The patient is a whole person who pees out their meds.

The good stuff always comes towards the end. After the "pertinent" information has been gathered: how long noticed memory problems, episodes of falling, do your own cooking, shopping, manage finances, med list, orthostatic hypotension, focal neuro findings... Then we fill in the gaps and add some color to the snapshot. Sometimes we hear about a traumatic event from earlier in their adulthood, travel between countries and continents, impressive careers, hearts broken, love lost. I like to save my notes from these evaluations because they become experience for me. They have the potential to stick with me for the rest of my life. The header is just an age and a sex. The rest of the page is the beating heart as told by the patient and if we are lucky by the patient's family too.
I think it is the ultimate goal of the family physician to get to a point in the relationship with the patient where you can acknowledge all the aspects of a person's well-being. You will probably not be able to fix everything. But you can always address things. And what we should really be doing with people is having conversations; letting the patient tell their story and interpreting it back to them; commenting on their story; giving our (hopefully) experienced opinion. Unfortunately our primary source of "opinion" has become the faxing of a script for a pill. And people, hold your hats because I am about to write something very disturbing. You know how people go fishing to relax and feel better by being in the outdoors, maybe relieve some depression? Well fish are now showing up with levels of prozac. That is just one example. I like the irony of the whole relaxing fishing vacation/depression med thing. But the thing is is that there are a lot of meds in our water now. And it is not just from flushing unused meds down the toilet but it is also from excreting swallowed meds via the flush. FYI

No Starving Pilgrims Here

Our locally raised slate turkey.


Locally grown cranberries prepped for cranberry pie. I forgot to add the almond flavor so it was a little more tart than usual. Excellent with vanilla ice cream.


I am thankful for all of the great food available to us either from local farms or generous gentlemen farmer friends.

I am thankful that my 1st choice residency interview is over and went pretty well, if a little unorthodox. I was the only candidate not wearing a black suit. I went to medical school, not business school and so I decided a smart gray skirt and sweater would be fine with my purple danskos and tights. So of course the doctor and geriatrics fellow I have been working with during this rotation tease me first thing in the morning about not wearing black. The interviews were my favorite part of the day. I received a few compliments on my personal statement and I felt I was able to be myself throughout the interviews. Now I will have to just wait for February.

I am thankful for the amazing support provided to me unconditionally by my family.

I am thankful for the invaluable teaching and autonomy offered upon me during my geriatrics rotation.

Ms Perpetual Motion was thankful for maple syrup and cookies.

I am thankful to Cooks Illustrated for enlightening me as to how to make a flaky, prize winning, crust by substituting vodka for water. I won the crust category of the pie contest two weeks ago at work.


Locally grown eggs with non-local milk for custard pie.
Happy Thanksgiving Everybody!!!

Euphrasia officinalis Morning

Upon awaking to L-sided conjunctivitis.
And trying to take a history from a three-year-old.
Without the parent from the night before around (hunting).


And no milk for pancakes.
Should have known there was no milk because I am mother.
But I was out last night with friends. Ha.
And going out again tonight.
After getting one solitary eyedrop into Ms Perpetual Motion's hurty eye.
She cried herself to sleep agonizing over another potential eyedrop.
Luckily I will have a beer to cry into soon.

Lipizzaners

After a week of a new, great rotation how better to celebrate than acrobatic, dancing horses? This is how pathetic I am though. During intermission while waiting in line at the snack bar for some juice and water I found myself visually inspecting a large skin lesion on the upper back of the person standing in front of me. Then I found myself looking around for one of the attendings I had seen earlier who was also watching dancing horses with her son because I really wanted a preceptor at that moment.
DDx:
giant seborrheic keratosis
melanoma
giant nevomelanocytic nevus
epidermal nevus
burn
french clay mud (on the upper back)

I was able to accept the fact that I would have to let this one go and return to being an attentive mother.