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

The intervention team's trolley had just stopped at the entrance of the emergency room when the old man's son called again.

All I could hear on the other end of the phone was the sound of traffic.

"Doctor, I'm at the highway exit, and my mom is crying too. Please treat her first. I'll sign all the forms; I agree to everything."

Chen Yan put his phone on speakerphone and placed it on the small table next to the emergency bed.

"Mr. Li, please listen carefully."

He speaks slowly, and each word is spoken with deliberate emphasis.

"Your father is now being considered for acute ischemic stroke."

Chen Yan pressed his fingertips on the examination form.

"The head CT scan did not show any obvious bleeding, but the vascular examination suggested a possible blockage in a branch of the left middle cerebral artery."

He looked up at the phone.

"Now we need to assess whether intravenous thrombolysis is necessary and also whether interventional thrombectomy is required."

Chaos erupted on the other end of the phone.

"Does thrombolysis involve medication? Does thrombectomy require surgery? Could it cause harm to the patient?"

The caregiver stood in the corner, her hand gripping the nursing home record sheet so tightly that it left a damp mark.

No one laughed in the emergency room.

We hear about this kind of problem far too often in the emergency room.

The family members were afraid that if they didn't get treatment, something bad might happen; they were also afraid that if they did get treatment, something

Chen Yan glanced at the monitor.

Blood pressure 176-194.

Heart rate 87.

Oxygen saturation is 97%.

The numbers weren't like the most frightening ones you'd see in the emergency room.

But the old man's right hand was still resting on the edge of the bed, as if someone had drained his strength.

The water stains at the corners of her mouth have been wiped away, but the nasolabial fold on the right side is still shallow.

Lin Ye carefully clipped the newly issued test reports together and handed them to Chen Yan.

Platelet count is normal. No obvious abnormalities were found in coagulation. Blood sugar is 6.4.

Lin Ye pushed the second form forward.

"The electrocardiogram showed no signs of acute myocardial infarction. The caregiver just asked the on-duty nurse at the nursing home, and there has been no recent surgery or history of external bleeding."

He turned to the page about medication.

"I've been taking antihypertensive drugs and aspirin for a long time, but warfarin, rivaroxaban, and apixaban were not detected."

Chen Yan took it, his finger pausing briefly on the words "aspirin".

"Aspirin alone is not an absolute contraindication. Continue to confirm the history of bleeding."

Qin Hai has already opened the timeline in the electronic medical record.

Everything was normal at 6:10.

Around 7 a.m., the child became drowsy and had slurred speech.

I arrived at the emergency room at 7:42.

The stroke green channel was activated at 7:48.

The head CT scan was completed at 8:06.

At 8:13, a vascular examination suggested a possible blockage.

Each time is followed by a name.

Who asked that?

Who recorded it?

Who notified me?

Liu Zhenhua stood to the side, neither urging nor interrupting.

He only looked down at the few lines of time.

After reading it, he put the pen cap back on.

"Keep this record for now, don't try to rewrite it later. Follow the neurologist's advice for now."

Chen Yan dialed the phone number of the head of the neurology department.

The phone rang only twice.

A sleepy male voice came out.

"Chen Yan?"

"Doctor, ischemic stroke within the emergency time window, 76-year-old male."

Chen Yan looked at the electronic medical record.

"He was normal at 6:10 a.m., but arrived at the hospital at 7:42 a.m. He had weakness in his right limbs and his speech was slurred."

Chen Yan turned to the video report.

"The CT scan did not show any obvious bleeding, but the vascular examination suggested possible occlusion of a branch of the left middle cerebral artery."

He paused for a second.

"Blood pressure is 176-194, blood sugar is normal, there are no obvious contraindications for coagulation at present, family members can contact us by phone, we are recording the conversation."

The sleepiness over there is gone.

What's the rating?

Chen Yan looked at Lin Ye.

Lin Ye pushed the evaluation form over.

"Speech impairment, 2 points; right upper limb weakness, 3 points; right lower limb weakness, 1 point; facial paralysis, 1 point."

