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

After the tour guide finished speaking, Liu Zhenhua dropped the red pen in his hand onto the triage table.

The pen cap hit the table, rolled half a circle, and came to rest next to the seating chart that was already wrinkled from being circled.

The last row.

elder.

I didn't get off the bus.

Qin Hai did not swear.

He only glanced at the door.

"Plain cart, portable oxygen cylinder, monitor. Lin Ye, come with me."

Nurse Zhao had already rushed to the door with the stretcher.

"Where's the driver?"

The tour guide's lips lost their color, and he turned and ran outside.

"He's in the car! He's in the car! I told him to open the door!"

It was past 2 a.m., and the wind outside the emergency room was colder than inside the lobby.

The bus was parked in the outermost lane, and there were still gray watermarks from the service area on its body.

The carriage lights weren't all on, only a yellow light remained on at the front door. The driver stood at the door, clutching the keys in his hand, the key ring clinking softly against his palm.

He kept muttering to himself.

"I thought he was asleep; he always loves to sleep... I really thought he was asleep..."

Qin Hai's steps were heavy as he boarded the train.

"If someone is asleep and cannot be woken up, you should call a doctor."

In the last row by the window, an elderly man was slumped in his seat.

His down jacket was zipped up to his chin, his head was pressed against the glass, and his face was ashen. There was a small patch of fog on the car window, but his breathing was very shallow, so shallow that his chest was barely rising and falling.

Lin Ye squatted down next to the seat.

"Grandpa Gu, can you hear me?"

The old man didn't move.

Nurse Zhao shone a flashlight into the pupil.

"It's responding, but slowly."

Qin Hai felt for the carotid artery, then looked at the old man's lips and fingers.

"There's a pulse. Move it downstairs first, don't bother moving it in the car."

Two security guards and the driver helped lift the armrests of the seats.

The old man's body was as limp as a bag of damp cotton.

As he moved, a plastic bag slipped out of his trouser leg.

The bag wasn't tied tightly; inside was half a bottle of water, a few loose pills, and a crumpled piece of paper.

Nurse Zhao glanced over at it.

"There is medicine."

Lin Ye picked up the bag but didn't look at it immediately.

"Get off the bus first."

The elderly man was lifted onto a flatbed cart.

A gust of wind blew, and he let out a soft hum, but he still couldn't lift his eyelids.

The tour guide followed beside him, his voice trembling.

"His name is Gu Jianguo, he is 79 years old, and he joined the tour alone. He said his children are all busy, so he came out to relax."

Qin Hai pushed the stretcher toward the emergency room entrance.

"Did you vomit? Did you have diarrhea?"

The tour guide shook his head.

"I didn't see him. He ate little at the service area that night and kept saying he was sleepy. I even asked him about it, and he waved his hand and said not to bother him."

Lin Ye paused in his steps.

I didn't vomit.

No.

Eat little.

I'm constantly sleepy.

His gaze fell on the old man's forehead.

No heavy sweating.

My skin feels cold.

The system interface lit up briefly at the edge of the field of view.

[High risk of untried diagnosis: altered mental status.]

Please verify blood sugar, body temperature, blood pressure, and medication history.

Lin Ye didn't read the prompt for too long.

He had already called towards the emergency room.

"Bedside blood glucose! Temperature! Blood pressure! ECG monitoring!"

Nurse Zhao pushed the stretcher into the red zone, connecting the monitor while placing the blood glucose meter next to the bed.

"Make way, stop crowding."

The tour guide tried to push forward, but Liu Zhenhua stopped him.

"Fill out the list here. Gu Jianguo's emergency contact, ID number, chronic illnesses, medications, write it all down."

"I...I don't know what's wrong with him."

Liu Zhenhua pushed the bag of medicine in front of him.

"Let's start recognizing from here."

The blood pressure cuff bulged.

The numbers jumped twice.

Eighty-four or eighty.

Heart rate 108.

Body temperature 35.8.

Oxygen saturation: 93%.

Nurse Zhao pricked the old man's fingertip.

The blood beads were squeezed out very slowly.

The blood glucose meter beeped.

A number pops up on the screen.

1.8.

The emergency room fell silent for a moment.

The child's father stood by, completely bewildered.

"What does 1.18 mean?"

Liang Xiulan was looking at the child's IV pump without even looking up.

"So low that it could cause unconsciousness."

Qin Hai immediately gave the order.

"Establish intravenous access. Administer high-concentration glucose first, followed by maintenance glucose."

