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

At 7:16 a.m., the neurology ward called.

Nurse Zhao had just re-drawn the stroke note from last night when the phone rang, and the pen tip dragged a black line across the paper.

She answered the phone, listened for a couple of sentences, and then pressed the receiver to her shoulder.

"Lin Ye, that old man Li from last night."

Lin Ye was filling out the emergency record when he stopped writing.

Chen Yan's voice came from the other end of the phone, hoarse from not having slept all night.

"There is currently no hemorrhage transformation, the right hand can be lifted off the bed, and speech is still slurred, but better than when the patient arrived. The patient has been transferred to the neurological intensive care unit for continued observation."

Nurse Zhao repeated what she said to Qin Hai.

Qin Hai simply hummed in agreement.

"To be clear, it's temporarily stable, not cured."

Liu Zhenhua was standing next to the nurses' station and happened to hear it.

He opened the notebook from last night.

"Also, write down the time of the follow-up phone call. This case needs to be reviewed later."

Nurse Zhao looked up.

"Another debriefing?"

Liu Zhenhua didn't avoid her gaze.

"I almost got dragged down by the word 'heatstroke.' If we don't review this, there will be more people waiting for me to wake up next time."

The list on the wall is thicker than it was yesterday.

Contaminated wound.

Fever and convulsions.

Suddenly, his speech became slurred.

Each sheet of paper is small.

They were stuck together, but they looked like holes being patched up one by one in the emergency room at night.

The morning meeting didn't last too long at 8:30.

Qin Hai projected Grandpa Li's timeline onto the screen.

Everything was normal at 6:10.

I arrived at the hospital at 7:42.

The stroke green channel was activated at 7:48.

Intravenous thrombolysis began at 8:33 AM.

Liu Zhenhua looked at the last line and tapped his finger on the table.

"This list cannot be written as 'If a stroke is suspected, call the neurology department.'"

Chen Yan leaned back in his chair, his eyes noticeably bruised.

"No one will read what I write. What we really need to focus on is sudden weakness on one side, slurred speech, normal blood sugar, and the last normal time."

Nurse Zhao pushed the three lists over.

[What you might 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 give her folk remedies, and don't wait until she wakes up.]

[Who to call: Neurology, Stroke green channel, CT room priority.]

Tang Zhendong watched the excitement in the group last night, but was the first to agree this morning.

"This could save your life."

Qin Hai looked at him.

"Your cardiology department head is praising the neurology department's policies; aren't you afraid they'll become arrogant?"

Tang Zhendong held the paper cup, his face expressionless.

"As long as the patient is alive, anyone can be proud."

The meeting room fell silent for a moment.

That's not funny.

But it's more useful than a joke.

Liu Zhenhua tucked the final version into the trial list.

"Starting tonight, the triage desk will operate according to this three-column system. Triggering conditions are not equivalent to diagnoses; they only ensure that people are directed to the correct process."

Qin Hai added a sentence.

"It doesn't mean Lin Ye should take all the blame. Who treated the patient, who conducted the examination, who notified the patient, and who recorded the results should all be clearly identified."

Lin Ye looked up at him.

Qin Hai didn't look at him, but simply turned off the projector.

"Meeting adjourned. Those who can sleep, go to sleep; those who can't, keep going."

Nurse Zhao left with the list, muttering, "This sentence should also be written on the wall."

No one answered.

Because the emergency room lobby had already started ringing.

The emergency room is different during the day and at night.

It was like a hole that suddenly collapsed at night.

During the day, it's like a pot of water that's always boiling.

Everywhere there were voices, footsteps, bills, crying children, and wheelchairs that couldn't be pushed.

When Lin Ye returned to the emergency room, the coffee cup he had left behind the night before was still on the windowsill.

There was a black mark around the bottom of the cup.

He had just thrown the cup into the trash can when the system interface suddenly jumped.

[Zero-death ER week: 5/7]

[The risk level is being updated for Night Six.]

Lin Ye stared at the line of text for two seconds.

No notification was given.

There is no disease name.

Only a gray cursor is visible during the refresh process.

He turned his gaze away.

I glanced casually at the door of the emergency room.

