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

The monitoring alert for the second bed was still ringing. Nurse Zhao had already stood by Chen Li's bedside, pressing her finger against the interface of the monitoring cable to confirm that it was not a poor connection.

The heart rate on the screen jumped from 112 to 131, and the blood pressure was 114/70 mmHg.

"Does your chest still hurt?"

Lin Ye bent down.

Chen Li's breathing became shallower, his left hand still pressed near the ligature mark: "It's more suffocating than before, like a stone is pressing down on me."

"Where does the pain go?"

"I also have it on my back, and my heart is racing."

Lin Ye gestured with his chin toward the ultrasound machine beside the bed: "Sister Zhao, move the ultrasound machine to bed number two, double-check the intravenous access, and put on oxygen first. Don't disconnect the cardiac monitor until the cardiology department arrives."

Nurse Zhao responded and turned to get the oxygen mask.

Just as Lin Ye had fastened Chen Li's oxygen mask, his cell phone vibrated in his pocket.

The caller ID showed Ma Hao.

He answered the phone, and Ma Hao immediately reported the results: "Cheng Xiaogang just finished his head and cervical spine CT scans, and the second-line orthopedic specialist has arrived."

"Let me first tell you about the results of the head examination."

"The radiology department said they haven't seen any obvious intracranial hemorrhage yet, but the cervical spine CT images need to be reviewed by the orthopedics department as well."

Lin Ye held the phone close to his ear: "Write down the neurological symptoms during the handover, keep the neck brace in place, send the person back to the emergency room, and wait for the orthopedic doctor's opinion."

"clear."

When Ma Hao and Cheng Xiao's stretcher returned to bed one, they first confirmed that the neck brace was securely fixed on both sides. Then they added the duration of the weakness and numbness in Cheng Xiao's right hand to the handover page before handing the X-ray to the bedside orthopedic doctor.

Chen Li's first electrocardiogram was laid out on the treatment cart, showing ST-T changes in the precordial leads.

Lin Ye left the paper on the treatment cart.

"Have you had heart disease before, or have you been taking medication regularly?"

"No. I drive a truck, and I get a medical check-up every year."

"Reiterate the order of impact."

"I nudged the steering wheel a little, and then the seatbelt tightened."

Lin Ye wrote the accident mechanism, changes in chest pain, and abnormalities in the first electrocardiogram into the medical record.

As I was writing the last item, the cardiologist came in from behind the curtain.

Which bed?

"Chen Li, 52 years old, was the driver of the car in front in the rear-end collision. He suffered severe chest pain after the impact to his left anterior chest, and his heart rate rose from 108 to 131. The first electrocardiogram showed ST-T changes in the precordial leads, and his blood pressure is currently 114/70."

The cardiologist took the electrocardiogram and first asked Chen Li, "Please point to the area where the pain is most severe."

Chen Li raised his hand and pointed to his left chest.

The doctor pressed around the ligature mark and then listened for a moment with his stethoscope.

"Blunt cardiac injury needs to be ruled out. The patient should remain on monitoring. The first step is to administer troponin and bedside echocardiography. The follow-up appointment schedule should be written down for Nurse Zhao. The chest CT scan should be performed according to the original trauma protocol."

Lin Ye handed the examination form to Nurse Zhao: "Sister Zhao, please take the troponin and repeat ECG tests first. If the ultrasound machine is available, bring it to bed number two."

"I know." Nurse Zhao clipped the form into the treatment tray, then noticed Chen Li trying to pull the electrode from his chest. She pressed down on his wrist, saying, "Chen Li, don't move your hand. If the wire comes loose, the machine will have to recognize you again." She then gestured with her chin towards the blood collection nurse, "This bed, go first."

Upon hearing the word "heart," Chen Li pulled his hand further under the sheets: "I just bumped into something, didn't I?"

The cardiologist put the stethoscope back in his palm: "The ECG showed changes after the impact, so we have to keep an eye on it. It's better for him to be under monitoring now than for something to happen again after he goes back."

Chen Li closed his eyes and placed his hands back on the bed.

On the other side of the emergency bed, Ma Hao stood beside Cheng Xiao's stretcher, CT scans tucked into his arms, while the orthopedic surgeon walked on the other side.

Cheng Xiao's neck brace was still on, and her right hand was resting outside the bed sheet.

The orthopedic surgeon placed the CT scan on the viewing light and adjusted the window twice: "There is no obvious bleeding in the skull for now, and the cervical spine CT scan does not show any obvious fractures or dislocations. However, her right hand is not strong enough, and the symptoms are still there, so we cannot remove the neck brace just because the scans seem normal."

