dialyzing to live instead of living to dialyze helps those who work do better physically, emotionally, socially, and financially...and research shows they often get transplants sooner and the transplants last longer. The Texas Department of Rehabilitation may be able to help him get further education, if needed, or find a job that he can do while on dialysis.
One thing that makes it easier to work is to do home dialysis. There are 5 types that you or your nephew can read about on the homepage of Home Dialysis Central. Another resource to help you and him learn about various aspects of kidney disease is Kidney School: http://www.kidneyschool.org.
I hope that your nephew is able to come to terms with his health condition, learn from others who have faced the same obstacles and have overcome them to live full lives in spite of kidney disease.