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

Tang Zhendong's words, "The wall is looking for me again," still resonate on the phone.

The emergency stretcher has been pushed to the triage station.

The wheel rolled over a trail of undried gray water on the ground, making a sticky sound.

The young man sat half-sitting on the flatbed, his right hand covering the area where his shoulder and neck met.

The collar of his white shirt was soaked with sweat.

He saw a row of people in the emergency room turn their heads, and he forced a smile.

"It's not that serious."

"I just slept in the wrong position and got a stiff neck."

Nurse Zhao didn't respond to his smile.

She held the handrail of the flatbed with one hand and wrapped the blood pressure cuff around it with the other.

"Would a stiff neck hurt so much that you need to call an ambulance?"

The young man was accompanied by a colleague wearing a name tag, whose face was even paler than his.

"He suddenly clutched his chest at the company, saying his right arm was numb and he was sweating profusely. I was afraid something was wrong, so I called 120."

The man immediately frowned.

"My neck pain is radiating to my chest."

"Don't talk nonsense, or my parents will find out."

Tang Zhendong lowered his voice a little when he heard this on the other end of the phone.

"Qin Hai, don't let him sit up on his own yet. Report the ECG, blood pressure, oxygen saturation, and bedside blood glucose immediately."

Qin Hai put his phone on speakerphone and tossed it onto the nurses' station table.

The plastic case hit the medical record folder with a loud thud.

"Did you hear that?"

Sun Zhiqiang had already pushed the electrocardiogram machine over.

When the electrode pads were placed on his chest, the young man flinched from the cold.

"Doctor, I really don't need such a big fuss."

Nurse Zhao tightened the cuff.

"If you really have nothing to do, the machine will want to go home more than you do."

Lin Ye stood on the left side of the flatbed cart.

He didn't look at the man's right shoulder, which was in pain, first.

Look at Khan first.

It wasn't sweat from the heat.

It's on the forehead, the tip of the nose, and the sideburns.

The sweat beads were very fine, sticking to the skin without dripping down.

The man's lips weren't a bad color, and his breathing wasn't rapid.

But his left hand was always gripping the flatbed sheet.

The knuckles are turning white.

"When did it start hurting?"

The man took a breath, sounding impatient.

"Half an hour ago."

Lin Ye bit off the pen cap, making a soft sound.

"What are you doing?"

"Meeting."

A colleague quickly added a comment.

"In the afternoon, he carried a bottle of water and said he twisted his shoulder. Later, while sitting in a meeting, he suddenly said it felt like someone was tearing his chest from the inside."

The young man's expression changed.

"I didn't say 'tear'."

My colleague got anxious.

"You said it."

"You also said your back hurts."

Outside the emergency room, another family member pushed open the door and entered. The curtain was lifted, bringing in a mixture of disinfectant and damp clothing smells.

Lin Ye's pen stopped.

Chest.

Right shoulder.

My right arm is numb.

back.

It started suddenly.

Sweating.

These words, placed side by side, felt like someone had pushed the sticky notes on the nurses' station wall an inch closer to his eyes.

The red border at the edge of my field of vision finally lit up for a moment.

No diagnosis was given.

It only gave a single, blunt reminder.

[High-risk chest pain: Do not treat as a stiff neck.]

Lin Ye blinked.

Qin Hai followed the tip of his pen and glanced at the few words he had just jotted down on the medical record.

"Give me your evidence."

Lin Ye pressed the pen tip onto the medical record paper.

"It's not just neck and shoulder pain that's occurring alone."

"He suddenly experienced chest pain, accompanied by sweating, numbness in his right arm, and pain radiating to his back."

"First, screen for high-risk chest pain."

The young man immediately sat up straight.

I'm only twenty-eight.

"Isn't heart attack something that only happens to the elderly?"

Tang Zhendong gave a cold laugh on the other end of the phone.

"You're 28 and you won't get sick? Who taught you that?"

