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

The stretcher wheels bumped past the threshold of the red zone, and the stretcher was pushed toward the CT room.

Nurse Zhao pushed the headboard, another nurse held the oxygen cylinder, and Qin Hai walked beside the monitor. Lin Ye followed at the bedside, his record folder pressed against his forearm, the pages slightly stuck together with sweat.

The old man didn't complain of stomach pain again the whole way.

He simply curled his body even lower, as if the twisting force in his stomach was pulling him inward.

The family members wanted to follow, but Nurse Zhao stopped them with one hand.

"Wait at the entrance of the CT room, don't run close to the beds. They'll call you when it's time to sign the papers, so don't silence your phone."

The woman nodded quickly, but her steps were a beat slower. She was still clutching the worn medicine bag in her hand, the pills inside gently touching the plastic.

At the entrance to the CT room, the previous patient had just been wheeled out.

The on-duty videographer shouted into the room while changing the bed sheets.

"The emergency room bed has arrived, with monitoring."

The vascular surgeon on duty was already waiting by the door, his phone still lit up. He didn't put the phone to his ear, but only on speakerphone.

A deep, husky voice came from the other end of the phone.

"Watch the scans first, don't argue in the hallway. If it really is a blockage in the upper blood vessels, the general surgeon will have to check the intestines as well."

The doctor on duty responded in a low voice.

"Director, I know."

Qin Hai glanced at him but didn't ask whether the director was coming or not.

When the elderly man was moved onto the examination bed, he suddenly opened his eyes.

"Will I die?"

That was a very light question.

It was so quiet that it almost drowned out the beeping of the machine next to it.

The woman stood outside the door and heard it through the half-open door. Tears welled up in her eyes, but she dared not cry out loud.

Qin Hai offered no words of comfort.

"Let's finish making the film first."

The imaging staff handed over the imaging informed consent form.

"Your creatinine level is 128. Didn't the emergency room already inform you of the risks?"

The elderly man was in so much pain that he was sweating profusely, his eyes were unfocused, and he could understand a few words, but he couldn't manage to read the entire notice.

Qin Hai whispered instructions to Lin Ye.

"The patient has verbally informed the doctor; their level of consciousness and the time of diagnosis should be written down. A family member should be present to sign on their behalf; please make sure nothing is omitted."

The vascular surgeon handed the pen to the family member.

"Sign here. It's not that there's no risk of kidney damage, but we need to check the blood vessels first. With you here, we'll explain the risks of angiography, allergies, and worsening of the condition clearly. If no one can sign, we'll still go through the emergency critical care process and report it for record-keeping. We can't let him die at the door."

The woman's hands were shaking violently.

The pen drew a line outside the column.

Nurse Zhao couldn't stand it, so she reached out and pressed the board firmly into her palm.

"Write your full name. Don't rush to write your ID number yet, and don't let your hand shake off the paper."

The woman took two breaths and finally finished writing the name.

The door to the examination room closed.

Lin Ye stood outside the door, his notebook open to the page with the old man with abdominal pain.

11:52 PM.

Patients were brought into the CT room with monitoring.

Oxygen is in use.

The on-call doctors from general surgery and vascular surgery were present.

Enhanced abdominal angiography is in progress.

He had just finished writing the last line when a patch of blue appeared at the edge of his vision.

[Stage Update: Key images are about to be formed.]

[Current risks: The extent of vascular occlusion, the degree of intestinal ischemia, and the necessary surgical or interventional approach remain unclear.]

[Evidence disclosed: Enhanced CT scan, elevated lactate levels, decreased blood pressure, and history of discontinuation of anticoagulation.]

Lin Ye shifted his gaze away from the blue lettering.

No one outside the door knew these words.

They could only wait for the machine to expel the unseen danger from their bodies.

A few minutes later, the screen in front of the imaging workstation lit up.

When the first set of images scrolled by, the on-duty radiologist paused for a moment.

"Pull the arterial phase forward."

The vascular surgeon leaned forward.

The general surgeon also leaned closer to the screen, his gloves still on.

The radiologist uses a mouse to click on a section of blood vessel.

"The contrast enhancement here is discontinuous. The distal portion of the superior mesenteric artery to its branch suggests a possible embolism. Looking at these segments of intestine, the enhancement is poor, and there is some exudate around them."

The woman didn't understand these words, but when she heard the word "embolism," her legs went weak.

Nurse Zhao supported her from the side.

"Stand firm. Now is not the time to fall."

The vascular surgeon did not immediately make a definitive statement.

"Highly suspected acute mesenteric vascular emergency."

The general surgeon stared at the layers of images of the intestines.

"The problem isn't just the blood vessels. The scans can only show part of whether the intestines are damaged. Lactic acid is building up, and the person is in so much pain; we can't just think about interventional treatment to clear the blood vessels and call it a day."

