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

The transport bed rushed into the No. 3 emergency room. Just as the patient was pushed to the bedside, another mouthful of blood welled up in his throat.

Nurse Zhu placed the curved plate under his chin, and dark red blood clots fell in.

"Turn to the side a little, don't choke."

Lin Ye supported the patient's shoulder, turning his face to one side.

The man was covered in cold sweat, his lips were pale, but he could still open his eyes when he heard the sound.

"Can you hear me? What's your name? How old are you?"

"Yes." The man took a breath. "Du Cheng'an, fifty-seven."

Monitoring connected, blood pressure 86.54, heart rate 132.

"Three beds, two access routes: complete blood count, coagulation, biochemistry, blood type, and crossmatch." Lin Ye touched Du Cheng'an's cold wrist. "Start with crystalloid solution, don't rush it all at once. No food, put the suction device by the bedside."

"The passageway left in the car is usable; I'll open another one on the left."

Nurse Zhu disassembled the second set of indwelling needles.

Lin Ye leaned down and asked, "How long has this black stool been going on? How many times have you vomited today?"

"I started having black stools last night, and I vomited once at home and once in the car." Du Cheng'an's voice grew softer and softer. "I've had stomach bleeding before."

Do you have liver disease? Have you recently taken any painkillers, aspirin, or anticoagulants?

The man closed his eyes but couldn't answer.

The accompanying doctor handed over a bag containing blood pressure medication and ibuprofen.

"The medical history wasn't fully taken. I took 200 ml of medication in the car, but my blood pressure didn't go up."

Lin Ye checked the medicine box: "Consult the gastroenterology department, prepare blood in advance, and prescribe intravenous acid-suppressing drugs."

Nurse Zhu announced the new numbers: "Eighty-four, eighty-five, eighty-two."

The second car arrived as well.

The triage nurse connected the flushing solution at the receiving point, protected the left eye, and carried the patient into bed four while flushing.

The nurse at the bedside took the saline solution and the IV bag.

"Vital signs are stable, no breathing difficulties. The right eye is still irritated, but the left eye is protected."

After the triage nurse finished speaking, she rushed to the arrival area.

The nurse at the bedside adjusted the flow rate of the flushing solution, and the young man gasped in pain.

"Nurse, will I still be able to see in this eye?"

Lin Ye looked in the direction of the sound.

The man in bed number four was wearing oil-stained black work clothes, his head turned to the right, and saline solution was flowing from the corner of his eye into the water bag next to the bed.

The nurse at his bedside held his upper and lower eyelids and kept rinsing them.

"Keep flushing the fourth bed, don't let him rub his eyes. Have Ma Hao bring the packaging to check, and call me when you're testing the conjunctival sac pH."

"Okay. I'll continue here. I'll call you when the pH value comes out."

The nurse at bed number two handed over a repeat electrocardiogram.

"Dr. Lin, I haven't had chest pain since then."

Lin Ye confirmed that the access to the third bed had been established, instructed Nurse Zhu to monitor the blood pressure, and then compared the two electrocardiograms.

"Is it a heart attack?"

The patient in the second bed asked.

"There are no new changes in ischemia at the moment, and troponin levels haven't returned. Tell me immediately if the pain worsens."

Ma Hao returned from the observation area.

"I've asked the nurse to keep an eye on bed two. Should I go check on bed four now?"

"Check the packaging and rinsing time, measure the pH level, and check the vision in both eyes. I'll follow up with the ophthalmologist."

"OK."

Ma Hao walked towards the fourth bed and leaned closer to ask Lin Ye as he passed by.

"Is the blood pressure in bed three still dropping?"

"He is 84 or 82 years old. He just vomited blood again, so we suspect he is still bleeding."

When Lin Ye returned to the third bed, Du Cheng'an's wife had just arrived at the door.

Her shoelaces were untied as she stood outside the police line, holding her medical insurance card.

"He was hospitalized two years ago for a stomach ulcer, and he stopped taking the medication after a while." She tiptoed to look inside. "This morning he said his stomach was burning again and took two painkillers. He doesn't usually take aspirin or anticoagulants."

"His blood pressure is low right now, and the blood has been sent for testing. He may need a blood transfusion or an endoscopy; we will let you know."

Du Cheng'an heard his wife call him and glanced towards the door.

Nurse Zhu noticed this and lowered the bed rails slightly.

"He can hear you. Don't block the door, stand here so he can see you."

The woman stepped back against the wall, still clutching her medical insurance card in her palm.

The monitor reported a low voltage again.

Eighty-seven and fifty, heart rate one hundred and thirty-six.

Lin Ye confirmed the two access routes and the time of blood draw, and found Zhou Min outside the emergency room.