Sun Zhiqiang was sitting in front of the computer working on medical records, his eyelids almost closed.

Stop staring at the door.

Sun Zhiqiang did not look up.

"Bad news in the emergency room never comes in advance."

Lin Ye hung the stethoscope back around his neck.

"Then we can only wait for it to crash in on its own."

Sun Zhiqiang sneered.

"That's good. You're scaring yourself more than the nurses' station phone calls now."

This prediction came true at 9:48 PM.

When the ambulance came in, the young woman on the stretcher was curled up, one hand pressed tightly against her left breast.

Her face was ashen white, and her forehead was covered in sweat.

A man was following beside her, holding a baby wrapped in a small blanket.

The baby cried very softly.

The man's voice was very loud.

"Doctor, she has a blocked milk duct and fever. She went to the postpartum care center for a massage this afternoon, and when she came back, she said she had chest pain and shortness of breath. You can help her clear her milk ducts!"

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

"Go to postpartum care for lactation support, not the emergency room."

The man became anxious.

"She just gave birth and shouldn't be overly active during her postpartum period. Her mother said it's because her milk is engorged."

The woman wanted to speak, but as soon as she took a breath, she winced in pain.

The monitoring clip is attached.

Heart rate 136.

Blood pressure is 92 or 96.

Oxygen saturation is 89%.

Nurse Zhao's expression immediately changed.

"Inhale oxygen."

Qin Hai came out of the office with quick steps.

How many days postpartum?

The man paused for a moment.

"Day Six".

"Vaginal delivery or C-section?"

"She had a C-section. She said her incision hurts today and she doesn't want to get out of bed."

Lin Ye stood by the bed.

The woman was breathing rapidly, and her chest was rising and falling very shallowly.

With each breath, his brow furrowed.

My left calf is sticking out of the blanket and is slightly more swollen than my right leg.

There was a deep mark from the sock cuff above her ankle.

Lin Ye bent down and touched the temperature of his calves, then looked at the monitor.

My heart rate is still rising.

141.

Oxygen saturation is 90%.

It only went up a little after receiving oxygen.

The system notification in front of Lin Ye finally lit up.

High-risk warning: Acute pulmonary embolism is possible.

[Risk of misjudgment: mastitis/milk blockage/anxiety.]

[Current Risk: Rapid increase in right ventricular load, leading to circulatory collapse.]

Lin Ye did not mention "pulmonary embolism".

He asked the woman first.

Did the chest pain start suddenly?

The woman nodded, her voice broken and intermittent.

"After breastfeeding... I stood up... and suddenly it hurt, and I couldn't breathe."

"Did you cough up blood?"

The woman shook her head.

The man interjected, "She just has a blocked milk duct; her breasts were really hard this afternoon."

Lin Ye raised his eyes.

"A blocked milk duct won't cause oxygen saturation to drop to 89, nor will it cause the heart rate to drop to 140."

The man choked.

Qin Hai had already heard this.

"On the sixth day postpartum, after a cesarean section, while in bed, I suddenly experienced chest pain, difficulty breathing, low oxygen levels, rapid heart rate, and low blood pressure."

His voice lowered.

"First, screen for high risk of pulmonary embolism."

The man's face changed instantly.

"Lungs what?"

While establishing intravenous access, Nurse Zhao said, "The blood vessels in the lungs may be blocked by a blood clot. This isn't a matter of promoting lactation right now."

The woman's eyes widened immediately when she heard "it's blocked".

"Am I going to die?"

Qin Hai didn't give any empty promises.

"Let's stabilize breathing and circulation first, and then check the evidence. Lin Ye, call the Department of Respiratory and Critical Care Medicine and the Department of Obstetrics and Gynecology, and notify the CT room to prepare for pulmonary artery imaging. First, draw blood for blood gas, coagulation, cardiac markers, and D-dimer. Prepare for bedside echocardiography."

Lin Ye immediately picked up the phone.

"Urgent consultation with the Department of Respiratory and Critical Care Medicine: A patient who underwent a cesarean section six days postpartum suddenly experienced chest pain and difficulty breathing, with symptoms of hypoxia, tachycardia, and low blood pressure, suspected of acute pulmonary embolism."

