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

It was just past 10 p.m.

The electronic clock in the red zone jumps to 22:03.

The man was still complaining of back pain when he was pushed into the red zone.

Fifty-six years old.

His name is Feng Jianping.

He was covered with a thin blanket that had been temporarily found in the outpatient hall, but he was still shivering underneath.

It's not that I'm shaking from pain.

It was a chill.

The teeth clicked together, making a soft, fragmented sound.

His wife followed beside the flatbed cart, clutching an old film bag in her hand.

The edges of the packet were white from being squeezed so much. As soon as she came in, she turned it over with the date side facing out and pointed it out to everyone.

Three years ago, I had a kidney stone in my right kidney.

"Doctor, he used to have this kind of pain from kidney stones. A painkiller injection would have been enough; he really didn't need to go to the emergency room."

Nurse Zhao wrapped the blood pressure cuff around her arm.

"Don't worry about that injection yet. Hold out your hand and see if he can still wait."

Feng Jianping stretched out his hand, trembling.

The back of my hands is dry, and my skin feels hot to the touch.

Lin Ye stood by the bed, watching the numbers on the monitor appear.

Heart rate 132.

Blood pressure: 92-58.

Body temperature 39.1 degrees Celsius.

Blood oxygen 95.

He was genuinely in pain.

However, the numbers on the monitor had already pushed the person into the red zone.

Qin Hai walked to the bedside.

"When did it start hurting?"

The woman answered immediately.

"Last night, his lower back ached first, then his right lower back hurt. He'd had kidney stones before, but he just endured the pain. This afternoon he developed a fever, and last night he was shaking badly, so I brought him here."

Qin Hai visits a patient.

"Where's the pee?"

Feng Jianping was panting.

"Not much. I haven't urinated much all day."

The woman added a sentence.

"He has diabetes, and his blood sugar is usually quite unstable. He didn't eat much today."

Lin Ye wrote these things down in his record.

The blue text frame at the edge of my field of vision is still there.

[Emergency Room Warning: Hidden High Risk.]

[Probability of misdiagnosis: 76% for common kidney stones/lumbar muscle strain.]

[Key Risk: Early stage of sepsis.]

[Considerations: High fever and chills, heart rate above 130, low blood pressure, oliguria, history of diabetes, lower back pain.]

[Risk window: continues to widen.]

Lin Ye did not say the last line.

He only reported what he could actually see to Qin Hai.

"High fever and chills, heart rate 132, blood pressure 92.58." Lin Ye glanced at the person on the bed. "Diabetes, right back pain started last night, and he's urinating very little today."

Qin Hai's gaze fell on the blood pressure.

"Enter the red zone."

The woman was taken aback.

"He really does have kidney stones."

Qin Hai didn't argue with her.

"Kidney stones can be very painful, but you also have a fever, chills, low blood pressure, and decreased urination. We'll treat it as an infection first and try to get it treated as more serious."

Nurse Zhao had already torn open the packaging of the indwelling needle and stuck the tape to the side of the bed rail.

"Leave two veins in place first. Don't let him get out of bed on his own."

Feng Jianping curled up to his right side in pain.

"Give me a shot, it hurts so much."

Qin Hai looked at him.

"Pain relief will be provided, but it won't be a one-shot deal."

He turned to Sun Zhiqiang and instructed him.

"Complete blood count, CRP, PCT, liver and kidney function tests, electrolytes, coagulation tests, and two blood cultures. Bedside blood glucose and blood gas analysis. If urine can be collected, do so; if not, perform catheterization for assessment first. Don't wait unnecessarily."

Sun Zhiqiang nodded and picked up the landline.

"Urology?"

"First, issue a warning."

Qin Hai added a sentence.

"The infectious disease department also administers the treatment. Don't let the critically ill patients die yet; let them get their blood gases and lactic acid levels first."

When Lin Ye heard the word "lactic acid," his pen paused briefly.