She had just finished a phone call, and her phone was still in her hand.

"Director Zhou, the patient in bed three is suspected of having persistent upper gastrointestinal bleeding. Two access routes have been established, and blood routine, coagulation, blood type, and crossmatch tests have been sent. The gastroenterology and blood transfusion departments have been notified. After a small amount of fluid resuscitation, the patient's blood pressure is 87.50 and heart rate is 136. I suggest initiating emergency blood transfusion preparations."

Zhou Min took the record and confirmed the latest blood pressure.

"Until the blood type results are back, have the blood transfusion department prepare according to the emergency plan. I'll contact the gastroenterology department supervisor and the on-call supervisor. You continue to monitor the resuscitation area."

"it is good."

As Lin Ye turned around, Ma Hao raised his hand from the fourth bed and called to him.

"A strong alkaline degreasing agent was used. The right eye was rinsed for five minutes at the scene, and the treatment continued after arriving at the hospital; the pH level was still slightly alkaline. The left eye has normal vision, but the right eye can only see the shadow of a person at the foot of the bed."

Lin Ye checked the ingredients and examined the skin around the right eye and the left eye. The conjunctiva of the right eye was already completely red.

"Keep rinsing, pause for a few minutes after each rinse and then retest. Stop only when the result is close to neutral and stabilized. The ophthalmology department is already on its way."

The man gripped the edge of the bed sheet.

"Doctor, is my eye ruined?"

"Rinse off any remaining cleaning agent first. Don't rub or touch it with your hands. Wait until the pH level stabilizes before consulting an ophthalmologist about corneal damage."

The bedside nurse connected the saline solution to the bed.

"Cooperate first, and the more urgent the situation, the less you should touch anything indiscriminately."

The gastroenterologist pushed open the door and walked towards bed three while putting on gloves.

Nurse Zhu raised her hand in Lin Ye's direction.

"Dr. Lin knows the situation best."

Lin Ye recounted the number of times he vomited blood, changes in blood pressure, the fluid resuscitation he received in the vehicle, and the current treatment.

After reviewing the records, the gastroenterologist examined Du Cheng'an's abdomen and the blood clots in the dish.

"The initial treatment went well, and we're preparing to continue the emergency blood transfusion." He straightened up. "I'll contact the endoscopy team. You guys keep an eye on the blood pressure and any further bleeding."

After the blood transfusion department called back, Zhou Min confirmed that the blood transfusion was ready.

The blood pressure in the third bed returned to 94 or 95. Du Cheng'an's complexion was still poor, but his eyes were clearer.

Beside bed number four, a young man in a chef's uniform stood guard at the foot of the bed, his hat askew on his head.

The cleaning solution packaging bag was placed next to the emergency room record.

"I've cleaned up the shop, and the boss said you should get your eyes checked first." He looked at his colleague on the bed. "Xiao Zheng, you'll still get paid for today. Don't worry about this."

Zheng Hang gritted his teeth, gripping the bed sheet so tightly that the fabric was torn into several wrinkles.

"I've only been doing this for three days... If I really can't see clearly with this eye, who will dare let me handle a knife in the future?"

The nurse at his bedside wiped the water from his ears.

"Don't think the worst yet. The ophthalmologist will come to check you right away, and we'll handle it step by step."

The ophthalmologist arrived pushing an examination cart.

After pausing for a few minutes, the test was repeated. The values ​​were close to neutral and did not rise. Only then were the visual acuity of both eyes checked and a slit-lamp examination performed.

"Go to the ophthalmology treatment room first, and I will report back to the emergency room as the situation develops."

The bedside nurse handed the packaging and emergency records to the ophthalmologist. After Zheng Hang was wheeled away, she separated the toiletries and gave up her bed.

The bed turnover nurse pushed the cleaning cart over, and the triage nurse also rushed to the door with the new forecast.

"The next ambulance is in four minutes. Male, 30 years old, fainted once after diarrhea, blood pressure is 96-96, currently receiving IV fluids on the ambulance. Can bed four go in directly?"

Lin Ye first confirmed that the patient in bed two was still waiting for troponin, and then asked the patient in bed three about his latest blood pressure.

"Prepare for bed four first. Change all the toiletries and reconnect the monitor. Go to the door to receive the ambulance and recheck the blood pressure and consciousness. If the blood pressure drops again, move bed four to the monitoring station at the emergency entrance without waiting for bed four. I'll go check on them later."

The triage nurse nodded: "I'll take the forecast over and connect the monitor at the door first."

The cleaning vehicle had just arrived at bed four when the siren sounded from the emergency entrance, a minute early.

Lin Ye handed the record in his hand to Nurse Zhu.

"Call me immediately if there are any changes in the third bed."

He turned and walked towards the arrival gate.