Disclaimer: This story is not the truth.  The events really happened, but the following portrayal contains hearsay, exaggeration, and possibly outright lies.  I will tell the tale as I remember it, pieced together from my inexact memories.  Please note that I write this from a place of fondness without intent to vilify or exalt.  It is meant to be a cautionary tale.  This is the legend of Doc J.  

Introduction 

     My nerves were already on edge when I entered the doctor’s charting area for my first morning shift as an attending ER doctor.  After graduating from my residency program, I drove a U-Haul truck from Georgia to West Texas.  On the way, my mother had a heart attack and needed a CABG, so I had to ask off my first few shifts, creating an inauspicious start to my career.  I was working for EmCare, and my new medical director didn’t seem very involved.  I hadn’t had any orientation, preparation, or sleep as I walked in at 7 a.m.

Old Smoker

      The night doc that I was relieving was named Doc J.  I’m not calling him that to protect his privacy; that was just what everybody called him.  He was tall and lean, probably 5’11” and 150 pounds.  It was difficult to tell because he hunched over and always wore the type of pants your mom would call slacks and a shirt that looked like it came out of the 80s.  The kind of clothes that look itchy and uncomfortable.  He also always had a black leather jacket on.  Not the Fonzie kind, but more like a members-only jacket made of leather.  He wore his long gray hair down, partially covering his face, and generally appeared disheveled.  He smelled heavily of cigarette smoke and took frequent breaks to the back stairwell, where he would chain smoke cigarettes in a crouched position.  This was 2006, long after smoking in the hospital was tolerated.  When I think back now, I hear his gruff voice in my head as my high school coach, Mr. Wilson, although I don’t believe that’s actually what he sounded like.  I guessed he was in his mid-60s, but it was hard to tell.  He could’ve been anywhere from 55 to 75.  I walked in and said, “Hey, I’m the new guy.  How’d your night go?”  He responded with the phrase I heard him repeat countless times over the next several years.  “Same sh*t, different day.  Nothing ever f*cking changes around here.”

    That was pretty much the only thing he said to me for a year.  Every time I relieved him, he said the same thing.  As time passed, I would hear bits of his story from some of the other docs that had been around for a while, but mainly, I heard stories from the veteran ER nurses.  For anyone who started working in the last ten years, you may not remember the grizzled veterans who used to staff ERs.  For years, they would not let new nurses work in the ER.  You had to pay your dues on the floor first.  Now, the ER is the starting place for any newly graduated nurse, where they stay for two years to get some experience, then move on to something else.  Throughout my residency, moonlighting, and my first few years as an attending though, the average ER nurse had 15 – 20 years of experience or more.  Anyway, as the nurses grew to know and trust me, they would tell me stories of the old days and of Doc J.

The Legend

    He was apparently born in Canada and had served in the Canadian or US military; I can’t remember.  He had moved to this small West Texas town in the early 1980s and had been at the same hospital since.  My understanding was that he was grandfathered into ABEM, which would make sense given his age.  He had worked his whole career in the ER on nights.

    There was another older doc around at the time that everyone called Grandpa.  Grandpa would tell me stories about how much money they were making back in the 80s, as he and J had worked together since then.  The early 1980s were boom years in oil-rich West Texas, and everyone was flush.  There were mansions, private planes, lavish parties, and, at some point, a Rolls-Royce dealership in Midland.  As tends to happen, the good times couldn’t last forever, and a major crash hit in 1986.  These were still great years for ER docs as quite the knife and gun club developed during the bust.  Everyone universally lauded Doc J’s medical knowledge, skills, and demeanor with patients.  Despite his rough exterior, he was quite the sweetheart to his patients.  

     Time passed, and rumors circulated as they do.  I’ve always said that the ER is basically an adult high school, and the gossip thus flowed forth:

     He wears his hair long because he flipped his brown convertible Porsche 911 one night, ripping off his ear and leaving the side of his face scarred.  His long hair hides the disfigurement.  He came to this ER as a patient when it happened.

     He wears the same clothes every day because he’s broke.  He lives in a small studio apartment above a warehouse near the airport.

     He used to have epic parties at his old house where all the nurses and staff would go after a night shift.  Sometimes, they would last all day.  

     He was quite the Vegas high-roller in the ’80s and ’90s.  He still goes twice a year and gets comped every time.  

     He is in trouble with the government.  

     The old-time nurses universally agreed that J was one hell of an ER doctor and a helluva good time.  Yet the tales of parties, Porsches, and poker didn’t mesh with the quiet, cynical, haggard-looking man who came to work night after night.  Grandpa clearly had money and only worked two or three shifts a month “to keep his skills up,” while J still worked full-time nights and drove an old beat-up Cadillac.  Something didn’t seem to add up.

The Secret

    Bit by bit, over time, J loosened up around me.  He still greeted me every morning with, “Same sh*t, different day.  Nothing ever f*cking changes around here.”  But now, he would chat with me a little more during our hour-long overlap.  Two years after I started working there, the hospital administration approached a few of us about starting our own group and taking over the ER contract.  They were unhappy with the contract management group and were willing to pay our buyout to get us out of our noncompete clauses.  As we discussed the logistics of making this happen, it came out that J could not or would not join our group.

