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

When the man said he couldn't open his mouth, there was a half-second of silence at the triage desk.

It's not that nobody heard it.

This symptom is so unlike the common complaints seen in the emergency room.

Fever, leg pain, nail puncture wound.

These can all be attributed to infection, cellulitis, or wound suppuration.

But as soon as he found it difficult to speak, the list that had just been posted on the wall suddenly seemed to be missing a piece.

Nurse Zhao went first.

She pressed down on the call button on the triage desk: "Don't wait in line, push us to the emergency room."

The man's wife was stunned: "Isn't it a tetanus shot? The community hospital said one shot would be enough."

Lin Ye had already walked around the triage desk.

He didn't touch the man's chin, but only let him try to speak.

The man tried to open his mouth, but his jaw seemed to be stuck, leaving only a narrow gap.

Sweat rolled down his cheeks from his forehead.

"Your legs hurt a lot?"

The man mumbled, "It hurts, my back is tight, and my neck is stiff."

Lin Ye looked at Nurse Zhao: "Don't move too much, don't let too many people gather around, go to the bed at the back of the emergency room first."

Nurse Zhao immediately rushed to the side and shouted, "Please talk to the unrelated family members away first, don't turn on all the lights, and move the monitor over there."

The wife panicked.

"Doctor, is he really that serious? He was walking on his own yesterday!"

Qin Hai looked up from the office doorway.

"Who is more seriously ill?"

Lin Ye held up the gauze on the man's right calf, not in a hurry to remove it.

"Contaminated wound, fever, difficulty opening the mouth, muscle tension, risk of tetanus."

Qin Hai's face immediately darkened.

"Call Sun Zhiqiang. Notify the on-duty doctor in the infectious disease department, and have the intensive care unit answer the phone first. Check the pharmacy's stock of tetanus immunoglobulin, prepare tetanus vaccine, and also stock up on antibiotics."

Nurse Zhao's hand was already on the phone.

Upon hearing this list of departments, the wife turned pale: "Wait, isn't tetanus a preventative shot? Why do we need the intensive care unit?"

Qin Hai didn't scold her.

He pointed to the man's tense jawline.

"Prevention is something that happens before the disease develops. Since there is already difficulty opening the mouth and muscle tension, we should treat it as a dangerous situation."

The man was moved to a bed further inside the emergency room.

Nurse Zhao pulled the curtain closed and turned down the volume of the monitor that was not in use next to her.

The emergency room was still calling numbers outside.

The room fell silent.

This silence is more unsettling than noise.

Lin Ye leaned down and asked, "How did you get pricked yesterday?"

The man swallowed hard. "It was a construction site. There was a nail on the board. I stepped on it."

Have you ever had a tetanus shot before?

The man shook his head.

The wife quickly added, "He doesn't remember. Maybe he hit me when we were kids?"

"The wound only appeared yesterday?"

The man averted his gaze.

Lin Ye stopped writing.

"I asked to clarify in order to assess the risks."

His wife turned and glared at him: "What are you hiding now?"

The man's lips trembled slightly: "I was stabbed once last week too. It wasn't this deep. I rinsed it with water and put on a band-aid. Yesterday I stepped on the same piece of wood again and it pierced almost the same spot."

Nurse Zhao paused for a moment.

Qin Hai glanced at Lin Ye.

That makes sense.

Typical difficulty opening the mouth appeared too quickly within a day.

But if there was a previous contaminated wound, things would be completely different.

Sun Zhiqiang strode in, listened to the patient's medical history, and frowned deeply.

"Remove the gauze first to check the wound, be gentle."

As the layers of gauze were unwrapped, a damp smell wafted out first.

There is a small, dark hole on the sole of my right foot near the forefoot. The area around it is red, swollen, and hot, and the edges are white from being soaked in water. You can also see some blackish-gray dirt inside.

The man winced in pain and jerked his leg back.

The next second, he suddenly froze.

My neck is tilted back, and my back muscles are as stiff as a bowstring.

The heart rate on the monitor spiked immediately.

The wife screamed, "Old Li!"

Nurse Zhao stopped her abruptly: "Don't touch him!"

Qin Hai lowered his voice: "Turn off the bright lights, and don't shout."

Half of the overhead lights in the emergency room were turned off.

Lin Ye stood by the bed, looking at the man's stiff shoulders and clenched teeth, cold sweat breaking out on his back.

The system indicated that no treatment plan had been provided.

But the risks involved are already glaringly obvious.

[Increased risk of airway spasm.]

Strong stimuli may trigger or worsen the condition.

Qin Hai has already given the orders: "Administer oxygen, establish intravenous access. Create a quiet environment. Prepare intubation equipment and notify the on-call anesthesiologist to be on standby in the emergency room."

Sun Zhiqiang added, "We'll draw blood for a complete blood count, biochemistry, and inflammatory markers, and also collect a blood culture. The wound needs to be cleaned, but don't try to open it up here yet."

When his wife heard the word "intubation," her legs went weak.

"He can still speak, so why do they need to intubate him?"

Lin Ye took the signature board, but did not hand it to her directly.

"We can't insert it right now. He might suddenly have a throat spasm and not be able to breathe, so we need to prepare the necessary equipment in advance. It will be too late if we wait until he really can't breathe."

The wife's lips trembled: "Will I die?"

No one in the emergency room responded immediately.

Lin Ye looked into her eyes.

"It could be life-threatening. So we can't just treat it as a regular wound infection now."

She gripped the bag strap tightly, her knuckles turning white little by little.