The vascular surgeon's voice was also harsh.

"If we don't restore blood flow first, there's nothing more to talk about later."

There was a brief pause between the two.

The only sound on the screen was the clicking of the mouse wheel.

The vascular surgeon stopped halfway off his gloves, while the general surgeon stared at the images of the intestinal tract without backing away.

Qin Hai tapped the record folder.

"Stop talking nonsense in front of the screen. Tell me your conditions now."

The vascular surgeon turned his head first.

"Notify the interventional radiology department to prepare a treatment room. The anesthesiology department assesses the situation and determines that interventional thrombectomy may be necessary, or the patient may need to be converted to open surgery midway through the procedure."

The general surgeon received the patient very quickly.

"The operating room also issued a warning. If there is indeed intestinal necrosis, we can't wait until blood flow is restored before taking action."

Qin Hai dialed the anesthesiology department directly.

When the call connected, the person on the other end had clearly just come out of another control room; their breathing was still a bit rapid.

Which bed?

Qin Hai only reported the key points.

"A man in his sixties, atrial fibrillation, stopped anticoagulation. The abdominal pain and the physical examination of his abdomen do not match."

"Lactate levels rose from 5.6 to 6.3. The scan suggests possible embolism in the distal and branch segments of the superior mesenteric artery, and several segments of the intestine show poor enhancement."

"The vascular surgery and general surgery departments are both located at the entrance."

The slight annoyance on the other end of the phone was completely dispelled by this string of numbers.

"I'm coming over. First, fast, prepare blood, check the last eating time and underlying medical conditions. Don't let the family think it's over after the scans."

"I'm already asking."

Qin Hai turned around and instructed Nurse Zhao.

"Save both IV lines. Administer fluids while monitoring blood pressure, and monitor coagulation, electrolytes, and crossmatching. The risk of intestinal ischemia and necrosis lies here. For anti-infection treatment, follow the protocol for acute abdomen. The specific medication will be reviewed by the specialists and the hospital's protocol."

Lin Ye looked up.

This was said to him.

He walked up to the woman.

When was the last time he ate anything?

The woman was still staring at the screen, as if the answer she could understand was on it.

"Dinner was around six o'clock. A cold dish and half a bowl of porridge."

When did the pain start?

"He said he felt unwell around 9 a.m., and the pain became severe around 10 a.m. He said he could bear it on the way to the hospital."

"Can the last time I took an anticoagulant be recorded?"

The woman handed him the phone.

"The pharmacy record shows it was bought last Wednesday. He said he stopped taking it after his gums started bleeding, so he probably stopped taking it last Thursday."

Lin Ye wrote down the timeline, without deciding the next step for anyone.

The examination room door opened, and the elderly man was wheeled out again.

His face was still covered in sweat, but his eyes were a little unfocused.

Nurse Zhao straightened the monitoring line again.

"Blood pressure is 88-54."

Upon hearing this number, the woman finally couldn't help but ask.

"The scans are all out, is it treatable?"

The vascular surgeon glanced at the general surgeon.

"Being curable does not mean being simple."

The general surgeon brought over the signature board.

"The blocked blood vessels are the problem we see now; whether the intestines are viable still needs to be assessed."

The woman grabbed the signature board.

"Go in? Go where?"

The anesthesiologist's footsteps were already approaching from the other end of the corridor.

Qin Hai closed the folder.

"Both the interventional room and the operating room need to be prepared."

As the elderly man was wheeled away from the CT room entrance, the blue frame at the edge of Lin Ye's field of vision slowly narrowed.

[Stage Feedback: Key visual evidence has been obtained.]

[Current Status: Entering the joint treatment process by specialists; the risk has not been eliminated.]

[Next risks: Treatment pathway selection, family consent, and assessment of bowel necrosis.]

Lin Ye remained silent.

But then the old call from the emergency room came through.

The support nurses who stayed at the nurses' station reported quickly via speakerphone.

"Director Qin, the vasopressors for Liang Shumin haven't been withdrawn yet; the bed with the dental infection still has a tube in place; Feng Jianping's stoma bag is draining, but we still need to monitor his total urine output. No one on any of the three sides dares to report that everything is alright."

After listening, Qin Hai only replied with half a sentence.

"Understood. Continue monitoring from the original department."

He hung up the phone and gestured with his chin toward the flatbed truck in front of him.

"Take this bed in first."

At the end of the corridor, the red light in the intervention room was not yet on.

The family member's signature board had already been handed to the woman.

She looked down at the entire page of risk disclosure, and before she could even finish reading the first sentence, someone else shouted from inside.

"Has the anesthesia taken effect? ​​We can't leave this bed lingering at the door any longer."