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

Chapter 67 Blood pressure was kept stable before the endoscope could be inserted.

The pen on the signing table ran out of ink.

The middle-aged man held the pen and made two strokes on the paper, leaving only a short, intermittent mark.

His hands were shaking violently.

The corners of the signature board were peeling, and layers of transparent tape had been applied.

His fingernail pressed against the upturned corner, creating a deep crease.

Lin Ye took a pen from the drawer and handed it over.

"Blood transfusion consent, informed consent for emergency gastroscopy, and assessment of endotracheal intubation and anesthesia if necessary."

The man stopped when he heard the word "intubation".

"Intubation?"

Lin Ye looked at him.

On the other side of the emergency bed, a trace of dark red seeped from the corner of the old man's mouth.

The night shift nurse turned to her side and placed the suction tube opening against it; a layer of dark red liquid immediately coated the inner wall of the transparent tube.

"He kept vomiting dark red liquid and was not fully conscious. If he vomits again during the gastroscopy, he might choke on it."

The man's Adam's apple bobbed.

"Isn't that very dangerous?"

"It's dangerous not to insert it now."

Lin Ye did not speak definitively.

"Therefore, the anesthesiology department should first consider airway risks."

The suction machine was still running over the emergency bed.

A dark layer had accumulated at the bottom of the suction bottle.

The blood pressure cuff bulged up again.

The monitor jumped twice.

72/38.

The night shift nurse glanced at the screen, her voice tense.

"Director Qin, your blood pressure has dropped again."

Qin Hai stood at the head of the bed.

His gaze remained fixed on the monitor, then swept over the IV stand.

The second vein had just been inserted, and the adhesive tape hadn't been pressed firmly yet, so the fluid was dripping slowly.

"Where is the first bag of blood?"

A hurried response came from the nurses' station.

"The blood transfusion department just left; the cold chain container is on its way."

Qin Hai pulled the gloves up to his wrists.

"The pressure pump is ready. How's the second vein?"

"It's barely usable, but it's slow."

"Keep it alive, don't let it become useless."

The gastroenterologist was already standing by the bedside.

He didn't rush to perform the gastroscopy.

He looked down at the mat and the suction bottle, then glanced at the old man's half-open eyes.

"If we stop filming now, the risk of choking is too high."

Just then, the anesthesiologist pushed the door open and walked in.

He wore a surgical gown over his white coat, and his hair was pressed flat.

As soon as he entered the room, he checked the monitor.

Now let's look at the attraction bottle.

"consciousness?"

Qin Hai stared at the monitor.

"Drowsiness, responsiveness to pain, persistent vomiting of blood-like substances, blood pressure 72-38."

The anesthesiologist put the stethoscope into the ear.

"Full stomach, active hematemesis, shock. An emergency gastroscopy is required. Prepare for endotracheal intubation to protect the airway."

The middle-aged man had just finished signing a name when he heard this, and his pen stopped.

The last stroke on the paper left a crooked line.

Lin Ye pressed down on the signing board.

"Sign it first."

The man looked up.

"What if it gets stuck after being inserted?"

The anesthesiologist did not avoid the topic.

"That's possible."

The man's face turned ashen.

The anesthesiologist continued the conversation.

"But if we don't protect his airway now, he could choke on what he vomits and immediately suffer from oxygen deprivation."

The man looked down at the paper.

The paper was covered with dense writing.

His eyes swept across the paper, then quickly looked away.

Lin Ye pointed to the key location.

"This is a blood transfusion."

"This is a gastroscopy."

"This involves the risks of intubation and anesthesia if necessary."

The man pressed the pen and signed his name.

As I was writing the last word, the alarm went off again from the emergency bed.

Heart rate 142.

The blood pressure readings haven't come out yet.

The old man made a gurgling sound in his throat.

The night shift nurse immediately turned her head to the side and attracted her attention.

The amount extracted this time was not large.

But the color is darker.

The gastroenterologist muttered a curse under his breath.

"We can't delay any longer."

The sound of running could be heard outside the corridor.

The cold chain box hit the door frame with a thud.

The box buckle was shaken open and half of it popped off.

The nurse delivering the blood placed the box next to the ambulance.

"The first bag of red blood cells."

The night shift nurse opened the box.

The cold air from the ice pack wafted out.

Water droplets clung to the outside of the blood bag, and she wiped the label with her thumb.

Water droplets rolled down the corner of the bag onto the back of her hand.

"Check."

Two nurses simultaneously read out the name, blood type, and number.

The sound was fast, but not chaotic.

Qin Hai stared at the monitor.