Qin Hai glanced at the medicine bag.

"Blood samples should be sent simultaneously, including electrolytes, liver and kidney function tests, infection markers, and blood gas analysis. Medication history must be thoroughly verified."

Nurse Zhao had already inserted the IV needle into the back of the elderly man's hand.

The elderly person had dry skin and collapsed blood vessels, so there was almost no blood return when the needle was inserted.

"The blood vessels are severely collapsed."

Qin Hai held down the old man's arm.

"Slow down, make sure it's secure."

Lin Ye opened the plastic bag.

It contains antihypertensive medication.

There is stomach medicine.

There's also a strip of blood sugar-lowering medication.

There are small prints on the back of the medicine blister pack.

Glibenclamide.

Several pieces are missing.

Lin Ye handed the medicine board to Qin Hai.

"Doctor, sulfonylurea hypoglycemic drugs."

Qin Hai's eyes darkened.

Ask him how many slices he ate today.

The tour guide stood by the triage desk, so anxious that he couldn't even write.

"He came alone, how were we supposed to know how many slices he ate!"

After administering the glucose, Nurse Zhao looked up and retorted.

"Therefore, when an elderly person travels alone on a tour, they must keep their medicine bag with them at all times, and attendance must be taken for all participants."

The tour guide's eyes welled up with tears after being rebuked.

"I really didn't expect this..."

Liu Zhenhua did not comfort him.

"Now I think about it. How many times did they take attendance before we got on the bus? Did anyone get off at the service area? Who sat next to him? Did they mention diabetes?"

A female tourist next to her raised her hand.

"I sat in front of him. He didn't eat much for dinner, saying the food was too oily. Later he took some medicine, and I asked him if it was stomach medicine. He said it was an old problem, and he had to take it."

Qin Hai looked at Lin Ye.

"Call the family members."

Lin Ye scrolled through Gu Jianguo's phone contacts and found "daughter".

The phone rang seven or eight times before it was answered.

The woman's voice was muffled.

"dad?"

Lin Ye reported the hospital and his identity.

The person on the other end of the phone immediately regained consciousness.

"What happened to my dad? Wasn't he on a group tour?"

Qin Hai took the phone and put it on speakerphone.

"Gu Jianguo is currently in the emergency room of the First Municipal Hospital. He is experiencing altered mental status, has a bedside blood sugar level of 1.8, and low blood pressure."

Qin Hai glanced at the monitoring screen.

"We are already working to correct his hypoglycemia, and at the same time we need to check his diabetes medication."

The woman's voice suddenly rose in pitch.

"He has diabetes! He's been taking medication to lower his blood sugar. Is he skipping meals and taking his medication again?"

Qin Hai asked very quickly.

"What do you usually eat? How many times a day? Do you have any kidney problems?"

"He takes glibenclamide twice a day, morning and night. He finds it troublesome and often adjusts the dosage himself. I've told him this many times. His kidneys... his kidneys don't seem to be very good; the physical exam showed his creatinine was a little high."

Qin Hai glanced at Lin Ye.

This answer is even more complicated than blood sugar levels.

老年人。

Eat little.

You may repeat or continue taking long-acting hypoglycemic drugs.

Poor kidney function.

Pushing a tube of sugar up doesn't mean it's safe.

Lin Ye wrote these things down in his record.

2:16.

Gu Jianguo, 79 years old, did not get off the bus and is in a state of impaired consciousness.

Blood sugar 1.8, blood pressure 84/50, body temperature 35.8.

The patient has a history of diabetes, is taking glibenclamide, has a poor appetite, and has abnormal kidney function to be investigated.

Intravenous glucose has been administered to correct the condition; continued monitoring is ongoing.

Nurse Zhao retested her blood sugar.

3.2.

The old man's eyelids twitched, and he managed to squeeze out a sound.

"cold……"

Qin Hai did not breathe a sigh of relief.

"Keep warm. Test again in ten minutes, don't let your blood sugar drop back down."

When the call to Han Qing from the Department of Endocrinology was answered, the first sound heard was the scraping of a chair leg against the floor.

When she spoke, she kept her voice very low at the end.

"Lin Ye, is your emergency room handling metabolic diseases tonight?"

Lin Ye looked at the blood sugar level on Gu Jianguo's bedside table.

"79 years old, altered mental status, blood sugar 1.8. Taking glibenclamide, eating little at dinner, possibly indicating poor kidney function."

Lin Ye looked at the blood sugar record that had just been posted on the headboard.

