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

Tian Jianjun had barely moved a little off the chair when Lin Ye blocked him back.

"Sit down first."

Tian Jianjun was still clutching the registration slip in his hand; the edges of the paper were soaked with sweat.

"Doctor, I really don't have chest pain. Please don't immediately think about my heart; I have to drive again at 4:30 tomorrow morning."

Qin Hai picked up the electrocardiogram paper.

"Ma Hao, print another one. Nurse Li, reconnect the monitor and measure the blood pressure again."

Nurse Li had already pushed the portable monitor next to the chair over.

"Master Tian, ​​loosen your grip a bit. The paper is all wet; I still need to check the messages."

Tian Jianjun was still thinking about the doorway.

My car is still parked at the entrance.

"The car's right outside, it won't get stolen. I'm really worried, I'll have the security guard check it later." Nurse Li rewound her cuff. "Don't worry about the car for now, relax your arm, we need to check your blood pressure again."

Before Tian Jianjun could say anything more, Lin Ye had already squatted down to his side and focused on the hand that was covering his chin.

"Which tooth is sensitive? Point to it."

Tian Jianjun raised his hand and touched his left jaw.

"This area... I can't say which one."

"Does it hurt when you bite down? Does it hurt when you drink cold water? Are your gums swollen?"

Tian Jianjun pressed the tip of his tongue against the root of his teeth, his voice becoming a little hurried.

"Nothing. It's just sour, even my chin is sour. My stomach is also uncomfortable."

Lin Ye didn't respond to his "My stomach isn't feeling well either," but continued asking questions.

When did your stomach discomfort start?

"I felt a little something after dinner."

"Are you sweating?"

"Around that time," Tian Jianjun said, then immediately added, "My car's air conditioning broke down that afternoon, it was so hot."

Lin Ye followed up with another question.

"It broke this afternoon?"

"Um."

Lin Ye didn't miss this opportunity.

"Then why do you break out in a sweat when you're waiting at a red light at night?"

"My back suddenly got wet. I thought it was because my stomach was blocked, and it was hot in the car."

Nurse Li stared at the monitor and reported the readings to Qin Hai.

"Blood pressure 168/96, heart rate 98, blood oxygen 98."

Qin Hai placed the first picture aside.

"Move to the monitoring position. Draw blood: complete blood count, troponin, cardiac enzymes, electrolytes, liver and kidney function tests, and coagulation tests. Also, take a bedside blood glucose test. Call the cardiology on-call staff down."

"I don't want to be hospitalized, doctor. I haven't finished paying off my car loan yet. Every day I don't drive is a day's loss."

Lin Ye reached out to stop him from getting up.

"I'm not asking you to talk about hospitalization first, I'm telling you not to drive yet."

"I've been driving for over twenty years."

Lin Ye did not move aside.

"After driving for so many years, you know better than anyone that you can't push yourself while driving."

Ma Hao pushed the wheelchair over, muttering to himself.

"Driver, if you really feel unwell halfway through the journey, the passengers will panic too."

Nurse Li glanced at him.

"Place the footrest properly. The patient is still sitting; don't scare them here."

Ma Hao quickly shut up and bent down to put the wheelchair footrest in place.

Lin Ye accompanied the wheelchair to the monitoring station, asking questions as they went.

"Have you ever had heart disease before? Have you ever had a stent implanted?"

"no."

"Did your blood sugar spike during the physical exam, and then it was normal during the follow-up test?"

"No follow-up check-up. The physical exam showed my blood sugar was a little high, but I haven't taken any medication."

Why not take your high blood pressure medication every day?

Tian Jianjun was a little embarrassed.

"Eating this will make you urinate more frequently. And it's hard to find a restroom in a sports car."

Nurse Li heard this from behind and laughed in anger.

"I know it's hard to find a restroom in a sports car, but you can't just skip your medication. You're in the monitoring position now, and your blood pressure is what it is, so don't try to fool yourself with the old stories of when you were fine."

Tian Jianjun did not refute.

"Nothing has ever happened before."

Lin Ye looked at the numbers on the monitor and picked up where he left off.

"These things tonight can't be ignored."

The second electrocardiogram was printed out quickly.

This time, Ma Hao didn't evaluate it himself; he handed the paper directly to Qin Hai.

Qin Hai took the first picture back and put it next to the second one, pushing the second one forward by half an inch.

