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

Nurse Zhao covered the microphone, but the lab technician hadn't hung up.

Qin Hai didn't answer the phone. He glanced at the red zone monitoring screen first, then at the record sheet in Nurse Zhao's hand.

"Sample time is checked first."

Nurse Zhao put the microphone back to her ear.

"Laboratory department, please report the sample receipt time again."

The voice on the other end of the phone was unhurried, with a slight rustling sound of turning pages.

"Received at 1:14. Report dispatched at 1:27."

Nurse Zhao repeated the words as she wrote them, her pen tip following the stroke.

Lin Ye pulled up the time on the emergency room blood collection barcode. 1:10.

Three time periods overlapped.

Blood was drawn at 1:10. Arrived at the lab at 1:14. Results came out at 1:27.

He had just finished writing when someone suddenly chimed in from the other end of the microphone.

"Your emergency room blood collection time is listed as 1:10 PM, but I received my sample at 1:14 PM. Who delivered it during those four minutes?"

His voice wasn't loud, but he pronounced each word clearly. Unlike the mumbling that sometimes comes with being on duty late at night.

Nurse Zhao was taken aback.

"Pneumatic transmission".

"Then there's no problem." It sounded like a line had been drawn on the other end of the phone. "The sample is normal, no hemolysis, no lipemia. I'll hang up now that you're done testing."

Nurse Zhao responded and put the phone down.

Lin Ye paused for a moment as he looked down to keep track of the time.

That voice was the same one that announced the digoxin just now.

Without thinking much, he continued writing.

Qin Hai pushed several test reports onto the side of the table.

Whether a geopotential height of 2.9 meters is high or not depends on several factors.

He didn't give a lecture; he just held up two fingers.

"First, when did you take the last dose of digoxin? Second, how long was the interval between the blood test and taking the medication? Without knowing these two things, it's hard to say whether 2.9 is high or low."

Li Wencheng's wife sat on a plastic chair by the bed, clutching the corner of the payment slip in her hand.

He only ate half a piece.

Nurse Zhao did not argue with her.

"Sister, did you see him eat half a piece at every meal, or did he tell you himself?"

Li Wencheng's wife was stumped by the question.

She glanced at Li Wencheng, her voice dropping.

"I saw it in the morning. He took it himself in the evening; I went to bed early."

Qin Hai took it.

"Who broke the pills?"

"He said that half a piece was too hard to break, so he ate it even if it was broken into pieces."

Nurse Zhao had just unscrewed the lid of her thermos when she heard this, and then snapped it back shut. She hadn't gotten a drink of the water.

"Eat it all together, not just half a piece."

Qin Hai didn't reprimand the family members. He took the medicine bottle out from under the transparent medicine bag and turned it upside down on the stainless steel treatment tray.

The small white pills bounced a few times as they hit the edge of the plate.

"Count the medicine. Take a picture after counting, then seal the bag."

Nurse Zhao squatted down and carefully moved the grains one by one to the edge of the plate.

Lin Ye was already standing outside the nurses' station at this time.

He didn't squeeze to the side of the bed.

Suddenly, the edge of my field of vision brightened.

The blue text pressed down in front of him, much clearer than the blurry "unclosed loop" he had seen a few days ago.

[Emergency room alert activated.]

[Target: Li Wencheng, 52 years old.]

[Probability of false positive: 64%]

[Effective review window: 19 minutes.]

There are only three lines below, each marked with a red dot.

[Last medication time: Not closed.]

[Interval between blood draw and medication administration: Unknown.]

[The remaining amount in the medicine bottle does not match the prescription cycle.]

Lin Ye looked at the nineteen-minute mark and cursed inwardly.

At least it doesn't just show "not closed loop" anymore.

The countdown is ticking. Eighteen minutes and forty-two seconds.

He didn't look up, nor did he say the blue letter out loud.

But he knows what he's lacking right now.

Lin Ye took out the community phone number from the notes and placed it next to Qin Hai.

"The community said this wasn't the first time he'd opened a digoxin bottle. He still has old bottles at home. Were the new and old bottles mixed together? Are the seeds still uneaten?"

Qin Hai glanced at the line of text.

"ask."

Lin Ye turned to Li Wencheng's wife.

"Are there any other medicine bottles like this at home? Old ones, new ones, pillboxes, everything counts. Look in the bedside table, drawers, kitchen, next to the TV, have your family look for them now."

Li Wencheng's wife picked up the phone and unlocked it after pressing the unlock button twice.

"I asked my son to look for it; he just went downstairs to get the car."

The moment the call was answered, everything went haywire.

"Don't come to the hospital. Go home and check your medication. The doctor said the medication is wrong. He didn't want you to come here, he wanted you to take the medication."

