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

As soon as Qin Hai finished speaking, the wheelchair was already being pushed inside by the paramedics.

The wheels rolled over the edge of the pool of dark red vomit by the door, leaving two dark, wet streaks.

The sour, fishy smell spread along the ground.

The triage nurse grabbed a pack of absorbent towels and used them to press down the edges of the passageway.

The color seeped into the tissue as soon as it touched it.

There were no vegetable leaves under the paper towel.

There was only a sticky, dark red layer.

As the elderly man was being moved onto the emergency bed, his thick coat slipped off his shoulders.

The collar of the shirt inside was wrinkled, and there were a few pieces of dark brown stuff stuck to the front.

The middle-aged man reached out to wipe it.

Lin Ye stopped his hand.

"Don't wipe it."

The man froze.

"Dirty."

"Keep it for the doctor to see."

Lin Ye placed a disposable pad under the old man's chin.

"When did it start vomiting dark reddish-brown?"

The man opened his lips slightly.

"He didn't say he vomited blood, he just had diarrhea."

Qin Hai has already connected the electrocardiogram monitor.

When the electrode pads were placed on the elderly man's chest, his skin felt cold and hard.

The monitor light came on.

Heart rate 128.

Blood pressure was re-injected.

79/43.

Blood oxygen 93.

The old man's eyes were half-open, the whites of his eyes were yellow, and his lips were dry and cracked.

Lin Ye reached out and placed his hand on the old man's wrist.

The pulse is thin and fast, like a thread sliding down the fingertips.

"Establish two intravenous access lines."

Qin Hai looked up.

"Blood test: complete blood count, coagulation, liver and kidney function, electrolytes, blood type crossmatch, and lactate."

The night shift nurse had already opened the packaging for the indwelling needle.

The sound of tearing plastic is crisp.

Another nurse placed the blood collection tubes into the tray, the red, blue, and yellow caps tapping against the stainless steel tray with a series of sounds.

The middle-aged man stood at the foot of the bed, his hand still dangling.

He stared at the dark red stain that had been covered by an absorbent towel, his Adam's apple bobbing violently.

"Doctor, did he eat something bad? He ate some leftovers yesterday."

Qin Hai did not look up.

"Eating an upset stomach wouldn't cause your blood pressure to drop this low."

"His low blood pressure is probably due to dehydration from not eating, right?"

Lin Ye glanced at him.

The man's voice grew softer and softer.

His hand, gripping the cuff of his coat, slowly tightened.

The old man on the bed suddenly coughed twice.

A gurgling sound came from my throat.

Lin Ye immediately turned his head to one side.

Another mouthful of dark red liquid gushed out.

The mat got wet, and the edges sank quickly.

The night shift nurse handed over the suction tube.

Qin Hai took it, his voice low.

"Attraction preparation".

The suction device started, and a rough gurgling sound came from the tube.

The old man frowned slightly.

His eyes were not fully open.

Lin Ye looked at the man.

What color is your poop?

The man was taken aback by the question.

"Black...black."

After he finished speaking, he hurriedly added:

"I thought it was from taking iron supplements. He's usually anemic, and we have his medication at home."

Qin Hai paused for a second.

"What medicine should I take?"

The man hurriedly rummaged through his bag.

Keys, tissues, half a pack of cigarettes, and a medical insurance card were scattered on the table.

Finally, they found a transparent medicine bag.

The edge of the medicine bag was worn out, and inside were antihypertensive drugs, painkillers, and an incomplete strip of painkillers.

Lin Ye picked up the medicine.

The aluminum foil had several holes torn in it.

"What is this?"

The man leaned closer to take a look.

"It's for pain relief. He had back pain, so he bought it himself."

"How long have you been eating?"

"About half a month."

The more the man talked, the less confident he became.

"I take it when it hurts, sometimes two or three times a day."

Qin Hai looked up.

That glance didn't involve any insults.

But the man immediately gripped the medicine bag tightly.

"Doctor, will this medicine cause bleeding?"

"We can't just blame the medicine now."

Qin Hai put the medicine bag into the transparent bag.

"However, long-term indiscriminate use of painkillers is one of the risks of stomach bleeding."

Lin Ye added:

"Black stool, vomiting dark red liquid, low blood pressure, and rapid heart rate."

He wrote those words down below the blood pressure reading.

The man's gaze changed little by little.

The hand that was just holding onto the "diarrhea" was slowly released.

The night shift nurse looked up.

"The first vein has entered."

Another nurse frowned.

"The blood vessels here are collapsed, so blood return is slow."

