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

Before the second night began, Lin Ye slept for forty minutes in the duty room.

When I woke up, there were three messages from the director's group chat on my phone.

Meng Qingwei: [The child was transferred to the pediatric intensive care unit last night; their blood pressure has stabilized.]

Shen Ruomei: [The new mother woke up and her first question was about the baby.]

Liang Xiulan: [The premature baby is still on a ventilator. Don't ask me if he's okay; just being alive is good enough.]

Nurse Zhao posted a single word below: 【凶】 (fierce/ ominous)

Liang Xiulan replied: [The emergency room was even worse last night.]

Lin Ye stared at the screen for a few seconds, then put his phone down.

He didn't dare show his relief on his face.

The second night in the emergency room was quieter than the first.

It was quiet until 12:30 a.m. before an ambulance brought in a patient with a fever.

The woman was in her thirties, wearing a woolen hat, with a sallow complexion, and a thin blanket draped over her shoulders. Her husband, who had accompanied her, pushed her wheelchair while explaining.

"It's just a low-grade fever, below 38 degrees Celsius. She recently finished chemotherapy, and the community hospital said her white blood cell count was low, so they told us to come to a larger hospital for a checkup."

Upon hearing the words "chemotherapy completed," Nurse Zhao immediately moved the triage sign in her hand from the yellow zone to the edge of the red zone.

The husband panicked: "Nurse, is this some kind of exaggeration? She's just weak and here for an IV drip."

Nurse Zhao looked up: "Low white blood cell count and fever after chemotherapy are not considered normal weakness."

The woman whispered, "I don't want to be hospitalized; my child has to go to school tomorrow."

As Lin Ye walked over, the system notification popped up.

[Emergency room alert activated.]

High-risk: Neutropenia with infection, early stage of septic shock.

Key abnormalities: low-grade fever, chills followed by fatigue, seventh day after chemotherapy, cold and clammy extremities.

[Risk window: 31 minutes 44 seconds.]

He looked at the monitor.

Body temperature 37.8, heart rate 128, blood pressure 92.55, oxygen saturation 97.

Judging by the body temperature alone, it certainly doesn't seem dangerous.

But her fingertips were cold, her lips were dry, and she was slow to answer questions.

When was your last chemotherapy session?

The husband said, "Seven days ago. After breast cancer surgery and chemotherapy, the doctor said my white blood cell count would be low these few days and advised me to be careful of infection."

"Have you been shivering today?"

The woman closed her eyes briefly: "It suddenly got cold this afternoon, and I shivered for more than ten minutes before I lost my strength."

Do you have a cough, painful urination, or abdominal pain?

"I didn't have a noticeable cough, but it hurt a little when I urinated, which I thought was because I wasn't drinking enough water."

Sun Zhiqiang came over from the side and, upon hearing this, his expression turned serious.

"Complete blood count, CRP, PCT, two sets of blood cultures, urinalysis, liver and kidney function tests, electrolytes, and lactate. Perform a culture first, then administer antibiotics. Notify the oncology and infectious disease departments."

The husband became unhappy when he heard "anti-infection" and "infectious disease department".

"Doctor, she just came in for a white blood cell booster injection, why did they draw so much blood? You were just on the news last night saying how serious car accident rescues are, you can't scare ordinary patients like this today, can you?"

Several people in the emergency room looked up.

Nurse Zhao slapped the tape on the treatment tray: "The news group won't save your wife. When her white blood cell count is low, even a temperature below 38 degrees Celsius can cause serious problems."

The husband's face flushed red: "It's not that I don't want to treat you, it's that I'm afraid you'll conduct excessive tests."

Lin Ye opened the medical record folder without arguing with him.

"She currently has low blood pressure and a fast heart rate. It's the seventh day after chemotherapy, and she's experiencing chills and painful urination in the afternoon. We suspect neutropenia with infection. Her temperature isn't high, but it could deteriorate rapidly."

The husband was stunned for a moment: "What...what will happen?"

"He will go into shock," Lin Ye said. "We'll draw blood for culture first, then start anti-infection and fluid replacement as soon as possible. Every step is written in the medical record; you can look at it, but we can't delay."

The woman gently tugged at her husband's sleeve: "Listen to the doctor."

The husband gritted his teeth: "Where should I sign?"