Lin Ye's voice was very steady.

"Consciousness can be awakened, but comprehension is lacking. Initial score: 8 points."

Chen Yan repeated it.

There was a few seconds of silence on the other end of the phone.

"It's no small matter."

He paused for a moment.

"Prepare for informed consent for intravenous thrombolysis. The interventional team should not leave; review the scans."

The director's voice was completely clear.

"If there is insufficient evidence of proximal large vessel occlusion, thrombolysis should be performed first, followed by close observation."

I heard the sound of someone getting out of bed on the other end of the phone.

"If symptoms worsen or subsequent imaging supports the assessment, then proceed with thrombectomy evaluation. Monitor blood pressure closely; if it exceeds the threshold, address it immediately."

Chen Yan responded.

"clear."

The director added another sentence.

"Don't let the nursing home confuse the time. Write 6:10 as the final normal time, and record who answered each phone call afterwards."

Qin Hai looked up.

"Taking notes."

The phone hangs up.

The air in the emergency room was still thick.

It's actually tighter.

Because everyone knows that the real difficulty isn't getting the director to come.

The decision rests with the patient.

Chen Yan picked up her phone again.

"Mr. Li, let me explain the risks to you now."

He slowed down his voice.

"Intravenous thrombolysis involves using medication to dissolve blood clots as much as possible, with the aim of reducing the risk of paralysis and aphasia."

Chen Yan paused for half a second.

"But it carries a risk of bleeding, including brain hemorrhage, which can be life-threatening in severe cases."

There was no interruption on the other end of the phone.

Chen Yan continued, "If we don't prescribe this medicine, we might miss the window of opportunity and suffer more serious aftereffects."

All that could be heard on the other end of the phone was rapid breathing.

"Doctor, what should we do?"

Chen Yan did not say "must" on behalf of the family.

"Based on the current examination and timeframe, there is an opportunity to evaluate thrombolysis."

Chen Yan looked at the record sheet.

"Ultimately, we followed the protocol, continuously monitoring blood pressure, consciousness, limb strength, and bleeding risk throughout the process."

Chen Yan handed the pen to Nurse Zhao.

"If you agree, we will record the phone authorization and you can sign a written informed consent form after you arrive at the hospital."

The family members were speechless for a long time.

"I agree."

Chen Yan pressed further, "Are you sure it's the patient's son, Li Zhiqiang?"

"confirm."

"The last four digits of your ID card?"

The other party gave the answer.

Nurse Zhao wrote down the time on the record sheet.

8:27.

Telephone authorization.

Record the audio.

Qin Hai handed the signature board to the caregiver next to him.

"You are not a family member, so you cannot sign the treatment agreement."

Qin Hai tapped the signature board.

"You sign the accompanying information and medical history source to prove who provided these dates and medication histories."

The caregiver was stunned for a moment, and her eyes immediately welled up with tears.

"I... I thought I had to sign them all."

"Sign what you're supposed to sign, and don't sign what you're not supposed to sign." Qin Hai's voice was firm. "The ER is most afraid of things getting messy."

While drawing up the medication, Nurse Zhao chimed in, "If it gets smeared, the doctors and nurses will ultimately bear the cost."

Liu Zhenhua glanced at her.

Nurse Zhao immediately lowered her head.

"I'm telling the truth."

"Write this down." Liu Zhenhua hugged the notebook to his chest. "This is also a matter of procedure."

A slight smile finally appeared amidst the tension.

I only missed one.

After the medication verification began, the emergency room fell silent again.

Chen Yan reports the doctor's orders.

Nurse Zhao recounted the story.

Another nurse checked the name, age, weight, dosage, and time of administration.

Lin Ye stood at the foot of the bed, staring at the old man's right hand.

The old man seemed to know that everyone was busy for him.

His left hand gripped the bed sheet, his knuckles turning white.

My right hand still has no strength.

When the thrombolytic drug was injected into the intravenous line, the clock on the wall had just jumped to 8:33.

There was no applause.

