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

Friday morning, in the emergency room lobby.

Tang Wen was sitting in front of a computer in the observation area, processing the data of a patient who had just finished an examination.

"Doctor, the X-rays are in. Would you mind taking a look at the bones?"

A middle-aged woman dressed in a business suit and wearing delicate makeup hurried over, holding a radiology report in her hand.

She was holding her phone in her other hand, the screen lit up, clearly indicating she had just been dealing with work messages.

Behind her, an elderly woman, around seventy or eighty years old, sat in a wheelchair at the hospital.

The old lady was wearing a slightly worn floral nightgown, clutching a cloth bag tightly in her hand, and looked somewhat tired.

"Okay, let me take a look."

Tang Wen took the report and retrieved the patient's imaging data on the computer.

The patient's name is Liu Shufen, and she is 78 years old.

She was pushed in by her daughter Zhang Mei in a wheelchair half an hour ago.

The patient's chief complaint was that while washing up in the bathroom in the morning, he accidentally slipped and fell, hitting his left hip hard against the door frame.

For the elderly, falling is an extremely dangerous sign, especially as it can easily lead to femoral neck fractures, which have a very high mortality rate.

Tang Wen didn't dare to be negligent and immediately had her body checked.

Fortunately, the old lady's left lower limb did not show the "shortening and external rotation" deformity that is characteristic of fractures, but just to be on the safe side, Tang Wen still ordered an anteroposterior and lateral X-ray of the pelvis and left hip joint.

"Ms. Zhang, your mother is lucky." Tang Wen carefully reviewed the X-ray, then breathed a long sigh of relief. "The cortical bone is intact, with no signs of fracture. The left hip only has a common soft tissue contusion."

"Oh, thank goodness, thank goodness!" Zhang Mei breathed a long sigh of relief upon hearing that "there was no fracture."

She turned her head and complained to the old lady in the wheelchair.

"Mom, how many times have I told you? The bathroom floor is slippery, you need to wear non-slip slippers! That caregiver is so inconsiderate, she only earns six thousand yuan a month, and she can make you slip and fall just by going to the kitchen to get a glass of water! I was getting ready for the company's morning meeting when I got the call, I was scared out of my wits."

The old lady lowered her head, breathing slightly heavily, and mumbled something indistinctly.

"It's not that my shoes are slippery..."

"It's alright, Mom. It's good that you're alright."

Zhang Mei didn't hear what the old lady said, nor did she care. She glanced at her watch, and her expression became anxious again.

"Doctor, since there's no fracture, can I just get some medicine to improve blood circulation and remove blood stasis, or spray some Yunnan Baiyao and go home? I have a very important client meeting at 10:30."

"Sure." Tang Wen skillfully typed on the keyboard, preparing to write a prescription for medication to be taken home from the hospital. "For the first three days after returning home, apply cold compresses, then apply hot compresses. The elderly person is old, so try to let her rest in bed as much as possible these few days, and make sure someone helps her when she goes to the toilet."

"Okay, okay, I'll go back and fire that caregiver and find a more reliable one."

Zhang Mei readily agreed.

Just as Tang Wen was about to click "Print Prescription", a hand reached out from the side and gently pressed on the mouse.

Tang Wen was taken aback, looked up, and saw that Lin Ye was standing behind her at some point.

"Teacher Lin?"

Lin Ye didn't look at the computer screen; his gaze went past the triage desk and was fixed on Liu Shufen, the elderly woman in the wheelchair.

He had heard every word of Tang Wen's conversation with her family.

If it were the Lin Ye of the past, upon seeing an X-ray showing no fractures, he would probably have thought, like Tang Wen, that the alarm was over.

But today, the quiet demeanor of the old woman in the wheelchair stirred a sense of unease within him.

It's too quiet.

Although soft tissue contusions are not as bad as fractures, for a 78-year-old man who is extremely sensitive to pain, it is impossible for him to hit his left hip on the door frame without making a sound.

Lin Ye walked around the triage desk, went to the wheelchair, and squatted down.

"grandmother."

Lin Ye softened his voice and gently took the old lady's hand, which was resting on her knee.

Lin Ye's brows furrowed slightly as soon as he touched the old man's skin.

The old lady's hands were extremely cold, and there was a faint layer of damp, cold sweat on her palms.

