This is a 69 year male presenting with abdominal pain. He has history of end stage renal disease on hemodialysis. Upon questioning the patient, he admits to eating chalk. Geophagy (soil-eating) is a form of pica where individuals ingest earthy or soil like substances. Pica in the absence of mental disorder it is often reported in patients with anemia and mineral deficiency, most commonly in pregnant women and children.  Pica, particularly “ice pica” is commonly seen in dialysis patients. In this case, geophagy pica was the diagnosis.