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

The nursing home's vehicle arrived before the ambulance.

As soon as the driver opened the car door, hot air and the smell of medicinal oil from the old man rushed into the emergency room entrance.

The elderly man on the flatbed cart was over seventy years old, with one side of his face drooping and a little water stain on the corner of his mouth.

The accompanying caregiver was covered in sweat, clutching a nursing home record sheet in her hand.

"He said he was sleepy after dinner. Everyone thought he had heatstroke because of the hot weather, so they gave him some Huoxiang Zhengqi Water. Later, he became slurred and couldn't lift his right hand."

Nurse Zhao had already pushed the stretcher toward the emergency room.

When was the last time it worked normally?

The caregiver was stunned.

"what?"

Lin Ye quickly followed.

When was the last time you saw him speaking, walking, and eating normally?

The caregiver bent down to flip through the record sheet, her fingers trembling so much that the pages rustled.

"She was fine at 6:10 pm before dinner, when the caregiver made her rounds. She ate dinner at 6:30 pm, and around 7 pm she said she was sleepy."

Qin Hai took the stretcher from the door of the emergency room.

"What time is it now?"

Nurse Zhao checked her watch.

7:42.

The window of opportunity is still open.

Lin Ye kept those four words to himself and didn't say them out loud.

When the old man was laid on the emergency bed, he mumbled a sound.

He wanted to speak, but his tongue seemed to be out of his control.

My right hand was resting on the edge of the bed, and I couldn't lift it up no matter what I did.

However, he could grab the bed sheet with his left hand.

Nurse Zhao wrapped the blood pressure cuff around her arm.

"What about your blood sugar?"

The caregiver immediately said, "It was measured on the way here, 6.2."

Nurse Zhao took the test again.

"6.4".

It's not low blood sugar.

Blood pressure is 178 or 196.

My heart rate is in the 80s.

Oxygen saturation is 97%.

He doesn't look like someone who's about to die.

But what Lin Ye fears most is patients who "seem to be able to wait."

The system countdown was still jumping at the edge of my field of vision.

[Time window remaining: 55 minutes and 36 seconds.]

Sun Zhiqiang had already picked up the flashlight.

"Pupils are equal in size and react well to light. The nasolabial fold on the right side is shallow."

Lin Ye stood by the bed, his voice very short.

"Have him raise both arms."

The old man managed to lift his left hand with difficulty.

His right hand moved only slightly before slamming back onto the bed.

The caregiver's face turned pale instantly.

"He can move his right hand normally, and he can even hold chopsticks by himself."

Qin Hai turned to look at Nurse Zhao.

"Stroke green channel"

Nurse Zhao picked up the phone.

"Neurology consultation urgently, suspected acute stroke, onset time 6:10 and lasted normal, arrived at the emergency room at 7:42, weakness in the right limbs, slurred speech, blood sugar normal."

The caregiver was stunned when she heard the word "stroke".

"Isn't it heatstroke? The air conditioner in his room broke today, and he sweated a lot."

Lin Ye spread out the medical record folder.

"Heatstroke doesn't just cause one arm to be unable to be lifted."

The caregiver's lips turned pale: "Could that be a stroke?"

Qin Hai glanced at him.

"We're saying it's suspected now. We need to act quickly, not rush to a conclusion."

This sentence was like a hammer blow, forcing everyone in the emergency room into the process.

Blood draw.

Electrocardiogram (ECG)

Coagulation function.

Complete blood count and biochemistry.

Establish intravenous access.

Confirm medication history.

Ask for the family's phone number.

Each item is moving forward.

Lin Ye asked the caregiver, "Has he taken any anticoagulants? Warfarin, rivaroxaban, apixaban? Does he have atrial fibrillation? Has he had any recent surgery, bleeding, or falls?"

The caregiver was stunned by a barrage of questions.

"I don't know, I only work the night shift."

Nurse Zhao has already dialed the nursing home's number.

"Call the head nurse on duty to answer the phone. Now. Not tomorrow to prepare the materials."

The person on the other end of the phone seemed to be asking what had happened.

Nurse Zhao lowered her voice.

"The elderly person is suspected of having a stroke, and it's within the critical time window. The medication history is unclear. If we delay even a minute, it might not just be a matter of whether they can walk or not."

The caregiver gripped the record sheet tightly with her fingers.

"I'll go find a picture of the medicine box."

Qin Hai immediately stopped him.

"Don't run away. Use your phone to find him. If you run away, no one will be able to complete his medical history."

The caregiver frantically scrolled through her phone.

The neurologist arrived quickly.

It wasn't the director who came; it was Chen Yan, the attending physician on duty, with dark circles under his eyes.

He checked his watch first, then looked at the old man as he entered the room.

"Finally, it was 6:10?"

Lin Ye handed over the nursing home record sheet.

"The ward round at 6:10 was normal. Lunch was at 6:30. Around 7:00, I started to feel drowsy and my speech became slurred. I arrived at the hospital at 7:42. My blood sugar was normal, but I had weakness in my right upper limb, slurred speech, and a shallow nasolabial fold."

Chen Yan flipped through the record sheet very quickly.

"First, perform a stroke assessment. Notify the CT room; a head CT scan is the priority. If necessary, add vascular imaging to check for large vessel occlusion."

Qin Hai nodded.

"The CT room has already called."

Chen Yan looked up at Lin Ye.

Who will be the first to ask about the final scheduled time?

Before Lin Ye could speak, Nurse Zhao pointed it out for him.

"he."

Chen Yan didn't praise him, but only said, "That's a good question. Without a proper final time, everything else is just empty talk."

The caregiver couldn't understand any of this; she just stared at the elderly man.

"Doctor, will he be paralyzed?"