Electrocardiogram (ECG) printouts began to come out of the machine.

The paper edge brushed against the paper outlet, and it was shaken out one grid at a time.

Sun Zhiqiang tore it off and glanced at it first.

"There is no obvious ST segment elevation."

Upon hearing this, the man's shoulders visibly relaxed.

"See, I told you it was nothing."

Tang Zhendong, however, did not give in.

Send it over.

Qin Hai takes a photo.

The phone camera focused twice, and the screen light reflected in his eyes.

There was a few seconds of silence on Tang Zhendong's end after the photo was sent.

It's not that we have nothing to say.

It's like watching.

"It doesn't resemble a typical ST-segment elevation myocardial infarction."

He slowed down his speech.

"But don't put it down."

The man heard the first part of the sentence and was about to speak.

Lin Ye had already raised his hand and pressed down on the flatbed railing.

When did the numbness in my right hand begin?

"When it hurts."

Is it your whole arm or just your fingers that are numb?

The man got a little annoyed by the questions, took his right hand off his shoulder, and shook it.

"This side, the outside of my arm, and my hand also feel a bit weak."

Nurse Zhao looked down at the blood pressure for the first time.

"Left upper limb, 176 to 98."

She finished reading the report and her hands didn't stop.

Then the cuff was removed and wrapped around the right upper limb.

The man watched her movements.

"Didn't we already measure it?"

Nurse Zhao pressed the Velcro firmly.

With a ripping sound.

You have two arms.

Both need to be measured.

Lin Ye watched as the sleeve bulged out.

The radial artery on the right side throbbed very lightly under his fingertip.

It is weaker than the left side.

It's not that you can't touch it at all.

But it's weak.

He looked up at Qin Hai.

Qin Hai's face darkened.

The second blood pressure reading popped up.

Nurse Zhao looked up.

"Right upper limb, 138 to 82."

The noise at the emergency room entrance seemed to be smothered by a hand.

No one asked for quiet.

Several nurses who were triaging patients stopped for a moment at the same time.

176 for the left upper limb.

One hundred and thirty-eight for the right upper limb.

Thirty-eight short.

Qin Hai reached out and took the stethoscope.

"Lower limb blood pressure is also measured."

Sun Zhiqiang had already handed over the bedside blood glucose meter.

"Blood sugar is 5.6."

"Oxygen saturation is 98%".

"Heart rate 112".

"The temperature is thirty-six point seven."

Tang Zhendong's voice came through the phone.

This time, no bombing.

"Qin Hai, don't rush to treat it like an acute coronary syndrome with antiplatelet therapy."

"Let's rule out aortic problems first."

The young man was stunned.

"What aorta?"

His colleague twisted his hand twice around the name tag rope.

"Doctor, is it serious?"

Qin Hai neither threatened nor comforted him.

He took the stethoscope off his ear, and the sound was short.

"Severe cases should be prioritized."

"It's not that you definitely are."

"If it leaks, people will die."

The man's Adam's apple bobbed.

That last bit of impatience vanished completely after hearing that sentence.

Lin Ye pushed the medical record towards Qin Hai.

"Sudden onset of chest and back pain, sweating, numbness in the right upper limb, large difference in blood pressure between the two upper limbs, and weakness in the right radial artery."

"You need to go through the chest pain green channel according to the risk of aortic dissection."

Qin Hai looked up.

"Who are you calling?"

Lin Ye did not hesitate.

"Cardiovascular Surgery".

"At the same time, contact the CT room to perform aortic CT angiography assessment."

"Draw blood for routine blood tests, coagulation tests, kidney function tests, electrolyte tests, troponin, and D-dimer. Establish two intravenous access lines and monitor the patient."

He paused for a moment after saying this.

"Don't let him get out of bed yet."

Tang Zhendong responded with an "Mmm" on the other end of the phone.

"This time, it's not like the wall is looking for me."

"It's like the wall brought Zhou Mingyuan back."

