I grab the chart from the bin outside the door, and walk directly into the consultation room. The patient sits in the room composedly, despite the fact that I am running late. He’s here for the surgical portion of a kidney transplant evaluation. He is a big man with an East African accent, dressed in a long earth-tone African shirt and matching pants. I introduce myself and apologize for being late. As we shake hands, I notice, almost in passing, that his grip is not as strong as it should be, and he moves his shoulder awkwardly to meet my hand. I sit down and quickly scan his chart.