A doctor is taking care of a Pacific islander. The man is on dialysis but since his immigration status is not legal he cannot get medicare, Medicaid or any kind of insurance to pay for his dialysis. I don’t know the details. It was not my own patient but some how he had come to United States  without the right papers. The Pacific islanders usually find immigration easy compared to Mexicans, South American and South Asians but  he had not signed the right stuff.

The doctor to the case manager, ‘ Is there anything we can do?’

‘No, not really. He can come to Emergency room every three days and get dialyzed.’

‘That’s crazy.’

‘It is, in California there may be some options, Of course he can go home. He will have better luck there. At the least it will take a few months.’

The doctor goes to talk to the guy. His whole family is there visiting him.

Now this is Trump era life, so every brown person is scared.

The daughter who has never seen the doctor before asks before he has time to say anything.

‘Where are you from.’

‘You mean where I was born?’


‘I am from Pakistan.’

‘Osama!’ collective sigh from several family members. This is several years after Osama was killed. Trump and Bannon are presidents. Osama is history but evidently not for them.

‘You muslim?’


‘We dont want you as my dad’s doctor. We are christians.’

‘OK.’ The doctor turns around and leaves.


Insurance train

A nephrologist walks into a patient’s room in ICU . Patient is admitted with a potassium of 7.5. Potassium has a very narrow range 3.5 to 5.4 . Above 6.2 it can potentially stop the heart in diastole , basically mid beat.

Kidneys excrete potassium and if kidneys don’t work and potassium go high people call nephrologist (kidney doctor )to fix the situation.

The nephrologist had already prior to seeing the patient  instructed the ER Doctor and Hospitalist about some emergency measures and the potassium subsequently had come down to 6.6.

Now in the room, after  the nephrologist introduced himself and the reason why he was there the patient asked.

“Who called you”

Unexpected question.

“Your main Doctor . The Hospitalist and the ER Doctor ”

“He did not ask me”

“Well, perhaps because the situation was emergent he decided to get things going before he comes and talk to you”

“I don’t want people to keep hopping on my insurance train. Just because I have insurance you are here ”

Most Doctor will agree ,more then  half of the patients we see in hospital on an emergency basis are uninsured or underinsured . In Most of these cases we don’t see any money. 

Depending on how critical your field is , more pro bono you are going to work . Like ,a cardiologist ,trauma surgeon and an ER doc probably will do more pro bono work then an orthopedic surgeon or a cPulmonary/critical care Doctor and an orthopedic surgeon possibly more then a nephrologist and obviously a plastic surgeon who specializes in boob jobs will Likely never be called for an emergency. Except of course if a porn stars implant burst open during athletic sex.

In this case , as usual the nephrologist had not looked at the patient’s face sheet before rushing to ICU . Like always doctors don’t look at insurance Cards before responding to emergencies. I m not saying we don’t care about money , of course we have families and dreams too but when somebody calls , we go.

 Potassium greater then seven puts an automatic spring in your feet.

“Well your potassium is high . It’s better then before but it  a still high. It can potentially kill you”

“It’s won’t. It’s getting better and it will get better when we check the next time ”

“Do you not want to see a kidney Doctor ”

“I don’t ” the patient replied resolutely.

And the nephrologist had to leave the room.

True story .

Open marriage

so a patient , a good looking blonde woman in early forties sat in front of me complaining about her husband.

They had been in an open marriage for probably more then ten years but now there was trouble in paradise.

Both the spouses had been my patient for many years . As usual I never cared about what and who they did In the bedroom.

“He fucks her behind my back. Never even tells me about it ”

Remember it’s an open marriage .

“I thought you were ok with this”

“I was ok with this when I was younger, when I could get as many men as he could get girls”


“we invited this girl to a threesome a few times , she is young and hot and now she is fucking him all the time ,all the time”with more emphasis


“She is a bitch”

“I understand”

“How do I stop him ”

“Hmm. I see the problem”

“I can only get old guys now . He can get any girls he wants”

What I wanted to say was 

“Well,you should have thought about it when you brought a younger and hotter girl to a threesome”


“Sorry about the current double standards which persists in our society, but perhaps it’s time to let your husband know you don’t want an open marriage or any marriage”

Or  what I really wanted to say 

“How is this my problem. The guy still in waiting room may have a ruptured appendix and I am sitting here talking to you about your crazy love life”

My residency program director voice hammered into my head .

“You don’t have to like your patients , but you still have  to take care of them to the best of your abilities”

Therefore what I really said was.

” I feel sorry for you. This is indeed a bad situation , perhaps I can refer you to couples counseling and maybe we can find a solution for this problem”

I hate you Sir for being my teacher.





Pain med

So a teenager walked in my office . I knew his grandparents and knew they were very close to being dirt poor . This dude wore 200 dollar boots, fairly expensive ( possibly 600 to 800 dollars) duster and a Swiss watch .

He asked me for pains meds possibly Percocet since his back was hurting. When a teenager knows his pain meds by name that’s a red flag . If he appears to be independently rich that’s another red flag. If he does not have any reason to need pain meds that’s a big red flag. The whole picture spells out high school drug dealing.

Any guess to whether or not I gave him the script he  wanted.

Number two Spot

So the patient is admitted from the ER At 11 pm . An intern goes to see her and do a history and physical . The patient , an African American woman refuses to let this intern take care of him.

” I don’t want no brown man  touching me ”

Unfortunately this being a major hospital In a major United States city , half the doctors are brown and coincidently all the interns on call at night are brown. Most of these interns are born and raised American though and speak American English

We discuss amongst each other and finally a 3rd year resident who is white goes to see the patient .

The senior resident has an Eastern European accent.

The patient says” Can’t I have an American doctor. A white or a black American”

We eventually called our attending who happened to be white . He came and saw the patient . Later on patient was given a letter explaining the rights and responsibilities of patients etc.

The funny part of the story is that until then I did not know that there was a tier system in racism .

Everybody agrees that the number one race is white . They are the baddest of them all , but my oh my ! if there isnt a competition for the number two spot.