Qin Hai glanced at his phone.

"Are you still listening?"

"nonsense."

The sound of a chair being pushed away came from Tang Zhendong's side.

"Don't just focus on the ECG if you're young and experiencing chest pain. Numbness in your right arm and poor blood pressure indicate you're on the right track."

"I won't come over to take him away yet. Your name is Zhou Mingyuan."

"Check troponin levels as well, don't overlook concurrent myocardial involvement."

Qin Hai immediately dialed the second number.

As soon as Zhou Mingyuan's name appeared, Nurse Zhao glanced at Lin Ye.

That look was very short.

The meaning is quite clear.

Another director.

The phone rang four times before it was answered.

Zhou Mingyuan's voice was low and strained, as if he had been interrupted from his work.

"Qin Hai?"

"Emergency room, 28-year-old male, sudden onset of chest and back pain, numbness in the right upper limb, and sweating. Blood pressure in the left upper limb is 176/98, and in the right upper limb it is 138/82. Weakness in the right radial artery. The electrocardiogram does not show obvious ST segment elevation. Aortic dissection is suspected. Prepare for aortic CT angiography."

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

"Don't let him move around."

"Keep your superiors watching over the blood pressure and pain relief; don't lower the target too drastically."

"I'm going down now. I'll do a full aortic angiography. Please notify the operating room and anesthesiology department before the results come out.

Qin Hai responded.

"Know."

The phone hangs up.

The young man's expression finally changed.

"Operating room?"

"Isn't it just a stiff neck?"

No one laughed.

Nurse Zhao handed the second indwelling needle to Sun Zhiqiang.

The man's hand tensed slightly as the needle pierced his skin.

The tape was applied, its edge pressing against the fine layer of sweat on the back of his hand.

Lin Ye leaned down to look at him.

"It's not certain yet."

"But the way you're experiencing pain doesn't fit your description of a stiff neck."

The man's lips moved.

"I have a project presentation tomorrow."

My colleague was standing next to me, his voice trembling with anxiety.

"You might not even be able to report back with your life."

Qin Hai glanced at him.

"Let the family members say that."

My colleague immediately shut up.

Lin Ye lowered his head and continued to ask about the patient's medical history.

Did you have high blood pressure before?

The man shook his head, then hesitated.

"The medical exam showed elevated levels."

"I didn't take my medicine."

Has anyone in your family ever had aortic or heart disease?

"My dad has high blood pressure."

He thought about it.

"My uncle passed away suddenly in his thirties due to chest pain; it was said to be a heart condition."

Upon hearing this, Qin Hai paused slightly in his hand, holding the medical record folder.

The sounds of the surrounding machines suddenly seemed even denser.

Monitor drips.

Infusion pump drip.

The electrocardiograph machine wasn't completely turned off; half a blank sheet of paper remained in the paper tray.

Lin Ye continued to ask.

"Have you been taking any medication recently? Weight loss pills, stimulants, or fitness supplements?"

A hint of unease flashed across the man's face.

"More coffee."

"I drink pre-workout supplements before exercising."

The colleague immediately made the change.

"He's been working overtime lately, drinking coffee during the day and going to the gym at night. Yesterday he even said he felt tightness in his chest, which I thought was from working out too hard with his chest muscles."

Sun Zhiqiang looked up.

"Were you bored yesterday?"

The man's voice lowered.

"A little bit."

"It suddenly started hurting today."

Qin Hai didn't ask any more questions.

He dictated the doctor's orders to Sun Zhiqiang.

"Monitoring, fasting, and absolute bed rest."

"Two veins."

"Prepare blood samples: troponin, complete blood count, biochemistry, coagulation, and crossmatch."

"Notify the on-duty imaging staff in the CT room to prepare for aortic CT angiography and transport the patient with monitoring."

"The Department of Cardiac and Vascular Surgery and the Department of Anesthesiology should notify you in advance."

