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

The next day, at 2:17 PM.

Lin Ye was reviewing X-rays for a young man with a sprained ankle when the siren of an ambulance sounded at the emergency room entrance.

Zhou Min was standing next to the triage desk coordinating observation beds when she heard the sound and looked up at the door.

"The Second Hospital's transfer vehicle has arrived. He's 66 years old and has pneumonia."

Lin Ye put the film back in the lightbox, instructed Nurse Zhu to first stabilize the young man's ankle, picked up the receipt and went out.

The stretcher was pushed off the vehicle, and Liu Guoqiang, wearing a nasal cannula, had his eyes half-open.

The caregiver followed beside her, carrying a transparent file bag.

"The Second Hospital diagnosed it as pneumonia. It started to get noticeably short of breath in the afternoon and I've already started taking antibiotics. Before being transferred, my blood oxygen level was 94 and I had 3 liters of oxygen. I didn't vomit or fall on the way."

Zhou Min put away her phone and looked at Liu Guoqiang on the stretcher.

But Liu Guoqiang's chest was heaving rapidly, and his nostrils were opening and closing with each breath.

Nurse Zhu secured the young man's ankle and rushed over to attach a portable monitor. His blood oxygen saturation jumped from 92 to 94, stabilized for just two seconds, then dropped back to 91. His blood pressure and heart rate were also displayed.

"Change the oxygen mask, adjust the oxygen flow to ten liters." Lin Ye pointed to the emergency room, "Don't go into the regular observation room, push her in."

Nurse Zhu turned to get her face mask, but Zhou Min had already made way for her.

The caregiver stands at the end of the stretcher.

"The Second Hospital said his condition was stable and he could be kept under observation directly."

"Treat him as if he's been admitted to the hospital." Lin Ye leaned closer to Liu Guoqiang. "Sir, can you hear me?"

Liu Guoqiang opened his eyes and his lips moved.

"asthma."

"Does your chest hurt?"

Liu Guoqiang shook his head, gripping the bed railing tightly.

"blood pressure."

Nurse Zhu glanced at the monitor: "102, 63. Heart rate 116."

She counted her breaths: "Thirty-two."

Half an hour ago, the Second Hospital reported 138, 76, and a heart rate of 102.

"Where are the family members?"

"My daughter and son-in-law are hailing a taxi in the back," the caregiver said. "The Second Hospital told us to send them first."

Liu Guoqiang suddenly raised his hand and pointed to his coat pocket.

The caregiver reached into an old cell phone; the screen was cracked and there were seven missed calls.

Lin Ye glanced at it.

"Get the person in first."

In the emergency room, Nurse Zhu put an oxygen mask on Liu Guoqiang, and his blood oxygen level climbed to 93.

Lin Ye glanced at the file bag; it contained only two pieces of paper: a referral form and a medication supplement form.

The name on the referral form is Liu Guoqiang, 66 years old.

Chest image, to be added.

The medication label says ceftriaxone, 1 pm, 1 gram.

History of allergies, penicillin allergy, reaction unknown.

Lin Ye glanced at the monitoring screen.

"Nurse Zhu, establish two intravenous lines and draw blood. We'll check blood gas, complete blood count, biochemistry, lactate, kidney function, and electrolytes all at once."

He then looked at Liu Guoqiang.

"When did you start administering this bag of medicine?"

The caregiver looked down at the IV bag.

"I don't know, it was a nurse from the Second Hospital who got it."

"The total amount, the amount already entered, and the pause time should all be made up by the Second Hospital."

Lin Ye handed the receipt to Zhou Min.

"We're also pushing for the filming of these videos."

Zhou Min took out her phone, walked to the door, and made a call.

Lin Ye listened to Liu Guoqiang's heart again.

Both lungs had moist rales, which were more pronounced on the right side.

Liu Guoqiang tried to speak, but only a series of rapid breaths came from behind his mask.

My blood oxygen level dropped to 88 again.

"Lin Ye, the Second Hospital's phone number."

Zhou Min handed over the phone.

"Upon arrival at the hospital, the patient's oxygen saturation was 88, blood pressure was 102, and respiratory rate was 32 breaths per minute. The patient has been admitted to the resuscitation room. Please reconfirm the last vital signs and time before transfer."

The other person said a few words, quickly and vaguely.

"I can't hear you. Please confirm when he started to get worse."

"You'd have to ask the ward about that."

"Go ask. Ask now."

There was a moment of silence on the other end of the phone, then an agreement was reached.

