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

Thursday, 8:30 a.m.

I spent the whole day on Wednesday resting completely in my rented apartment.

Fully recovered, Lin Ye put on a crisp white coat, hung up a name tag that read "Team Leader of Emergency Room A," and went to work on time.

Good morning, Teacher Lin!

Fang Rui approached with a stethoscope in hand.

"You'll be in charge of the outpatient observation area today. If you encounter any problems, just call me."

Lin Ye was tidying up the first aid records on the table while giving instructions.

"clear!"

Just after nine o'clock, a middle-aged man with an extremely listless expression was wheeled into bed number two of the observation room.

The patient was forty-five or forty-six years old, wearing a gray short-sleeved work uniform, with a sickly sallow complexion, and was shivering despite being covered with a thin blanket.

His wife, with red-rimmed eyes, was holding a thick stack of lab reports and film bags from another hospital, her voice hoarse with anxiety.

"Doctor, please save my husband! He's been on IV drips at a small local hospital for a week, and his high fever just won't go down. He's almost delirious from the fever!"

Fang Rui quickly stepped forward to treat the patient.

The mercury thermometer was removed, and the red mercury column reached a temperature of 39.4℃.

With the multi-parameter monitor attached, the heart rate was 115 beats per minute, blood pressure was 110/70 mmHg, and pulse oximetry was within the normal range.

However, upon reviewing the patient's blood routine and biochemistry reports from another hospital, a string of red text with downward arrows on the lab reports was glaringly obvious:

Platelet count dropped to 54×10^9/L, and alanine aminotransferase (ALT) soared to 380 U/L, doubling in transaminase levels, indicating early signs of multi-organ involvement.

"Where did you go for treatment? What medications were used?"

Fang Rui asked questions while flipping through the medical records.

"I first went to the community clinic, where the doctor said it was a cold and prescribed antipyretics and amoxicillin. After three days of taking them, the fever did not subside, so I went to the Second District Hospital. A chest CT scan showed a small patchy shadow in my lungs, and I was treated for severe bacterial pneumonia. I received high-dose antibiotics, including cefoperazone and sulbactam, for four consecutive days."

The wife wiped away her tears.

"But the fever keeps getting higher every day. This morning I couldn't even walk straight, and every bone in my body aches!"

Despite four full days of treatment with broad-spectrum, potent antibiotics, the high fever not only failed to improve, but platelet counts and liver enzymes also deteriorated drastically.

Fang Rui frowned.

The referral recommendation from the other hospital even included "suggestion to screen for hematologic malignancies".

But Fang Rui's mind was instantly filled with Lin Ye's stern admonitions:

"In the emergency room, when faced with fever of unknown cause, we must never blindly rely on machines and lab reports. If a clear source of infection cannot be found in the fever, we must examine every inch of the patient's skin!"

Fang Rui did not rush to order expensive blood biopsies or advanced screening tests.

He turned around and instructed the nurse, "Draw the curtains and prepare for a full physical examination."

The light blue curtains slammed shut, shutting out the noisy corridor.

Fang Rui put on sterile gloves, picked up the flashlight from the bedside, and looked focused and calm.

He started by examining the patient's hairline, carefully parting the hair inch by inch; then he examined the area behind the ears, the neck, the chest, the back, and under the ribs on both sides.

Apart from the skin turning red due to the high temperature, there were no obvious rashes or bleeding points on the skin surface.

The patient sighed weakly, "Doctor... I've had my whole body checked, there are no external injuries, but my whole body feels hot and my bones ache."

Fang Rui did not stop moving.

He gently lifted the patient's right arm, his movements delicate yet thorough as he parted the layers of skin deep within the patient's right armpit.

Shining the cold light of a flashlight, Fang Rui discovered a lesion the size of a soybean hidden deep within the skin fold of the patient's right armpit.

It was a small, round nodule with a charred, sunken, dry scab in the center. The edges were slightly raised, and a dark red, congested halo about half a centimeter wide surrounded it!

There is no pus discharge, nor is there any redness or swelling; the patient does not even feel the slightest pain or itching.

"Effusion!"

Fang Rui's heart pounded wildly.

He immediately lifted the curtain and strode towards the nurses' station.

"Teacher Lin! The patient in bed two has a fever of unknown origin, could you come and take a look?"

Lin Ye put down his pen and strode into the enclosure with Fang Rui.

Fang Rui gently lifted the skin folds under the patient's right armpit with a cotton swab.

"Teacher Lin, look here. There is an isolated eschar deep in the armpit. The surface is smooth and dry, but the edges are congested and edematous, which is consistent with a painless necrotic ulcer."

Lin Ye bent down and examined the area closely for two seconds.

"Did you inquire about the epidemiological history?"

Lin Ye turned to look at Fang Rui.

