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

The sound of Dubler was still echoing beside the bed.

rustle.

Let's break it down.

Two more rustling sounds.

I could still hear the sound of blood flowing continuously from my right foot, like water rushing through a narrow tube.

When I switched to my left foot, the sound became thinner.

The probe was pressed against Xu Jianmin's instep, and the white coupling gel was squeezed out in a circle, making his toes twitch slightly from the cold.

Nurse Zhao pressed down on his knee.

"Don't shrink back."

Xu Jianmin gritted his teeth.

"pain."

"I know you're in pain."

Nurse Zhao pulled the monitoring cable out from under the bed railing to prevent it from getting tangled in his left leg.

"Don't move around right now."

Xu Jianmin's daughter stood at the foot of the bed, still clutching the torn-off plaster wrapper in her hand.

The edges of the packaging were crumpled from her gripping.

The words "lower back and leg pain" were written on it.

She just used it as evidence.

Those words felt like a hot piece of iron pressed against my palm.

Qin Hai glanced at the monitor.

Blood pressure 156/90.

Heart rate 112.

Blood oxygen 98.

The numbers didn't collapse.

But Xu Jianmin's left foot is getting whiter and whiter.

The tips of his toes were gray, and his skin looked bloodless under the light.

Lin Ye stood by the bed, his fingertips landing on the back of his left foot again.

I still can't touch it.

He then checked the posterior tibial artery.

It was much weaker than the right side, almost drowned out by its own pulse.

"The dorsalis pedis artery on the left side is not palpable, and the posterior tibial artery is very weak."

Lin Ye looked up.

"Poor active movement of the toes, and the skin temperature is lower than that of the right side."

Sun Zhiqiang tore down the record sheet next to the bed.

The paper tape came out of the machine, its edges still a little warm.

He circled two places on it with a pen.

"The sound of blood flowing in the right foot can be heard, while the blood flow in the dorsum of the left foot is mostly intermittent. The time is clearly stated: it is now 4:23."

Qin Hai nodded.

"Record."

Xu Jianmin's daughter's lips moved slightly.

"Doctor, isn't this a case of nerve compression in his lumbar spine?"

Qin Hai did not answer immediately.

He placed the back of his hand on Xu Jianmin's left foot, then on his right foot.

The temperature difference between the two sides is quite significant.

"Compression of a nerve in the lumbar spine can cause numbness and pain."

Qin Hai withdrew his hand.

"But it won't make one foot so cold, nor will it make the veins on the instep undetectable."

My daughter felt like something was stuck in her throat.

"So it's congested?"

"Highly doubtful."

Qin Hai spoke very briefly.

"Now we need to let the vascular surgeons determine whether the blood flow can be reopened."

The moment the words were spoken, the elevator doors outside the emergency room opened.

A ding sound.

hurried footsteps echoed down the corridor.

The vascular surgery doctor on duty strode in carrying an old canvas bag, his white coat only buttoned up the middle two buttons, and his mask hanging on one ear.

His eyes were bloodshot from staying up all night.

The first thing they said upon entering wasn't a greeting.

Which leg?

Qin Hai led the person to the bedside.

"Left leg. Sudden onset of severe pain for two hours, atrial fibrillation, stopped anticoagulation on its own. Left foot is cold and pale, dorsalis pedis artery not palpable, and Doppler flow at the bedside is very weak."

The vascular surgeon had already squatted down.

He didn't let anyone repeat their lamentations; he looked at their feet first.

Left foot.

Right foot.

Next, palpate the femoral artery, popliteal artery, dorsum of the foot, and posterior tibial artery.

With each change of position, he would press his brow inward a little more.

"Where does the pain start?"

Xu Jianmin was panting.

"Calves...burrowing into the soles of the feet."

"Does it feel numb?"

"It's numb. The toes don't look like mine."

"Can I flex my foot upwards?"

Xu Jianmin exerted his strength.

My left instep only twitched once.

Nurse Zhao stood beside him, her eyes fixed on his toes.

"It's even worse than before."

The vascular surgeon looked up.

When was the last time you took anticoagulants?

The daughter immediately looked at Lin Ye, as if she had finally gotten a question she could answer.

"He used to take warfarin, but stopped almost half a month because he found the frequent blood draws troublesome. A few days ago, he felt palpitations, but he said it was nothing."

The vascular surgeon paused for a moment.

