Back in Seattle, Bottle of Gin Intact

When I unzipped my checked baggage upon arriving home, I found this official notice tucked inside:

Either they failed to detect my bottle of gin (given to me as a door prize at the clinic holiday party in December) wrapped inside my white coat which was wrapped inside one leg of my ski pants...or the TSA has given its seal of approval to juniper-derived spirits.  If any of my peeps from Swedish are reading this, we must have a gin & tonic party soon...

When They Say Potluck, They're Not Kidding

At my farewell potluck, there were no fewer than 4 slow cookers, 2 different kinds of chili, multiple casseroles and pasta salads, scalloped potatoes, a chocolate cake, and a strawberry rhubarb cobbler.  To be polite, I had to eat one of everything.  It was all perfectly delicious.  My nurse implored me to return in the summer, so she can give me a ride on Pearl, her prized Harley-Davidson motorcycle.  

Despite the crazy work hours, a teeny part of me will miss practicing full spectrum family medicine at the clinic, hospital and nursing home:

I will most definitely miss the H's and their cozy home in the mountains:

Dr & Mrs H then...

...and now

Qu'est-ce Que C'est?

A 51-year-old female asks me to remove an intriguing growth from her right inner thigh.  She calls it a skin tag.   I call it a violaceous 1.5 cm x 0.8 cm pedunculated mass that--I kid you not!--is shaped like a kidney.  There's no other way to describe what looks like a miniature kidney sprouting from her thigh...has she discovered the secret to growing diminutive replicas of vital organs?  I want to take it home and transplant it into a Barbie doll with end stage renal disease.  Sadly, pathology confirms it's just a humble capillary hemangioma.

A very young 24-year-old mother of four brings her 7-year-old son to clinic with great urgency.  "There are these lumps!" she tells me, getting very upset, "On his stomach!".  I am half expecting to see something crazy like dermatofibrosarcoma protuberans, but when she lifts up her son's shirt to reveal his abdomen, I see...  cellulite.

Pimp My Ride

Found in the forest while snowshoeing...

Police Blotter

For hours of endless entertainment, my nurse recommends reading the Police Blotter which is a verbatim account of all local police dispatch calls.  Check out these awesome gems:

B11-0068 13:53:30 Starr Rd  SUBJECT IS BURNING MODEL AIRPLANES AND BIRDHOUSES IN A BAR B Q, HIGHLY INTOXICATED

T11-0107  14:18:11 Western Ave  CHAINSAW TAKEN FROM SOMEWHERE IN TONASKET

W11-0013  08:35:14  Bigelow St  MAN SAYS WIFE IS THROWING BOOKS AT HIM

R11-0070  15:46:37  Golden St  STRAY CHIHUAHUA IN AREA.  UNABLE TO CATCH.

K11-0309  19:43:50  Engh Rd  INTOXICATED MALE WEARING A HAT AND DRIVING ELECTRIC CART, OFFENDING FEMALE CUSTOMERS

And last, but not least, my all-time favorite:
THE REPORTING PARTY'S PERSONAL PET GEESE HAVE GONE MISSING EVERY NIGHT THAT HER CAR ALARM GOES OFF.  HER DOGS ARE BARKING AND LOOKING TO THE EAST

Ever File An L&I Claim for Someone Kicked By A Cow?

A lovely lady was milking one of her cows on Sunday when the cow became startled and kicked her in the face.  That's right, my patient was sucker punched by her very own quadruped ruminant.  Filling out L&I forms for patients who get injured on the job is tremendously tedious, but it becomes ever so much more delightful when writing a narrative description of a cow assailant.  Anyone know if there is an official ICD-9 code for injuries sustained from being kicked by a cow?  The facial swelling has improved significantly, but my patient still has a bit of a black eye.  I decided to call it a "periorbital contusion" (ICD-9 code 921.1) and to be extra appreciative of the milk I'm having with my chocolate chip cookies.

Beyond Gingivitis

I never knew how much I appreciated dental hygiene until recently, when I saw a patient with several teeth that were visibly rotting, and a stupendously receded gum line on her lower jaw.  It looked as if her central incisors were held up almost solely by levitation.  "I think I have a tooth infection," she said in what I believe is the understatement of the year.  For some unknown reason, she adamantly refused to go to the dentist.  I visualized myself with a sturdy pair of Kelly clamps and a half gallon of novocaine, removing bad teeth like a vigilante in the name of Truth, Justice and Dentures.  I would not have been surprised to see a maggot crawling by her 2nd or 3rd molars.  Why do methamphetamine users always have the worst teeth?

Hooked On Antibiotics

I can't get over the amazing number of clinic patients who believe that antibiotics will cure all the evils of the world.  They come into clinic demanding antibiotics and if I don't give it to them, they'll make an appointment with another doctor who will.  I'm getting tired of trying to explain how a huge proportion of respiratory illnesses are caused by viruses, and that even if antibiotics are warranted, it's important to choose one that is targeted toward a specific type of bacteria.  This town is teeming with people who are hooked on antibiotics.  One lady even requested antibiotics for "fatigue".  So don't blame me, tiny town of Tonasket, if one of you falls prey to a super-resistant bacteria that was able to flourish due to handfuls of amoxicillin and azithromycin being thrown around here like confetti.

Now that I have succumbed to the respiratory virus that has been nipping at my nose & throat, I have even less of an inclination to prescribe antibiotics for most respiratory infections because I know that antibiotics would do absolutely nothing for my nasal congestion, cough and laryngitis.  I got sent home early from clinic Wednesday when I lost the very last remnant of my voice.  Try dictating hospital discharge summaries over the phone when your voice is an unpredictable mess of screeching, warbling, and honking...it ain't pretty.  When I returned to work on Friday, my voice had recovered to about 35%, so I was trying to speak as little as possible.
Ancient elderly male patient: You speak really good English, especially for someone from China
[note: I have never even been to China]
Me: [thinking, "Are you freakin' kidding me?!", but instead saying...] Thank you?