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

After Zhou Hang entered the operating room, the emergency room did not quiet down.

The operating room door closed with a soft click from the hinges.

The sound was very soft.

It felt like a weight was being placed on the hearts of the nurses at the station.

Zhou Hang's colleague was still standing by the corridor, his name tag strap crumpled in his fist. The man who had been complaining of a stiff neck just moments before now had pale lips and his eyes were fixed on the operating room corridor.

"Haven't answered yet?"

"Nurse Zhao asked."

My colleague shook his head.

"His mother answered, but didn't understand. His father called six times, but still didn't answer."

He flipped his phone over; the call log was filled with a row of red missed calls. A corner of the screen was cracked, and his fingertip slipped as he swiped across it.

Qin Hai glanced at it.

"Keep trying. Once you get through, don't scare people. Just say the person is in the hospital and has already entered the surgical procedure. Let the cardiac and vascular surgeons explain the specific details of the condition."

The colleague nodded.

After ordering, I looked up again.

"Doctor, can he survive?"

No one answered immediately.

It's not that nobody heard it.

That statement was too harsh.

In the emergency room lobby, the IV pump was still beeping. Xu Jia's potassium supplement pump was pumping steadily, the green numbers on the screen ticking calmly. Someone on the observation bed next to her turned over, the bed rail making a dull thud.

Qin Hai flattened the electrocardiogram paper in his hand.

"They're already in the operating room; it's a fight for survival."

My colleague's Adam's apple bobbed.

"What are you arguing about?"

"Buy time."

After Qin Hai finished speaking, he did not explain further.

He clipped Zhou Hang's first blood pressure record for both upper limbs into his medical record.

Left upper limb 176/98.

Right upper limb 138/82.

The right radial artery is weak.

These numbers, pressed onto the paper, are more reassuring than any comfort.

Zhou Li stood in front of the nurses' station, still holding the short sheet of chest pain she had just written.

The corner of the paper was stuck together with tape, and the edge was curled up a little.

Tang Zhendong had just come back from the phone call, his eyes were very red.

He put the electrocardiogram paper on the nurses' station.

"Young patient with chest pain and an atypical electrocardiogram cannot be diagnosed solely as acute coronary syndrome."

The paper still carried the heat from the machine, and the edges slowly curled up.

He pointed to Zhou Hang's blood pressure record.

"Chest and back pain, sweating, numbness in the arms, and uneven blood pressure on both sides—put these together and rule out the aorta first."

Qin Hai picked up a red pen and added a line below the original short version about chest pain.

Even if you have chest pain, you should have your blood pressure measured in both upper limbs. If your pulse is not right, call your supervisor immediately.

That's the short version.

Qin Hai pointed at Liu Zhenhua.

"Remember the rest."

Liu Zhenhua tightened his grip on the notebook.

Nurse Zhao passed by and whispered a final remark.

"Congratulations, your workload has increased again."

Liu Zhenhua did not answer.

He turned to a new page in his notebook, his pen pausing for two seconds.

Lin Ye stood to the side, holding Zhou Hang's blood pressure record in his hand.

The edges of the paper were slightly softened by sweat.

The system in front of Lin Ye was not lit up.

But his back was still tense.

"Linye."

Qin Hai suddenly called him.

Lin Ye looked up.

Qin Hai pressed the note he had just written onto the wall.

The tape wasn't torn properly and stuck to his fingertip, making a ripping sound when it was pulled off.

"Keep an eye on it."

Lin Ye nodded.

"I know."

No sooner had the words left his mouth than a dispute arose from the triage desk.

"My dad's legs just go numb!"

A woman's voice was very low, but she was clearly already on the verge of losing control.

"Didn't you just say the person with chest pain was the first to arrive? He doesn't have chest pain, so he shouldn't have had to wait so long, right? His legs are hurting so much he can't stand it!"

The triage nurse looked up.

"Family members, please don't panic. First, check their vital signs."

"He's been in pain for two hours!"

A woman was supporting a man in his fifties.

The man sat half-reclined in the wheelchair, his left leg stretched out straight, his trousers rolled up to halfway down his calf. His face was ashen, his forehead was covered in sweat, and his hands gripped the wheelchair armrests tightly.

The wheelchair tires were covered in dust and water from outside, leaving two shallow tracks on the ground as it was pushed.

The woman pushed while explaining.

"He has a herniated lumbar disc and often experiences numbness in his legs. Today he suddenly said he was in severe pain and his feet were cold. I'm wondering if he's pressing on a nerve."

The triage nurse bent down to measure blood pressure.

As the cuff tightened, the man's shoulder hunched over.

Blood pressure 158-192.

Heart rate 108.

Blood oxygen 98.

The numbers aren't too bad.

But his left leg was very straight from the knee down.

The hem of my trousers was damp with sweat.

"Where does it hurt?"

The man clenched his teeth.

"Left leg."

"Does your back hurt?"

"It doesn't hurt too much, but my leg hurts."

"Can you move your toes?"

The man moved slightly.

His toes twitched slightly.

The woman became anxious.

"Move."

The man was panting.

"I can't move."

Lin Ye's gaze fell on his left foot.

That foot was sticking out of the slipper.

The color is whiter than the right foot.

The skin on the instep was taut, with little sweat, and the tips of the toes were a bit grayish.

It doesn't look like a simple lumbar disc herniation.

Nurse Zhao saw it too.

She put the treatment tray aside.

The bottom of the plate hit the table with a crisp sound.

"Roll up your trouser legs a little higher."

The woman froze for a moment.

"Isn't it a problem with your back?"

Nurse Zhao didn't explain. She just squatted down, touched the back of her hand to the man's left foot, and then to his right foot.

Her expression changed.

My left foot is cold.

Sun Zhiqiang walked over from the side.