"Then you guys do the rescue. I'll sign whatever I need to sign."

Qin Hai immediately looked at Nurse Zhao.

"Record the time, and that family members were present. Write down the phone numbers for the ICU, infectious disease department, and anesthesiology department."

As Nurse Zhao took notes, she muttered under her breath, "Why does the community clinic only give injections for every sentence?"

Sun Zhiqiang did not join in the cursing.

"In the early stages, it's easily mistaken for a minor wound. The problem is, it's no longer a minor wound."

The infectious disease specialist on duty arrived first.

The doctor who arrived was Xu Mingzhe, the associate chief physician. He had buttoned one of the buttons on his white coat wrong.

He entered without exchanging pleasantries, first examining the jawline, then the wound, and finally the monitoring.

"Treat it as a suspected tetanus case. Administer tetanus immunoglobulin as soon as possible, and also get a booster shot. Cover with antibiotics, and clean the wound, but avoid any rough stimulation before the spasms are controlled."

Qin Hai nodded: "What about the intensive care unit?"

The call connected just then.

Nurse Zhao turned on the speakerphone.

The voice of the on-call doctor in the intensive care unit came through: "How is the patient's consciousness? Is there any laryngospasm or difficulty breathing?"

Lin Ye reported quickly: "Conscious. Significant difficulty opening his mouth, tension in the neck and back muscles. He had a generalized tonic-clonic seizure after the mild stimulation. Oxygen saturation is currently 97, and heart rate is 120. He has a contaminated puncture wound on the sole of his foot. His immune history is unknown. He had an old injury in the same area last week."

There was a moment of silence on the other end of the phone.

"Admit the patient as a high-risk individual first. We will prepare beds and provide sedation, airway protection, and monitoring if necessary."

Upon hearing the word "stop," the wife burst into tears.

"He just stepped on a nail."

Nurse Zhao stuffed a tissue into her hand.

"The most frightening thing in the emergency room is the word 'just'. It could be a stomachache, dizziness, or just a quick prick, but it could be life-threatening later."

The pharmacy called back.

Tetanus immunoglobulin is available.

Tetanus vaccine is available.

Antibiotics can work immediately.

Qin Hai breathed a sigh of relief.

"Pick up the medication. Check allergy history before medication. Take photos of the wound for record-keeping. Have the orthopedics and infectious disease departments come together for wound cleaning."

When his wife signed, her hand trembled so much that she wrote her name crookedly.

Lin Ye broke down each item of information and explained it to him.

Why not just give a simple injection?

Why was I admitted to the intensive care unit?

Why do we need an airway?

Why can't you just squeeze a wound a couple of times and call it a treatment?

At first, the wife just nodded, but towards the end, she suddenly looked up and asked, "If he had come to the hospital earlier last week when he had his injection, would he be much better?"

Nobody wants to make definitive statements.

Xu Mingzhe took off his gloves.

"At least the risk will be much smaller."

The wife's tears fell onto the signing board.

The man lay on the bed, his jaw still clenched, but his eyes were red.

He mumbled, "I'm afraid it will delay my work."

Qin Hai gave him a cold look.

"It's not about wasting time now, it's about risking your life."

Nurse Zhao brought in the medicine and checked the name and dosage.

No one spoke when the medication was administered in the emergency room.

This is not a medicine that can bring someone back to life immediately.

It can only neutralize toxins that haven't yet combined with the toxins as much as possible.

The spasms that have already occurred will require monitoring, sedation, airway management, and time to gradually wear them down.

Lin Ye swallowed those words and replaced them with something the family could understand.

"This step is to suppress the risk of further deterioration. She will need to be observed in the intensive care unit later."

The wife nodded, her hands still trembling.

When the transfer bed was brought in, the man experienced another brief period of rigidity.

This time, there was no chaos in the emergency room.

The lights were dimmed.

Lower your voice.

Oxygen, monitoring, intravenous access, and intubation equipment were all kept at the bedside.

The on-call anesthesiologist stood at the head of the bed, his hand never leaving the airway bag.

The ICU doctor came down to pick him up personally.

The transfer door opened, and a cold draft rushed in from the corridor.

Lin Ye held onto the bed railing and followed them to the elevator.

The man's wife suddenly turned around.

"Dr. Lin, is this on that list?"

Lin Ye looked at the white paper behind the triage desk.

No.

Not at least not until tonight.

"Now we have it."

The elevator doors closed.

A system notification appears in your field of vision.

[The high-risk treatment for the fourth night has been completed.]

The patient has been admitted to the intensive care unit monitoring pathway.

[Zero-fatal ER weekly progress: 4/7]

When Lin Ye returned to the triage desk, Nurse Zhao had already picked up a black marker.

She attached a temporary note at the bottom of the trial list.

[Difficulty opening the mouth and muscle tension after a contaminated wound: Don't just assume it's a follow-up injection. Prepare an airway to reduce irritation, and call the infectious disease department and the intensive care unit.]

Qin Hai stood to the side and watched for two seconds.

"It will be included in the official version tomorrow."

Nurse Zhao flicked her pen: "The handwriting is ugly, but it's usable."

Just as Lin Ye was about to laugh, another series of hurried footsteps came from outside the emergency room.

A young man rushed in carrying a child.

The child's face was flushed, but his lips were blue, and he was making soft, wheezing sounds in his throat.

The young man's voice cracked.

"Doctor! He had a fever and a seizure, and now he can't breathe!"

The sticky notes on the wall weren't dry yet.

The next item, which wasn't even on the list yet, had already squeezed in through the crack in the door.