The last outbreak of dental infections has just ended, and the word "lactic acid" is back on the page.

Feng Jianping's wife was still clutching the old film bag.

"Doctor, look, he really did have kidney stones before."

She handed the bag of film to Qin Hai, but stopped halfway through, rubbing her fingers back and forth on the edge of the bag.

Qin Hai took it and glanced at the date.

three years ago.

He placed the bag of film beside the bed.

"Old films can show that he had kidney stones in the past, but they can't show that he only has kidney stones today."

The woman gripped the bag tightly, her knuckles tightening instantly.

Nurse Zhao placed the blood collection tube into the tray without raising her voice.

"First, take out his ID card and medical insurance card. Don't throw away the old films, the doctor will look at them; but don't bring films from three years ago, just to cover up today's cold sweat."

The woman frantically rummaged through her bag.

The blood sugar level at the bedside came out first.

Sixteen point eight.

The blood glucose meter beeped.

Nurse Zhao read out the values.

"Blood sugar is 16.8."

Qin Hai frowned.

"Diabetes carries a higher risk of infection. Be cautious with fluid replacement therapy, and monitor blood pressure, urine output, and cardiac function together."

Feng Jianping suddenly trembled again.

The thin blanket slipped down from her chest.

Lin Ye helped raise the bed rails without putting pressure on the patient's back.

"Right-sided lower back pain, worsened by chills."

Sun Zhiqiang turned around from the phone.

"The urology department said they'd be there in ten minutes. The infectious disease department is on their way."

The blood energy machine beeped beside the bed.

The note was still warm when it was spat out.

The young nurse tore it off and handed it to Qin Hai.

When Qin Hai glanced at the lactic acid section, his expression softened considerably.

"Lactate level 3.8"

The woman's hand, holding the medical insurance card, froze in mid-air.

"Is this serious?"

Qin Hai handed the note to Lin Ye.

Write it down.

Lin Ye recorded the values ​​in the logbook.

Lactic acid 3.8%.

High fever and chills.

Heart rate 132.

Blood pressure: 92-58.

diabetes.

Infrequent urination.

Qin Hai did not look at the old film bag again.

His gaze shifted from lactic acid to blood pressure, then back to the words "low urine output".

Qin Hai picked up the phone.

"CT room, emergency red zone. 56-year-old male, lower back pain, high fever and chills, borderline blood pressure, lactate 3.8, diabetes, oliguria. Prepare for an enhanced abdominal and pelvic CT scan, focusing on the urinary system and perirenal area. First, review the renal function test results, then consider the urology, imaging, and nephrology departments together. If necessary, inform us to go to the emergency room."

The person on the other end of the phone asked something.

Qin Hai answered quickly.

"This isn't the usual outpatient kidney stone pain. I'm currently in the red zone."

Feng Jianping's wife finally stopped saying "get an injection".

She looked at her husband's trembling, bluish lips and lowered her voice.

"So, is he infected?"

Qin Hai did not directly give a specific name for the illness.

"The evidence now suggests the infection is progressing. Whether there's a problem around the kidneys, we'll need to see the scans."

When the urologist arrived at the red zone, Feng Jianping had already administered the first bag of fluid.

My blood pressure stopped rising.

Ninety six sixty.

Heart rate 128.

The urologist examines the patient first, then looks at the old film bag.

"A kidney stone X-ray from three years ago?"

The woman nodded.

"Yes, he always experiences pain on his right side."

The urologist put the film bag down.

"Today is different. Fever, chills, low blood pressure, and high lactic acid levels cannot be treated as mere pain relief for kidney stones."

As he bent down to examine Feng Jianping, when he pressed on the right costovertebral angle, Feng Jianping shrank upwards.

"pain!"

The urologist straightened up.

"There is significant tenderness on the right side when percussed."

The infectious disease doctor also arrived.

She took the bloody note, and the first thing she asked after reading it wasn't about the film.

