The Immigrant Patient
Week One
You are reading Ask The Patient by Dr. Zed Zha, a doctor’s love letter that gives patients their voices back. If you enjoy it, please comment, like, share, and/or subscribe!
My name is Zed Zha, and I am an immigrant physician serving immigrant patients. This July, to offset the chaos and heartbreak in the world, I am writing a love note each day, true stories of resilience, courage, and connection from inside the clinic. These are small moments with big hearts. These are immigrant stories in America.
Here are this week’s stories.
Day 1: Alive and Smiling
She has kidney failure. She’s been waiting on the transplant list for years. I see her every few weeks. Every time, I mean every time, she walks in with the biggest, brightest, most disarming smile. The kind of smile that comes from the heart, flows through the eyes, and fills the entire room. The kind of smile that makes you stop, catch your breath, and feel something.
I’ve always wondered: how does she do it? Recently, I decided to ask.
“I love your smile. Even though I know your life can be really hard, you never lose that smile. How do you do it?”
She paused. Then she smiled even brighter (if that was at all possible) and said:
“Each day I wake up, I know I am alive. And I know that I stand another chance to receive a phone call for a second chance at life. That’s a reason to smile. So, every day I am smiling, I am alive.”
I don’t think any of us in the room were ready for that answer. We cried, hugged her, and thanked her for the gift.
In a world shaped by fear and hopelessness, her words reminded us that joy is a form of resistance, and gratitude is its own kind of medicine.
Now, I try a little harder to smile when the world feels heavy. Because as long as we still see each other, really, really see each other, we are still alive.
Day 2: You must dance!
She is 98 years old. She spent most of her life in Mexico and speaks no English. She has witnessed history, endured sorrow, and lived a full, remarkable life. And now she was sitting in my exam room in the cutest dress, with a fresh flower tucked behind her ear.
I told her she was doing very well. But I had a feeling she didn’t need me to tell her that.
“What’s your secret to a healthy, long life?” I asked.
She hopped off the exam table and said, “I dance every day! Do you dance?”
I admitted that I wasn’t much of a dancer.
“Let me teach you,” she reached for my hands. Then, right there in clinic, she started moving her hips in elegant salsa steps, puppeting my arms along with her. I, on the other hand, was not as graceful.
My medical assistant and her daughter started giggling and joined us.
“To stay young,” she beamed, “you must dance!”
I felt so honored just to be in her presence.
Her joy was a medicine of its own and an invitation to feel alive,
and to celebrate the miracle of still having legs to move and hands to hold.
“Thank you for coming to visit us,” I said, holding her hand and giving her a small bow as the visit (dance party) ended.
I didn’t master the moves, but my heart danced when she reached out and held mine.
For as long as we can reach each other, we must always dance.
Day 3: A cart of watermelons.
I was leaving clinic one afternoon when I saw a woman in farm-working clothes pushing a big cart of watermelons toward the clinic door. A nurse stepped outside, her face lighting up with recognition and joy. The two of them began chatting in Spanish like they’d known each other for a long time.
Curious, I wandered over. “What’s going on?” I asked.
The nurse grinned. “Every year she brings a big cart of watermelons for the clinic staff! Dr. Zha, take one home!”
Before I could say no, the woman reached into the cart and hoisted the biggest, heaviest watermelon she could find. Then she placed it firmly into my arms. I staggered under the weight. “Oof!”
They both giggled. I joined them.
In that moment, I thought of my own mother, walking around the neighborhood with containers of homemade dumplings for anyone who happened to say hello.
Food is a language of love. And how could I say no to love?
“Thank you so much,” I said, eyes stinging unexpectedly.
I work at a migrant health center, caring for farm workers and their families. The woman looked like she’d come straight from the fields, hands still stained with soil and sun. And yet, when she had extra food, she brought it here to share and to nourish those who care for the community.
That watermelon sat on my kitchen counter for days before we sliced it. And when we finally did, it was every bit as sweet as I imagined.
It tasted like gratitude.
It tasted like home.
Day 4: The American Dream
Before I left my last practice in another migrant health center, he and his wife invited my family to their ranch for dinner. I had been taking care of him and his loved ones for years by then. We had been through some tough times together. This was a goodbye, but also something more.
When we arrived, I learned he had butchered one of his goats and slow-roasted it all day in a clay oven, because one of my medical assistants had mentioned I loved goat meat. He handed me a shovel and invited me to break open the clay together, while his wife flipped fresh tortillas on an outdoor stove. One by one, their children arrived. They were the doctors, dental hygienists, engineers, and teachers in the community. The grandchildren ran across the ranch with the chickens and dogs, but not before landing loud kisses on their grandparents’ cheeks.
My parents were guided to the garden, where they picked vegetables and fruits with wide smiles. My dog, Moshi Moshi, quickly joined the laughter and chaos of the little humans and the farm animals.
It was the most memorable sunset of my life.
At the table sat two pairs of elders who barely spoke any English or each other’s languages, yet shared home-cooked food with quiet reverence. Around them, their adult children translated conversation and passed warm plates between generations.
“Mi doctora,” he said, hugging me tightly, turning to my mother. “Mi familia.”
I didn’t need to translate. My mother’s eyes had already filled with tears. My father beamed.
And in that moment, I knew:
This, the aroma of food, the sound of laughter, the shared language of love across cultures, and the warmth of the late afternoon sun,
this had to be the American Dream.
Day 5: I will pay!
There are stories that change a doctor’s practice forever. This is one of mine.