"I've asked! The week before the onset of the illness happened to be a weekend, and the patient went fishing with friends on a grassy beach near a reservoir in the suburbs. They sat in the knee-high weeds for a whole afternoon! At the time, they felt some itching in their armpits and ankles, but thought it was just mosquito bites and didn't pay any attention to it!"

The history of fishing in the wild, the unusual black eschar, high fever, a sharp drop in platelets, and liver damage—the chain of evidence instantly and tightly sealed the case.

"Typical eschar."

"Scrub typhus is an acute rickettsial infection caused by the bite of chigger larvae in wild weeds."

His wife, standing nearby, was stunned.

"Scrub typhus? What kind of bug is that?"

"A tiny larva that parasitizes wild mice and grassy weeds. The cephalosporin antibiotics used in other hospitals only target common bacteria and have no effect on rickettsia, which is why the high fever persists. The toxins spread throughout the body via the capillaries, causing widespread inflammation of small blood vessels, which leads to the massive consumption and destruction of platelets."

Lin Ye picked up the medical record folder and turned to look at Fang Rui.

"Let's give the doctor's orders."

"Discontinue all cephalosporins and antibiotics that increase white blood cell count. Administer oral doxycycline hydrochloride tablets, 200 mg initially, followed by 100 mg twice daily; supplement with reduced glutathione for liver protection and warm fluid replacement to promote toxin excretion!"

"The doctor's orders are accurate and should be followed."

Lin Ye neatly signed his name as the team leader for the review.

Sister Zhao carried the medicine tray and walked quickly into the ward.

Just half an hour later, the specific targeted drug was precisely administered.

Stepping out from behind the curtain, Fang Rui let out a long breath and touched the tip of his nose somewhat shyly.

"Teacher Lin... I didn't miss anything during my physical exam, did I?"

Lin Ye stopped and turned around to carefully examine the young man who had followed him through thick and thin.

Lin Ye reached out and patted Fang Rui hard on the shoulder, a rare, hearty smile appearing on his lips:

"You spotted that blind spot deep in the armpit, a detail that three senior doctors from another hospital couldn't see, right away. Your physical exam was thorough, and your questioning of the patient's history was accurate. Fang Rui, you've really hit the nail on the head. You've done a great job for our Group A today."

Upon hearing this weighty recognition, Fang Rui's eyes welled up with tears, and his back straightened instantly.

"It's all thanks to the hard work and dedication that Teacher Lin put us through!"

At the nurses' station, Sister Zhao and several nurses on duty gave a thumbs up after hearing the story, creating a rare light and harmonious atmosphere in the corridor.

At 11:30 a.m., the morning rush hour for the day shift passed smoothly.

The triage desk phone rang.

Sister Zhao answered the phone, listened for a couple of minutes, and then gestured to Lin Ye.

"Lin Ye, Director Qin wants you to go to his office."

Lin Ye straightened his collar, strode across the corridor, and knocked on the door of the emergency department director's office.

"Enter."

Qin Hai sat behind his large desk, on which lay several thick official documents, and steam rose gently from his teacup.

Seeing Lin Ye walk in, Lao Qin raised his head, his eyes revealing an unprecedented scrutiny and gravity.

"I heard about Fang Rui finding the scrub typhus eschar on the patient in bed two with a high fever."

Qin Hai leaned back in his chair and tapped his knuckles lightly on the table twice.

"He's doing a pretty good job leading the team, and his subordinates have also developed their skills."

Fang Rui is meticulous.

Lin Ye said modestly.

"Alright, stop trying to fool me."

Qin Hai suppressed his smile and pushed the official document with the bright red lettering of the Provincial Health Commission onto Lin Ye's desk.

The official document, printed in black on a red background, prominently displays its title:

[Decision on Selecting Top-Tier Hospital Physicians to Provide In-Depth Pairing Assistance to Cangshan County People's Hospital through the Medical Consortium]

Lin Ye's eyes narrowed.

Qin Hai lit a cigarette, and the bluish-white smoke slowly dissipated in the sunlight.

"The city is deepening the construction of medical consortia, and it is necessary to truly bring top-notch medical resources down to the grassroots level. Cangshan County is located in a remote mountainous area with difficult mountain roads. The county hospital's emergency department has a weak foundation, outdated equipment, and lacks decisive front-line leaders."

Qin Hai's gaze fell on Lin Ye's face.

"Old Liu nominated you at the hospital affairs meeting, and I agreed. You will be the head of the emergency department, stationed at Cangshan County Hospital, to take over their emergency department operations."

Qin Hai slammed the document heavily into Lin Ye's palm.

"This trip to the county won't have any on-call specialists or readily available thin-slice CT scans; you'll have to rely entirely on your naked eye and two fingers. Lin Ye, are you willing to take on this heavy responsibility?"