When I'm on the night shift, all the department heads can't sleep.

At 2:17 a.m., the automatic door of the emergency room at the First Municipal Hospital was forced open.

"Doctor! Doctor! My husband's stomach is in unbearable pain!"

The woman dragged a middle-aged man in. The man was pressing his upper abdomen with one hand, his face was as white as if he had been soaked in water, beads of sweat rolled down his forehead, and the back of his shirt was soaked.

Behind the triage desk, Nurse Zhao looked up and glanced around.

"What did you eat?"

"I had some barbecue and two bottles of beer for dinner," the woman said, her voice trembling with anxiety. "He said his stomach felt like it was being churned with knives."

Sun Zhiqiang, the senior doctor on night shift, had just come out of the observation room, still holding a half-cold cup of tea. Upon hearing "barbecue," "beer," and "stomach ache," his brows furrowed.

"First, take your blood pressure, order an electrocardiogram, and draw blood to check your amylase and troponin levels."

After he finished speaking, he looked at Lin Ye, who was standing next to him.

"Lin Ye, take this call. Don't panic, acute gastritis and pancreatitis are common. Just follow the procedure."

Lin Ye nodded, picked up the medical record folder, and walked over.

A photocopy of his name tag was clipped to the first page of his medical record folder.

Lin Ye, third year of residency training at the First Municipal Hospital, rotating through the emergency department.

Tonight is my first time working the night shift independently.

It's called independence, but Sun Zhiqiang is right there, keeping things under control. When it comes to making the final decision, it's not his place.

The man was helped onto the examination bed, and as soon as his body touched the bed, he curled up.

"Where does it hurt?"

"Here," the man pointed to his upper abdomen, his lips trembling, "my back hurts too, like it's being torn apart."

Lin Ye paused, his pen poised.

"Torn open like this?"

Hearing this from the side, Sun Zhiqiang casually remarked, "Don't take the description of pain too seriously. People with stomach cramps after drinking alcohol might say the same thing."

Lin Ye didn't reply, but reached out and touched the man's wrist.

Cold skin, rapid pulse.

Just then, a line of light blue text suddenly popped up in front of him.

[Emergency room alert activated.]

Lin Ye's fingers froze.

The text wasn't projected on the screen or appeared in the medical record folder; it was as if it were directly pasted into his field of vision.

Patient: Chen Jianguo, male, 49 years old.

Chief complaint: Upper abdominal pain accompanied by tearing pain in the back.

High-risk: Stanford type A aortic dissection.

[Probability of misdiagnosis: 83%]

[Death countdown: 42 minutes and 17 seconds.]

Lin Ye's Adam's apple bobbed.

He thought he was hallucinating from staying up all night, so he closed his eyes for a moment and then opened them again.

The countdown is still ticking.

42 minutes 09 seconds.

"What's your blood pressure?" Lin Ye suddenly asked.

Nurse Zhao glanced at the machine: "Right arm 189, 102."

"Measure your left arm again."

Sun Zhiqiang frowned: "One measurement is enough. Let's do the electrocardiogram first."

"Sister Zhao, measure your left arm too." Lin Ye didn't look up, and went to feel Chen Jianguo's left radial artery.

Pulse is weak.

very weak.

Seeing that his expression was off, Nurse Zhao didn't ask any further questions and switched the sleeve to his left arm.

The machine made a few beeps.

"One hundred and forty-three, eighty-eight."

There was a moment of silence around the examination bed.

The blood pressure difference between my left and right arms is more than 40.

Sun Zhiqiang's teacup stopped in mid-air.

Lin Ye immediately said, "Professor Sun, I suspect aortic dissection. We need to perform an aortic CTA immediately and call for a consultation with a cardiac and vascular surgeon."

The woman didn't understand any of this; she only heard "aorta," and her face turned pale.

"Doctor, it's just a stomachache, isn't it?"

Sun Zhiqiang's face darkened: "Lin Ye, don't scare the family. How can you make such a diagnosis of aortic dissection so easily? You're just a resident trainee, finish your basic examinations first."

"He had a tearing pain in his back, a significant difference in blood pressure between his two upper limbs, cold sweats, and high blood pressure."

Lin Ye spoke quickly, "We can't treat it as gastritis, etc."

Sun Zhiqiang lowered his voice: "I said, follow the procedure first. It's past 2 a.m. now. If you call a CTA and a cardiac vascular surgeon, who will put you through the aortic dissection if it's not the case?"

Lin Ye looked at the countdown in front of him.

39 minutes 32 seconds.

His palms were sweaty.

The medical record folder was pressed under his palm.

Each column above requires a signature, date, and supporting documentation.