Her tiny 6-month-old body was covered in raw, red, broken skin caused by severe eczema. She had been suffering for four months, which was most of her life, from constant itching, infections, sleepless nights, and endless crying. Her mother had quit her job in the fields just to hold her, all day and all night. Her father picked up extra labor jobs to make ends meet. No one in the family was sleeping.
When I saw her, I knew exactly what she needed. But I couldn’t prescribe it because of “step therapy,” a cruel barrier imposed by insurance companies, she had to "fail" cheaper treatments first. It took me all the courage in the world to look into her mother’s eyes, filled with tears and exhaustion, and offer the best promise I could.
“Just one more month of creams, and then I’ll get you the good medicine.”
But she couldn’t hear me. She couldn’t understand me. All she saw was yet another doctor sending her baby home to suffer.
That’s when the father spoke, who had sat quietly in the corner the entire visit. He stood suddenly, chest rising, eyes wet with fury.
“How much is it?”
“You don’t think I have the money?”
“I will pay!”
He was shouting, but I wasn’t scared of him. My heart simply shattered into sand. There was nothing I could say in that moment to make the world less cruel. So, I held their hands.
No one should have to pay thousands of dollars out of pocket for medicine their child desperately needs.
No one.
His words have never left me.
I will pay!
I could do it. I must do it. Even if that were the last thing I did in my life.
But here’s the truth: They already pay. With their labor. Their sleep. Their bodies. Their sacrifices. And with every night when they break into pieces just to put themselves together by sunrise. It’s time we do our part.
Two weeks later, after raising hell with insurance, I got the medicine. For the first time in months, they had all slept through the night.
On the days when I sit staring at a thick stack of denial letters and endless prior authorizations, when I think of putting it off or giving up… I will remember the day when the baby smiled from my exam table, finally looking like any other healthy, thriving infant.
I will remember her mother, weeping in my arms.
I will remember her father, standing in his aching body, seeing through bloodshot eyes.
And I will say:
You will not do it alone.
PS: Here is the full story.
Day 6: The Walking Platform
One day, a young man who had recently come to the U.S. as a seasonal worker arrived at clinic with a shoulder injury. His friends came with him, cheerful and teasing.
“What happened?” I asked.
He looked sheepish.
“I forgot the platform walks,” he said. His friends burst into laughter.
It turned out he had been pruning apple trees from a robotic orchard platform, which slowly rolls forward while workers trim branches. He had stepped off to climb a nearby pole and cut a tall limb. But when he was ready to come back down, the platform had moved on without him. He clung to the pole, yelling for help, until someone brought him a ladder. By then, he had already strained his shoulder muscles.
“This is a work-related injury,” I said, reaching for the state paperwork.
But he shook his head quickly.
“No. I don’t want to. I’m afraid they’ll fire me. Just give me ibuprofen. I’ll go back to work tomorrow.”
His friends nudged him, laughing.
“Tomorrow, he’ll remember the walking platform!”
He chuckled too, clutching his shoulder. But what none of them could laugh away was the quiet truth that his injury was real. And untreated injuries, over time, leave permanent scars. They bend backs. They stiffen joints. They make people limp through life in unspeakable pain.
There are so many ways to get hurt as a migrant farm worker. Falling from ladders. Slipping on apples. Tearing muscles to reach that one stubborn branch. Getting sprayed with pesticides. You name it, I’ve seen it. And my patients have endured it, pushing past fatigue, day after day, with no time to rest or recover.
While we have the technology for robotic orchard platforms, can we also build the moral infrastructure to care for the hands that feed us?
Because the machines may walk forward on their own, no worker should be left hanging behind.
Day 7: I went to the fields.
Her mother is a migrant farm worker who has spent her whole life in the fields so her children could have a better one. One time, we were driving down the highway and passed a big sign that read: "U-Pick Blueberries!"
“You mean they want you to pick the berries and pay for them?” she said, half-laughing.
We both laughed, but I knew what she meant. When your family picked fruit to survive, that kind of leisure feels foreign.
Another time, we were traveling in New England and passed a well-known summer camp, where kids wore matching t-shirts and learned to sail boats on the lake. A sweet older couple, chatting with her in passing, asked:
“Did your parents send you to camp when you were little?”
She smiled politely.
“No,” she said. “I worked in the fields instead.”
There was a pause.
“Oh…” they said, visibly saddened.
While other kids were roasting marshmallows or learning to kayak, she was waking up at 3 a.m. to pick cherries and harvest apples. She didn’t go to Disneyland. She didn’t take ballet. There were no birthday ponies or piano recitals. People often feel sorry when she tells them. But she is proud.
Because there was grit. And love. And a mother who showed her what it meant to give everything so someone else could fly.
She got herself through college and then graduate school, all debt-free.
Recently, she took her mother on her first real vacation in over a decade. They went to the beach, which reminded her mother of where she grew up in Mexico. She showed me a photo on her phone: Her mother standing barefoot on a rock, facing the ocean. The wind had tossed her hair into a joyful mess. And the sun was setting behind her.
It was the portrait of a strong, beautiful woman.
I love the photo. But I love the woman my dear friend grew up to be even more:
The kind of woman you become when your childhood was the camp where love was picked fresh, by hand, before dawn.
Stay tuned for next week’s stories.
With love,
Zed
PS: Anesthesiologist and activist Alyssa Burgart, MD, MA, and I are having a live discussion soon about medical trauma and medical gaslighting. If you are looking to have hope that many of us within medicine are calling out the harmful culture of our very own profession, come and join us here today at 4:30 PM ET (1:30 PM PT).
