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

Less than two minutes after the glucose was injected, the nurse checked the blood sugar again.

"4:80. They're up."

The numbers were up. But Lin Ye, squatting in front of the wheelchair and looking at Wu Deming's face, felt something was wrong.

When blood sugar rises from 3.4 to 4.8, a person should theoretically become more alert. After the hypoglycemia is corrected, the person's reaction time will return, their gaze will become more focused, and they will speak faster.

But Wu Deming was still the same. His gaze was unfocused, and he would only turn his head three or four seconds after being called by name; his palms were still damp.

Zhou Min noticed it too.

She didn't say anything, but took the stethoscope off her neck and placed it on Wu Deming's stomach.

The day shift supervisor at the nurses' station heard the commotion and came over. A male doctor in his forties, holding a half-full cup of tea, stood next to the wheelchair and glanced at it.

"What happened?"

"The patient under observation didn't go back to bed after the CT scan last night. We just found him in the corridor." Zhou Min moved the stethoscope to a different position. "His blood sugar was 3.4. We gave him a glucose tolerance test, and it came up, but his reaction time hasn't caught up."

The day shift supervisor placed the tea on the nurses' station table and bent down to glance at the old man's face.

"Where are the pupils?"

"Wait a minute." Zhou Min took out a pen lamp from her pocket and shone it on Wu Deming's eyes.

"Both sides are equal in size and circular, and it reacts to light."

"That's not a brain problem." The day shift supervisor glanced at the bedside record. "What was your blood pressure when you came in last night?"

"One hundred and twenty-two to seventy-eight," Ma Hao read aloud, flipping through the handover notebook.

"Now it's 98 to 62."

The supervisor on the day shift frowned.

"His blood sugar has returned, but he's still unconscious, and his blood pressure has dropped. It's not just low blood sugar caused by hunger."

He glanced at Zhou Min.

"How does your stomach sound?"

Zhou Min put the stethoscope back around her neck and lowered her voice by half a octave.

"The bowel sounds are weak. I listened to two locations, and neither was very active."

The day shift supervisor remained silent for two seconds.

"He came in last night complaining of abdominal pain. The CT scan came back normal. Now his stomach doesn't hurt anymore, but his bowel sounds are weak."

He straightened up and looked at Wu Deming's face. The old man's eyes were half-open, not showing any signs of pain, but his whole body was ashen and lifeless.

"Draw blood. Complete blood count, liver and kidney function tests, electrolytes, blood gas analysis, lactate levels, and coagulation tests." The day shift supervisor began issuing orders. "Do an electrocardiogram and connect the monitor."

He turned to Zhou Min and asked.

"Was it a plain CT scan last night?"

"Yes, abdominal CT scan."

"No enhancements?"

"No. The initial diagnosis was abdominal pain, pending further investigation. We ordered a plain CT scan first. The results were normal, so we didn't proceed with any further investigations."

The supervisor on the day shift nodded but didn't immediately order reinforcements. He first looked at Lin Ye.

"You were on the night shift last night, right? What was the situation when he came?"

Lin Ye stood beside the wheelchair, not getting too close.

"He had intermittent, dull pain around the navel, which wasn't severe. I saw him once in the observation area between 12:10 and 12:00, and he said he was feeling better than when he arrived. His vital signs were stable, there was no tenderness or rebound, and no obvious abdominal distension."

"What is the medication history?"

"No special medications were listed in the handover log."

"Then why is the blood sugar low?" the day shift supervisor muttered to himself.

The day shift nurse had already pushed the blood-drawing cart over and started giving Wu Deming an injection. When the old man was pricked, his eyelids twitched, but he didn't pull his hand away or complain of pain.

Lin Ye stood to the side watching, his hands in his coat pockets.

He knew there wasn't much he could do right now. Checking patients, giving prescriptions, calling consultations—these were all the day shift supervisors' jobs. He wasn't on the schedule and didn't have the authority to make any medical decisions here.

But one thing kept running through his mind.