Qin Hai couldn't stand it anymore, so he picked up his phone and put it on speakerphone.

"This is Qin Hai from the emergency room. Don't rush to the hospital yet, go home first. Take photos of all the medicine boxes, front and back, and how many pills are left. Send them to me clearly. Don't spill them, don't throw them away, don't tidy up."

He was panting on the other end of the phone.

"Doctor, is my dad poisoned from eating too much?"

"The current risk is digoxin poisoning. The severity depends on heart rate, electrocardiogram, potassium levels, kidney function, urine output, and exactly when and how much he took the medication. Please take a clear picture of the medication first."

"Okay, I'll go back right away."

The red zone was quiet for a short while. The sealed bag next to the treatment tray was still empty.

Nurse Zhao has finished counting.

"Seventeen pills." She took a picture of the pills, put them in a bag, labeled them with the date, and wrote down the person who checked them.

The sealed bag was handed to her.

"Please confirm that this is the medicine from the bottle you brought."

Her signature was crooked.

Li Wencheng suddenly spoke. His voice was very soft, as if he was afraid someone would hear him.

I only added a little bit.

Li Wencheng's wife suddenly turned around.

"What did you add?"

He avoided eye contact.

"I've been feeling anxious and unable to sleep at night these past two days, so I took half a tablet again."

Qin Hai immediately gave chase.

Which two days?

"The night before last. Last night."

What time was it last night?

"Around 10 or 11. I can't quite remember."

"Did you eat anything between finishing your meal and having your blood drawn?"

"I can't remember."

Nurse Zhao couldn't take it anymore.

"Brother, forgetting what to eat can make you feel better, but forgetting what to take can be fatal."

After she finished scolding, she didn't stop, but instead reattached the loose lead wire.

My heart rate dropped from 50 to 48.

Over at the observation station, the cardiology doctor on duty didn't leave Meng Chi, but only turned around and called out once.

"Li Wencheng, get another electrocardiogram. If the heart rate drops again or conduction block occurs, call me immediately."

Nurse Zhao pushed the electrocardiogram machine over, the leads clattering on the floor.

Qin Hai tilted his head slightly towards Lin Ye.

"Write it in. He said he took half a tablet each night after experiencing heart palpitations the night before last and last night, but he doesn't know the exact time last night."

After Lin Ye finished writing, he added a line below: Seventeen pills in a bottle, sealed, confirmed by family members.

The countdown timer at the edge of my field of vision was still ticking.

Fourteen points.

Thirteen minutes and fifty-nine seconds.

The system didn't provide a treatment. The three red dots are still lit, with the one for the last dose being the brightest.

The nephrologist on duty arrived at the entrance to the red zone.

The consultation form was tucked under my arm; the first thing I noticed when I entered the room was my blood potassium and creatinine levels.

"Potassium 5.6, creatinine 176. How much urine did you produce?"

Nurse Zhao handed over the bedside record.

"Not good enough."

After reviewing the records, the on-call nephrologist looked at the medicine bottles in the sealed bag.

"Poor kidney function means the medication is being excreted slowly. The combination of high potassium and digoxin toxicity significantly increases the likelihood of heart rhythm problems. We need to recheck potassium, creatinine, urine output, and perform an electrocardiogram."

Qin Hai nodded.

"Keep an eye on the kidneys. Monitor heart rate, ECG, and digoxin levels; the cardiology department will handle the risk."

Lin Ye wrote the two departments separately in the record to avoid having to call back to the emergency room later.

On the observation side, the probe was still pressed against Meng Chi's chest.

The gray-white images flickered layer by layer, and the cardiologist on duty stared at the screen without saying a word.

Meng Chi was much quieter than before. He was just thinking about tomorrow's meeting, but now he didn't even dare to touch his phone.

His girlfriend stood at the foot of the bed scrolling through her phone, clearing out messages in the work group one by one, and finally typed only one line: "I'm in the emergency room, not coming back tonight."

Meng Chi lowered his voice.

"Don't write anything too scary."

The girl didn't look up.

"Just don't describe fainting as blacking out."

The cardiologist on duty moved the probe away and wiped off the coupling gel.

"The ventricular septum appears to be thickened. We can only make a rough assessment at the bedside; whether there is obstruction in the left ventricular outflow tract needs to be confirmed with a formal echocardiogram. The patient will remain on monitoring tonight."

He had barely finished speaking when his phone rang.

Tang Zhendong replied.

He answered the call and reported Meng Chi first.

"Director Tang, the ventricular septum appears thicker at the bedside, so it's impossible to make a definitive diagnosis at a glance. A formal echocardiogram and a repeat troponin test are both scheduled, so the patient will remain in the emergency room for monitoring."