"The glucose level is now 3.2."

There was only the rustling sound of blankets rubbing together on the other end of the phone, which paused for a moment.

Han Qing's voice hardened.

"Don't let it go. Sulfonylurea-induced hypoglycemia is prone to recurrence, especially in the elderly and those with poor kidney function."

"Continuous glucose monitoring and repeated blood sugar checks are necessary. Liver and kidney function tests and electrolyte tests will be performed. Hospitalization may be required."

"Keep the family's phone number on."

Qin Hai answered the phone.

"Come down here."

Han Qing took a deep breath.

"I know."

After hanging up the phone, the group chat for the directors lit up again.

Han Qing: [Who threw the elderly man with glibenclamide into the bus carrying patients with diarrhea?]

Tang Zhendong: [We just restored blood flow to the right coronary artery in my catheterization lab, but the blood pressure is still unstable. What's going on over there?]

Qin Hai: [The list is missing someone. The elderly person is in a coma due to low blood sugar.]

Liang Xiulan: [The child's blood sugar has returned to 4.6, but potassium levels need to be checked again. Please don't overlook the adults around the child.]

Xu Mingzhe: [Has Yuan Guilan's urine output been released yet? The source of infection has not been determined.]

Nurse Zhao glanced at the group messages.

"The directors are really not going to get any sleep tonight."

No one laughed out loud.

But the tense atmosphere in the emergency room eased slightly.

News from Jiang Lei's side quickly came back from the catheterization lab.

Tang Zhendong sent a voice message.

Qin Hai clicked on it.

"Right coronary artery proximal occlusion, blood flow has been restored, but heart rhythm needs to be monitored, and blood pressure is not good. Stop writing 'safe,' transfer to the cardiology intensive care unit for further observation."

Upon hearing the phrase "open up blood flow," the tour guide's legs went weak, and he almost collapsed to the ground.

Nurse Zhao acted swiftly and pressed him into a chair.

"Don't fall down yet. If you fall down, we'll have to triage you."

The tour guide covered his face.

"I'll resign as soon as I get back."

Liu Zhenhua pushed the seating chart in front of him.

"I'll talk about resigning tomorrow. Tonight, let's count all twenty-seven people."

A section of the whiteboard was erased.

Nurse Zhao rewrote:

Total number of people: 27.

Arrived at the hospital: 27.

Gu Jianguo: Found, red zone.

Unverified chronic disease medication: Continue to follow up.

Lin Ye stared at the number "27" before daring to let out half a breath.

He counted the red zones.

Yuan Guilan's blood pressure was 96-58, and finally a little pale yellow urine appeared in her urine bag.

The second elderly person's blood pressure remained low, but their heart rate decreased slightly after rehydration.

The child was nestled in bed, looking a little better than before. Liang Xiulan was having the nurse check the electrolytes again.

Jiang Lei went to the catheterization lab, where blood flow to his right coronary artery was restored, but he remained under monitoring.

Gu Jianguo's blood sugar rose to 3.2, and he was not fully awake yet.

Every line is moving forward.

We haven't finished traversing any of the lines yet.

When Han Qing arrived at the emergency room, she hadn't even had time to change her coat.

She checked the blood glucose record first, then looked at the medicine plate.

"Six tablets of glibenclamide are missing?"

Lin Ye nodded.

"The family said he often adds or subtracts the values ​​himself."

Han Qing turned the medicine board over, his face even more pale than before.

"This wasn't just a little less tonight."

Qin Hai frowned.

"What do you mean?"

Han Qing pointed to the edge of the medicine board.

"He would take the pills out and mix them together with the rest of the medicine, so nobody knew exactly how many pills he took that day."

Han Qing put the medicine blister pack back into the treatment cart.

"If an elderly person's kidney function is truly poor, it could drop further over the next few hours."

Gu Jianguo suddenly opened his eyes.

His eyes were glazed over.

He stared at the ceiling, his lips moving slightly.

Nurse Zhao bent down.

"Grandpa Gu, can you hear me?"

The old man's voice was so soft it was almost drowned out by the monitor.

"I...haven't had breakfast yet..."

In the emergency room, everyone paused for a moment.

It is 2:23 a.m.

He can no longer distinguish between day and night.

The system interface lit up in Lin Ye's eyes.

[Final risk of not being able to triage overnight: identified.]

[Risk of recurrent hypoglycemia: Not eliminated.]

The whiteboard on the wall wasn't dry yet.

Nurse Zhao circled Gu Jianguo's name again with a red pen.