"Have you had any stomach bleeding? Brain hemorrhage? Have you had any surgery recently?"

"no."

"Drug allergy?"

"Allergic to penicillin, nothing else."

How was your kidney function before?

The daughter shook her head.

"I don't know. He doesn't like to check."

The vascular surgeon stood up.

"Preparing for lower extremity arterial CT angiography."

Qin Hai looked at Sun Zhiqiang.

Sun Zhiqiang had already picked up the phone.

"CT room, emergency lower extremity arterial CT angiography, 58-year-old male, suspected of acute lower extremity arterial embolism. He needs to be brought in for monitoring. Kidney function results are pending."

I don't know what was said on the other end of the phone.

Sun Zhiqiang's voice lowered.

"This isn't just ordinary leg pain. My left foot is cold and pale, and I can't feel the dorsalis pedis artery. The vascular surgeon is at the bedside. Please make way if you're in line; this is a high-risk emergency."

He hung up.

"The radiology staff on duty in the CT room said that the machine had just finished scanning a patient with abdominal pain, and they immediately cleared the table."

Qin Hai responded.

The lab called back at that moment.

Nurse Zhao answered the call.

"Xu Jianmin, Emergency Room Monitor."

She listened for two seconds, then looked up.

"Muscle enzymes haven't fully recovered, lactate is 2.8. Creatinine is 98, and blood clotting is occurring."

The vascular surgeon nodded.

"We can start with contrast-enhanced kidney function tests and then collect more data."

After he finished speaking, he turned to Xu Jianmin's daughter.

"Listen carefully."

The daughter shrank her shoulders.

The vascular surgeon neither frightened nor comforted her.

"What I fear most now is not pain."

He pointed to Xu Jianmin's left foot.

"The blood can't get through. The longer it goes on, the more the nerves and muscles will suffer. First, do a lower limb artery CT angiography to see where the blockage is. If it can be opened with intervention, then do it; if it cannot be opened with intervention or is not suitable, then evaluate surgical thrombectomy."

Tears streamed down the daughter's chin.

"Will that lead to amputation?"

Xu Jianmin, lying on the hospital bed, suddenly opened his eyes.

He looked at his daughter, then at his feet.

My left foot was resting on a thin pillow, and the instep of my foot was as white as a piece of cold wax.

The vascular surgeon's gaze also fell there.

"We are doing all this now in order to avoid getting to that point."

The daughter gripped the bed railing tightly.

The bed rails creaked as she pressed them down.

"I'll sign. I'll sign whatever it takes."

Qin Hai raised his hand to stop him.

"Listen to the full risks first."

He looked at Xu Jianmin.

"The patient is currently conscious and able to communicate, and is informed of the situation first. Family members are also present."

Xu Jianmin was in so much pain that he was covered in sweat.

But he understood.

He raised his right hand, the newly inserted IV needle on the back of his hand secured with tape, the edge damp with sweat.

"I'll sign."

The nurse pushed the informed consent form and transfer slip over to me.

The paper was placed on the small table beside the bed, with Doppler's notes underneath.

The vascular surgeon pointed to a few lines with the tip of his pen and explained them one sentence at a time.

Purpose of the inspection.

Increased risk of contrast agents.

The condition may worsen during transport.

Subsequent interventions may include thrombectomy, anticoagulation, and reassessment based on blood flow recovery and the risk of limb necrosis.

Not a single promise was made that "it will definitely be saved".

Xu Jianmin's right hand trembled as he listened to the end.

When signing, the pen tip drew a crooked line on the paper.

His daughter wanted to hold his hand.

Nurse Zhao stopped her.

"Let him sign it himself."

The daughter's hand froze in mid-air before slowly retracting.

At that moment, all the sounds around the emergency monitoring unit went quiet.

It's not quiet.

Everyone has shortened their sentences.

The oxygen cylinder was pushed over, and the metal frame hit the bed leg with a loud bang.

The monitor was switched to transport mode, and the screen lit up briefly.

Nurse Zhao re-secured the indwelling needle and then pulled the sweat-soaked sheet outwards a bit.

"Don't press down on your left leg."

Lin Ye helped to prop up Xu Jianmin's left leg.

The thin pillow sank in.

My left foot was dangling, not touching the foot of the bed.

The vascular surgeon glanced at him.

"Your emergency room stopped them early."

