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

At 7:30 a.m., the list on the wall of the emergency room nurses' station no longer looked like a list.

The official printed version is pasted on top.

The two temporary sticky notes below are on the left and right.

A sign reads: "Difficulty opening mouth after contamination of wound."

A sign reads: "Fever, convulsions, and then sudden wheezing."

The black marker words were pressed down very heavily, as if afraid that no one could see them.

Lin Ye stood in front of the wall, holding the newly completed emergency record in his hand, his eyes stinging with tears.

Nurse Zhao peeked out from behind the triage desk.

"Stop looking at it, it won't become neat by itself."

Qin Hai came out of the office, holding a screenshot of the message Liu Zhenhua had sent him in the middle of the night.

"The medical affairs department will arrive at 8:30."

Nurse Zhao immediately frowned.

"Again?"

Qin Hai slammed the screenshot onto the table.

"The hospital director wants to see the new clauses. Liu Zhenhua said that there are two more clauses on the first night of the trial, and it must be made clear whether this thing is for saving lives or turning the consultation phone into an alarm clock."

Sun Zhiqiang rubbed his temples as he came out of the emergency room.

"To be honest, it's normal for the directors to have complaints."

Nurse Zhao glanced at him.

"Which side are you on?"

Sun Zhiqiang placed a stack of medical records on the table.

"Stand on the side of the living. But even the living have to follow the procedures."

No one refuted this statement.

The fourth night was originally only considered a suspected case of tetanus.

But in the middle of the night, the child who had a fever and convulsions added another item to the list.

The system progress did not advance.

But the paper on the wall was indeed a thicker layer.

Lin Ye looked down at the record.

The tetanus report stated: contaminated foot puncture wound, difficulty opening the mouth, neck and back muscle tension, transient rigidity, airway preparation, intervention from the infectious disease department and intensive care unit.

The child's report stated: "After fever and convulsions, the family stuffed gauze into the child's mouth; wheezing, cyanosis, decreased oxygen saturation, weak breath sounds on the left side; the gauze corner was removed under otolaryngology endoscopy."

Each one, viewed individually, is not complicated.

All of this happened overnight, like an emergency room taking over the risks that others hadn't finished writing.

At 8:27, Liu Zhenhua appeared at the nurses' station on time.

He was followed by an officer from the quality control office.

Tang Zhendong, Liang Xiulan, Jiang Shumin, and Xu Mingzhe also came.

It was not a hospital-wide meeting.

It was more like an interrogation than a plenary meeting.

As soon as Jiang Shumin entered the room, he pointed to the wall.

"I have a suggestion. Don't just write 'call the ENT department' for everything. Last night when I came down, the child was indeed in danger. But from now on, if the triage desk sees someone wheezing, they should just call me. My on-call doctor will have to go to the ER."

Liang Xiulan sneered.

"You think you can just stay in the pediatric ward? The moment the words 'fever and convulsions' are mentioned, nine out of ten family members will immediately cry that the fever has damaged their brains. The one who is actually having trouble breathing is almost blocked from getting the fever reduced."

Xu Mingzhe leaned against the wall, his voice low.

"The same applies to the infectious disease department. There are many contaminated wounds, but not all of them cause tetanus. The checklist needs to include the triggering conditions, otherwise there will be excessive consultations."

Liu Zhenhua opened the notebook.

"That's all for today."

He looked at Qin Hai.

"The hospital director asked, 'Two new items were added to the checklist on the first night of the trial. Does this mean the original checklist is insufficient? If we add more every night, won't it eventually become an emergency room encyclopedia?'"

Nurse Zhao said in a low voice, "An encyclopedia is fine, but I'm afraid it will become a comprehensive guide to responsibilities."

Liu Zhenhua heard it.

"Make a note of this sentence as well."

Nurse Zhao was taken aback: "I just said it offhand."

"What you say casually sounds like the truth." Liu Zhenhua picked up his pen. "If the list makes frontline workers feel like they're taking on a burden, no one will be willing to use it."

Qin Hai's expression softened slightly.

Lin Ye stood to the side, not in a hurry to speak.

He knew he couldn't present the list as a panacea at this point.

Everything that is all-powerful will eventually become something that oppresses people.

Liu Zhenhua looked at him.

"Lin Ye, tell me. Why were those two lines added last night?"