There was a half-second pause on the other end of the phone.

"Coming right away."

The second call was to the obstetrics and gynecology department.

Shen Ruomei answered quickly.

Her first words were: "Lin Ye, you better not be asking me to treat your postpartum illness again."

Lin Ye watched the woman's increasingly rapid breathing.

"Director Shen, on the sixth day after the cesarean section, she suddenly experienced chest pain, low oxygen, heart rate of 140, blood pressure of 92.6, and swelling in her left calf, suspected of pulmonary embolism."

There was a thud from the chair on the other end of the phone.

"I'm coming down."

The baby in the man's arms was still crying.

He looked down at his child, then at his wife on the bed, feeling as if he had been torn in two.

"Doctor, she was fine this afternoon. She just wanted to breastfeed more, so how did her lungs get blocked?"

Nurse Zhao increased the oxygen flow rate.

"Postpartum women are prone to blood clots. Cesarean section, bed rest, leg swelling, and sudden shortness of breath are not minor issues."

The man opened his mouth.

"What about the baby? She still needs to breastfeed."

Qin Hai turned to look at him.

"Prioritize the mother's life. Hand the child over to family members and call another family member immediately."

The man frantically reached for his phone.

Before the call could be made, the monitor suddenly emitted a sharp sound.

Blood pressure is 84-85 or 86.

The woman's eyes began to glaze over, and her fingers slid down her chest.

Lin Ye immediately bent down.

"Can you hear me?"

The woman's lips were purple, and she uttered only two words.

"So boring..."

Qin Hai reached out and pressed down on the bed railing.

"Bring the resuscitation bed in. Has the respiratory and critical care medicine team arrived yet?"

Hurried footsteps could be heard outside the corridor.

A middle-aged doctor in a white coat pushed open the door and came in, followed by an ultrasound machine next to the bed.

Who is suspected of having a pulmonary embolism?

Qin Hai handed over the guardianship record.

"On the sixth day postpartum, I suddenly experienced chest pain and difficulty breathing, low oxygen, low blood pressure, tachycardia, and swelling in my left calf."

The other party only glanced at it.

"First look at the right side of the heart."

When the ultrasound probe pressed against her chest, the woman gasped in pain.

The black and white image on the screen flickered.

The middle-aged doctor's brows furrowed more and more deeply.

"Heavy load on the right heart."

Lin Ye heard the system risk bar rising rapidly.

The risk of cycle collapse has increased.

[Sixth Night, Critical High Risk: To be confirmed.]

Shen Ruomei also arrived.

She was still clutching the cuffs that she hadn't had time to button up.

Did she experience bleeding after her C-section? What was the condition of her incision? How much lochia did she have?

The man was so flustered that he couldn't finish his sentence.

"I...I don't know, but her mother knows. Her mother is at home watching the soup."

Shen Ruomei's face turned cold.

"Have her mother bring the discharge summary and medication prescription. Now."

Doctors in the Department of Respiratory and Critical Care Medicine look up.

"Acute pulmonary embolism is highly suspected. Whether a CT scan is possible depends on the stability of the blood pressure. First, administer fluids and raise blood pressure, and assess anticoagulation and subsequent resuscitation plans. The obstetrics and gynecology department should simultaneously assess the risk of postpartum hemorrhage."

Qin Hai nodded.

Record the time. Leave a record of all notifications.

The man finally understood a little, and his hands holding the child began to tremble.

"Doctor, can you save him?"

No one answered immediately.

Because the woman in the bed started losing oxygen again.

Eighty-eight.

Eighty-seven.

Lin Ye tore a new note off the wall.

He did not write down the name of his illness.

Write only the first line.

What to see: sudden postpartum chest pain, shortness of breath, rapid heart rate, low oxygen saturation, and swelling in one leg.

Before the pen could even reach the second line, the phone in the CT room outside the emergency room rang.

Nurse Zhao answered the phone, her face even more somber than before.

"Director Qin, the CT room says there's an intubated patient who just got onto the examination table, and it will take at least ten minutes."

Qin Hai watched the blood pressure fluctuate on the monitor.

"Ten minutes?"

He rolled up his sleeves.

"She might not be able to wait ten minutes."