It’s not often that a letter from Texas’s Paris Regional Medical Center ends up as a filing in an Islamabad courtroom. But that was the case this January, when Dr. Arjumand Hashmi, the Pakistani-born cardiologist-mayor of Paris, Texas, penned a missive voicing his medical opinion that his patient, former Pakistani president Pervez Musharraf, was suffering from “significant” coronary heart disease that required treatment abroad. “It is clear that his disease has progressed significantly,” Hashmi wrote in his letter after comparing Musharraf’s current medical chart against tests he conducted at his center in 2006 and 2009.

The missive garnered a flurry of mentions in the Pakistani and international press, some of which accused the doctor of using this as a ruse to get Musharraf—the first-ever former military ruler to face treason charges in Pakistan’s 67-year history—out of the country. The same question was asked back in Paris, where ten years ago it would have been impossible to imagine Musharraf becoming a household name, or the city of 25,000, which often garners unfavorable headlines for racial tensions between blacks and whites, electing a Muslim mayor.

Over endless cups of milky tea in his brick home in Paris one evening in March, Hashmi brushed off those theories with a laugh. “Did you see the headline which ran in one of the papers? ‘Small Northeast Texas Town Mayor Derails Presidential Trial.’ That was actually the headline,” he said. “I really did what a doctor’s supposed to do, I wrote a doctor’s letter, just like I would do for any other patient. It was not a question of friendship. And if it affects his trial, I can’t help it. That’s a political issue. I’m not interfering in Pakistani politics by any means, and neither do I have interest in doing so.” A naturalized American citizen, Hashmi makes it clear that his future political ambitions lie in America, not Pakistan, while remaining demure on what the specifics of those aspirations might be.

(A special court in Islamabad indicted the former president on treason charges on March 31, but in mid-April he was flown across the country, to Karachi, to have his heart condition evaluated by doctors at a Pakistani Naval Hospital, further delaying the inquest.)

Hashmi, a 53-year-old Republican, took a more circuitous path to becoming the mayor of Paris than most of his good ol’ boy predecessors. He was born in Karachi, a bustling port city on the Arabian Sea, and raised in Abu Dhabi, where his father, a Pakistani air force officer, served as a defense attaché to the military of the United Arab Emirates. After graduating from the American Community School of Abu Dhabi, Hashmi returned to Karachi to attend Dow Medical College, commuting home to Abu Dhabi on a two-hour flight each weekend, he explained to me one morning in the hospital break room over a snack of almonds and golden raisins, imported from Quetta, a city near the Afghan border known for its fruit.

In 1986 Hashmi moved to Connecticut to complete his internal medicine internship and cardiology residency at Yale’s Bridgeport Hospital. After eight years in New England, he relocated for his first job in Tampa, Florida, finding the muggy clime there far more similar to the weather of his youth, and became a civilian liaison to U.S. Central Command at MacDill Air Force Base. There, he befriended American generals, including Tommy Franks, and connected with Musharraf for the first time. In 2006 the hospital administrator in Tampa tapped Hashmi to revamp the cardiology department at Paris Regional Medical Center. Drawn to Dallas’ sterling public schools, his wife, Rizma, and three school-age sons opted to move into a mansion in Highland Park, one hundred miles from Paris. (His youngest son is now in middle school and his two older boys live at home and attend UT-Dallas, so the family still shuffles back and forth between Paris and Dallas on the weekends.)

Paris residents would be introduced to Musharraf soon after Hashmi’s arrival in town. In September 2006, following a visit to New York for the UN General Assembly and to Washington to meet with President George W. Bush, the sitting Pakistani president broke off from his traveling press corps and took an unannounced side trip down to Texas that included stops in Dallas and Paris. As black helicopters buzzed overhead, a motorcade of more than twelve vehicles, including a Secret Service escort, gummed up traffic in Paris, where Musharraf underwent a set of cardiovascular tests and was found, according to a hospital spokesman, to be “in excellent health.” (Hashmi declined to discuss the scope of the tests and treatment he provided Musharraf, citing the HIPAA privacy rule.) “Someone whispered to me that Musharraf had gotten a checkup,” recalled Shaukat Paracha, a mustachioed television correspondent with AAJ TV in Islamabad who had accompanied the president to New York and Washington, and news of the doctor’s visit would quickly morph into rumors that Musharraf, who took power in a military coup in 1999, had been deposed. (This theory was lent credibility by the fact that Pakistan was in the grips of a nationwide power outage that day.)

