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

On the day Zhou Fengying was transferred to the neurosurgery ward, Lin Ye pasted photos of the medicine boxes she carried with her into the medical record appendix one by one.

Aspirin, clopidogrel, antihypertensive drugs, and lipid-lowering drugs—each one was clearly photographed.

Sun Zhiqiang scanned the medical record pages, tapping the photos of the medicine boxes with his fingertip: "This step was done well. The elderly person has a poor memory and can't speak clearly, so the medicine box is more accurate than their words."

Lin Ye smiled and said, "As Director Luo of the Neurosurgery Department just said, asking about past medication history was the right thing to do."

Sun Zhiqiang snorted: "Getting cocky just because the director praised you?"

That's what he said, but he immediately stuffed the medical record into a folder used for morning meetings and teaching, and even put a conspicuous red label on the cover.

When Qin Hai was flipping through the materials for the morning meeting, he saw this medical record and his fingertips paused for a full three seconds.

"Let's bring up this case."

Ma Hao and Jiang Peng, who had been huddled together in the office slacking off, immediately looked up.

Qin Hai tapped the photo of the medicine box with his pen: "The previous cases were all critically ill patients who were rushed and treated by the second. This case is different. It tests whether you can ask one more question after the phrase 'old ailment'."

He glanced at Ma Hao and Jiang Peng: "Elderly, chronic disease, long-term use of antiplatelet drugs—these three factors combined mean that no matter what kind of external injury they suffered, the family can't just say 'the usual' and let it go. Don't think that only Lin Ye could discover this. The history of antiplatelet drug use, external injury, vomiting, and transient confusion are all clearly written on the patient's body. It's not like he has supernatural powers."

Ma Hao muttered softly, "Director, we know."

"Knowing it's useless." Qin Hai snapped the medical record shut. "Tonight, each of you will see three elderly patients with dizziness and write a complete differential diagnosis for each."

A low groan instantly filled the office.

Nurse Zhao was carrying a treatment tray past the door when she heard the commotion inside. Without turning her head, she tossed out a single word: "Serves you right."

Lin Ye didn't laugh along.

He ran his fingertip across the photo of the medicine box on the medical record.

aspirin.

Clopidogrel.

External injury, vomiting, transient confusion.

Even without that red warning, these keywords could have saved my life.

At nine o'clock in the evening, a middle-aged man in a wrinkled Brazilian suit came into the emergency room, his hand pressed tightly against his left chest, a slightly embarrassed smile on his face: "Doctor, I think I'm having an anxiety attack. I've been under a lot of pressure from company layoffs lately, and my chest feels tight all the time."

His wife, who accompanied him, looked helpless: "He stays up until two or three in the morning every day and can't sleep. The community doctor said it's most likely anxiety disorder."

The man placed his phone on the consultation table; the screen was still lit, displaying the pinned message in the company group chat: "Submit the optimization list by 10:00 AM tomorrow."

He noticed Lin Ye's gaze and forced a smile. "Doctor, I really don't want to be hospitalized. There's a crucial meeting at the company tomorrow. If I don't go, I'll be the first one on the layoff list."

When Ma Hao received the patient, he immediately went through the chest pain screening process.

Lin Ye stood to the side and scanned the results.

The electrocardiogram showed no obvious ST segment elevation, the initial troponin screening was negative, the man was conscious, and all vital signs were within the normal range.

No red alerts appeared at the edge of the field of vision.

The wife breathed a sigh of relief: "I knew it was anxiety. What a wasted trip."

Ma Hao relaxed his shoulders: "If there's no other discomfort, shall we observe for half an hour?"

Lin Ye didn't reply.

He pressed the electrocardiogram onto the cover of the medical record folder.

Stomach pain, drunkenness, cold, anxiety.

Once these terms, which sound too much like "mild symptoms," are included in the initial diagnosis, all subsequent treatments will tend to follow this line of thought.

He cannot draw conclusions based on the first seemingly similar answer.

Lin Ye moved the electrocardiogram aside and looked up at the man: "Is the chest pain related to activity? For example, does it get worse when climbing stairs or walking briskly?"

The man thought for two seconds: "Oh right, it hurts a lot when I climb to the third floor, but I'll be fine after resting for two minutes."

Ma Hao's relaxed shoulder instantly tensed up.