"ST segment depression in several leads in the chest, more obvious in the second image, like a dynamic change."

Tian Jianjun couldn't understand the lead, he only understood "more obvious".

"What does 'more obvious' mean?"

Qin Hai put the paper back next to the monitor.

"That means you shouldn't keep saying it's just a toothache. We'll call the cardiologist down to examine it before we decide."

Tian Jianjun's phone rang.

The screen displayed "Old Zhou's Racing Team".

Lin Ye didn't stop him.

"You can answer the phone. Don't promise to send a car right away."

He answered the call only when it was about to stop ringing.

"Hey, Lao Zhou."

The voice on the other end of the phone was very loud; even Ma Hao could hear half of it.

"Don't forget that order from the high-speed rail station tomorrow morning; it belongs to a long-time customer."

Tian Jianjun stared at the waveform on the monitor, his throat bobbing.

"I might not be able to escape."

There was a pause on the other end of the phone, followed by immediate panic.

"What do you mean you can't run away? Is your car broken down?"

"He's a bad person."

Ma Hao almost couldn't hold it in.

Nurse Li tapped the blood collection tubes onto the tray.

"Stop joking. Find out if someone can run errands for you. If not, transfer the passengers' phone numbers so you don't end up unable to find anyone at either end."

Tian Jianjun whispered a few words to the person on the other end of the phone.

When he hung up, the IV line was already attached to the back of his hand.

Nurse Li handed the first emergency examination tube to the field staff.

"Send the troponin vial to the window first, don't mix it with the ones behind it."

"My wife is back in my hometown. My son is a senior in high school, so please don't call him."

Qin Hai was dialing the cardiology department's on-call phone when he heard this and turned around.

"Keep an adult available to answer the phone in the middle of the night. As for your son, try not to disturb him if possible; if something really happens, we can't afford to be unable to find any family members."

Tian Jianjun pulled out his brother's number.

"He hit my brother. He runs a late-night food stall in the north of the city."

Lin Ye repeated the number and had Ma Hao enter it into the contact field.

"Did you take any medication just now? Painkillers, stomach medicine, aspirin, nitroglycerin, or any nitroglycerin that someone gave you?"

Tian Jianjun shook his head.

"I didn't take any. I just wanted to get some painkillers."

"Black stools, stomach bleeding, brain hemorrhage, recent surgery, anything like that?"

Tian Jianjun was stunned.

"No, I don't think so. Does having a bad stomach count? Sometimes I experience acid reflux."

Qin Hai answered the phone without waiting for any pleasantries.

"Emergency ICU, male, 52 years old. Toothache radiating to the jaw, upper abdominal tightness, sweating, further questioning reveals chest tightness and back pain. Both ECGs show ST segment depression in the precordial leads, more pronounced in the posterior leads. Discontinued high blood pressure medication, smokes. Blood pressure 168-96, heart rate 98, troponin just delivered. Please come down and take a look."

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

"Take a picture and send it to me, I'll come down right away."

Qin Hai hung up the phone and turned to look at Lin Ye.

"Keep asking about the onset time."

Lin Ye nodded.

Tian Jianjun removed his hand from the registration slip, and his tone was no longer as aggressive as before.

"Go ahead and ask. Fine, I'm not leaving, okay?"

Lin Ye went through the previous sentences and only added the questions that hadn't been asked.

"My stomach felt congested after dinner, and my teeth ached more while waiting at a red light. I'll make a note of that time. Did you walk, carry anything, or climb stairs in between?"

Tian Jianjun thought for a while before adding the middle section.

"After delivering the airport order, I helped someone carry a suitcase; it wasn't heavy. Later, driving back into the city, it got a bit stuffy on the way."

Do you experience shortness of breath when you feel stuffy?

"A little. Even with the car windows open, I still feel like I don't have enough air."

Is your left arm numb?

"It's not numb. It's just that my shoulder feels heavy."

Lin Ye turned to look at Ma Hao.

"Ma Hao, write down the heaviness in your left shoulder as well."

When Tian Jianjun heard that "left shoulder heaviness" had been noted down separately, his voice lowered.

"Could this really be my heart?"

Lin Ye glanced at the waveform on the monitor.

"We can't say anything definitively right now. But with these two electrocardiograms right here, we can't just let you go because of a toothache."

