This story is fiction but inspired by the real and worsening challenges faced by international medical graduates navigating U.S. immigration policy.
The acceptance letter sat printed on top of Nabeel Khan’s passport, still warm from the old inkjet printer in his family’s living room in Lahore. The words glowed like prophecy: “Congratulations! We are thrilled to welcome you to our Internal Medicine Residency Program at St. Julian’s Hospital, Topeka, Kansas, beginning July 1, 2025.”
Nabeel, twenty-eight, brilliant, humble, and sleep-deprived, had spent years chasing this dream—late nights studying for USMLE exams, tutoring biology students to fund his prep courses, and learning every possible cultural idiom that might ease the transition to American medicine. He had watched YouTube clips of morning report, memorized differentials like psalms, and practiced his “Tell me more about that” for simulated patients.
And now? Now he refreshed the U.S. consulate appointment page every twenty minutes like an addict. Each time, it returned the same message: No appointments currently available.
“It’s like standing at the gate of your dream,” he told his mother in Urdu, “with someone on the other side deciding whether you look like trouble.”
She placed a soft hand on his shoulder, her eyes rimmed red from prayer and worry. “You will get there,” she said. “Just keep your head high and your phone charged.”
***
Dr. Carla Miron, Associate Director for Residency Programs at St. Julian’s, had a spreadsheet open with more red than green. Nine incoming interns. Five delayed by visa issues. One, a general surgery match from Ethiopia, had his visa denied outright. No explanation. Just ineligible at this time.
The hospital’s leadership urged patience. “They’ll trickle in,” said the Chief Medical Officer. “They always do.”
Carla knew better. Every year it got worse. More scrutiny. More delays. More political theater played out on the backs of idealistic trainees. And this year? With the administration’s new executive order tightening the travel ban and mandating full disclosure of social media accounts, even the most benign online post could become a red flag.
She clicked on Nabeel’s name in the spreadsheet and opened his email thread. His last message was heartbreaking in its politeness:
Dear Dr. Miron,
Thank you for your continued support. I still haven’t secured a visa appointment, though I’ve expanded my search to embassies in Jordan, Sri Lanka, and the UAE. I am very eager to begin. Please let me know if there’s anything I can do on my end to keep my position.
Sincerely,
Nabeel Khan
***
In a rented apartment in Novi Sad, Serbia, Drs. Vera Kovačević and Milos Đorđević stared across from each other at a kitchen table crowded with embassy documents and half-drunk coffee.
“They’re asking us to make our Instagram accounts public,” Vera said, disbelief in her voice. “Mine has pictures of cats and my nephew’s birthday. Is that hostile?”
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Milos shook his head. “I posted a meme during medical school of a burning exam paper. What if they think that’s anti-American?”
“You studied at NYU for a summer!” she shot back. “You love hot dogs!”
“Doesn’t matter,” he said. “They don’t see that. They see the passport.”
The two had matched to family medicine in rural Ohio—places where physicians like them weren’t just welcomed but needed, and where unmatched American students shunned despite their own desperation to practice medicine. But the visa system didn’t seem to know—or care—about the hundreds of international doctors who were due to start medical residencies and whose visas were in limbo.
***
Back at St. Julian’s, July 1 approached like a siren’s wail. Carla attended orientation with a hollow pit in her chest. Five empty chairs sat in the back row of the auditorium where new residents filed in wearing ill-fitting white coats and nervous smiles.
“Are they still coming?” asked a curious U.S. graduate from Missouri.
Carla hesitated. “We hope so.”
Behind the scenes, the hospital’s HR team had submitted waiver requests to defer some of the affected residents to the following year. Others they might lose entirely—ghosted by bureaucracy.
Carla pulled Nabeel’s file one last time that evening. His final note had just come in.
Dear Dr. Miron,
I’m sorry to inform you that despite checking every embassy and consulate within reach, I was unable to secure an interview. I understand the hospital may not be able to hold my spot. Please know how grateful I am for the opportunity and how hard I tried.
Sincerely,
Nabeel Khan
She printed it. Folded it. And slid it quietly into her drawer next to last year’s letter from another unmatched dream.
***
Somewhere in Lahore, Nabeel walked the edge of the rooftop at dusk, the call to prayer drifting through the warm air like memory. He didn’t know what came next. Maybe next year. Maybe Canada. Maybe the fire would go out.
Below, his younger cousin pointed to the laptop screen where a breaking news banner ran across an international channel: U.S. faces physician shortage in underserved areas.
A flash of irony. A deeper burn of injustice.
“I could’ve helped,” Nabeel whispered.
He still might.
Someday.
But not today.
Not because he wasn’t ready.
Because the country wasn’t.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Narrative Medicine: New and Selected Essays, and Narrative Rx: A Quick Guide to Narrative Medicine for Students, Residents, and Attendings, available as a free download.