Upon hearing "no fracture," Cheng Xiao's shoulders relaxed a little, and she reached out to touch the edge of the neck brace.

Lin Ye pressed down on the back of her hand: "Don't touch it yet."

Cheng Xiao looked up: "Didn't you say there was no fracture?"

"The scans have cleared out some of the problems, but the numbness in my hand and the inability to lift my arm are still there."

Lin Ye put her hand back on the sheet.

"Keep the neck brace for now, and we'll do further examinations to make sure we can see the nerve line clearly."

The orthopedic surgeon continued, "Schedule a cervical spine MRI. If the strength or sensation in your right hand changes again, get a re-evaluation immediately, and move the MRI priority up. If it's stable, and we can't schedule it tonight, you'll need to stay for observation and further examinations."

Ma Hao stuffed the CT report into the medical record folder: "The MRI team asked her if there was any metal in her body, and they're already checking. I recorded the muscle strength in her right hand according to the orthopedic department's requirements; she'll have a follow-up check every half hour after returning to the emergency room."

"Keep an eye on Cheng Xiao."

Lin Ye pointed to a bed.

"My right hand is numb, I have difficulty raising my arm, and I have trouble moving my toes. I record the time for each follow-up appointment. If there are any changes, I call the orthopedics department first, then I call you."

"OK."

Nurse Zhao came out of bed number two carrying a blood collection tray and nodded to Lin Ye with her chin: "Chen Li's blood has been delivered, and the ultrasound machine will be here in five minutes. The wrist X-ray for bed number three is also done; the radiology department said to wait for the report."

Lin Ye responded and walked to bed three: "Have your dizziness, nausea, and drowsiness gotten worse?"

"no."

Lin Ye instructed the nurse to fill in the symptoms and medication history on the head injury observation form: "Keep this under observation until the X-ray report comes out. If the dizziness worsens, you vomit again, or you become increasingly sleepy, call someone immediately."

The driver of the car behind looked down at his right wrist, which was now immobilized, and then used his left hand to take out his phone: "I'll tell the traffic police that I won't be going home for now. As for how to tow the car, I'll have them contact my family."

After the call was connected, he first gave the license plate number and the hospital where he was.

The nurse clipped the observation form to the foot of the bed for him, reminded him to keep his right hand still while on the phone, and confirmed his family's contact information and expected arrival time.

Lin Ye handed the third bed to the nurse and turned to walk to the second bed.

The bedside ultrasound machine has been moved into place.

The cardiologist placed the probe on Chen Li's chest, and the image on the screen lit up.

Lin Ye wrote down the time of the first tube of troponin test on the whiteboard by the bedside, and then wrote down the time for the follow-up electrocardiogram and troponin test in three hours on the next line.

Nurse Zhao checked the records twice and added the same time to the medical record.

The cardiologist changed the CT scan twice, but the probe remained on Chen Li's chest: "The chest CT scan will continue according to the trauma procedure. Until the follow-up results are available, he will remain under monitoring."

Nurse Zhao stood at the foot of the bed, staring at the monitor: "Dr. Lin, Chen Li's heart rate is rising again."

Lin Ye looked up and saw the number jump from 128 to 136.

The cardiologist took a look.

"Don't stop the ultrasound yet."

Ma Hao's voice came through the curtain in the emergency room.

"Lin Ye, the numbness in Cheng Xiao's right thumb and index finger is worse than before."

Lin Ye shifted his gaze from the monitoring screen of the second bed, took half a step toward the first bed, and then stopped.

"Ma Hao, immediately recheck the strength and sensation in both hands, and the movement of the toes. Note the time and notify the orthopedics department immediately. At the same time, report that the MRI shows worsening symptoms and move the priority to an earlier level. Don't move the neck brace. Sister Zhao, call me immediately if there are any changes in the monitoring of the patient in bed two."

Nurse Zhao had already placed her hand next to the call bell: "Go to bed number one, I'll keep an eye on things here."

Ma Hao rechecked the grip strength of Chen Li's right hand at the foot of the first bed. After the orthopedic department called, they first reported the changes in symptoms. Next to the second bed, the cardiologist still had the probe attached to Chen Li's chest, while Nurse Zhao stayed by the oxygen and monitor.

Lin Ye squeezed past the treatment cart and hurried toward a bed where Ma Hao was already waiting.