Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.

HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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And THEN there I was working in the ER, where NO doctor in our hospital is comfortable seeing children.

Toddler comes in with babysitter in mild respiratory distress. I go see him, get him calmed down and start breathing treatments. Kid is super scared of the 53 nurses all around him getting stuff done, and it’s clear that he doesn’t really know his male babysitter all that well either. 

After about 30 minutes, I go back in the room to recheck him and repeat his lung exam. I sit down on the bed to get down to his level, and he climbs out of the babysitter’s lap and into mine. 


Oh, and he’s not just gonna sit in my lap. He snuggles into my side and lays his head on my chest. 


So the other day in clinic I experienced the rarest of pediatric rarities…

I walked in to the exam room to see a toddler around 20 months old. 

For those who haven’t studied child development, this is prime “stranger danger” time. Well child checks at 18-24 months are awful because the kids scream if they’re looked at the wrong way. 

So I walked in with my guard up. 

I sat down on my stool and this ADORABLE little girl climbed down out of her daddy’s lap, walked up to me, and  laid her head down in my lap. 

And then she did the arm raise. You know, the universal sign for “pick me up.”

And then she climbed into my lap and played with my badge for the entire office visit. 

Asker bintesaadat Asks:
So you took the MCAT twice? or I did I read that wrong? That's what I will be doing. Just looking for some encouragement.
wayfaringmd wayfaringmd Said:

I did indeed take it twice. I had not finished the last part of one of my prereq classes when I took it the first time. I was ok with my score but thought I could do better. On the second try, my score went up in that category but went down in another so I ended up with the same score again.

ER doc: How many Lortab do you take every day?

Teenager: Um, like 10-15 if I can get ‘em. 

ER doc: What do you take those for?

Teenager: Life is painful. 

ER doc: 

As a current medical student in the armed forces, a lot of emphasis is placed on leadership as a way of life, not as something to be “checked off” on a residency or medical school application. I happen to be pretty shy and soft-spoken, and I don’t eloquently vocalize my ideas on the fly like many extroverts and practiced students can. How can I develop my leadership skills as an introvert, and how can a quiet student get noticed in a positive way during rotations? -lisypants

Remember that leadership involves much more than words. Good leaders live out the principles that they hope to pass on to others. It is possible to lead quietly and lead well. 

A good way to get noticed as a med student is being a great team player and encouraging the others on your team to do well too. Practically, this means showing up on time, never complaining about work, getting your crap done in a timely manner and then offering to help others when they’re behind. That stuff gets noticed. 

Being pimped is difficult for introverts. If you’re like me, your brain flickers the blue screen of death when an attending asks you a point-blank question.


So if you have a hard time being noticed by answering all the questions, at least be seen reading. Then jot down questions after you read to ask on the wards so you don’t have to come up with spontaneous questions. Also, write thorough, thought out SOAP notes. Even if an attending never mentions them to you, I promise you they’re being noticed. 

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I woke up today with the worst crick in my neck. Like I can barely turn past midline on the right. My trap is tight from my head to my scapula and all my posterior neck muscles are all knotted up. I have massaged it, heating-padded it, and Ibuprofened it to no avail. 

Halp. Tell me what magic button in my neck I’m supposed to press to make it all go back nice and loosey goosey. 


You’re seeing SIX patients this afternoon?! And they expect you to actually see them in under 20 minutes each?! I’m never gonna get there.

New intern.

A) you don’t have a choice, buddy.
B) I’m bored cuz I’m only seeing 6 patients today. Like somebody please give me more. Please. So I don’t have to listen to this kid talk anymore.

Other than continuing education credits, do you do any skills testing as a doctor? Our clinic recently decided to do "skills check ups" on the nurses and medical assistants, and some people are a bit huffy about it. I guess it's going to be proving we can do vitals correctly and give shots accurately?
wayfaringmd wayfaringmd Said:

In residency we have to be “checked off” on certain procedures to prove that we are competent to perform them without supervision. For example, as interns we had to do a few pelvic exams supervised by attendings before we could do them solo. There was no specific number we had to do though. It was left to attendings’ discretion.

We also have to be observed (in person and videotaped) with a certain number of patients throughout our time in residency so that the attendings know that we know how to interview and examine patients properly.

When you get out of residency, you have to show documentation of your procedures (different #s for different procedures) to get privileges to do them in a hospital or hospital-owned practice. That goes for everything from surgeries to colonoscopies to joint injections and shaving off moles. But after residency, no, I don’t think doctors get skill check ups. If you don’t have it by then, you probably shouldn’t practice.


Coffee beans is also supposed to do the trick….. sniffing them.

true statement. I forgot about coffee. Our ER sometimes puts out cups of coffee grounds or peppermint oil when we get a C. Diff explosion or something.

Any tips on how to get the "cadaver lab" smell off? Sometimes I feel like I still smell like it after I shower...
wayfaringmd wayfaringmd Said:

It’s probably not you that stinks. It’s probably your nose. The smell can stick in your nose even after you’ve showered. 