When the cardiology doctor on duty arrived, Nurse Li had just put the third tube of blood into the tray.

As soon as he arrived at the bedside, he reached out to the electrocardiogram machine.

"Both of them are from tonight?"

Qin Hai pointed out the printing date to him.

"Less than ten minutes passed between them."

The cardiologist examined the two pieces of paper side by side, while his other hand had already reached Tian Jianjun's radial artery.

How tight is your chest right now?

Tian Jianjun wanted to say it didn't hurt, but he stopped himself from saying it.

"If it's stuffy, I'd give it a 5 or 6 out of 10. If it's tooth-

The cardiologist looked up.

"That makes it much clearer. Chest tightness is treated as chest tightness, and tooth sensitivity is treated as tooth sensitivity."

Tian Jianjun was a little embarrassed.

"I was afraid you wouldn't let me leave."

The cardiologist put the paper down.

"You're right to be afraid. You really can't leave tonight."

Tian Jianjun didn't laugh this time.

Is it serious?

The cardiologist put the stethoscope in his ear, his tone still firm.

"Don't scare yourself unnecessarily, and don't use toothache as an excuse. The symptoms and the image match, and the blood pressure and smoking history are all present. First, admit the patient for high-risk chest pain and keep them under monitoring. Don't even think about going back to drive until you understand the troponin levels."

After listening to his heartbeat, he turned to Qin Hai.

"I'll check the contraindications. I'll prescribe antiplatelet and anticoagulant medications; don't repeat them. First, keep an eye on the blood pressure and heart rate. If there are any changes in toothache or chest tightness, call me immediately."

Qin Hai responded.

Upon hearing a list of medicine names, Tian Jianjun reached into his pocket again.

There was only one set of car keys there.

A small taxi model hangs on the keychain, its edges worn smooth and shiny.

He took out the key and placed it on the bedside table.

"What should we do with the car?"

Nurse Li put the blood glucose syringe into the sharps container.

"We'll talk to security about the car later. If you really need it moved, someone will help you ask. Don't get out of bed now, and don't go to the door to check on it yourself."

Nurse Li glanced at the blood glucose meter.

"Blood sugar 8.9".

Tian Jianjun's voice trailed off.

"I had fried noodles for dinner."

The cardiologist only glanced at him.

"We'll settle the bill for the fried noodles later. Are your teeth aching and your stomach feeling better now than when you arrived?"

Tian Jianjun pursed his lips.

"My teeth are still a little sensitive, and my stomach feels stuffy."

The cardiologist looked at Lin Ye.

"He just said his shoulders were heavy?"

Lin Ye continued with the questions he had just asked.

"Yes, the heaviness in my left shoulder came on later. I had my teeth checked before, and cold water, biting food, and my gums didn't match up. In terms of timing, it's a feeling of fullness in my upper abdomen after dinner, and the toothache worsens while waiting at a red light, accompanied by sweating and shortness of breath. I haven't taken any painkillers, aspirin, or nitroglycerin. I'm taking my blood pressure medication intermittently, I smoke, and my physical exam showed high blood sugar."

The cardiologist nodded.

"This is enough for now; we'll see how things go and what happens next."

Ma Hao changed his wristband.

The waveform on the monitor ran for another twenty minutes or so before the emergency call came back.

Nurse Li answered the phone.

"Tian Jianjun from the emergency room?"

She listened for two seconds, then turned around.

"The high-sensitivity troponin level is slightly above the upper limit of the reference range. The person at the counter said that the blood collection time and barcode match."

Tian Jianjun suddenly looked up.

The cardiologist took the phone.

"Don't look up. It won't change anything now."

He double-checked the results and the blood collection time.

After hanging up, he placed the test results next to the two electrocardiograms.

"Call me your superior. Also, inquire about the availability of cardiac monitoring beds."

He added another sentence to Nurse Li.

"Draw troponin at the second point according to the time interval, don't just focus on this one sample."

Tian Jianjun looked at the car keys on the counter.

"Doctor, does this mean I really won't be able to drive tomorrow morning?"

Qin Hai glanced at the bunch of keys.

"Let Lao Zhou think about tomorrow morning's matter."

Lin Ye pushed the bunch of car keys next to the bed a little further into the cabinet to prevent them from falling out.

The taxi model on the keychain has been flipped over.

The small light on the roof of the car was facing downwards and resting on the counter.