     J had gotten himself in trouble with the IRS for not paying his taxes.  I never discovered the exact details, but (of course) several rumors eventually went around.  One was that he thought that as a Canadian citizen, he didn’t have to pay US taxes.  Another was that he had never claimed his gambling winnings to the IRS.  He briefly mentioned to me one morning that he had owned a wine store during the oil boom, had lost a lot of money during the bust, and somehow that was the cause.  I didn’t quite understand it.  Whatever the initiating factor, it seemed that all was good until he got divorced, and his ex-wife tipped the IRS off that something wasn’t quite right with her soon-to-be ex-husband‘s taxes.

           If you don’t pay the IRS when it’s due and you get caught, whether intentional or not, you don’t just owe the back taxes.  You owe the back taxes, a hefty penalty, and an usurious interest rate.  It is not uncommon to owe many multiples of your original tax burden.  This was the case with Doc J since his infractions dated back to the 80’s.  He owed millions of dollars to the IRS, enough that there was no real hope of paying it back at his age.

Tax Evasions

The Consequences 

     The IRS gave J a choice: go to jail or work out a plan to pay back what he owed, even if it took the rest of his life.  That is how a high-rolling ER doctor became the beaten man chain-smoking in his leather coat.  To his great credit, I never once heard him complain other than uttering his daily catchphrase.  He accepted his lot like the old-school man he was.  He was obligated to continue working full-time indefinitely and had his wages garnished by the IRS.  He was allowed a small stipend to live on every month.  He never told me the exact amount, but I heard it was around $2500 a month, which was why he drove the old Cadillac and lived in a small apartment above a warehouse by the airport.  This is why he wore the same clothes every night.

  This was also why he refused to join our new group.  Since the IRS would confiscate any money he made over his monthly stipend, it didn’t make any sense for him.  He said it would be better if we made the money instead of giving it to the government.  Looking back, he must have felt hopeless about the amount he owed and the possibility of ever paying it off.  I always appreciated his honesty about his situation, which made our partnership more lucrative.  He continued to work for us after we took over as an independent group and carried on at night, as he always had.

The Friendships

     Over the next few years, we bonded a little more.  He would give me advice and share stories from his decades in the ER.  I really enjoyed talking to him and counted him as a friend.

     Despite the alleged restrictive terms of his agreement with the IRS, he still managed to get away once or twice a year to Vegas.  A group of older doctors in the area would go together, and their trips were canonized in the hospital lore.  I don’t know whether he was able to squirrel away some money from his monthly stipend or whether he was able to hide money from the IRS, and I don’t want to know.  It’s also possible that his friends just paid for him.  Before the trip, you could sense his excitement in the ER, subtle but present.  One year, I was in Vegas with some of my friends during one of these trips.  I called J to see whether he wanted to meet up with us, but we kept missing each other.  I saw some of his buddies at the airport when I was returning home, and they told me that he had had a great time.  I was sad that we had not been able to hook up while we were there.  I really wanted to buy him a drink.

The Conclusion 

     Shortly after that trip, I was working an evening shift that overlapped with the night shift.  Jay was supposed to come in at nine to start his 10 hours.  He showed up a little late, which was unusual.  He looked gray and unwell, even more so than normal.  I asked him how he felt, and he told me he would be OK.  He had RT come down to give him a breathing treatment, a common occurrence; however, he still didn’t look well when he finished.  I told him he looked like sh*t and needed to check in, to which he, of course, said no.  He was adamant that he would not be a patient, but eventually, he said he would go home if I could cover the rest of the night.  I figured he just needed to get some rest.  As we were single-covered at night, I essentially worked a double but was happy to do it.

    J had the next couple of days off.  When it was time for his next shift, I got a phone call from one of my partners saying that J hadn’t shown up.  We quickly got the shift covered and called the police.  He was found dead in his apartment.  It appeared that he had been that way for a couple of days.  It later came out that he had known that he was sick, having been followed by one of the old local cardiologists, but refused all treatment.  I think he was finally ready for something to change.

The Lessons Learned 

     No one likes paying taxes.  For new medical professionals, it’s more than just unpleasant; it can be challenging to decipher federal taxes, state taxes, NIT taxes, quarterly estimated taxes, and more.  It never fails that young independent contractor doctors look for extra shifts around tax time because they underestimated what they would owe.  For a primer on the US tax basics that will affect medical professionals, read “Taxation: The Inescapable Bane of Medical Professionals“.

     The bottom line is to pay your taxes.  That’s the moral of this story.  I don’t want to pay the government any more than I’m obligated, but every time I hear a young doctor discuss a new tax avoidance strategy, I tell them the story of Doc J.  Conservational easements?  Doc J.  Setting up a corporation in Nevada for your individual practice?  Doc J.  The new accountant that can save you a ton on your taxes?  Doc J.  I don’t mean to discourage you from pursuing any and all legal tax savings; I just want you to be careful.  Measure twice and cut once.  Doctors are the high-income earners that the government loves.  I suggest you consider the IRS a loan shark, where you really don’t want to get behind on your payments.  Except in this case, they don’t just break your legs; they break your spirit.  Remember Doc J.