"I'll take care of the pain and blood pressure control."

After he finished speaking, his gaze fell on Lin Ye.

"You follow the car."

Lin Ye nodded.

The transfer flatcar was pushed up.

The wheel bumped slightly as it passed over the newly installed magnetic clasp in front of the nurses' station.

The board is shaking.

The topmost note, labeled "Short Version of Chest Pain," was partially lifted by the wind.

It originally read:

What you should see: chest tightness and sweating, upper abdominal pain, changes in electrocardiogram.

Don't do anything yet: Don't just assume it's stomach problems, anxiety, or muscle pain.

Who to call: First, do an electrocardiogram and troponin test; if necessary, call the cardiology department.

Zhou Li stood in front of the board, her face a little pale.

She was still holding the low potassium note that Xu Jia had given her earlier.

"This one isn't enough."

Nurse Zhao pushed the ambulance to make way.

"Don't change it now, send the person over first."

Zhou Li, however, did not leave.

She unlocked the tablet again.

"I remember."

"If you have chest pain, you also need to write down your blood pressure on both sides."

Qin Hai walked past her.

"Writing is one thing, but writing is another."

"Don't turn the wall into a textbook."

Zhou Li pursed her lips.

"Write it in a way that night shift workers can understand."

The stretcher was taken out of the emergency room.

The corridor lights receded one by one.

The young man was lying on the bed, and just moments ago he had insisted that he was fine, but now he was gripping the sheets with one hand.

His shirt sleeves were rolled up to his elbows.

The red marks left by the blood pressure cuffs on both sides are still there.

At the entrance to the CT room, the on-duty radiology staff had already been called by phone.

The other person's hair was a little messy, their name tag was hanging askew, and they were holding a half-cold cup of tea in their hand.

"The aorta?"

Qin Hai nodded.

"Complete aortic CT angiography, urgent."

The videographers didn't waste any words.

"What were the kidney function results?"

Sun Zhiqiang glanced at his phone.

"Cretin levels have not yet been reported. The patient is at high risk. Director Qin is present."

Qin Hai took over the conversation.

"Go through the emergency procedure first, and I'll record the risks."

The cameraman glanced at him, then turned and pushed open the door.

"Go to bed."

The transfer tray was placed under the patient.

The plastic sheet made a dull thud as it brushed against the bed sheet.

The man gasped in pain.

Lin Ye pressed down on his shoulder.

"Don't use force."

Move horizontally.

Four people lifted it together.

As the man was moved onto the CT scan bed, his right hand suddenly grasped at the air.

My right hand is even more numb.

Lin Ye immediately looked at the guardian.

Heart rate 118.

Blood pressure remains high.

Oxygen saturation is 98%.

The fingertips of my right hand are a little cooler than my left hand.

He reached out and felt for the radial artery.

The right side is weaker.

Qin Hai stood beside the examination bed, his face ashen, as if weighed down by iron.

"accelerate."

The door to the CT room was closed.

Outside the glass window, only the low hum of the machine starting up could be heard.

A circle of white light swept across.

The young man lay inside, his eyes open.

All that energy I had just felt—wanting to explain, wanting to go back to the company, and being afraid my parents would find out—was gone.

He only stared at the top of his head.

It's like finally realizing that you don't have a stiff neck.

A few minutes later, the first set of images came out.

The cameraman's hand stopped on the mouse.

The blue light from the screen illuminated his face.

He didn't draw a conclusion directly.

He simply slid the chair to the side.

"Director Qin, look at this."

Qin Hai walked over.

Lin Ye also stood at the back.

On the screen, an unwanted line inside the aortic lumen split the blood flow into two layers.

From the ascending aorta down.

When Zhou Mingyuan pushed the door open, only two buttons were fastened on his white coat.

He glanced at the screen.

The sleepiness on her face was completely gone.

"Type A aortic dissection."

As soon as those words were spoken, all the sounds in the CT room seemed to be hushed down.