Qin Hai's gaze remained fixed on the monitor.

"If this one is still usable, keep it; don't remove it. Notify the gastroenterology department, the general surgery department to issue a warning, the anesthesiology department to prepare an airway, and the blood transfusion department to prepare blood."

Someone answered from the nurses' station.

One phone call after another was made.

The landline buttons were being pressed repeatedly.

Lin Ye wrote down the blood pressure record.

79/43.

He finished writing, but the pen tip didn't leave the paper.

The old man moved slightly again.

Dark red liquid was dripping from the corner of his mouth.

The night shift nurse wiped it with gauze.

The gauze was stained with color, as if it had been soaked in old rust.

The man stared at the gauze, his lips turning pale.

He told me last night that he was fine.

No one responded to that sentence.

The sounds of suction devices, monitors, and blood collection tubes being labeled were all mixed together.

The on-duty trainee put the label on crookedly, then pressed it back on with his fingernail.

The gastroenterology department's phone number was answered first.

The on-duty trainee handed the phone to Qin Hai.

"On-call duty in the gastroenterology department."

Qin Hai pressed the speakerphone button.

"Emergency room, elderly male, low blood pressure, heart rate 128, vomiting dark red fluid, black stool, diarrhea-like symptoms for two days, suspected upper gastrointestinal bleeding. Long-term self-medication with painkillers. Blood routine and coagulation tests are being sent, crossmatching has been completed, blood is ready, general surgery and anesthesia are on alert."

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

"How is your consciousness?"

"Drowsiness, able to respond to pain, and persistent vomiting of blood-like substances."

"First, expand blood volume, prepare blood, administer proton pump inhibitors, withhold food, and provide airway protection if necessary. We're going downstairs."

Qin Hai didn't waste any words.

"quick."

The phone hangs up.

Upon hearing the words "vomit-like substance," the man's shoulders slumped.

"Is it really blood?"

Lin Ye looked at him.

"picture."

The man lowered his head and wiped the corner of his eye.

"But he had diarrhea for two days."

"Black stool can also be blood."

Lin Ye placed the painkiller on the tray next to the bedside table.

"Don't mistake black stools for diarrhea in the future."

The man nodded, very quickly.

His eyes never left the emergency bed, and the medicine bag in his hand was crumpled from being gripped so tightly.

The blood gas analyzer next to the bed first spat out a piece of paper.

The night shift nurse tore off a piece of paper and handed it to Qin Hai.

The paper strip still carried the heat of the machine.

"Lactate 5.2."

Qin Hai frowned.

"What about hemoglobin?"

"The blood test results haven't come back yet."

At that moment, Qin Hai's phone vibrated in his pocket.

He glanced at the incoming call.

operating room.

The sounds around the resuscitation bed were as thin as if they had been sliced ​​off.

Qin Hai answered the call.

"explain."

The person on the other end of the phone was a vascular surgeon.

His voice was even hoarser than before.

"Liang Shumin step down."

Qin Hai did not reply immediately.

Lin Ye, who was standing next to him, also stopped writing.

The call didn't stop.

"With tubes in place, vasopressors still in place, and blood transfusions still running, go directly to the intensive care unit."

"The bleeding during the operation was partially controlled, but the blood clotting was still poor, and the next 24 hours are crucial."

Qin Hai closed his eyes.

"I know."

"What did the family say?"

"Don't say 'peaceful'."

The person on the other end of the phone should stop them from saying that.

"Just say, after you step down, go to the intensive care unit and keep fighting."

Qin Hai glanced at the old man on the bed in the red zone.

They just came off the operating table.

They just brought the emergency bed onto the patient in the red zone.

He gripped the phone tightly.

"I asked Nurse Zhao to pass on the message."

After hanging up, he didn't leave.

He handed his phone to the nurse on the night shift.

"Call the operating room door and ask Nurse Zhao to say three sentences."

The night shift support nurse took the phone.

He's stepped down.

"Transfer to the intensive care unit with tubes attached."

"We must continue to rob."

Qin Hai nodded.

"Not a single word more."

The night shift nurse took out her phone and made a call, then moved to the door to avoid the noise of the emergency bed.

She held the phone to her ear and listened for a second.

"Sister Zhao is still outside the operating room."

She lowered her voice and repeated the three sentences into her phone.

The next second, the blood pressure alarm went off for the elderly man on the resuscitation bed.

The cuff deflated again.

73/39.

The veins on the back of the middle-aged man's hand, which was gripping the bed railing, were bulging.

"doctor!"