Lin Ye handed the phone back to Zhou Min and turned to look at the bedside.

Liu Guoqiang's daughter was stopped at the door by Nurse Zhu. She was in her thirties, and her hair was messy from the wind. Her son-in-law stood behind her, holding her bag and putting his other hand on her shoulder.

She saw her father through the glass and knocked on the door twice.

"Doctor, how is my dad?"

"He's experiencing low oxygen levels and we're trying to resuscitate him." Lin Ye walked to the door. "Don't come in yet. Tell me when he started having difficulty breathing today, what medications he took this morning, and whether he has any heart or kidney problems."

"He went downstairs to buy groceries this morning," the woman said quickly. "When he came back at noon, he said he felt tightness in his chest and couldn't breathe. The hospital said an IV drip would do the trick, but he got worse and worse, so they asked us to transfer him to another hospital."

"What kind of fluid was administered?"

The woman shook her head, her eyes fixed on what was inside.

"I don't know. The caregiver brought me here first while I was on my way."

Liu Guoqiang heard the sound outside the door and his fingers moved slightly on the bed sheet.

The daughter pressed herself against the glass: "Dad, I'm here."

Liu Guoqiang didn't open his eyes, but his hand moved slightly.

Lin Ye saw it and pointed to the bedside: "He heard it."

The woman covered her mouth, nodded twice, and stopped knocking on the door.

She pressed her forehead against the glass.

"Don't be afraid, I'm here."

Lin Ye returned to the bedside, and Liu Guoqiang had already opened his eyes, his gaze tilted towards the door.

"Catch your breath first." Lin Ye bent down. "Your daughter has arrived and is waiting for you outside."

Liu Guoqiang blinked.

The blood oxygen level on the monitor rose from 88 to 90, and then slowly dropped again.

"Director Zhou, the non-invasive preparation is complete. The patient can still understand instructions, has not vomited, and the blood pressure is temporarily stable. First, check the blood oxygenation and breathing function after non-invasive treatment. If the patient's consciousness deteriorates, oxygenation cannot be maintained, or the airway cannot be protected, then we need to upgrade airway support."

Zhou Min glanced at the monitoring screen.

"Start with non-invasive procedures. Nurse Zhu, push the resuscitation cart to the bedside and prepare all necessary equipment for intubation if needed. I'll call the anesthesiology department, and I'll also let Director Qin know."

Nurse Zhu pushed the ambulance to the bedside.

"Director Zhou, the patient's oxygen saturation was 88% upon arrival, but it was still unstable under the oxygen mask. His respiratory rate was 32%, and his blood pressure was 102." Lin Ye followed Zhou Min to her side. "The imaging and complete medication have not yet arrived, and the changes in shortness of breath after the infusion also need to be verified."

Zhou Min wrote these items down on the receipt.

"I told Director Qin, 'Keep an eye on the bedside, and keep following up on the data from the Second Hospital.'"

She took out her phone, walked to the door of the emergency room, and dialed Qin Hai's number.

A non-invasive mask was placed over half of Liu Guoqiang's face.

He raised his hand to block, but Lin Ye grabbed his wrist.

"Wear it for a while."

"If you feel uncomfortable, raise your left hand. I'm watching you."

Liu Guoqiang looked at him for a few seconds, then slowly lowered his hand.

The machine started supplying air, and the blood oxygen level rose to 92.

The woman outside the door saw the numbers change, took a step forward, and then stopped.

Zhou Min returned to the bedside: "The anesthesiology department is on their way, and Director Qin already knows. Report to me first if there are any changes in blood oxygen or respiration."

She stared at the monitoring screen, recording the time when non-invasive prenatal testing began.

Lin Ye looked at the IV bag at the foot of the bed; there was only a small amount of liquid left in it.

He removed the IV tubing that was pressing down on the label, which read: Sodium Chloride, 500 ml. The already entered volume was illegible.

"Stop adding this bag for now and note the remaining amount," Lin Ye said to Nurse Zhu. "Don't add any more until we've verified how much has already been added."

My blood oxygen suddenly dropped to 87.

Liu Guoqiang closed his eyes and weakly raised his left hand.

Zhou Min glanced at the monitoring screen: "Hasn't the anesthesiology team arrived yet?"

"Still on the way."

Someone answered from outside the door.

Lin Ye turned around and dialed back to the Second Hospital.

"Please confirm immediately how much of this 500 ml of fluid has been administered and when it was stopped. The patient is still on oxygen."

The continuous beeping of the monitor drowned out the response on the phone.