"Has a blood culture been drawn?"

Nurse Zhao pointed to the tray.

"I've already drawn both sets."

The infectious disease doctor nodded.

"Don't delay with the anti-infection treatment. Two sets of blood cultures have already been drawn; start the first dose intravenously. The specific drug name and dosage will be adjusted according to the hospital's protocol and kidney function."

Lin Ye added "blood culture has been drawn" to the record.

The system window bounced slightly.

[The chain of evidence is being formed.]

[The next key step: identifying the source and extent of the infection.]

[Risk window: Still widening.]

He did not stop writing.

The urine test results are not yet available.

The phone call about kidney function should come back first.

Creatinine levels are higher than usual.

When the nurse repeated the contents of the phone call to Qin Hai, her voice was noticeably tense.

"The lab said my creatinine has gone up, but my potassium levels are okay for now."

Qin Hai went to see a urologist.

"Can we go for enhancement?"

The urologist did not nod immediately.

"This isn't a routine enhanced scan. Creatinine levels have already risen, and we acknowledge the risks. But what we're more worried about now is obstruction, infection, or perirenal abscess—those life-threatening things. If the source can't be found, the person is in even greater danger. How we prepare the scans will involve both imaging and nephrology teams, and if necessary, we'll inform them of the risks."

The old film bag in the woman's hand drooped down.

"Isn't it a kidney stone?"

The urologist looked at her.

"Kidney stones are possible. But if they are complicated by infection or an abscess has formed around the kidney, it's not something that can be resolved with just an injection of painkillers."

Feng Jianping shivered again.

The heart rate on the monitor jumped back to 134.

Qin Hai pressed the blood gas strip onto the medical record folder.

"Notify the CT room to bring monitoring personnel. The urology department should accompany them for a while. Get them treated for infection first; don't wait for the full report and make them anxious."

The woman moved closer to the flatbed cart.

"Can I come along?"

Nurse Zhao stopped her.

"Follow him to the CT scan entrance. Don't go inside. Think carefully about all the medications he's been taking recently, his blood sugar medication, and whether he's had a fever or taken any fever reducers. The doctor will ask about that later. Don't rush into saying it's just his old problem."

The woman nodded, no longer offering the old film bag forward.

She looked down and rummaged through her bag, pulling out a box of medicine.

One of the medicine boxes had its lid not closed properly, and white pills spilled into the bottom of the bag.

Lin Ye saw this and added a comment.

"Make a note of the medications as well. When were the diabetes medication, painkillers, and fever reducers taken?"

The woman immediately handed over the medicine box.

"I'll look, I'll find them all. There are words on the medicine boxes, but I can't read them all. Look."

As the stretcher was being pushed toward the CT room, Feng Jianping suddenly opened his eyes.

"Doctor, do I need surgery?"

Qin Hai looked at him.

"Let's get it checked out first. Your most important thing right now isn't the pain, but whether the infection is getting out of control."

The CT room called back.

"We can install one in the emergency room first. The patient can go straight in when they arrive."

Qin Hai hung up the phone.

"Walk."

The flatbed truck wheels rolled over the entrance to the red zone.

Feng Jianping's wife followed behind, carrying the old film bag and medicine box in her arms.

She ran alongside them, opening her mouth several times, but in the end she only held the medicine box and the old pill bag tighter.

Lin Ye stood beside the bed, watching the heart rate on the monitor.

134.

Blood pressure is 96 or 96.

Lactic acid 3.8%.

The blue text frame lowers the brightness at the edge of the field of vision.

[Risk of infection progression: Not yet eliminated.]

[Image assessment: To be completed.]

[The window for confirming the source of infection is continuously shortening.]

The door to the CT room is open at the front.

Upon seeing the stretcher and monitor, the imaging personnel immediately blocked the door.

"This bed in the red zone?"

Qin Hai nodded.

"Yes. Let's check what he's hiding behind his waist first."