Qin Hai returned to the bedside.

"Don't shout."

He placed his hands on the bed railing.

"We can't bring the blood pressure back down."

"Where is the blood preparation?"

Someone at the nurses' station was watching the phone.

"The blood transfusion department is preparing the blood. The first bag of red blood cells will be ready in ten minutes at the fastest."

Qin Hai's hand remained on the bed railing.

"Use a small amount of crystalloid solution to maintain the pathway first, then administer it as soon as blood arrives; vasopressors are only a temporary measure. Where should we go to the gastroenterology department?"

"I'm going downstairs."

"Anesthesiology?"

"I answered and they said there was a risk to the airway and they would be there immediately."

The old man vomited again.

The quantity this time is not large.

But the color is darker.

The suction tube tip was pressed against the surface, producing a muffled sound.

Lin Ye looked at the monitor.

Heart rate 136.

Blood pressure is 73 or 39.

Lactic acid five point two.

Black stool.

Hematemesis-like substance.

Long-term self-medication with painkillers.

These words, when written on the record sheet, meant that the mere hope of "ordinary diarrhea" was no longer valid.

When the on-call doctor from the gastroenterology department arrived, his coat was not even buttoned up properly.

The first thing he did upon entering the room was to look at the doormat.

Let's look at the monitor again.

"Once the blood arrives, prepare for an emergency gastroscopy assessment."

Qin Hai glanced at the blood pressure reading.

"Can blood pressure be measured like this?"

The gastroenterologist pulled his gloves on.

"First, raise the blood pressure. Then, have the anesthesiologist assess the airway. Check the amount of bleeding and the level of consciousness. If necessary, intubate to protect the airway before proceeding."

The general surgery department also answered the phone.

"If the endoscopy can't stop the bleeding, or if the blood pressure can't be controlled, the general surgery department will have it on hand."

Qin Hai only managed to utter one sentence.

"Someone come first."

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

"I'm going down."

The middle-aged man's legs went weak when he heard the words "gastroscopy," "intubation," and "general surgery."

He leaned against the wall for support.

There was an old crack on the wall; when you pressed it, a little bit of white plaster fell off.

Lin Ye walked over.

"Are any family members here? Who else can sign the consent form for the blood transfusion and emergency gastroscopy?"

The man looked up.

"I am the son."

"Inform us if the patient is critically ill as well."

The gastroenterologist straightened the gloves.

"Transfusion reactions, gastroscopy failure to stop the bleeding, intubation if necessary, and surgical intervention if endoscopy fails to control the bleeding—all these must be clearly explained."

"Did you bring your ID card?"

"I brought it."

Does the elderly person have liver disease, stomach ulcers, a history of vomiting blood or having black stools, or are they taking aspirin or anticoagulants?

The man was dumbfounded by the question.

He opened his mouth.

"I have no idea."

Lin Ye did not blame him.

"Call your family now."

He made the key points very clear.

"Medicine box, medical records, history of stomach problems, liver disease, anticoagulants, aspirin, and how much painkiller I've taken."

The man frantically pulled out his phone.

The screen unlock failed twice.

My fingers were shaking so badly I couldn't press it down.

Lin Ye pressed the phone firmly into his palm.

"Slow down."

"Don't hang up."

No sooner had he finished speaking than someone at the nurses' station raised their voice.

"The hemoglobin has returned!"

The sound of the paper being torn was very loud.

The on-duty trainee rushed over.

"Sixty-two grams per liter."

Qin Hai's eyes darkened.

The gastroenterologist also looked up.

Hemoglobin 62 grams per liter.

Blood pressure is 73 or 39.

The vomit-like substance was still gushing out.

The middle-aged man stood frozen against the wall, holding his phone.

Someone on the other end of the phone asked him what was wrong.

He moved his lips twice, but the phone was still pressed against his ear.

Qin Hai had already spoken.

"Notify the blood transfusion department to send the first bag to the red zone immediately upon arrival."

"The anesthesiologist will assess the airway upon arrival."

"The gastroenterology department is preparing for bedside emergency gastroscopy."

"General surgery personnel are on standby."

He finished speaking before looking at Lin Ye.

"Bring the family members to the signing table."

Lin Ye nodded.

He helped the middle-aged man up.

The man's arms were trembling even through his shirt.

Behind me, the suction device next to the resuscitation bed started beeping again.

The dark red liquid flowed into the bottle through the transparent tube.

Segment by segment.

The middle-aged man leaned against the wall, his hand constantly trembling as he struggled to hold his phone steady.