'Things happen really, really fast in the emergency room, and so when someone's really in a critical state, you have to move fast,' he said. 'Seconds count. Minutes count.'
And since Jesuit High School, this New Orleanian knew becoming a doctor would be his destiny.
'It's very dynamic. No telling what's coming in the door. It's nice to be able to help people that are really sick and have an impact and hopefully have a good outcome.'
But there's another side to this doctor's world. From the adrenaline rush of life-saving work in the emergency room to a life of patience and serenity in a small valley in Oregon, Moises is also a wine maker -- and not with a kit in the kitchen either.
He has 40 acres in Oregon's prestigious Willamette Valley, where he's produced four different pinot noirs.
'It's fun to create something, to put these vines in the ground and see them year after year get bigger and produce more fruit.'
During his residency at LSU, Moises met fellow doctor Mark Wahle, who used to live in Oregon and make wine.
In 2002, on a leap of faith, Moises jumped in as a business partner, knowing virtually nothing about the business or even how to make wine.
'I was very naive. I was thinking, I'm just going to plant 10 acres and in three years we're gonna have grapes and we're gonna make wine, and it's going to be that easy,' he said. 'Well, it wasn't that easy.'
Moises first learned that 10 acres is really big and it meant planting 10,000 vines, all of it by hand. And with a small start up, everything was and is still a hands-on operation.
'Oh yeah, hands and knees. Everything's done by hand, from cultivating the vines to pruning them. We prune the vines three times a year,' Moises said. 'It's all hand done. There's nothing done by machines.'
His first planting was in 2003. Three years later the grapes were harvested. Three years later he finally released the wine.
The ER doctor who measured his work in seconds and minutes was now measuring success in months and years.
'So that's six years of waiting and hoping that something nice might come out of this,' he said. 'It was long. It was very expensive and long.'
The high-end boutique wine, retailing for $30 to $40, came out great. But now the doctor and wine maker had to become a marketer and convince the picky New Orleans restaurant market to carry it.
'I was scared,' Moises said. 'I was like, here I am. Somebody that's learning the whole process and the whole business trying to sell some wines and see how I can compete with these well-known wines that they already have.'
But loving the taste and the local story, many of the city's finest restaurants now carry Moises wines.
Though it's Moises that truly does the carrying. Yes, the one-man show continues, from hand-planting and harvesting to marketing. James takes the daily orders, loads up his truck and delivers it as well.
'It's nice. It keeps it personal. The wine buyers like seeing me and we talk about the wines, and it keeps it a small operation.'
But Moises hopes the small operation will double in size from 40 acres to 80 acres in the coming years. If that happens he'll still be a doctor always will but he'll spend more time at the vineyards and maybe even less time in the truck.
'At that point I hope to have a delivery person, although I'll miss it.'
Moises said the shift work of the emergency room allows him to get to Oregon at least once a month, longer during the fall harvest.
Right now he says he splits his time 50-50 between wine and the ER. He hopes in the future to make that 70-30, wine to the emergency room.