It is late afternoon, your eyes start to droop, head starts to nod, and you feel like someone slipped you a mickey. You rifle through drawers, pockets, or cupboards desperately foraging for chocolate to get you through the afternoon.

These scaly plaques on the scalp of a 32-year-old man have failed to respond to a topical antifungal. The patient has a 3-year history of pulmonary sarcoidosis.

A 24-year-old man is concerned about a large, hairy "mole" on his left shoulder. The lesion appeared during adolescence as a group of small, dark blotches. These eventually coalesced into a hyperpigmented patch with hair and acne.

In many instances, our patients receive invasive and aggressive subspecialty care at or near the end of life. Such care can become burdensome and painful without a favorable outcome. As advocates for our patients, we must ensure that their pain, shortness of breath, and other bothersome symptoms are alleviated, thus leading to a “good death.”

A linear, severely pruritic rash erupted on the lateral and plantar aspects of the left foot of a 72-year-old woman who had recently been camping on a Caribbean beach. Antihistamines and locally applied antifungal agents offered no relief.

Beans are a super healthy, super versatile, super affordable food. Beans are high in antioxidants, fiber, protein, B vitamins, iron, magnesium, potassium, copper and zinc. Eating beans regularly may decrease the risk for diabetes, heart disease, and colorectal cancer and helps with weight management.

During a routine physical examination, a 3-mm dark brown streak is noted on the fourth toe of a 54-year-old man.

For the past several years, I’ve listed “difficult parents” on my department’s conference evaluation form as my answer to the question, “What do you consider to be the single biggest problem that you face in your practice?” At times, I have to admit that difficult parents have made me dread my decision to become a pediatrician.

Avoidance of guidelines because they are “cookbook” is no longer an adequate excuse—especially when we are doing things incorrectly and expensively, while adding to potential complications.

Thoughts of my summer vacation are on the back burner now as I prepare to welcome the incoming pediatric residents. July 1st has a special meaning to all of us who have survived the grind of an internship. Fear was probably my main emotion at the start of my residency, while I’m sure for others it was excitement and anticipation. On July 8, I have to give a talk to the newcomers at our institution.