Wu Deming came in last night with abdominal pain. The CT scan didn't show anything wrong. He didn't come home afterward, sitting on a chair in the corridor for nine hours. Now his abdominal pain is gone, his blood sugar is low, his blood pressure has dropped, his reactions are slower, and his bowel sounds are weaker.

If it's just low blood sugar caused by hunger from not eating, the person should feel better after taking supplements.

But he didn't.

The blood gas results aren't out yet. The lactate levels aren't out yet.

Lin Ye glanced at the labels on the blood collection tubes of the day shift nurses. Purple tubes, green tubes, blue tubes, orange tubes, lined up in a tray.

He's waiting for a number.

Zhou Min walked over and stood next to him, her voice very low.

"What are you thinking about?"

Lin Ye didn't say it aloud. He couldn't guess without evidence.

"Let's wait for the blood and energy to mature."

Zhou Min glanced at him but didn't ask any further questions.

Ten minutes later, the day shift nurse jogged over from the blood gas analyzer with a slip of paper in her hand.

"The blood and qi have been released."

The supervisor on the day shift took it, and stopped when his eyes landed on the lactic acid column.

5.1.

He flipped the slip of paper over to glance at the blood collection time, then flipped it back over and stared at the number.

Zhou Min leaned over for a look, then pursed her lips.

"Lactate 5.1." She repeated the number, as if to confirm.

The supervisor on the day shift placed the note on the table and tapped it twice with his fingers.

"I had abdominal pain. The CT scan was normal, but I felt terrible afterward. Low blood sugar can be caused by hunger, but high lactic acid isn't."

He looked at Zhou Min.

"Do you have atrial fibrillation? Do you have a history of anticoagulation? Do you have any underlying vascular diseases?"

Zhou Min flipped through the handover log.

"It wasn't written."

The day shift supervisor looked at Lin Ye.

Did you ask about his or her heart history when you saw him last night?

Lin Ye thought for a moment.

"I asked him when he came. He said he used to have high blood pressure and was taking medication. He said he hadn't been diagnosed with any heart problems. But I didn't ask him what specific medications he was taking or whether he had seen a doctor elsewhere."

Do you have the family's phone number?

Ma Hao pulled out his phone. "Yes, his wife's number is in the observation registration book."

"Tell him. Ask him what medications he usually takes, whether he has atrial fibrillation, and whether he has taken anticoagulants or aspirin."

Ma Hao dialed the number and walked to the side to answer the call.

The supervisor on the day shift had already started the inspection application on the computer. He spoke to Zhou Min as he typed.

"An enhanced abdominal CT scan is necessary. The plain scan doesn't show any blood vessel problems. With such high lactate levels and weak bowel sounds, I suspect a vascular issue."

Zhou Min nodded. "I'll notify the CT room. His kidney function hasn't returned yet; we'll reassess the contrast agent issue later."

"Move him to the monitoring position first. We can't let him sit in the corridor anymore."

The day shift nurses are already preparing for the transfer. The monitor is connected, the blood pressure cuff is wrapped, and the IV stand is hung up.

When Wu Deming was moved from the wheelchair to the stretcher, his eyes moved slightly and his lips moved as if he wanted to say something.

Lin Ye bent down and moved a little closer.

"Uncle Wu, what are you trying to say?"

The old man's voice was very soft and intermittent.

"My stomach doesn't hurt anymore. I just feel weak all over."

Lin Ye looked at his face. His face was more than one shade darker than it had been nine hours ago.

He straightened up. Ma Hao had finished his call and jogged back.

"His wife said that he does have atrial fibrillation and had gotten warfarin from the community clinic, but he didn't take it regularly because it was too much trouble. She couldn't say exactly how long he stopped taking it."

Upon hearing this, the supervisor on the day shift stopped typing.

Atrial fibrillation. Anticoagulation stopped. Abdominal pain. Now bowel sounds are weak, and lactate levels are high.

He turned to look at Zhou Min and Lin Ye.

"Notify the general surgery department first. The CT room should prepare for contrast enhancement."

He paused for a moment, picked up the bloody note from the table, and looked at it one last time.

"This person cannot be delayed."