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Have you ever had a gunny sack with a mad rattlesnake dumped at your feet? I have, and this and many other stories of the emergency room and primary medical practice are in my book 44 Years on the Frontlines of Medicine. The book describes the practice of primary care medicine both in the office and in the emergency room and largely consists of the stories doctors tell each other over dinner when our spouses let us get away with it. It also references the huge changes in medicine over the same time period.