All eyes turned to them.

Lin Ye placed the two emergency records on the triage desk.

"It's not because it's rare."

He first pointed to the tetanus vaccine.

"There are many contaminated wounds, but few cases of difficulty opening the mouth, neck and back muscle tension, or transient rigidity. The list should remind you: do not treat people who already have neuromuscular symptoms as if they are simply coming for a booster injection."

Then it pointed to the child's share.

"Fever and seizures are common, but after the seizures, there is often sudden wheezing, cyanosis, decreased oxygen saturation, and weak breath sounds on one side. The checklist reminds you: don't just focus on the seizures, check the airway first."

Jiang Shumin crossed his arms.

"Then write the abnormal combination, not the disease name."

Lin Ye nodded.

"I also think we should write about abnormal combinations."

Liang Xiulan glanced at him.

"One more thing, we must ask about the family's treatment history. Did they feed them water, medication, or force-feed them anything?"

Nurse Zhao tore off the sticky note and took a new piece of paper.

"I wrote."

She stopped writing halfway through.

"There are too many words, and no one is reading them at the triage desk."

Qin Hai looked up.

"Then let's go with three columns."

He picked up a pen and drew three lines on the blank paper.

"What did you see?"

"Don't do anything yet."

"Who are you calling?"

Liu Zhenhua paused for a moment.

"This structure is good."

Nurse Zhao immediately took it.

[What you see: Difficulty opening your mouth and muscle tension after the wound is contaminated.]

[Don't do anything yet: Don't treat it like a regular injection, and avoid strong stimulation.]

[Who to call: Infectious Diseases Department, Intensive Care Unit, Anesthesiology Department (prepare airway).]

Article .

[What you should see: fever, convulsions followed by wheezing, cyanosis, and uneven breathing on both sides.]

[Don't do anything yet: Don't feed it water or medicine, don't insert anything, and don't try to remove it blindly.]

[Who should be called: Pediatrics, Otolaryngology, Anesthesiology.]

After reading it, Jiang Shumin's complexion improved slightly.

"That's more like it."

Xu Mingzhe nodded.

"Writing a combination of symptoms is better than writing down departmental responsibilities."

Tang Zhendong remained silent.

He flipped through the list and suddenly tapped the page for "atypical chest and abdominal pain".

"I'd also like to add something. For every item you add to the list, you also need to periodically remove the old ones. Otherwise, you'll just keep adding more and more, and eventually nobody will read them."

Qin Hai looked at Liu Zhenhua.

Liu Zhenhua also wrote this sentence down.

"A two-week trial period will be conducted, focusing not only on new additions but also on mergers and deletions."

Nurse Zhao muttered to herself, "Finally, someone remembered that the wall isn't infinitely large."

The tense atmosphere eased a little.

Lin Ye also breathed a sigh of relief.

He thought today would turn into a denunciation meeting.

Unexpectedly, it ended up as a discussion about how to write a list without causing harm.

I felt relieved until 7:30 p.m.

The fifth night had just begun when the triage phone rang.

Nurse Zhao answered the phone, listened for two seconds, and her expression slowly changed.

"120? How many minutes until they arrive?"

She looked up at Qin Hai.

"An elderly person was brought to the nursing home. They said they were drowsy and slurred their speech after dinner, but their blood sugar was normal, so their family thought it was heatstroke. On the way there, they started having trouble lifting one arm."

Tang Zhendong asked instinctively, "Stroke?"

Lin Ye glanced at the list that had just been compiled on the wall.

Head injuries are common in the elderly.

I have chest pain.

Hypoglycemia is present.

However, items like "heatstroke-like drowsiness, slurred speech, and weakness on one side," which seem to be neurological symptoms, have not yet been added.

The system notification lights up at the edge of the field of vision.

[Fifth high-risk alert activated.]

Symptoms: Heatstroke/drowsiness after meals.

High risk: Acute ischemic stroke, within the thrombolysis time window.

[Key abnormalities: Slurred speech, unilateral upper limb weakness, with a traceable onset time.]

[Time window remaining: 58 minutes and 12 seconds.]

Lin Ye picked up the medical record folder.

"Don't accept the list yet."

Qin Hai looked at him.

Lin Ye held the pen between his fingers.

"We might need to reserve space for this one too."