Today, I shadowed Tom S. in the Emergency Department.  It was quite a night. We had two trauma I patients flew in by Mayo 1 helicopter. Here is a quick review of the cases.

1. Trauma one patient. 43 yr old male. Was in a semi-truck vs. train accident. The driver had deceased. He was the passenger. He had right 1st rib fracture, multiple spine fracture, pelvis fracture ( right Ilium ring), anoxic brain injury, ( effusion in the brain), and sth. else that I can't remember. He was sedated when he came in. Performed primary and secondary survey, then FAST, then x-rays and labs.  He was given sodium bicarbonate, sodium acetate, concentrated sodium chloride,. 4 units of RBCs.  Afterwards he was taken to the CT room. It was right there on the CT scan table, a neurosurgeon drilled a hole in his head to relieve his intracranial pressure.  The neurosurgeon didn't think he was going to make it. Even if he survived, he would probably only have motor functions, not cognitive functions.

2. Trauma one patient.  65 yr old female. Restrained driver. She was driving a mini-van and T-boned by another vehicle at highway speed. She was flew in by Mayo 1 helicopter from OSH as well. She had kidney lac, spleen lac and liver lac. Rib fracture. Hypotension, but responded to bolus.

3. A 39 yr old male. He was burning bushes when he spilled some gasoline. He was caught on fire. Was brought in by his nephew. He had 1st and 2nd degree burn on his left arm, upper back, axilla and especially his left hand. Skin was hanging, blood everywhere.  The nurses took him to a shower when he came in. He rated the pain as 8 on a scale of 10. Was given two does of fentanyl.  Tom suggested antibiotics, but was denied by Brain B.  What an idiot! Later I talked to Scott, he said that the skin was sterile for 72 hrs after the burn. That is probably why he didn't start on the antibiotics right away.  Luckily the patient was fully conscious, and we expect him to recover fairly well.

4. A 42 yr old male. Was working out at a gym when he collapsed. Primary diagnoses was ventricular fibrillation led to cardiac arrest, confirmed by ECG. Shocked him twice and was able to restore the heart beat. He was given midazolam and later propofol. He was sedated and paralyzed, then incubated.  His fiancé came in crying. Dr. Drew O. comforted her.  

• 上周四和Donna和一个日本人去了Street Market,挺好玩的，在一个以P开头的荷兰餐馆吃了垃圾食品。
• 上个周末去看了一位88岁的老人，帮她剪了脚趾甲，可怜的她虽有儿女在同一个城市，却很少能见到儿孙，一个人孤独的住在养老院里。美国社会老年人的典型。谁说多子就多福？谁说养儿能防老？屁。不禁对我的晚年产生了担心，我是孝子贤孙，可谁能保证我有孝子贤孙？ 我的观点，小孩要不要都罢了，下次再详细论述。 最主要趁着年轻积累财富，保养好自己--人老没关系，有钱还是可以过得很舒服的。 那天还见到一位98岁的老太太，穿着红色套装，腰杆笔直，健步如飞，赞。
• 周一去了Salvation Army Free Clinic 做义工。Mayo Clinic 每年捐一百多万的药品给Salvation Army（救世军），许多医生、护士、药剂师都在此做义工，免费开诊，非常有意义。
• 实习生间的竞争十分激烈，没有明争，全是暗斗。许多人臆想美国社会关系简单，我说那是他们太乐观。有人的地方，就有是非，就有竞争。我强迫自己长大，我想象中的那个完美、和谐的大环境和小环境根本不存在。
• 最近花钱如流水，十分内疚。老爸让我把挣的钱都花掉，我看我还是节省点才行，下个学期要花钱的地方太多了。
• 十分讨厌穿高跟鞋，可是今天没办法，必须穿得人模狗样的去上班，走了好多路，尽管这双鞋非常舒适，还是磨破了脚跟。那些天天穿高跟鞋的人，她们的脚会不会磨破？我不管了，明天我穿平底鞋，不好看就不好看吧。
• 最近抑郁和焦虑又有复发的迹象。觉得自己是一堆屎，一文不值。我对未来感到十分担心。我想毕业后回来做一个residency（临床住院培训？）, 可是他们每年只招4个人，我太逊了，根本没什么可能被录取。想到这里就无比颓废。想给主管留一个好印象，可是却觉得往往太小心翼翼反而适得其反。今天Julie B跟我说，在这里做实习生的经历是把双刃剑，如果你非常优秀，那么被招回来的可能性就大；反之，他们会坚决不要你。 真是担心我会给他们留下消极的坏印象。
• 今天跟Julie，复诊了6个因白血病而进行骨髓移植的病人。除了常见的排斥反应外，骨质疏松、皮肤紧缩、黑色素沉淀都是常见的后遗症。平均每个病人吃17-20种药，还有胃口吃饭吗？
• 今天早上参加了多学科会议，讨论了一些骨髓移植的病例。今天也是Mayo Clinic的 medical grand rounds, 请了一个嘉宾来讲利用基因诊断和预防疾病，以及病人、医疗工作者、医疗保险公司是否有权知道自己的基因等问题，涉及到伦理。可以看一个网页，叫做23 and Me.
• 我终于明白为什么我们要学那么多东西了，因为我们学的东西都是现实中要用到的。所谓书到用时方恨少。今天Julie不停地说ketorolac和indomethacin，我非常弱智地问她那是什么，她愣了一下，说injectable NSAIDS（可注射用的非类固醇类抗发炎剂）. 我当场想钻到一个地缝里去。唉，她肯定觉得我是一个弱智，肯定不会招我回来做resident了。咋办？

每天都活得好沉重。我好累。体力上、智力上、心理上。我好累。上帝，请您保佑我吧。

努力地快乐一点。