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

The door had only been pushed open halfway when the young man's cell phone rang in his pocket.

Lin Ye saw the triage form that popped up on Ma Hao's end and gestured to the side: "Qiu Mingyu? Dr. Ma, over here."

The man responded and walked over to sit down.

A layer of fine white dust settled on the shoulders of his gray overalls. He was breathing a little fast, but his speech was still coherent.

"Doctor, can you check if this thing is broken?"

He placed the inhaler on the table.

"I pressed it several times, but no medicine came out."

Ma Hao picked it up and glanced at it; the counter on the side had already reached zero.

He tried pressing it again, but there was still no mist coming out of the bottle.

"This is all empty."

"Is it empty?"

The man took it back and looked through it.

"You could still press it yesterday."

Nurse Li pushed the blood pressure monitor in.

Ma Hao put the inhaler aside for a moment: "When did you start experiencing chest tightness?"

"A little after one o'clock. The warehouse was taking inventory tonight, and I went in to dust. When I came out, something felt wrong." The man reached out and unbuttoned the top button of his work clothes. "I have asthma; I used to be able to feel better after a couple of inhalations."

The cuffs begin to inflate.

Taking advantage of this opportunity, Ma Hao asked him about the circumstances of his previous episodes.

I was diagnosed with asthma when I was in school, and I have never been hospitalized for it. The worst time was when I just had nebulizer treatment in the emergency room and went home.

This time there was no fever, chest pain, or hemoptysis, just a tightness in the chest and difficulty breathing.

The blood pressure monitor stopped, and Nurse Li glanced at the screen: "Blood pressure 132/80, heart rate 104, blood oxygen 96. Breathing rate 24 breaths per minute."

Ma Hao placed the stethoscope on the man's back.

Scattered wheezing can be heard in both lungs during the expiratory phase, and there is no obvious retraction above the clavicle and between the ribs during the inhalation.

Have you been coughing at night lately?

"It happened a couple of days ago," the man said, then added, "just once, I didn't think much of it."

Ma Hao picked up the inhaler and looked at it: "This bottle was opened last spring? You haven't had a follow-up appointment since?"

"Pretty much. I usually just put it in the closet when I'm not panting." The man nodded, and his phone screen lit up again. He glanced at the caller ID. "The warehouse is urging me to go back and reconcile the numbers. Could you do a nebulizer treatment for me first?"

"Don't worry about the warehouse tonight." Ma Hao put the inhaler back on the table. "You sit down first, I'll ask Dr. Sun to come over and listen to you."

Sun Zhiqiang is checking an electrocardiogram at the workstation.

Ma Hao went over and said a few words. He put the mouse down and went into the examination room. He listened to both lungs again and looked at the blood oxygen and respiratory rate that had just been measured.

"Do the nebulizer first, then listen to the stethoscope again." Sun Zhiqiang put the stethoscope back in his pocket. "Don't go back to the warehouse to collect dust tonight. We'll talk about the medication after the nebulizer treatment."

Ma Hao entered the bronchodilator nebulization order according to the feedback.

Nurse Li led the man to observation station number four and connected the nebulizer. The nebulizer quickly filled the mask, and just as the man put it on securely, his cell phone vibrated in his work uniform pocket.

He reached out to remove his mask, but Nurse Li stopped him, saying, "Don't take off your mask yet. Call me back after you finish inhaling this dose of medicine."

The digital clock on the wall showed 2:12.

Ma Hao noted down the start time, stood beside the man for half a minute to make sure he wasn't breathing any harder, and then prepared to return to his workstation.

Nurse Li then reminded him, "The IV infusion for observation bed number six has finished, and we're waiting for your reassessment."

"I'm going there now."

Ma Hao glanced at the monitor screen at position four, then turned to Nurse Li. "Nurse four's nebulization started at 2:12. Her blood oxygen is currently 96, her heart rate is 104, and she can speak coherently. I'll be back at 2:30 to listen to her lungs."