Nurse Zhao handed over the informed consent form: "Sign the treatment consent form first. This isn't a house sale contract, so don't let your hands shake so much."

The husband lowered his head to sign, still stubbornly insisting, "I'm just cold."

The woman suddenly shivered.

The blood pressure on the monitor dropped to 86 or 85.

Sun Zhiqiang immediately raised his voice: "Establish a second access route, administer fluids. Prepare antibiotics, and start the culture immediately after it's taken."

Lin Ye watched the system countdown tick, but did not report it to the system.

He simply placed the evidence, one by one, on the medical records.

"On the seventh day after chemotherapy, the patient has a low-grade fever, chills, and decreased blood pressure, suspected of having an infection with neutropenia. Professor Sun, I suggest notifying the ICU for evaluation at the same time, instead of waiting for the lactate test results to come back."

Sun Zhiqiang glanced at him.

This time, they didn't say "You're here again."

"Call up."

Jiang Peng immediately picked up the phone: "Is the ICU on duty? Emergency, fever after chemotherapy, low blood pressure, suspected neutropenia with infection, please come and assess."

Ten minutes later, the critical values ​​came back first.

White blood cell count: 0.4.

The absolute number of neutrophils is 0.05.

Lactic acid 3.6%.

The husband sat frozen in his chair.

He looked at the test report, and his voice suddenly lowered.

"Is her condition really that serious?"

The infectious disease department called and demanded that the case be treated as high-risk immediately, and the oncology department also sent someone down.

When the ICU doctor arrived, the woman's blood pressure was barely maintained by intravenous fluids.

The system prompts an error.

[Patients in the red zone: Entering effective treatment procedures.]

Lin Ye handed the test results to her husband.

"It's serious now, but not hopeless. You signed quickly, which is important."

The husband's eyes reddened, and he raised his hand to wipe his face.

"Doctor, I apologize for what I said earlier."

Nurse Zhao walked by and said, "Save your energy for admissions. Apologizing won't raise your white blood cell count."

The husband nodded quickly, "Okay, okay."

As the woman was being wheeled into the transitional ward of the intensive care unit, she suddenly turned around.

"Doctor, my child has school tomorrow..."

Lin Ye leaned down: "You need to save yourself first. Someone will take the child to school."

The woman closed her eyes, a little wet at the corners.

At 2 a.m., Liu Zhenhua came again.

He didn't bring an umbrella this time; instead, he held a preliminary review form of the multiple traumas he experienced last night.

"Lin Ye, Director Qin, the hospital will be holding a debriefing meeting for the emergency team tomorrow morning. It's good that you had zero deaths last night, but there are a few points regarding the procedures that need to be clarified."

Qin Hai didn't even look up: "Speak."

Liu Zhenhua looked at the patient who had just been wheeled away: "This one will also be reviewed tonight."

Sun Zhiqiang frowned: "She hasn't given us the results yet."

Liu Zhenhua said, "Precisely because the results are not yet available, the hospital now wants to know whether the emergency team relied on Lin Ye's early warning or a replicable procedure."

The emergency room was silent for a few seconds.

Lin Ye put the medical record he had just finished writing into the medical record folder.

He said, "Then write down the process."

Qin Hai looked at him.

Lin Ye's voice was a little hoarse, but very steady.

"Under what circumstances should the red zone be moved forward? Under what circumstances should a culture be drawn before medication? Under what circumstances should the intensive care unit be called in advance? Write everything you can down."

Liu Zhenhua neither said it was good nor bad.

He simply placed the debriefing sheet on the table.

"Tomorrow morning at eight o'clock. Don't be late."

Nurse Zhao glanced at the clock on the wall: "Eight o'clock? We're not finished with our night shift yet."

Liu Zhenhua paused for a moment: "I'll bring you breakfast."

Nurse Zhao raised an eyebrow: "Director Liu, should I put that in the medical record?"

Liu Zhenhua said expressionlessly, "I'll remember it."

The system taskbar flashed briefly in Lin Ye's field of vision.

[Current night shift: Night 2.]

[In-hospital deaths: 0.]

[Emergency Room Weekly Progress (Zero Fatalities): 2/7, Pending Confirmation]

Lin Ye looked at the debriefing sheet.

Saving one patient tonight is not enough.

They need to write down why they were able to save people, so that others can use it next time.