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

The woman held the pen in her hand, the tip hovering above the name field.

She pressed several wrinkles into the paper.

She couldn't finish reading that whole page.

Should we send them in?

The old man lay on the stretcher, sweat trickling from his temples into his ears. He moved his lips twice, but didn't cry out in pain; he just pressed his hand closer to his stomach.

When the anesthesiologist arrived, he checked the monitor first.

Blood pressure: 88-54.

Heart rate 137.

The oxygen is still there.

He put the stethoscope in his ear, bent down and listened for a couple of moments, then asked Qin Hai.

"Eating last?"

Lin Ye immediately reported.

"Around 6 PM, I ate half a bowl of porridge and some cold dishes. The pain started around 9 PM and worsened after 10 PM. I've had atrial fibrillation for many years and stopped taking anticoagulants for about a week; the specific medication name is still being verified."

The anesthesiologist removed the stethoscope.

"There is a risk of stomach upset. It's on the verge of shock. If we switch to open surgery midway, it will cause problems with the airway and blood pressure."

The woman's hand trembled again when she heard the word "trouble".

"Does that mean we can't do it?"

The vascular surgeon clipped the image screenshots onto the board, speaking slowly but in short sentences.

"It's not that we can't do it. It's that not doing it is more dangerous."

The general surgeon continued.

"The scans show blocked blood vessels and ischemia in the intestines. Whether interventional treatment can open the blood vessels depends on what happens after the procedure. We also need to assess whether the intestines are damaged and to what extent."

The woman's tears fell onto the edge of the signing board.

"You guys just say, if we do it, will it get better?"

As soon as he said that, no one in the corridor responded immediately.

Nurse Zhao lifted the monitoring cable from beside the bed wheels and casually pulled the woman half a step towards the wall.

"If a doctor dared to say that, they would be lying to you."

The woman was stunned.

Nurse Zhao didn't look at her; her hands were still tidying the threads.

"What you need to hear now is: what can you gain by going in, and what will you lose by not going in?"

The vascular surgeon glanced at Nurse Zhao but did not refute her.

"Go in and fight for blood flow. The sooner blood flow is restored, the greater the chance of saving the intestines."

The general surgeon completed the sentence.

"But if the intestines are already necrotic, simply connecting blood vessels won't be enough, and open surgery may be necessary. In severe cases, it's not impossible to remove the necrotic intestinal segment."

The woman's face turned ashen when she heard the words "cut it off".

"Cut out his intestines? Didn't he just have a stomachache?"

Qin Hai stood to the side, his voice lower than usual.

"He wasn't just in danger a moment ago. He was just brought to us by you."

The woman's lips trembled, as if she wanted to explain, but then she looked down at the medicine bag in her hand.

She knew about the days when the medication was stopped.

No one expected that the stomachache would be related to those few pills.

Lin Ye watched her clutch the medicine bag tightly, without saying a word.

At the edge of my field of vision, the blue text box lit up again.

[Emergency Room Warning: The current risk has not been eliminated.]

[Key milestones: treatment pathway selection, anesthesia risks, family consent, and intestinal viability assessment.]

[Based on: imaging findings, elevated lactate levels, decreased blood pressure, history of discontinuation of anticoagulants, and worsening abdominal pain.]

He turned his gaze back to the notepad.

Lin Ye lowered his head to finish taking notes.

Opinions on video.

lactic acid.

blood pressure.

Notification time.

The vascular surgeon's phone rang again.

He answered the call and put it on speakerphone.

"Director, I've seen the scans. There may be distal and branch embolism, poor intestinal enhancement, lactate 6.3, and blood pressure 88.54."

There was a two-second pause on the other end of the phone.

"Initiate intervention to open the pathway; the general surgeons should not leave. If blood flow is impaired or the bowel condition is abnormal after entering the operating room, immediately transfer the patient to the operating room. The anticoagulation regimen will be determined based on the intraoperative situation; do not make noise at the entrance."