Lin Ye did not respond to the compliment.

He only looked at that foot.

The system's red border still hangs at the edge of the field of vision.

High-risk: Acute lower extremity arterial embolism.

[Ischemia window: Under continuous evaluation.]

[Current Status: Entered the specialist assessment pathway.]

Evaluation path.

It's not safe.

Lin Ye mentally repeated those words.

The stretcher was pushed out to the monitoring station next to the emergency room.

The wheels made a soft, sticky sound as they rolled over the undried disinfectant stains on the ground.

The daughter followed beside her, still clutching the plaster packaging in her hand.

She paused suddenly as she reached the door.

"doctor."

Lin Ye looked up.

She looked at him, her eyes reddening.

"I was just about to give him a hot compress."

Lin Ye glanced at Xu Jianmin's left foot.

If you suddenly experience pain in one leg, cold feet, or white feet on one side, do not rub or apply heat.

He spoke very slowly.

"First, check if there are any pulses on the backs of both feet."

The daughter nodded.

He tapped very hard.

It's like nailing that sentence into your brain.

When the door to the CT room opened, a rush of cold air rushed out.

The inspection table has an old scratch on its leather surface, with the edge slightly raised.

When Xu Jianmin was moved over, he gasped in pain and gripped the edge of the bed with his fingers.

A vascular surgeon stands in front of a screen.

Qin Hai and Lin Ye stayed at the door, watching the monitor and the color of the left foot.

After the contrast agent was injected, Xu Jianmin frowned.

"I feel hot."

The on-duty radiology staff in the CT room said through the glass, "It's normal, don't move."

The machine started running.

With a buzzing sound.

Round and round.

Lin Ye listened to the sound, his eyes never leaving the screen.

Blood vessels, like thin lines, slowly emerge in the gray-white image.

The vascular surgeon's finger stopped on the left side of the screen.

"here."

Qin Hai took a half-step closer.

On the screen, a segment of the artery in the left lower limb suddenly severed.

Below the fracture end, the contrast becomes noticeably lighter.

The vascular surgeon flipped the image back.

"Consider acute arterial embolism, with poor distal blood flow. It's still early, but movement is already affected; we can't delay."

After he finished speaking, he immediately took out his phone.

"Notify the interventional radiology department and operating room to be prepared."

The call was connected.

His voice was both fast and steady.

"A 58-year-old patient with atrial fibrillation who has stopped anticoagulation, has acute ischemia in the left lower extremity. Imaging shows arterial embolism in the left lower extremity with poor distal blood flow. We will prepare according to the emergency limb-sparing procedure, conduct interventional assessment, and if that fails, proceed with surgery to remove the embolus."

Xu Jianmin's daughter stood outside the door, unable to understand a single word.

But she understood that "we can't delay."

Her hand loosened.

The plaster packaging fell to the ground.

I gently flipped the wrapping paper over, revealing a line of small print on the back.

Suitable for lower back and leg pain.

Lin Ye bent down, picked it up, and threw it into the ordinary trash can next to him.

As he turned around, the light from the CT room corridor fell on Xu Jianmin's left foot.

The toes are still white.

It was colder than when I first entered.

The vascular surgeon pushed the stretcher out.

"To the interventional room."

Qin Hai followed beside him.

"The emergency department is continuing to process the coagulation results and family information records."

Nurse Zhao ran over from the other end of the corridor and handed the repaired blood test label to Sun Zhiqiang.

"Don't forget to have your muscle enzymes checked again."

Sun Zhiqiang accepted it.

"Know."

The flatcar turned the corner.

Xu Jianmin's left foot rested on a thin pillow, swaying gently with the wheels.

Lin Ye stood there, watching the foot disappear in the direction of the intervention room.

The system border finally jumped.

[Current Status Update: Acute lower extremity arterial embolism has entered the effective treatment process.]

[Result: Still under evaluation.]

Still under evaluation.

Lin Ye withdrew his gaze.

It was already fully light in the emergency room lobby.

A new round of calls came from the triage desk.

He had just turned back when the phone at the nurses' station rang again.

The phone rang short and sharp, striking the emergency room in the early morning.

Nurse Zhao answered the phone, and after hearing only one sentence, her face darkened.

"Director Qin."

She covered the receiver and looked at Qin Hai.

"A guy with chest pain walked in by himself at the door, and his face was unusually pale."