Chen Yan's hands didn't stop.

"No one can guarantee anything right now. We'll first check for bleeding, then assess whether thrombolysis or thrombectomy is an option."

The caregiver panicked even more.

"What is thrombolysis? What is thrombectomy? Does it require surgery?"

Lin Ye put the signing board aside for the time being, without rushing to hand it over.

"Don't sign up for treatment yet. The first step is to do examinations. We need a head CT scan to rule out bleeding, and a vascular examination to see if there's a blockage in a major blood vessel. Whether medication or interventional thrombectomy is possible will depend on the neurology department's examination and contraindications."

The caregiver nodded, then shook his head.

"His son is out of town, and no one answers my calls."

Qin Hai's expression darkened.

"Keep calling. Contact the person in charge at the nursing home simultaneously. Nurse Zhao, record the timestamps of all calls."

Nurse Zhao had already written three lines on the paper.

Telephone call time.

The person answering the call.

Reason for not answering.

These words look cold and impersonal.

In the emergency room, they can sometimes be just as important as medication.

When the elderly man was wheeled into the CT room, the caregiver followed beside him, her steps unsteady.

Lin Ye held onto the railing of the flatbed cart.

The corridor lights slid across the old man's face, one grid at a time.

The old man suddenly made a muffled sound.

It's as if they're asking themselves what's wrong.

Lin Ye lowered his head.

"Your speech is slurred and your right hand is weak. We need to check for bleeding or blocked blood vessels in your brain first. Don't move around too much; the examination will be quick."

The old man's eyes slowly rolled.

It was as if they understood, yet also as if they didn't.

The radiology staff were already waiting at the entrance of the CT room.

It's not because of Lin Ye.

It was Nurse Zhao's phrase "within the time window" that woke people up.

Chen Yan stood by the computer, waiting for the first set of images to appear.

The caregiver kept making phone calls.

The sixth call was finally answered.

He almost cried.

"Hello? Is this Mr. Li? Your father is in the emergency room at the First Municipal Hospital. The doctor said it might be a stroke and he needs an urgent evaluation... It's not heatstroke, and it won't get better after a nap. You need to answer the doctor's call immediately!"

The phone was handed to Qin Hai.

Qin Hai didn't waste any words.

"This is Qin Hai from the emergency department. Your father is suspected of having an acute stroke, and he is currently within the critical time window. We are performing a head CT scan and vascular assessment. Further evaluation may involve intravenous thrombolysis or interventional thrombectomy. You need to come to the hospital as soon as possible and keep your phone accessible."

The voice on the other end of the phone suddenly panicked.

"My dad was perfectly fine this morning, how could he suddenly have a stroke?"

Qin Hai looked at the door of the CT room.

That's why it's called "impatient".

The first set of images appears.

Chen Yan stared at the screen, his fingers sliding slowly across the mouse.

"No obvious bleeding has been observed at the moment."

The caregiver just breathed a sigh of relief.

Chen Yan added, "It doesn't mean everything is fine. Continue checking the blood vessels."

The vascular imaging images are gradually being generated.

The people in front of the screen fell silent.

Chen Yan frowned.

He applied pressure to a section of blood vessel.

"Possible occlusion of a branch of the left middle cerebral artery."

Lin Ye heard the system countdown jump again.

[Time window remaining: 38 minutes and 09 seconds.]

Chen Yan picked up the phone.

"Notify the head of neurology and the interventional team that there is a suspected ischemic stroke within the time window, with possible occlusion of a major blood vessel branch. Prepare to assess the indications for thrombolysis and thrombectomy."

The caregiver clutched the hem of her clothes.

"Doctor, can you save him?"

Chen Yan didn't offer any pleasantries.

"There's an opportunity, that's why we're in such a hurry."

These four words carry more weight than any comfort.

As the elderly man was being wheeled back into the emergency room, his son called again.

This time, her voice was trembling with tears.

"Doctor, I agree to the examination and resuscitation. I'm heading back now, but it will take at least an hour. Can you prioritize treatment?"

Qin Hai looked at Liu Zhenhua.

Before anyone knew it, Liu Zhenhua was already standing at the door of the emergency room.

He was still holding the list he had kept that morning.

Liu Zhenhua said in a deep voice, "Follow the emergency green channel and authorized procedures. Continue to inform by phone, record the conversation, and document the process. Even if we can contact the family but they are not present, we cannot let the window of opportunity pass by in vain. The neurology department will conduct a standardized assessment to determine the specific medication and intervention decisions."

Qin Hai nodded.

Chen Yan explained the inspection results, risks, and possible solutions one by one over the phone.

It's not about making family members understand all the medical terms immediately.

It's to record every minute.

Lin Ye stood to the side, looking at the list on the wall that had just been formatted.

What do you see?

Don't do anything yet.

Who are you calling?

The answer to this question was soon found as well.

What you see: sudden slurred speech, weakness on one side, and normal blood sugar.

Don't do these things right away: Don't get heatstroke, don't wait until you wake up, and don't try any folk remedies first.

Who to call: Neurology Department, CT Room, Stroke Green Channel.

A system notification appears in your field of vision.

[The critical process for the fifth night has begun.]

The patient has been admitted to the stroke green channel.

[Zero Mortality Emergency Room Week Progress: Under Evaluation]

Just as Lin Ye finished reading that line, a message popped up in the director's group chat.

Chen Yan: [Who wrote the list for stroke on this emergency room checklist?]

Tang Zhendong: [Finally, it's the neurology department's turn to have trouble sleeping.]

Qin Hai did not laugh.

He watched as the interventional team's trolley was quickly pushed into the emergency room and said only one sentence.

"Let's keep people in time first."