"Pressure transmission".

Hang the blood bags up.

The pressure bag was gradually inflated, the plastic skin tightened, and it made a faint squeaking sound.

The red color traveled down the blood vessel.

The man stood next to the signing table, his eyes fixed on the tube.

His fingers gripped the edge of the signing board, his nails leaving a white mark.

Qin Hai didn't hold him for too long.

"This is just stalling for time."

The man's eyes flickered.

"The blood has entered, but that doesn't mean it has stopped."

He nodded.

On the second tap, tears fell.

The anesthesiologists have begun preparations.

The laryngoscope, endotracheal tube, suction tube, and fixation tape were laid out in sequence.

The wrapping paper was torn open, and the plastic sheet rolled up to the edge of the tray.

The crisp sound was very soft, but it startled the man by the signing table, making him raise his eyes slightly.

Dark red oozes from the old man's lips again.

The anesthesiologist glanced at Qin Hai.

"Blood pressure is too low; caution is needed with induction drugs."

Qin Hai nodded.

"On the booster pump."

Lin Ye stood to the side, holding a notebook in his hand.

He wrote down the time.

The first bag of red blood cells arrived.

Pressurized infusion.

The anesthesiology department assesses airway risk.

Emergency gastroscopy after preparing for endotracheal intubation and protecting the airway.

As the pen reached the last line, the suction tube beside the resuscitation bed trembled again.

He did not close the notebook.

The anesthesiologist leans over.

"attract."

The suction sound suddenly became louder.

The liquid in the old man's throat was drained, and the tube vibrated twice.

"Provide oxygen."

Press the oxygen mask down.

The mist spread out layer by layer inside the mask.

"Get ready."

Everyone in the emergency room took a half step back from their respective positions.

It doesn't scatter.

It's about making room for the airway.

Lin Ye saw the night shift nurse raise the head of the bed a little and then put the suction tube back to her hand.

The metal clips on the headboard clicked into place.

The suction tube opening was pressed against her palm.

The intubation process took only a short time.

Before the middle-aged man could even react, the catheter was already fixed to the old man's mouth.

The suction tube remained in the oropharynx.

After confirming the tube position and waveform, the anesthesiologist nodded to the gastroenterologist.

After the ventilator was connected, the waveform on the screen appeared one after another.

Blood oxygen levels climbed from 90 to 94.

Blood pressure remains low.

76/41.

Qin Hai only glanced at it.

"Don't think you're fine just because you're full of oxygen."

The night shift nurse's eyes, which had just been raised, fell back onto the monitor.

The gastroenterologist has already picked up the endoscope handle.

"Let's take a look first."

"Continue to administer blood transfusions while maintaining blood pressure, and do not stop the vasopressors."

He pulled the screen closer to the bed.

"First, check if you can find the bleeding point near the bed."

The screen was pushed to the side of the bed.

As soon as the screen lit up, a black and red liquid filled the field of vision.

The night shift nurse replaced the suction bottle with a new one.

When the old bottle was put down, the bottom of the bottle made a dull thud on the floor tiles.

The gastroenterologist frowned.

"My stomach was full of blood and blood clots."

Lin Ye stood to the side and behind.

The image on the screen is unclear.

Water rushes in and is then sucked out.

The dark red color was taken away layer by layer.

The middle-aged man dared not look at the screen.

He stared at his hands.

There was ink smeared on the back of my hand from when I signed it.

When the general surgeon arrived, the shoe covers hadn't been pulled up properly.

He stood at the foot of the bed and stared at the endoscope screen.

"Have you found the spot yet?"

The gastroenterologist didn't look up.

"There are too many blood clots, and it's gushing out. It seems to be coming from the pylorus into the duodenum."

The general surgeon looked at Qin Hai.

"Can your blood pressure handle it?"

Qin Hai did not look away from the monitor.

"The first bag just arrived; the vasopressors are being used."

The general surgeon nodded.

"If the bleeding can be stopped endoscopically, we'll do so. If it can't be stopped, or if the blood pressure continues to drop, we'll call for interventional embolization to stop the bleeding, and the operating room will also be alerted."

He spoke very calmly.

But when the middle-aged man heard the words "operating room," his shoulders tensed abruptly.

Lin Ye walked over to his side.

"We're still looking for the blood spots."

The man's voice was incredibly hoarse.

"Will things be alright once we find it?"

Lin Ye paused for a moment.

"Only if we find it will we have a chance to stop it."

The man slowly loosened his grip on the pen.

He didn't ask "whether it can get better" again.

The image on the endoscope screen suddenly stopped.