Sniff a dryer lint sheet or lemon (or lemon scented candle). They’re strong enough to usually wipe out the smell. 

But seriously.  Ask me a question. 

Hey! I was wondering, how did you study in third year? For us we spend 1 week on each “system” so we had our first week on cardiology, and I noticed we get very few lectures and a lot of it is just learning on the wards. It seems like we’re just expected to do our own readings and figure stuff on our own!? Any advice!? -mediocremedstudent

Well, mediocremedstudent, welcome to your first taste of being a doctor. 


In the real world, doctors have to do this silly stuff called continuing medical education. It’s one of those little requirements for maintaining board certification and licensure. And guess what? No one holds your hand. You are expected to do readings on your own and learn on your own. Sure, there are lectures and conferences that will spoon feed you material, but you have to dig around and find those for yourself too. 


Welcome to being a grown up. 

Third year is your introduction to real live medicine. You’ve read the book stuff. Now you have to learn how it translates into real life. On the wards, there’s no set syllabus. There’s no “examine 5 COPD patients, admit 5 chest pain rule outs, diagnose 5 strokes.” You don’t just learn by watching docs treat patients. You gotta pick it up as you go along. Every single patient you see can teach you something.

So when you interact with a patient, write something down about their case that you don’t understand. Why did they have XYZ exam finding? What was that new drug the doc prescribed? Why did they adjust their insulin that way? How did the patient present, and what other diagnoses are in the differential? That’s how you find stuff to read. For each new diagnosis you encounter, read up on it - how it presents, how it’s diagnosed, and how it’s treated and what evidence-based guidelines you can find. 


Now where you find that information to read is also up to you. Ask questions of your attendings and residents (if they’re not up to their necks in work).


UpToDate is my jam. Most hospitals these days have access to it. The Blueprints and Step Up review books are also good. Ask someone who is ahead of you or who has already been on the rotation you’re on to recommend a book for you. Your down time on wards should be spent reading to replace that formal teaching time you’ve lost. 

4th Year Med Student: Wayfaring, what can I do now to really prepare me for intern year? I don’t wanna look stupid. 

Wayfaring: Pretend that you’re an intern now. Take responsibility for your patients. Know everything there is to know about them. Read their old reports, dictations, and labs, even if you don’t think they apply right now. Think hard about what evaluation you would do to figure out their problem. Think about how you would treat them — not just the medication, but the dose too. You wanna be a good intern next year? Be a good intern this year. 

Asker Anonymous Asks:
Hi! So I'm in BioChem (undergrad) and I have to do a research essay about a disorder and the biochemical pathways it affects. Please suggest topics. We're graded on originality as well.
wayfaringmd wayfaringmd Said:







Bb I’m sure you’re a sweet lil muffin but for realsies quit being lazy and asking a random blogger to pick your topic. Like who are you even. There is the google machine. Also libraries.

Plus I hate biochem and spend most of my time hoping I can imagine it out of existence.

9/10 times the type of ppl to ask others for topic help have nooooo clue wtf is going on. My 2cents.

Maybe… but in this case if you google “biochemical pathway disorder” about a million great topics, even compendium of topics, pop up, so this person probably didn’t even try THAT. Hence, no pity from Castle AspDocs.

I know braining is hard sometimes but can we make some effort for the love of holy tacos?

Some people after googling still don’t know what to go with ..In thattt case, they prob don’t have it learned well enough to distinguish what is out of reach as far as.. is this appropriate for this level of undergrad work or I am a phd researcher work..

P.s: I’m down for tacos, always. Actually, just had a burrito. S/o to my homies.

True that.


Zero points for originality in attempt to trick a busy med student into doing his/her work

These are the people who grow up into ortho surgeons and consult internal medicine for “medical management,” AKA checking blood sugars and giving blood pressure meds. 

Also radiologists. Because “clinical correlation required.”

This might sound dumb but I can not for the life of me find the answer on the Internet. Does a person's heart stay the same size all throughout their life? Like, is a baby's heart the same size as an adults? Could a child get a heart transplant from someone way older? Thanks!
wayfaringmd wayfaringmd Said:

Nope, the heart and every other organ except the thymus grows as you get to adulthood. The thymus actually shrinks to almost nothing in most folks. Once you’re “full grown,” your organs generally stay the same size. But the heart is a muscle, and like your biceps, if the demand for the muscle increases, the muscle gets bigger. Except in the heart, it’s not necessarily a good thing because the muscle gets to a point where it’s too thick for it’s own good and then you end up with heart failure. 

A good estimation for a healthy person—child up to an adult— is that the heart is about the size of the person’s fist. 

I haven’t worked in a transplant center, so I’m not totally sure, but I think that donor hearts are not usually older than the recipient. So a child would get another child’s (of similar age and body size and of course blood group compatibility) heart because the heart will grow with the child.