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

Ten minutes? In the emergency room, it's never ten minutes.

The CT room said it would take at least ten minutes.

The monitor in the emergency room was pressing down second by second.

Blood pressure: 82-54.

Oxygen saturation is 86%.

Heart rate 148.

The young woman's lips had turned purple, and her fingers gripped the sheets, but couldn't hold on, and they slipped down.

Her husband stood by the door, holding the child, completely frozen in place.

The baby cried softly, as if it were being suppressed behind a layer of glass.

Qin Hai raised his hand.

"Take the child out. Nurse Zhao, tell the security guards to clear the entrance."

The man acted as if he hadn't heard.

"Doctor, will she be alright?"

Qin Hai looked at him.

"You're standing here, blocking the way. Get out of here and call your family to bring the discharge summary, cesarean section record, and medication prescription."

This statement is more effective than words of comfort.

The man finally moved.

He carried the child outside, his hands trembling so much he almost dialed the wrong number.

The emergency room door closed, shutting out the sounds.

The middle-aged doctor in the Department of Respiratory and Critical Care Medicine is surnamed Shao.

Shao Mingyuan removed the bedside ultrasound probe from the patient's chest and glanced at the screen again.

"The right ventricular region is clearly under strain. With blood pressure like this, the risk of complications during transport is very high."

Shen Ruomei had already put on gloves and was checking the abdominal incision and lochia.

She speaks very quickly.

"There is no obvious bleeding from the incision, and the uterine fundus is contracting well. The amount of lochia should be determined by asking the family and reviewing the nursing records; we cannot rely solely on what the husband says."

Nurse Zhao arranged the blood collection tubes in a row.

"The blood and qi have come out."

Lin Ye took the order.

The oxygen partial pressure is low.

The carbon dioxide level is not high.

Lactic acid levels are elevated.

None of them seem like they can wait.

He handed the form to Qin Hai.

Qin Hai glanced at it and then handed it to Shao Mingyuan.

"Is there enough evidence to treat it as a high-risk pulmonary embolism?"

Shao Mingyuan did not nod immediately.

He looked at Shen Ruomei.

"It's been six days postpartum, and I just had a C-section. Anticoagulation carries a risk of bleeding. Thrombolysis would be even riskier."

Shen Ruomei's expression was also not good.

"But if the person dies first, there is no risk of bleeding to speak of."

After those words were spoken, no one in the emergency room responded.

Everyone knows she is telling the truth.

Qin Hai pushed the hospital bed in half a foot.

"Stabilize circulation first. Administer small amounts of fluids, prepare norepinephrine, and closely monitor blood pressure. The anticoagulation and follow-up plan will be jointly determined by your two departments; I will be responsible for implementation and recording on the emergency side."

Nurse Zhao has already pushed the pump over.

"Prepare vasopressors."

Lin Ye stood at the foot of the bed and noticed that the patient's left calf was more taut than his right.

He said in a low voice, "Could we do a bedside ultrasound of the lower extremity veins first?"

Shao Mingyuan looked up at him.

Lin Ye focused his gaze on the patient's legs.

"Her left calf is swollen, and there are deep marks from the sock cuff. If we can see deep vein thrombosis, it will provide at least one more piece of evidence. Her risk is high if she is transferred to a CT scan now."

Shao Mingyuan did not praise.

"Tell the nurses at the station to borrow an ultrasound probe. Let's check the groin and popliteal fossa first."

Lin Ye immediately turned around.

"Bedside lower extremity venous ultrasound, emergency room, suspected pulmonary embolism, swelling in the left lower extremity."

The person on the other end of the phone asked if it was now.

Lin Ye simply replied, "Now."

Shen Ruomei wrote down the examination results on a piece of paper.

"There is no evidence of active massive bleeding at present, but six days after a cesarean section, she cannot be treated as a regular patient. The family must be informed again about the risks of postpartum hemorrhage, incision bleeding, and intrauterine bleeding upon arrival at the hospital."

Qin Hai nodded.

"Where is Liu Zhenhua?"

"On the way," Nurse Zhao replied.

Qin Hai looked at the record sheet.

"Please write down all the details. Suspected high-risk pulmonary embolism, hypotension, hypoxia, right ventricular overload, high risk of postpartum hemorrhage, multidisciplinary consultation underway."

The patient suddenly took a deep breath.

It's like I can't get to the bottom no matter how hard I try.

Lin Ye leaned over.

"Don't talk, save your energy. We're handling it."

The woman's eyes were half-open, and tears slid down her cheeks.

She looked towards the doorway.

There are no children there anymore.

She opened her mouth.

Lin Ye heard a very soft word.

"baby……"

Nurse Zhao paused for a moment, then immediately continued adjusting the pump.

"The child is outside, someone is holding him. You should take care of yourself first."