Nurse Li nodded: "Please explain clearly first, what situation warrants me calling you directly?"

"If your blood oxygen level drops below 94, or if he can't speak in complete sentences or is breathing more heavily, call me immediately, and also call Teacher Sun."

Ma Hao entered the bed number (number 4) and the time of the re-evaluation into the observation column.

"If I'm not back by 2:30, go find me at number 6."

"Okay, I'll keep an eye on this side."

Ma Hao then left his observation post.

The man glanced at him through his mask.

Nurse Li straightened the nebulizer tubing: "Don't talk, just inhale properly. We'll have to listen to it again when the doctor comes back."

At 2:29, Ma Hao returned from bed number six.

The nebulization at position four had ended. The man leaned back in his chair, finished his phone call, his work uniform collar still open, and his breathing was much slower than when he first arrived.

"How are things now?"

"Much more relaxed." The man put his phone back in his pocket. "My chest isn't as tight anymore, but I can still hear a little snoring."

Nurse Li checked again: "Heart rate 96, blood oxygen 98, respiratory rate 20 breaths per minute."

Ma Hao asked the man to count from one to ten, and he counted them all in one go.

The wheezing in both lungs was significantly reduced compared to before nebulization, with a slight wheezing sound remaining at the end of expiration.

He recorded the changes in vital signs and lung auscultation from the two examinations into the medical record, then picked up the inhaler that had been reset to zero: "How do you usually use it? Show me."

The man pulled off the cap, didn't shake it well, pressed it to his lips first, and then inhaled after a short pause.

"The order is reversed." Ma Hao handed the air inhaler back. "Shake it well first, then exhale."

Once the man had the mouthpiece in his mouth, he raised his hand slightly: "Inhale slowly as you press down. Yes, just like that. Don't exhale immediately after inhaling; it's best to hold your breath for ten seconds."

The man did it again, and this time he got the movements right.

"Then just give me a new one, okay?"

"It's not just about changing a bottle." Ma Hao opened the newly completed record. "You woke up coughing a couple of nights ago, and it hasn't been well controlled lately. Use the prescription for now, and go to the respiratory department when you have time. Have the outpatient clinic readjust your medication."

Ma Hao didn't immediately issue a discharge form, but instead had the man sit in seat number four for another twenty minutes.

At 2:50, the chest tightness did not recur, the blood oxygen level was still 98, the breathing rate was 20 breaths per minute, and the wheezing at the end of exhalation was milder.

After reviewing the final re-evaluation data at the workstation and listening to Ma Hao describe his breathing and lung condition after nebulization, Sun Zhiqiang confirmed that he could be discharged from the hospital according to the prescription.

Ma Hao handed the discharge papers to the man: "Don't go back to the warehouse tonight. If you're short of breath again when you go back, and even after taking the medication you can't feel better, or you can't even speak coherently, come straight back. If your chest feels increasingly tight, call 120. Don't try to tough it out on your own."

The man took a picture of the new prescription and discharge form on his phone and finally replied to the warehouse: I'm not going back, I'll check it tomorrow morning.

He stood up, took a deep breath, and stopped rushing towards the door: "Okay, I won't go back to the warehouse. I'll go back and get some sleep first."

After seeing the patient off, Ma Hao added the departure time to the record, including the time he left for bed number six and the time he returned for the re-evaluation.

Sun Zhiqiang walked by, stopped, and glanced at the room: "You went to bed number six in between?"

"I've been there." Ma Hao moved the record to the corresponding location. "What he said before leaving, what time he returned, it's all recorded here."

Sun Zhiqiang gestured with his chin toward the workstation: "Submit the medical record first. Before handing over the shift tomorrow morning, bring me this original record."

"it is good."

Ma Hao submitted his medical records, and a message popped up in the lower right corner of the screen indicating successful signature.

The evaluation form is still in the drawer, the third blank space is empty.