If a resident trainee bypasses their superiors to push for inspection, and is ultimately found to be wrong, the first report of the situation will end up on their desk.

Chen Jianguo, lying on the examination bed, suddenly groaned, his hand gripping the bed sheet, his knuckles turning blue.

"It hurts...it hurts all the way down my back..."

Lin Ye put the medical record folder at the nurses' station.

"Sister Zhao, take him to the emergency room, establish an IV line, and get him on monitor. Teacher Sun, I request an emergency aortic CTA."

Sun Zhiqiang's face turned completely dark.

"You're applying? What makes you think you can apply?"

Lin Ye looked at him and said, "He probably won't live more than forty minutes."

Upon hearing this, several nurses on duty nearby looked up.

Just as Sun Zhiqiang was about to start cursing, Chen Jianguo's wife suddenly grabbed Lin Ye's sleeve.

"Doctor, please tell me the truth, what's wrong with my husband?"

Lin Ye did not speak definitively.

"Right now it's just a strong suspicion, but this disease can't wait. By the time the blood test results come back, it might be too late."

The woman's lips trembled: "Then investigate! I'll sign, I'll sign!"

Sun Zhiqiang slammed the teacup down on the table.

"Okay, you can check if you want. It's your insistence to write the medical records clearly."

"I wrote."

Lin Ye picked up a pen and filled in the medical history and his signature on the emergency room application form.

His back was wet as he wrote the strokes.

Nurse Zhao pushed the gurney towards the CT room, muttering under her breath, "You're on your first shift tonight, and you've already brought in something this big?"

Lin Ye didn't say anything.

There are 35 minutes left in the countdown.

The CT room radiology staff on duty were woken up by a phone call, their voices filled with impatience.

"Aortic CTA? At this location? Who submitted the request to the ER?"

"In the emergency room, Dr. Sun Zhiqiang was aware of the application submitted by Lin Ye."

"Lin what?"

"Standardized residency trainees".

There was a two-second silence on the other end of the phone, followed by a string of curses that could be heard through the receiver: "A resident performing an aortic CTA in the middle of the night? Are you out of staff in your ER?"

Lin Ye answered the phone.

"Teacher, the patient is highly suspected of having type A aortic dissection and is already on their way. Please prepare."

"You'd better actually have something."

The phone hangs up.

Ten minutes later, Chen Jianguo was wheeled into the CT room.

The woman squatted by the door, her hands clasped together, her nails digging into her flesh. Sun Zhiqiang stood at the other end of the corridor, his face grim, not uttering a single word.

Lin Ye stared at the control panel screen.

Contrast agent is injected.

The image emerges layer by layer.

The CT scanner operator, who had been slouching in his chair, slowly straightened up halfway through the scan.

"Wait a moment."

He enlarged the image and sliced ​​it into another layer.

The next second, he turned to look at Lin Ye, and his voice changed.

"Aortic dissection."

Sun Zhiqiang suddenly walked to the screen.

The imaging technician cut two more images and pointed to the clear inner membrane.

"Type A, involving the ascending aorta."

In the corridor, Chen Jianguo's wife couldn't understand the results, but she could read the expressions on the faces of the doctors. She stood up, leaning against the wall, her voice weak.

"Doctor...is it very serious?"

Lin Ye glanced at the countdown.

27 minutes 48 seconds.

He picked up the phone, flipped through the hospital's on-call directory, and stopped his finger on the column for "Zhou Mingyuan, Director of Cardiac and Vascular Surgery".

Sun Zhiqiang grabbed his phone.

"Are you crazy? You're going to hit Director Zhou directly?"

Lin Ye looked up.

"Teacher Sun, if we don't do it now, he really won't make it off the operating table."

The two stared at each other for three seconds.

Finally, Sun Zhiqiang released his grip and muttered a curse under his breath.

"beat."

The phone rang seven times before it was answered.

A hoarse voice, as if awakened, came from inside.

"Who?"

Lin Ye gripped his phone tightly.

"Director Zhou, this is Lin Ye, an emergency room resident. We have a 49-year-old patient with type A aortic dissection. He has been ill for less than two hours, has high blood pressure, and we have already performed a CTA."

There was a moment of silence on the other end of the phone.

The next second, the man's voice became completely clear.

Send me the video.

Lin Ye had just sent the video over when the phone rang again less than half a minute later.

This time, Zhou Mingyuan only said four words.

"Open the operating room."

At the end of the corridor, the light in the emergency room was on.

Lin Ye looked at the countdown on the screen.

25 minutes 12 seconds.

The automatic door at the emergency room entrance opened again, and the night breeze carrying the smell of disinfectant rushed into the corridor.

This night shift has only just begun.