That's a tough statement.

But after she finished speaking, the patient's fingers loosened a little.

When the person performing bedside lower limb ultrasound arrived, the patient's blood pressure was barely kept around 90 thanks to vasopressors.

Shao Mingyuan stared at the monitor.

"I'm not comfortable transferring him to a CT scan in this condition."

Qin Hai asked, "If we don't transfer it, how do we confirm it next?"

Shao Mingyuan pointed to the patient's leg.

"Check the legs first. Then look at the test results. Pulmonary angiography is crucial for diagnosis, but if a person collapses in the corridor, then there's nothing left."

The ultrasound probe pressed against my left leg.

The patient groaned in pain.

The radiologist's expression changed quickly.

"There is a high probability of thrombosis in the vein from the left popliteal vein to the deep vein in the calf, and it cannot be crushed."

There was a moment of silence in the emergency room.

Qin Hai looked at Shao Mingyuan.

Shao Mingyuan looked at Shen Ruomei.

Another piece of evidence was added.

Postpartum.

Bedridden.

Swelling on one leg.

Sudden onset of chest pain and difficulty breathing.

Low oxygen.

Low blood pressure.

The right ventricle is under heavy load.

Deep vein thrombosis in the lower extremities.

This can no longer be explained by "milk blockage".

A man's voice suddenly came from outside the door.

"Doctor! My mom answered the phone. She said her discharge summary is at home, and she'll bring it right away!"

Nurse Zhao yelled back through the door.

"Tell her not to just take the soup!"

Qin Hai glanced at her.

Nurse Zhao did not bow her head.

"I'll tell the truth this time too."

Liu Zhenhua arrived at that moment.

He glanced at the patient on the bed, then at the man holding the child outside the door, and his face immediately darkened.

"Has the family been informed?"

Qin Hai handed him the record.

"We have already given a preliminary notification. Now we are providing a formal notification."

Liu Zhenhua took the record and walked directly to the door.

"Are you the husband?"

The man nodded, his eyes bloodshot.

"I am."

Liu Zhenhua's voice was not loud.

"Your wife is now highly suspected of having an acute pulmonary embolism, and her condition is critical. She may need anticoagulation and even further intensive care, but she just had a cesarean section, so there is a risk of bleeding. We will have the emergency department, respiratory and critical care medicine department, and obstetrics and gynecology department jointly evaluate her. Please keep your phone accessible, cooperate by signing the informed consent form, and stop using milk blockage as an explanation for her breathing difficulties."

The man held the child, his lips trembling slightly.

"I'll sign, I'll sign. As long as she's saved."

Liu Zhenhua did not hand over the pen.

"Listen to the risks before signing."

This made the man's face turn even paler.

But he nodded.

In the emergency room, Shao Mingyuan had already made his decision.

"Start with unfractionated heparin for anticoagulation, administered via infusion pump. This is manageable and will be adjusted based on coagulation and bleeding patterns. Systemic thrombolysis is not recommended at this time."

Shen Ruomei immediately added a sentence.

"The obstetrics and gynecology department is monitoring the bleeding simultaneously. They need to observe the incision, lochia, and hemoglobin levels. After her mother arrives, they will review the cesarean section records."

Qin Hai asked, "What about the CT scan?"

Shao Mingyuan glanced at the monitor.

Blood pressure: 92-58.

Oxygen saturation is 90%.

It's still low.

But there's a little more leeway than before.

"Maintain vasopressors, stabilize oxygenation, and after clearing the CT scan room, take the monitor, oxygen, and resuscitation medication with you. I'll go with you on the way."

Qin Hai looked at Lin Ye.

"You'll be working with the shipping company, responsible for recording time and monitoring changes. It's not about making decisions, it's about writing down every single second."

Lin Ye nodded.

"clear."

He clipped the transfer record sheet onto the board.

9:59.

The pressurizing drug is pumped in.

10:03.

Start with unfractionated heparin.

10:05.

Possible cause of deep vein thrombosis in the left lower extremity.

10:08.

Prepare for pulmonary artery angiography with monitoring.

As these words were written, the patient's husband signed them outside the door.

He was halfway through signing in when the baby started crying again.

The man's hand trembled, and the pen tip drew a long line.

Liu Zhenhua did not urge him.

"Re-sign."

The man lowered his head and rewrote his name.

This time, the characters were terribly crooked, but at least I managed to write the whole thing.

The CT room finally called back.

"The examination bed is now available."

Nurse Zhao picked up the transport oxygen cylinder.

"Walk?"

Shao Mingyuan examined the patient first.

"Can you hear me? We're taking you for a checkup. You might feel uncomfortable on the way, so don't move around."

The patient's eyelid twitched.

Qin Hai pressed the emergency medicine box to the lower level of the flatbed.