In the emergency room lobby, which wasn't particularly cold in early autumn, this body temperature was definitely abnormal.

The old lady slowly raised her head, her eyes somewhat cloudy as she looked at Lin Ye.

"Grandma, do you remember how you fell this morning?" Lin Ye looked into her eyes. "Did you slip on water, or did you trip over the threshold?"

Zhang Mei hurriedly interjected, "Doctor, it must be because the floor was slippery. The caregiver I hired just mopped the floor not long ago..."

Lin Ye raised a hand to stop Zhang Mei from speaking, his gaze still gentle yet firm as he looked at the old lady.

"Grandma, you tell me yourself."

The old lady opened her mouth slightly, her breathing becoming somewhat rapid.

She shook her head, her voice hoarse and weak.

"I didn't step in the water... it's just that when I stood up, my legs suddenly felt like noodles, I had no strength at all... everything went black and I collapsed."

Lin Ye's eyes sharpened instantly.

It wasn't a slip or a trip, but a fall caused by **"weak legs"** and **"a sudden blackout"**!

In geriatrics, this is called a non-mechanical fall.

For an elderly person who was previously able to walk normally, this sudden general weakness is definitely a sign that there is a serious problem with some internal medical system!

Lin Ye immediately stood up and glanced at the vital signs record sheet that had been taken at the triage desk when the old lady came in.

Body temperature: 36.8 degrees.

Blood pressure: 105/60 mmHg.

Heart rate: 108 beats/min.

Breathing: 24 breaths/min.

This blood pressure might be normal for a young person.

But Lin Ye turned to look at Zhang Mei.

Does your mother have high blood pressure? Does she usually take antihypertensive medication?

"Yes, I've had high blood pressure for over ten years. My blood pressure is usually around 140/90, and I've been taking Glucobay."

Zhang Mei was a little confused by Lin Ye's suddenly serious tone.

Lin Ye's heart skipped a beat.

My blood pressure is usually 140, but now it has dropped to 105! In the elderly, this is called "relative hypotension," and it is only a thin line between being in shock and actually going into shock.

In addition, a heart rate of 108 beats per minute and rapid breathing of 24 breaths per minute are definitely not normal signs for a patient with "soft tissue contusion"!

"How has the elderly person's appetite been these past few days? Have they been coughing? Are their bowel movements and urination normal?"

"Her appetite... doesn't seem very good." Zhang Mei seemed flustered and stammered, "I'm usually too busy with work, I only come to see her on weekends. A full-time caregiver takes care of her daily needs. I haven't even paid attention to her bodily functions."

This is the situation that Lin Ye hates the most, yet is most common in the emergency department—**care gap**.

Family members who truly understand the details of an elderly person's daily life are often not around, and caregivers who are present often only care about basic needs like eating, drinking, and toileting, lacking medical knowledge. By the time the elderly person is taken to the hospital, the information provided by the family is often delayed or even completely incorrect.

"Tang Wen, don't write the prescription. This patient can't leave." Lin Ye turned around and decisively gave the order, "Draw blood from the old man immediately, do a complete blood count, a full biochemistry panel, and add an arterial blood gas analysis to check lactate! Also, collect a urinalysis!"

Tang Wen was stunned.

"Dr. Lin, the X-ray doesn't show a fracture... What are you suspecting by checking these internal medicine indicators?"

Zhang Mei panicked, glancing at the endless stream of unread messages popping up on her phone: "Doctor, what are you doing? Didn't you say the bone was fine? The old man is getting on in years, why are you drawing so much blood? I'm really in a rush to get to my meeting!"

"Your mother didn't slip and fall by accident at all."

Lin Ye turned his head and looked at the anxious middle-aged woman, his voice as stern as a heavy hammer.

"She collapsed because some system inside her body was severely failing, causing her to completely lose the strength to stand! If I let you spray some Yunnan Baiyao on her and take her home today, I guarantee you won't even have time to call an ambulance before tonight!"

Lin Ye pointed to the phone that Zhang Mei was clutching tightly in her hand.

"If you think that meeting is more important than your mother's life, you can sign the papers and force her to leave. But if you want her to live, call your caregiver now, immediately, and ask about every single detail of your mother's bowel movements and urination over the past two days!"