On another visit, CNN would dispatch satellite trucks to Dr. Hashmis’ street so Musharraf could be interviewed by Wolf Blitzer from the mayor’s living room. Other guests often in the pages of Dallas society columns have included the dashing cricketer-turned-conservative-politician Imran Khan and former Pakistani Army chief Ashfaq Parvez Kayani. “I’ve been friends with people who have had influence on the world,” Hashmi said about his impressive Rolodex of connections. His knack for putting himself in proximity to power is on full display in his Dallas home, which is bedecked with photos of his family with presidents Bush and Musharraf and other dignitaries.

Musharraf’s visits to Paris (he made another one in 2009, a year after resigning from the presidency, and a third in 2011) would occupy a prominent place in the local rumor mill as well. When Hashmi announced his bid for city council in 2011, after five years in Paris, a fair amount of uncharitable chatter regarding the former leader found its way onto local message boards devoted to the race. (“Maybe, if Hashmi wins, Musharraf will give him some money to help ‘attract new industry, clean up the city and rebuild the infrastructure,’ just like Musharraf did in Pakistan,” one commenter wrote. “Heck, we may finally get us a Gold Domed Mosque downtown.” Another poster suggested Hashmi would use Paris as a jumping-off point to impose sharia law statewide.)

Hashmi was undeterred by such talk and campaigned on an anti-cronyism, pro-business platform. He viewed his outsider status as an asset. “I didn’t grow up over here. I was in an ideal position where I didn’t really owe anything to anyone and could do what is good for the community, based on merit,” he told me. “My responsibility is to the community, not to individuals. But if the community benefits, the individual benefits. Rising water raises all the ships.” Following a campaign heavy on door-knocking, the doctor unseated incumbent councilwoman Rhonda Rogers in a June runoff after she sent emails about her Christian faith (and, by implication, his Muslim beliefs) to her friends, one of whom leaked them to the local paper. “He does not know my God. God is still in control and has picked me to stand in this battle for Him,” Rogers wrote.

For the most part, such talk has quieted since Hashmi became mayor, in July 2011, after winning his council race handily. (In Paris the mayor is not directly elected but instead is selected by a majority vote of the seven-member city council.) He ran unopposed in 2013. “He made a lot of us in Paris more broad-minded,” said Bill Strathern, Hashmi’s friend and campaign manager. Among his accomplishments, Hashmi said he is most proud of hiring the first city planner in Paris’s history, buying three fire trucks to replace some of the department’s aging fleet, and convincing 93 percent of voters last May to approve a $45 million bond issue to replace some of the city’s decrepit water and sewer lines. And he did all this without raising taxes, he adds proudly.

The word “indefatigable” comes to mind when considering Hashmi. His typical day starts at 3 a.m., when he works on city business from home for three hours before heading over to the hospital, where he is greeted with choruses of “Hello, Dr. Mayor!” as he roams the halls in cowboy boots, making rounds to visit patients and performing angiographies in the lab. Lunch provides no respite either, as he often holds working meetings in the conference room of his cardiac clinic next to the hospital. On any given evening he could be editing a PowerPoint presentation to present at a city council meeting, dining with guests at his home on an array of samosas and curries prepared by his personal cook, feting a famous Pakistani singer at an event for other Pakistani expats in Dallas, or reclining in his seat in the first-class cabin on an Emirates flight to Dubai, where he occasionally pops over for a quick weekend away. He’s unabashed about his wealth, picking a different car from his fleet of luxury vehicles each day, driving his red Lamborghini around town one morning and his more understated black Suburban the next, complete with a magnetic, circular seal of the City of Paris.

He’s upbeat about Paris’s future and wants to see the city revamp itself to attract new residents, particularly young people. “I want more rooftops. I want a bigger tax base,” he said. “But one cannot expect you to move into a dilapidated city. That’s why we’re trying to make improvements.” He hopes to be reelected to a final two-year term in 2015, after which term limits kick in, but his future as mayor depends on the outcome of the May 10 council elections, in which three members are up for reelection. His background shapes his perception and fuels his ambitions; because he comes from an authoritarian society, he better appreciates the potential of a place like Paris. “My origin is in a very undemocratic society. One is privileged to live in America,” he told me. “People who have not lived in other places don’t realize how good they have it, and take it for granted—things like freedom of speech and the ability to do things, to do the right thing and not face censorship.”