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

As soon as Wu Jianping's wheelchair left the emergency room, another stretcher was pushed in from the triage desk.

The man in the car was turned to the side, his right hand pressed tightly against his lower abdomen, his forehead covered in sweat.

The woman accompanying him hadn't even stood up properly when she anxiously cried out, "Doctor, please help push it back in! It used to go back in after a couple of rubs, but today no matter how much I press, it's not working!"

Lin Ye quickly pulled the curtain shut, and seeing her hand reaching towards her husband's groin again, he stopped her, saying, "Stop massaging. How long have you been massaging him?"

"It's been over half an hour. I massage it at home and on the way." Her hand was still suspended in mid-air. "Before, if I lay flat and gently massaged it a couple of times, the lump would go away on its own."

The man winced in pain: "You guys know this, could you help me push it? This has been an old problem for years, it's nothing serious."

"What time did it bulge out?"

"Around 8 o'clock. I helped someone move a washing machine, and when I went downstairs, I felt something was wrong."

"Did it hurt this much before?"

The man was about to answer when the pain in his groin flared up again. He gritted his teeth and paused for a few seconds before saying, "I've never felt this much pain before."

His wife added, "He threw up before we came; he threw up his entire dinner, and his stomach is so bloated."

"Did you pass gas after dinner?"

The couple exchanged a glance.

The man thought for a long time: "No. I think they let us go this afternoon."

Have you had a bowel movement today?

"It happened once this morning."

Lin Ye asked Nurse Zhao to check his vital signs first, and then put on his gloves and lifted the thin blanket.

A lump bulged in his right groin, the skin taut and shiny. The moment his fingers touched the edge of the lump, the man's leg jerked back.

"It hurts, stop pressing!"

"I won't push it in." Lin Ye stopped, only gently touching around the perimeter. "When I lay flat before, it would gradually disappear on its own?"

"Most of the time it's possible, but if it's not possible, then you rub it a couple of times with your hands."

"Has this bag not gotten any smaller today?"

"no."

A notification appears in the field of vision:

[Risk Factor: Unclear blood supply status of the embedded contents]

The handwriting faded.

Lin Ye covered him back with the thin blanket: "Stop pressing it."

The man frowned: "How can we go back if we don't press it?"

"This time is different from before. It's been hurting for several hours, and I've been vomiting and have a bloated stomach. I can't push it back in any further." Lin Ye pulled up the railing of the flatbed cart. "We need to check what's stuck inside first."

Nurse Zhao looked at the screen and read out the numbers: "Blood pressure 148/92, heart rate 104, body temperature 37.4, blood oxygen 98."

"Stop him from eating and drinking, and establish an intravenous line." Lin Ye turned to his wife, "Don't give him any water either."

The woman had just pulled a thermos from her bag when she heard this, so she put it back: "He threw up everything he had for dinner, and he still needs to fast for the tests?"

"In case of emergency surgery, eating or drinking will delay the anesthesia process."

She held onto the zipper of her bag without moving: "I need surgery again?"

"It's not decided yet. I'll ask a general surgeon to come and take a look first, and I'll schedule a CT scan as well."

After asking about her past surgical history, medication history, and allergies, Lin Ye returned to the workstation and ordered an urgent blood test and an enhanced CT scan of the abdomen and pelvis, and submitted an urgent consultation with the general surgery department.

Nurse Zhao inserted an IV into the man's left hand, attached a label to the blood collection tube, and sent it out.

Not long after the painkiller was administered, the man's tense shoulders relaxed a bit.

"Doctor, the medication is working, does that mean I don't need to take X-rays anymore?"

"The medicine only relieves the pain; the pack is still there." Lin Ye glanced under the thin blanket. "The X-ray still needs to be taken."

Dr. Wei, a general surgeon, arrived first.

After listening to Lin Ye's explanation, he pulled back the curtain to look at the mass and then pressed his abdomen.

The man had significant tenderness in his lower right abdomen, and his stomach was more bloated than when he arrived.

Dr. Wei took off his gloves.

"Where is the CT scan queue located?"

"We've reserved a spot in the examination room; we'll send the kidney function test results over once they're available."

"I went to watch the original film."

When the caregiver pushed the trolley to the CT room, his wife was still carrying that old thermos.

Nurse Zhao told her to put the cup in her bag and not to block the side of the stretcher when she was being moved to the next bed.

The workstation displays a notification of the test results.

Lin Ye checked the results: lactate level was 2.8, and white blood cell count was also high.

He added the values ​​to the medical record and was about to contact the CT room when Dr. Wei called first.

"The scan shows a section of small intestine is stuck in the hernia, the proximal intestinal tract is dilated, and there is fluid in the hernia sac. Continue withholding food and water. I'll contact Director Wang."

"Okay, I've already explained things to the family."

The stretcher was pushed back, and the man stared at Dr. Wei as he approached: "Is it really stuck in your intestines?"

Dr. Wei turned the film in front of the two of them.

The woman couldn't understand the grayscale images; her eyes only followed his finger.

"This section is stuck, and the intestines above it are already swollen." Dr. Wei flipped it forward two layers. "We need to loosen it as soon as possible; if we delay, there's a real possibility of necrosis."

"So what do we do now?"

"Prepare for emergency surgery. I've already contacted the head doctor, and he'll come over to talk to you after he reviews the scans."

Director Wang arrived in about ten minutes.

I first reviewed the original images with Dr. Wei, and then went to the bedside to see the patient.

"We'll perform a laparoscopic exploration to loosen the stuck intestine. Whether it can be saved depends on how it is loosened; no one can say for sure just by looking at the images now."

He covered the man with a thin blanket.

The sweat on the man's forehead hadn't dried yet: "What if it breaks?"

"If it's really necrotic, we'll have to cut off the damaged part and reconnect the two ends. If the blood supply can be restored, then we won't need to cut it." Director Wang turned to his wife. "I'll explain the specific risks to you in detail later. Let's do the preoperative preparations first."

The clock on the wall had already passed 11:30.

After the routine nursing handover, Nurse Zhao separately explained the intravenous access and preoperative preparations for this bed to Nurse Li. After signing the form, she went to the changing room to change clothes.

When Director Wang returned to his workstation, he casually opened the initial consultation record written by Lin Ye.

"You used to rotate through general surgery, and you did laparoscopic hernia repair, right?"

"I've worked with two different stations."

"Have you adjusted the mirror before?"

"Help him up."

Director Wang turned to Sun Zhiqiang and asked, "Are you letting anyone go in the emergency room? I need a second assistant."

Sun Zhiqiang glanced at Lin Ye's to-do list: "How many beds do you have left?"

"Three beds. One bed needs a follow-up blood test, one bed needs a reassessment after the IV fluids are finished, and the other bed needs a urine test."

"Who do you plan to give these three beds to?"

Ma Hao had just seen a patient off when he pulled out a chair and sat down. "Leave it to me. Just make sure you don't forget the bed number and the follow-up assessment time."

Lin Ye went from bed to bed, explaining which results hadn't been returned, what stage the handling had reached, and when the review would be conducted. For each item he mentioned, Ma Hao would mark it off in the to-do list.

After completing the three-bed check, Ma Hao confirmed that he had taken over the case in the handover column.

Sun Zhiqiang then looked up: "Okay. I'll come back after the surgery; it's still the night shift here."

"Know."

Director Wang had already taken two steps outside when he turned back and waved.

"Go change your clothes. Tonight you'll be my second assistant, responsible for adjusting the mirror."