Lin Ye's pen paused on the medical record: "Did you break out in a cold sweat when you were in pain? Did your left shoulder and left arm also hurt?"

"There was one thing, I thought it was from being tired."

Sun Zhiqiang happened to be passing by and, after hearing a couple of sentences, immediately said, "We can't just treat it as anxiety. Administer observation, and repeat the electrocardiogram and troponin test every half hour. Consult a cardiologist if necessary."

The man frowned: "But the tests we just did were all fine, weren't they?"

Lin Ye pushed the printed observation form in front of him: "One negative result does not mean absolute safety. Your pain is clearly related to your activity, so you must be observed for further investigation."

The wife grew anxious: "Doctor, we have to go to work tomorrow, we don't have time to waste here!"

Nurse Zhao, who was preparing to seal the indwelling needle, overheard this and retorted without even looking up, "You have to work, even if it means you have to. Ask it if it'll give you time off!"

The wife was so choked up that she couldn't speak.

This time, Ma Hao didn't back down.

He handed over the informed consent form for observation, using the same plain language that Nurse Zhao had taught Lin Ye: "The most dangerous thing right now is that early heart blood supply problems can't be detected. The observation is to wait for dynamic changes. If it's really an early heart attack, and something happens to you on your way home now, no one can save you."

The man stared at the form in silence for a few seconds before finally picking up the pen and signing his name.

Two hours later, the man's follow-up electrocardiogram showed dynamic ST segment changes and a significant increase in troponin levels.

Holding the follow-up test results, the man's embarrassment vanished completely, and his voice tightened: "R-really not anxiety?"

Ma Hao wiped the sweat from his forehead: "Now it seems we absolutely cannot treat this as anxiety."

His wife sat on the chair next to him, her voice trembling: "Thank goodness we didn't go back... I was just complaining that you were inconveniencing me."

Nurse Zhao, carrying a blood collection tray, casually added, "You can take leave for your shift, but you can't get leave for heart disease."

Tang Zhendong, the director of the cardiology department, rushed over for a consultation. After reviewing the re-examination results, he glared at Ma Hao and said, "It's a good thing you managed to keep him here. If you had been two hours later, who knows what might have happened."

Ma Hao's white coat was soaked with sweat.

The electrocardiogram from a follow-up examination is pressed on the table.

There was no Red Alert in sight this time.

Just one sentence, "Chest pain worsened after activity," kept the person in the emergency room.

Lin Ye stood beside him, his hand holding the medical record folder more firmly than ever before.

Before leaving, Tang Zhendong glanced at Lin Ye and asked, "Why didn't you call me this time?"

"This time it was Ma Hao who made the call."

Tang Zhendong turned to look at Ma Hao, who was standing ramrod straight, and nodded: "The electrocardiogram is clearer than last time, not bad."

Ma Hao straightened his back even more instantly, and Lin Ye couldn't help but smile when he saw him like that.

Before handing over his shift in the early morning, Qin Hai spread out the day's medical records on the table at the nurses' station.

"I'll remember it all." He tapped his fingertips on the table, his voice not loud but clear to everyone. "The emergency room isn't a riddle. What you're seeing isn't a disease name written in a textbook, but the most vulnerable spot on a patient's body that's most easily overlooked and most prone to problems."

His gaze fell on Lin Ye: "No matter what kind of intuition you have, in the end it all comes down to physical examination, medical history, tests, and teamwork. Nothing else can be relied on."

Lin Ye's fingertips paused on the edge of the medical record folder.

Qin Hai, of course, had no idea what had flashed in his field of vision.

But he had pressed a faint white mark into the edge of the hard plastic cover.

He nodded: "Understood."

Qin Hai pushed the stack of medical records in front of him: "If you understand, write a debriefing. Don't write how you 'guessed' it, just write how you managed to contain the risks step by step if no one had pointed them out in advance and the heads of each department were on standby."

Lin Ye picked up his pen.

The first line was written exceptionally neatly:

[In the absence of obvious red flags, the basis for observing and screening for chest pain].

It started raining outside the emergency room at some point.

Raindrops pattered against the glass and slid down, but the line in front of the triage desk didn't shorten at all.

Lin Ye put the stethoscope back around his neck.

The next patient had already sat down at his examination table.