"If anyone falls behind on the way, I'll scold them one by one when we get back."

Nurse Zhao pushes the cart.

"Then start by complaining about the elevator; it's always slow at night."

No one laughed for long.

As the stretcher was taken out of the emergency room, security guards parted the people in the corridor to both sides.

The patient's husband was standing against the wall, holding their child.

The woman's eyes strained to look away.

The man immediately lifted the child forward a little.

"Don't be afraid, I'm here."

The woman's lips moved.

No sound.

Lin Ye stared at the monitor.

Blood pressure is 96 or 96.

Oxygen saturation is 91%.

Heart rate 132.

None of the numbers seem secure.

But at least we're still moving forward.

As the elevator doors opened, Lin Ye heard the system notification light up again.

[Critical high-risk case confirmed for Night Six.]

[Current effective procedure: multidisciplinary assessment, anticoagulation initiation, and transport with monitoring.]

He didn't stop.

The stretcher was brought into the CT room.

The CT imaging staff were already standing by the door, their faces still damp with sweat from the patient who had just been intubated.

"Get into bed quickly."

Shao Mingyuan immediately corrected him.

"Slow down. She has low blood pressure, don't move her too much."

The four of them lifted the bed sheet together.

When the patient was moved from the stretcher to the examination bed, the monitor suddenly screamed.

Oxygen saturation is 85%.

Heart rate 150.

Lin Ye pressed down on the oxygen tube.

"The oxygen hasn't been removed."

Nurse Zhao bent down to check the tubing.

"The pipe is compressed."

She quickly straightened out the pipes.

The oxygen saturation gradually climbed back up to 89.

Shao Mingyuan's expression did not soften.

"pay close attention."

Scanning begins.

The machines started whirring in the CT room.

Lin Ye stood outside the lead door, his eyes fixed on the monitoring screen.

It was the first time he had ever felt that a machine could sound so slow.

a circle.

Another lap.

When the images were displayed, the CT room radiology staff did not speak.

Shao Mingyuan moved closer to the screen.

Qin Hai also arrived.

On the screen, the filling defects in the pulmonary artery were glaringly clear.

Shao Mingyuan lowered his voice.

"Bilateral pulmonary embolism."

Qin Hai asked, "Can you explain the shock?"

Shao Mingyuan nodded.

"able."

Shen Ruomei listened to the result over the phone and remained silent for a second.

"Proceed as a high-risk pulmonary embolism patient. The obstetrics and gynecology department is waiting for her in the intensive care unit; we'll monitor the bleeding risk."

Shao Mingyuan turned around.

"Go directly to the intensive care unit. Continue anticoagulation and blood pressure control, and closely assess whether interventional procedures or thrombolysis are necessary. Don't go back to the emergency room and waste time."

Qin Hai looked at Lin Ye.

"Record."

Lin Ye wrote on the transfer slip:

10:22.

Pulmonary angiography revealed bilateral pulmonary embolism.

The patient is scheduled to be transferred to the intensive care unit for further treatment.

He had just finished writing when a system notification popped up.

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

[In-hospital deaths: 0.]

[Zero-fatal ER weekly progress: 6/7]

Lin Ye did not look up immediately.

He put the pen cap back on and realized his palms were sweaty.

The stretcher was pushed from the CT room to the intensive care unit.

At the end of the corridor, the patient's husband was still waiting there, holding their child.

Liu Zhenhua stopped him.

"She's going to the intensive care unit, not back to the resuscitation room. She's still not out of danger, but she's heading in the right direction."

The man nodded quickly.

Tears fell onto the baby's blanket.

"Just being alive is enough."

Nurse Zhao walked by and whispered, "Keeping you alive isn't enough; there's a whole bunch of paperwork to come."

Qin Hai heard it.

"I'll sign the contract, you guys keep an eye on the people."

Before the stretcher entered the elevator, Lin Ye glanced back at the emergency room.

The new sticky note on the wall of the nurses' station only had one line written on it.

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

The two lines below are left blank.

Nurse Zhao saw it too.

She shoved the pen into Lin Ye's hand.

"Complete."

Lin Ye lowered his head and wrote.

Don't do anything yet: don't treat it as a blocked milk duct, don't just try to clear the milk duct, and don't let her bear it all on her own.

Priority should be given to the following departments: Respiratory and Critical Care Medicine, Obstetrics and Gynecology, Intensive Care Unit, and CT Room.

Just as I finished writing the last word, the sound of an ambulance siren came from the emergency room entrance.

"Director Qin, these three people were brought in from the factory; they inhaled an unknown gas, and they're feeling dizzy and nauseous!"

Qin Hai stood at the elevator door, his face darkening.

The system interface did not jump.

But Lin Ye had already gripped the pen tightly.

Because another section of the list on the wall is now empty.