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

At 11:05 p.m., Lin Ye pushed open the door of the emergency CT room with one hand.

"Push on machine number one! Thin-slice scanning plus 3D reconstruction!"

Lin Ye didn't stop walking; the flatbed was directly aligned with the examination bed.

Fang Rui and Nurse Zhao worked together from both sides to move the limp and unconscious patient onto the examination bed.

The gastric tube has been successfully connected.

Lin Ye picked up the infusion syringe, drew up 30 milliliters of the prepared meglumine diatrizoate water-soluble contrast agent, and gently pushed it into the gastric tube.

"Breath-holding scan, quick!"

The lead door slid inwards perfectly, sealing the door tightly.

Inside the control room, Lin Ye and Fang Rui stood in front of the transparent radiation-proof lead glass, their eyes fixed on the high-resolution monitoring screen.

The CT scanner emits a high-frequency rotating hum, and the green tomographic beam rapidly cuts and advances across the patient's chest and abdomen at millimeter-level speeds.

One second, two seconds, three seconds.

The black-and-white tomographic images on the screen were scrolling down frame by frame at breakneck speed.

When the scanning beam swept across the lower esophagus above the diaphragm, the image in the center of the screen made the CT technicians in the control room hold their breath.

On the left posterior wall of the lower esophagus, there was a clear tear that was 3.5 centimeters long.

The high-density white contrast agent that had just been injected through the gastric tube surged out of the huge hole like a flood bursting through a dam, filling the entire posterior mediastinum and overflowing into the left pleural cavity through the mediastinal hole!

The entire mediastinum was severely swollen and enlarged by a mixture of black and white gas and liquid, and the lower lobe of the left lung was compressed into a solid, fleshy sheet by the high-pressure gas and liquid.

"It...it really exploded?!"

Fang Rui stared at the overflowing imaging on the screen, feeling a chill run down his spine.

"This is a typical case of spontaneous esophageal rupture."

Lin Ye stared at the long, lacerated wound.

The lead door slid open again.

As soon as the flatbed cart was pushed out, a series of hurried footsteps came from the end of the corridor.

The on-call doctor in the cardiothoracic surgery department rushed to the door, panting, clutching a pair of surgical gloves.

"Where's the patient? Have the scans come back yet?"

The thoracic surgery duty officer strode to the screen, glanced at it, and immediately broke out in a sweat.

"Holy crap... a longitudinal rupture in the lower esophagus, with massive contrast agent leakage! It's a genuine spontaneous esophageal rupture! We haven't seen a single case of this in three years in our department. He's only twenty-four; how could he have gotten his esophagus into this state?"

"Binge eating combined with violent dry heaving caused a sudden increase in intracavitary pressure, leading to a physical rupture."

Lin Ye pushed the flatbed cart out.

"The stomach acid and digestive enzymes have completely rotted the posterior mediastinum, so we must immediately perform open-chest surgery to repair it and drain the mediastinum."

"Understood! I'll call the department head right away and have him go on stage!"

The thoracic surgery duty officer acted decisively, reaching out to grab the flatbed cart handle.

"The emergency access to the operating room is already set up, and the anesthesiology department is waiting upstairs. Push them directly into the elevator and into the operating room!"

"etc!"

Lin Ye suddenly pressed down on the front brake of the flatcar.

The young man in the hospital bed suddenly coughed violently, his whole body displaying extreme terror and near-death experience.

His face, which had been deathly pale, turned a terrifying bluish-purple cyanosis in an instant, and he gasped intermittently from his throat.

Beep...beep...beep...!

The alarm on the portable monitor suddenly went off!

The pulse oximetry reading plummeted from 91% to 82%, 75%, 68%...

The cuff inflated and deflated automatically, and the screen displayed an extremely low reading indicating imminent death: 58/36 mmHg, with the heart rate soaring to 148 beats per minute!

"His blood pressure has plummeted! He's cyanotic due to lack of oxygen!" Fang Rui exclaimed in a hysterical voice, "How could it deteriorate so quickly?"

"It's tension pneumothorax!"

The thoracic surgeon on duty was so anxious that his eyes turned red, and he frantically pushed the handlebars flat.

"The rupture is leaking air and water continuously, and the intrathoracic pressure is completely out of control! Don't stop, push the elevator! Rush up and intubate again!"

"No elevator!"

Lin Ye's hands gripped the car body tightly like iron clamps.

"The mediastinum is severely shifted to the right, and the inferior vena cava has been twisted into a dead knot by high pressure, almost completely cutting off blood return to the heart! It takes two minutes to go up in the elevator, and he will suffer electromechanical dissociation and die suddenly inside before the elevator doors open!"