It's not that nobody is talking.

Everyone knows that we can't waste any more time on small talk.

Zhou Mingyuan turned his head.

"Has the anesthesia taken effect?"

Qin Hai picked up his phone.

"On the way."

"What about the operating room?"

"You have already been notified."

Zhou Mingyuan flipped the video over.

"Notify the blood bank to prepare blood."

"Family members?"

My colleague stood outside the door, still clutching the name tag rope in his hand.

"His parents live in another city. I just called them, but no one answered."

Zhou Mingyuan's face darkened further.

Qin Hai had already spoken.

"Continue to contact the family, record the time and phone number. The patient is conscious, have him sign the informed consent form first, and report to the on-call supervisor and the medical affairs department simultaneously."

After he finished speaking, he looked at Lin Ye.

"Go and bring the person over here."

Lin Ye nodded.

When he reached the door, the young man was still lying on the examination bed.

The imaging technicians are removing the contrast tubing.

The tape was peeled off my skin, bringing with it a little sweat.

The man looked at Lin Ye.

"Is surgery really necessary?"

Lin Ye did not speak definitively.

"The head of cardiac and vascular surgery has arrived."

"The scans indicate a serious problem with the aorta, requiring immediate surgical evaluation."

The man's throat tightened.

"Will I die?"

Lin Ye looked at his hands gripping the bed sheet tightly.

The fingertips of that right hand were still cold.

"If we don't handle it, it will."

The man's eyes immediately welled up with tears.

He opened his mouth.

"My mom doesn't know yet."

Lin Ye handed the phone to him.

"Keep fighting."

"After the call is connected, tell them you are in the emergency room of the First Municipal Hospital."

"Don't mention a stiff neck."

The man's hands were shaking violently.

It took three tries to unlock the screen successfully.

His colleague helped him dial the number.

No one answered the first time.

The second time, still no one answered.

On the third try, the call finally went through.

A woman's muffled voice came from inside.

"Zhou Hang? What's wrong?"

The man had barely uttered the word "Mom" when his voice cracked.

Zhou Mingyuan turned around from in front of the screen.

He didn't urge him.

He only said one sentence to Qin Hai.

"Give him a minute."

"Leave in one minute."

This minute is very short.

The message was so short that the patient's mother didn't even fully understand the word "aorta".

It was so short that my colleague kept explaining that it wasn't a neck pain.

The edge of the medical record folder in Lin Ye's hand was already a little slippery from being soaked with sweat.

But in the emergency room, there isn't even a minute longer.

The flatbed cart was pushed up again.

Zhou Hang was led towards the operating room by a monitor.

Tang Zhendong called again.

Qin Hai answered the call.

"Type A aortic dissection."

There was a pause on the other end of the phone.

Tang Zhendong cursed under his breath.

"I knew it."

Where are they?

"Zhou Mingyuan received the call and headed towards the operating room."

There was the sound of a keyboard on Tang Zhendong's end.

"I added the electrocardiogram and initial screening records to the chest pain procedure."

"Don't write 'successful cardiology consultation' in this case."

Qin Hai's brow twitched.

"Then what should I write?"

Tang Zhendong said, "I almost got delayed by the cardiology department while writing."

Qin Hai put down his phone.

Zhou Hang's first blood pressure record is still in his medical record folder.

The corner of the paper was softened by sweat.

Left upper limb 176/98.

Right upper limb 138/82.

Nurse Zhao glanced at it.

"Don't throw this one away."

Qin Hai didn't praise him.

He placed the record on top of the medical record folder.

Whether it can save a life depends on the operating room.

Zhou Li stood to the side, the tablet still lit up.

Lin Ye stood to the side.

The red border at the edge of the field of vision did not disappear.

It simply retreated slowly to a corner.

Like a lamp, it illuminates the two sets of blood pressure readings in the medical record folder.

In the emergency room lobby, the sound of the wheels of the next stretcher was already approaching.