Nobody said "it's all settled".

Only the monitor kept beeping.

Chen Yan pulled the chair to the bedside.

"Check neurological signs every fifteen minutes. Call me immediately if your blood pressure is above the normal range."

Chen Yan pulled the chair a little closer to the bed.

"Headache, vomiting, and decreased consciousness: stop medication immediately and reassess."

Lin Ye nodded and turned to a new page in the record sheet.

Fifteen minutes.

The right upper limb is still unable to withstand gravity.

The language is ambiguous.

Blood pressure is 172-192.

Thirty minutes.

The old man's eyelids twitched more frequently.

Chen Yan bent down.

"Uncle Li, can you hear me? Raise your left hand."

Raise your left hand.

"Raise your right hand."

The fingers on his right hand curled up slightly first.

Then lift your wrists slightly off the sheet.

Very low.

It was so low that the caregiver next to her almost didn't notice.

But Lin Ye saw it.

Chen Yan saw it too.

Nurse Zhao pressed the pen tip onto the record sheet.

"Can you move your right hand a little now?"

Chen Yan did not exaggerate.

"Written: Slightly improved compared to before, but still cannot withstand gravity."

The caregiver covered her mouth, tears streaming down her face.

"He moved! He really moved just now."

Chen Yan raised his hand to stop her from getting closer.

"Don't get excited, the danger period isn't over yet."

The old man uttered a few indistinct sounds from his throat.

I can't hear clearly.

But compared to the muffled breathy voice when he first came in, there were a few more words.

The phone rang again.

Li Zhiqiang asked from the other end, "Doctor, how is my dad?"

Qin Hai glanced at Chen Yan.

Chen Yan picked up the phone.

"Intravenous thrombolysis has begun. The patient's right hand has slightly more movement than before, but speech is still unclear. Continued observation is necessary."

Chen Yan glanced outside the door.

"When you arrive at the hospital, don't cry or ask questions of the patients. First, find a nurse to complete the formalities, and then listen to our instructions."

The person on the other end of the phone repeatedly said yes.

After hanging up, Nurse Zhao muttered to herself, "This sentence should also be written on the list."

Qin Hai asked, "What should we write?"

While changing the IV dressing, Nurse Zhao said, "When family members arrive at the hospital, please don't cry. Find a nurse first."

Sun Zhiqiang came in through the door and overheard the conversation.

"Could the directors also write a clause? When you receive a call from Lin Ye, don't yell at him first; look at the evidence first."

Several people in the emergency room finally burst out laughing.

The laughter was short.

Because the old man suddenly frowned.

Lin Ye immediately lowered his head.

Do you have a headache?

The old man's lips moved slightly.

"No……"

This word is slow and broken.

But it was so clear that it made everyone pause for a moment.

Chen Yan immediately re-examined the pupils, consciousness, and limbs.

"Keep watching. Don't let your guard down just because of one word."

Liu Zhenhua stood at the door, looking down at his phone.

The group chat for directors has already been filled with messages.

Tang Zhendong sent a string of ellipses.

Shen Ruomei asked, "Who was called this time?"

Chen Yanhui: [Neurology. Stroke, recent fusion.]

Liang Xiulan: [Is that list going to get thicker again?]

Qin Hai took the phone and replied with only one sentence.

[I have to write this even if it's not a big deal. I almost got delayed tonight because of the word "heatstroke."]

Lin Ye did not check the group chat.

He took another note from the wall at the nurses' station.

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

Don't do anything yet: Don't get heatstroke, don't take folk remedies, and don't wait until you wake up.

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

When you finish writing the last line, a system notification appears.

[On the fifth night, the critical high-risk patients entered the effective treatment process.]

[In-hospital deaths: 0.]

[Zero-fatal ER weekly progress: 5/7]

Lin Ye stuck the sticky note below the list.

The paper wasn't glued on properly yet; the edges were curling up a little.

Nurse Zhao passed by and casually pressed the button.

"Get closer."

she says.

"Don't let anyone slip through this crack again."