"Duodenum bulb, look here."

Several pairs of eyes, one at the head of the bed and one at the foot of the bed, pressed down on him.

On the screen, a bright red spot was oozing out from the edge of a piece of mucous membrane after rinsing.

It wasn't sprayed very high.

But one wave after another.

The small opening at the edge of the mucosa hasn't closed yet.

The gastroenterologist lowered his voice.

"Active bleeding."

Qin Hai pressed his fingers against the edge of the clipboard.

"Can you handle it?"

"try."

The gastroenterologist didn't say much.

The instruments are inserted through the endoscope channel.

The image on the screen flickered.

The night shift nurse is monitoring blood pressure.

"Seventy-eight forty-two."

"Heart rate 138".

Qin Hai's gaze never left the monitor.

"The bleeding continues."

"The second bag of red blood cells has caught up."

Someone at the nurses' station immediately made a phone call.

"Blood transfusion department, resuscitation area, massive upper gastrointestinal bleeding, second bag of red blood cells prepared, first bag being transfused under pressure."

The gastroenterologist barely blinked in front of the screen.

"Clips".

The endoscopy nurse handed it over.

The small metal clip flashed briefly under the light and quickly disappeared into the endoscope channel.

The little red dot on the screen was brought closer.

Closed.

The video is shaky.

Rinse with water.

The red color has decreased slightly.

But it didn't stop completely.

The gastroenterologist's forehead was sweating.

"One more."

No one spoke.

The only sounds in the emergency room were those of monitors, suction devices, ventilators, and the flushing of gastroscopes.

The second clip went in.

The blood flow decreased a little.

This time, the water on the screen did not immediately turn red.

The middle-aged man finally raised his head.

Qin Hai first kept quiet.

"Don't report good news."

The man's gaze lingered in mid-air.

Qin Hai looked at the screen.

"Your blood pressure hasn't come back up, and your hemoglobin is still low. You might experience further complications later."

The gastroenterologist didn't laugh either.

"Suppress it a little for now."

"Continued observation is needed."

"There are many blood clots in the stomach, and the field of vision is not clear, so we cannot guarantee that there are no other bleeding points."

Lin Ye wrote these words down.

Suppress it for now.

Continue to observe.

No guarantee.

There wasn't a single word like "done" on the record sheet.

Qin Hai's phone vibrated again in his pocket.

This time it wasn't the operating room.

It's the intensive care unit.

He answered the call.

"Qin Hai".

The voice on the other end of the phone was very fast.

"Liang Shumin has arrived. He's on tubes, with two lines of vasopressors, but his temperature is still low, and we're continuing to correct his coagulation. His family is outside asking if they can get a glimpse of him."

Qin Hai glanced at the endoscope screen.

"Follow the intensive care unit procedures."

"Don't say 'peaceful'."

The call was answered quickly on the other end.

"I know. They just said to continue the emergency treatment and observation."

Qin Hai hung up.

He did not tell the family members at the bedside about the emergency call.

The middle-aged man's eyes were still glued to the endoscope screen.

On the other side, the light outside the intensive care unit was still on. The family members outside stopped and started walking, waiting for the words "continue to be observed" to fall.

As dawn approached, the corridor lights were still blindingly white.

The day shift staff have been arriving at the nurses' station one after another.

The handover log was spread out next to the ambulance. The on-duty nurse first circled two names in red pen: Liang Shumin, an elderly man with upper gastrointestinal bleeding.

The day shift doctor bent down to look at the emergency record folder, while the nurse next to him filled in the handover book with the infusion pump and blood pressure records.

Qin Hai did not go to the duty room.

He only pulled his mask down for a moment, revealing red marks on the sides of his nose, but his voice remained steady.

"Keep an eye on these two procedures during the day shift. Observe after the gastroscopy, check blood pressure, and recheck hemoglobin. Don't let Liang Shumin's work stop either."

The water glass in the corner of the nurses' station was still there, the condensation on the glass had dried.

As Lin Ye raised his hand, his sleeve brushed against the rim of the cup, and he realized that he hadn't touched it all night.

On the endoscopy screen, the bleeding points have temporarily stopped appearing.

My blood pressure was measured again.

84/45.

The middle-aged man stared at the numbers, his lips moving slightly.

This time, he didn't dare ask if it was better.

Lin Ye closed the folder halfway, then reopened it.

The bottom half of the page was still blank, with the pen tip resting there, uncapped.

Just then, hurried footsteps came from outside the nurses' station.

A boy in a school uniform was helped in by his teacher.

The boy covered his chest with his right hand.