Tang Zhendong responded with a "hmm".

"There's an empty bed in the cardiac monitoring department. If troponin levels rise again, or if the ultrasound shows an outflow tract obstruction, don't delay in the ER. Keep an eye on things tonight, and report back to me immediately if there are any changes."

The on-duty doctor agreed and then took over Li Wencheng's case.

"There's another patient in bed, Li Wencheng. His digoxin level is 2.9. His heart rate is 48-51 bpm, potassium is 5.6, and creatinine is 176. He admitted to taking half a tablet each day before yesterday and last night, but he couldn't say when the last dose was taken. The medicine bottle is sealed, and we're trying to get more medicine from home."

Tang Zhendong didn't yawn this time.

"Continue monitoring. If the heart rate slows further, blood pressure drops, or the ECG shows high-grade conduction block, report to me immediately. The last medication administration time must be traced back; if we can't catch up, we'll have to consider the worst-case scenario. Has the nephrologist arrived yet?"

"arrive."

"Okay. Don't let the family touch the medicine bag again."

Tang Zhendong hung up the phone after he finished speaking.

Nurse Zhao locked the sealed bag into the storage box, making a clattering sound as she closed the lid.

Li Wencheng's wife stared at the box for a long time.

"Doctor, I really didn't know he ate by himself at night."

Qin Hai did not comfort her.

"Now that you know, stop guessing for him. If the doctor asks what you saw, say you did. If you didn't see it, say you didn't see it."

She nodded. This time, she didn't make any further promises for Li Wencheng.

Lin Ye lowered his head and finished adding the last few time points.

The countdown in my field of vision jumped to eleven minutes.

There are three red dots, with the one for the last dose still being the brightest. However, next to the third dot, "The remaining amount in the medicine bottle is inconsistent with the prescription cycle," there is an additional small print: "To be verified."

He knew what this meant.

The counted seventeen pills didn't match the prescription cycle, but the emergency room medicine bottles weren't enough. The medicine from home hadn't been ordered yet.

Nurse Zhao's phone suddenly rang.

Li Wencheng's son sent a photo.

The first picture is blurry. The medicine boxes in the bedside table drawer are crammed together in a mess.

The second one is clearer.

On the wooden table sat a small blue-lidded pillbox, next to which lay a half-empty bottle of mineral water. The lid wasn't fully closed, and white pills were scattered in the compartments.

The label was half-covered by the box lid. Only two words were visible: Rice Flakes.

Nurse Zhao zoomed in on the image.

"What is this?"

She leaned closer for a look, and her face was even paler than before.

"He said to eat something to drain water when his legs are swollen."

The nephrologist on duty immediately looked up.

"Make him take another picture. Take clear pictures of the front, the back, and how much is left. Don't touch the medicine box."

Qin Hai pushed the phone in front of her.

"Say it exactly as instructed. Transmit it word for word. Don't let him touch the medicine box."

Li Wencheng's wife repeated this over the phone.

"Don't move, don't put it away, the doctor wants you to take a clear picture of the words."

A new photo appeared a dozen seconds later.

The blue cap was flipped open, revealing the label in its entirety.

Furosemide tablets.

Nurse Zhao glanced at it for two seconds, then turned her phone screen towards Qin Hai.

Qin Hai took it, glanced at it, and handed it to the cardiology doctor on duty.

The cardiologist on duty frowned slightly. Furosemide depletes potassium. Digoxin poisoning and hypokalemia are mutually reinforcing. Li Wencheng's potassium level is currently 5.6, which isn't low, but if he's been secretly taking diuretics, his potassium level might have been even lower recently, amplifying the toxicity of digoxin.

He didn't finish his sentence; he simply forwarded the photo to the nephrologist on duty.

The nephrologist on duty stared at the scattered white pills in the photo.

"When did you start taking this furosemide? How many days have you been taking it? Which doctor prescribed it? Have you taken potassium supplements? You need to find out all of that."

Qin Hai looked at Lin Ye.

"Record supplement. The family has provided a replacement blue-capped medicine box; the medicine is furosemide tablets. The date of administration, dosage, and source of the prescription are pending verification."

As Lin Ye wrote this line, the electrocardiogram machine by Li Wencheng's bedside had just finished running the last piece of paper.

Nurse Zhao tore it off and handed it over.

The cardiologist on duty took the electrocardiogram chart and stopped in his tracks, having been about to return to the observation position.

The PR interval on paper is longer than the previous one.

He didn't say anything, but simply placed the paper on the treatment table, side by side with the previous one.

Qin Hai's gaze shifted from the electrocardiogram to the photo of furosemide on his phone screen.

"There's more than one pill missing from the bottle."