"Dorsalis pedis artery."

Lin Ye had already half-squatted down.

His fingertips landed on the man's left instep.

I can't touch it.

The skin felt cool, unlike someone who had just been brought in from outside.

It's a kind of coolness that comes from the inside out.

Switch to the right foot.

A faint pulse can be felt on the right side.

The difference between the two sides is too obvious.

He looked up.

"It's not just ordinary leg numbness."

The woman's voice suddenly became shrill.

"What do you mean?"

Lin Ye didn't look at her and continued asking the patient questions.

Did the pain start suddenly?

The man nodded with his eyes closed.

"I was sitting on the sofa just now, and suddenly it felt like being cut by a knife."

"Have you ever had atrial fibrillation? Is your heartbeat irregular?"

The woman was stunned.

"Yes. The doctor prescribed anticoagulants, but he found the frequent blood draws troublesome and stopped taking them for a while."

The woman spoke faster and faster.

"He said the numbness in his legs was a chronic problem, and he had some pain relief ointment at home. I just put one on for him."

She reached out and lifted the man's trouser leg.

A smell of plaster mixed with the smell of sweat wafted out.

The plaster was applied to the outside of my calf, and the edges had curled up.

Nurse Zhao grabbed her hand.

"Don't rub it randomly, and don't apply any more heat."

The woman's hand froze in mid-air.

"Even applying heat doesn't work?"

Lin Ye looked at the pale foot.

"Don't let it consume any more oxygen for now."

Sun Zhiqiang's face darkened.

Qin Hai had already walked to the triage desk.

"Move him to the monitoring position next to the emergency room."

The woman hadn't even realized what was happening.

"The emergency room? He just has leg pain."

Qin Hai looked at her.

"Legs can also experience ischemia."

"If the blood can't get through, and it goes on for too long, the leg will be lost."

The color drained from the woman's face little by little.

Upon hearing "You can't save your leg," the man gripped the handrail tightly with his fingers.

The plastic handrail was scratched by his fingernails with a screeching sound.

The system in front of Lin Ye lit up at that moment.

[Emergency room alert activated.]

Patient: Xu Jianmin, male, 58 years old.

Symptoms: Lumbar disc herniation, numbness and pain in the left leg.

High-risk: Acute lower extremity arterial embolism.

[Probability of misdiagnosis: 81%]

[Key abnormalities: Sudden onset of severe limb pain, low skin temperature in the left foot, absence of dorsalis pedis artery pulsation, and a history of discontinuation of anticoagulants due to atrial fibrillation.]

[Ischemia window: Under evaluation.]

Lin Ye only glanced at it.

He only presented the evidence that was immediately available to everyone, the evidence that could get everyone moving.

"The skin temperature of the left foot is low, the dorsalis pedis artery cannot be felt, the toe movement is poor, and there is a history of atrial fibrillation with anticoagulation stopped."

He spoke very quickly.

"Treat it as acute lower limb ischemia first, don't send it to the orthopedic clinic."

Qin Hai has already given the order.

"Monitor and establish intravenous access."

"Check coagulation, complete blood count, biochemistry, muscle enzymes, and lactate."

"Check the blood flow at the bedside first, then contact the vascular surgery department."

"Find out when the last time you took the anticoagulant."

Sun Zhiqiang pushed the monitoring cart over.

The wheels made a series of soft sounds as they rolled over the wet ground.

Nurse Zhao propped up the man's left leg and immediately pressed down on his knee.

"Don't move."

The man was in so much pain that sweat beaded on his forehead.

"I'll just move it a little."

"I won't move it."

Nurse Zhao tucked the monitoring cable around the bed rails and kept her voice very low.

"If you move now, there won't be enough blood in your foot."

The women ran alongside the flatbed cart.

"Doctor, will he need an amputation?"

No one answered easily.

Qin Hai only said, "The reason we're doing this now is to avoid it from coming to that point."

The vascular surgery hotline was answered quickly.

Qin Hai put the phone on speakerphone.

"Emergency room, 58-year-old male, sudden onset of severe pain in the left lower extremity for two hours, low skin temperature in the left foot, dorsalis pedis artery not palpable, poor toe movement. Atrial fibrillation, recently discontinued anticoagulation."

The voice on the other end of the phone snapped me awake.

"Don't let him move around."

"Dubler, please sit by the bedside first, I'll get down right away."

"Prepare for lower extremity arterial CT angiography, and simultaneously assess coagulation and renal function. Clearly identify contraindications, and evaluate interventional or surgical thrombectomy if necessary."

Qin Hai responded.

"Know."

After hanging up the phone, Qin Hai did not speak immediately.

He looked at Xu Jianmin in the monitoring position.

The man's left foot was propped up on a thin pillow, the instep of his foot was blindingly white.

Doppler leaned over the bed and pressed down.

There was a hissing noise coming from the machine.

There was a sound of blood flowing from my right foot.

The sound weakened noticeably on the left side.

Sun Zhiqiang looked up.

"The blood flow in the dorsalis pedis artery in the left foot is very weak."

The woman covered her mouth, and tears immediately streamed down her face.

Qin Hai then turned around.

"Liu Zhenhua, take note."

Liu Zhenhua looked at him.

Qin Hai didn't look at the wall.

"If you suddenly experience leg pain and numbness, and your feet feel cold and pale, first check the dorsalis pedis arteries on both sides."

Liu Zhenhua bowed his head and took notes.

The paper rustled as he wrote on it.

Qin Hai looked at the monitoring station.

"Don't let anyone die young."

Lin Ye stood to the side, the red border still visible in his field of vision.

Outside the emergency room, it was already bright daylight.

Xu Jianmin's left foot was propped up on a thin pillow.

The faint sound of blood flowing could still be heard intermittently inside the machine.