The general surgeon's expression didn't change when he heard the last sentence; he simply put his gloves back on.

"I'm not leaving."

The anesthesiologist flipped over another information sheet.

"The risks of anesthesia also need to be explained in the contract. Things like a full stomach, low blood pressure, conversion to open surgery during the operation, endotracheal intubation, and admission to the intensive care unit must all be clearly explained."

The old man's eyes were still open, and he could hear intermittently, but he was in so much pain that he couldn't even hold a pen properly.

Lin Ye added this entry to the record.

The patient had verbally acknowledged the information, but due to pain and being on the verge of shock, was unable to read and sign the document completely. A family member signed on their behalf at the scene.

The woman looked at one sheet of paper after another, her voice so soft it was almost inaudible.

"Can I sign it by myself? His son lives in another city."

"Make a phone call first."

Qin Hai handed over his phone.

"Put it on speakerphone. If you can answer, then listen. If you can't, you, as a family member present, should sign first, and we'll record the call time."

The woman's phone screen was blindingly bright when she dialed.

No one answered the first time.

The phone rang a second time, almost stopping, before a young man's muffled voice finally came from the other end.

"Mom, what's wrong?"

The woman burst into tears as soon as she opened her mouth.

"Your dad needs to have surgery. The doctor said there's a blockage in his abdominal blood vessels, and he might need to have his intestines removed."

The person on the other end of the phone was instantly wide awake.

"What do you mean, cut your intestines? Didn't you just have a stomachache?"

This sentence seems to have come full circle back from the corridor a few minutes ago.

Qin Hai pulled the phone a little closer to himself.

"This is Qin Hai from the emergency room. Listen to the important points first; the person can't wait for you to come back."

He glanced at the door of the intervention room.

"Your father has atrial fibrillation and stopped taking his anticoagulant medication about a week ago."

"My stomach is hurting terribly now, and my lactic acid levels are rising. The scan looks like there's a blockage in the blood vessels in my abdomen, and my intestines are already showing signs of ischemia."

"The vascular surgery, general surgery, and anesthesiology teams are all here; she'll be taken in immediately. Your mother will sign the consent form on-site, you'll be informed by phone, and I'll record the time."

The person on the other end of the phone panicked.

How great is the risk?

Qin Hai did not provide any numbers.

"It's too big to wait for you to come back at the door."

After that sentence, only the sound of breathing could be heard on the other end of the phone.

The vascular surgeon looked down at his watch.

"You can enter the interventional room now."

Nurse Zhao shoved the pen back into the woman's hand.

Write your name here. Don't write it in the risk section.

This time, the woman didn't ask if it would make her better.

She lowered her head and wrote down her name.

The first stroke is still crooked.

The second stroke was a bit more stable.

Lin Ye added the time to the record.

0:03.

Family members signed informed consent forms on-site regarding intervention and possible transfer to surgery.

The son, who lives in another city, found out by phone.

The risks of anesthesia have been explained.

After a joint evaluation by specialists, the procedure proceeds with priority given to interventional procedures and general surgery on standby.

When he wrote the word "process", the old man suddenly opened his eyes from the flatbed.

"Do I need surgery?"

The vascular surgeon bends over.

"Let's go check the veins first. They'll assess the situation further inside."

The old man looked at the woman.

The woman wiped her face and stuffed the medicine bag into her pocket.

"Never mind that, I'll sign it."

These words were spoken softly, yet they were more resolute than all her previous questions.

The trolley was pushed towards the entrance of the interventional room.

Just before the red light came on, the anesthesiologist suddenly turned around.

"What about a follow-up lactate test?"

Just as Lin Ye was about to answer, a support nurse from the direction of the nurses' station ran over, holding a new piece of paper in her hand.

She crumpled the edge of the paper.

"Just got back."

She handed the paper to Qin Hai, her voice immediately lowering.

"Lactate level is 7.1%".

The red light at the entrance to the intervention room came on.