The thoracic surgery duty officer froze.

"What do we do then? Just stand here and stare blankly?!"

"Relieving stress by dissecting your chest on the spot!"

Lin Ye suddenly turned his head.

"Fang Rui, lock the stretcher against the wall and go to the CT preparation room to get the sterile thoracentesis drainage kit! Sister Zhao, get the local anesthetic lidocaine that's already been tested and the No. 10 surgical blade!"

In this critical moment, the emergency team cooperated without hesitation.

The flatbed cart braked sharply, and a sterile treatment towel was spread out on the patient's sweat-soaked left chest wall with a snap.

Apply iodine solution immediately.

Lin Ye put on a sterile glove on his right hand and precisely placed two fingers of his left hand into the fifth intercostal space between the anterior axillary line and the mid-axillary line on the patient's left side.

There was not a single unnecessary movement.

Lidocaine quickly seeped in, and Lin Ye grabbed a scalpel and decisively made a two-centimeter incision at the target point.

As soon as the dark red blood beads appeared, a medium-sized curved hemostat landed steadily in Lin Ye's palm.

Blunt dissection of the intercostal muscles.

Slide along the upper edge of the ribs, avoiding the nerve and blood vessel bundles under the ribs, press the tip of the clamp against the tough parietal pleura, and suddenly exert force with the right wrist, sinking the wrist and pushing.

puff!

With a muffled popping sound, a nauseatingly strong, sour, and putrid stench mixed with high-pressure gas gushed out from the cut!

Immediately afterwards, a dark brown, murky liquid mixed with undigested meat scraps and thick stomach acid, along with blackened blood, gushed out from the wound.

"Use forceps to open the channel! Use a large drainage tube!"

Lin Ye's right hand was as steady as a rock as he took the large-diameter No. 28 chest drainage tube and precisely inserted it eight centimeters into the left pleural cavity through the channel guided by the hemostat.

Use a slip-lock ligature to secure the pipeline and connect the water seal drainage bottle!

Glug, glug, glug...

The sterile saline solution in the water-sealed bottle was instantly stained thick with turbid gastric juice, and huge bubbles burst out of the long tube. The water level column churned violently up and down under the intense release of pressure in the chest cavity.

In just half a minute, a full 600 milliliters of a sour and foul-smelling liquid-gas mixture was drained!

The twisted mediastinum instantly rebounded and returned to its original position, and the collapsed inferior vena cava re-dilated and filled.

On the monitor, the pulse waveform, which had been a weak straight line, suddenly spiked, and the heart rate quickly dropped from a frantic 148 beats per minute to 112 beats per minute.

血压如同弹簧般触底反弹：75/48……85/55……96/62 mmHg！

With high-flow oxygen via a face mask, the pulse oximetry reading climbed back up from a suffocating 68% to 95%, albeit with difficulty and determination.

The young man, who had been convulsing on the verge of death, finally relaxed his tense limbs, and his breathing became deep and even again.

In the far depths of my vision, the line of pale blue, semi-transparent numbers faded, gradually becoming lighter and completely disappearing from sight.

The on-call thoracic surgeon looked at the bubbles in the water-sealed vial and the stabilizing vital signs, his forehead dripping with cold sweat.

He looked up, his eyes filled with lingering fear and amazement as he gazed at Lin Ye.

"President Lin... if you had actually listened to me and pushed the elevator, this guy would be dead in the elevator shaft. I'm impressed, truly impressed."

Lin Ye took off his rubber gloves, which were splattered with tiny stains.

"The high pressure has been relieved, and the mediastinum has returned to its original position. The intrathoracic pressure is now stable. We'll move him to the operating room immediately. He's within the golden twelve-hour window, and there's still time to repair his esophagus."

"Alright! Leave the rest to us in the chest surgery department!"

The on-call thoracic surgeon grabbed the bubbling drainage bottle, told the operating room nurses to push the trolley, and ran towards the dedicated surgical elevator.

The elevator doors slid open, a flatbed cart was pushed in, and the metal doors slowly closed.

The noisy corridor fell silent instantly.

Lin Ye stood still, raised his hand to wipe the fine sweat from the tip of his nose, and let out a long breath.

Fang Rui leaned against the wall, looked down at his aching arms, and smiled with lingering fear.

"Teacher Lin, every time I'm on duty with you, my heart rate never drops below 120."

"Go back to the emergency room and clean the floor."

Lin Ye patted him on the shoulder.

The two walked back to the red zone through the empty emergency room corridor.