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

When the signature board was handed to Feng Jianping's wife, Nurse Zhao's work cell phone vibrated in her pocket.

She glanced down at the caller ID, her brows furrowing.

"They replied from the ICU."

Nurse Zhao held her phone between her shoulder and ear, keeping an eye on the monitoring line next to the stretcher while listening to the person on the other end.

"Are there enough beds available?"

She frowned slightly.

"This isn't a regular kidney stone. The patient's blood pressure is already borderline, lactate is 3.8, and the CT scan suggests a perirenal abscess. Have them take a look at the consultation report first."

I don't know what the person on the other end of the phone replied.

Nurse Zhao handed the phone to Qin Hai.

"The ICU said they just finished two surgeries, and one bed hasn't been freed up yet."

Qin Hai took the phone but didn't start cursing.

He glanced at Feng Jianping.

The man on the gurney was still shivering, the thin blanket trembling, and the IV tube swaying with it.

The monitor showed a heart rate of 138.

Blood pressure: 92-56.

Nurse Zhao looked down at the records she had just read, her voice tightening slightly.

"It was ninety-four or ninety-eight just now."

Qin Hai lowered his voice towards the phone.

"There aren't any beds available, and we can't leave people waiting in the hallway. Give me a temporary spot where I can be monitored; my blood pressure needs to be kept under control until the urology department addresses the root cause."

There was a two-second pause on the other end of the phone.

"I'm not taking your bed, I'm taking your time."

There was a two-second silence on the other end of the phone, then someone else answered.

"Push him to the bed near the door in the emergency intensive care unit first, and the ICU doctor will go over to check on him. We'll continue to coordinate for a regular bed."

Qin Hai hung up the phone and turned to look at the urologist.

"How are you handling this on your end?"

The urologist's films were still pressed against the signing board.

"The doctor has reviewed the scans. We'll clear the blockage first. Whether a stent can be placed depends on his blood pressure and anesthesia; if not, we'll need to create a fistula, or perform a puncture to release the pus and pressure."

Feng Jianping's wife held the pen, her eyes fixed on the words "ostomy" and "drainage".

"Is this surgery?"

The urologist was unambiguous.

"Yes. We need to insert a needle and leave a catheter, not just take an X-ray. We need to sign some forms, and we need to check the coagulation and blood pressure immediately."

The woman's pen stopped at the edge of the signature bar.

"What will happen if I don't do it?"

The infectious disease doctor adjusted the drip chamber for the anti-infective medication and then took over the conversation.

"The medication has been applied, but the pus is stuck inside and can't come out. If we delay any longer, my blood pressure will drop further, and my kidneys will suffer too."

The woman looked at the flatbed cart.

Feng Jianping's eyes were half-closed, his lips were pale, and his teeth were still chattering.

She asked in a low voice, "Can he handle it?"

The intensive care unit doctor didn't look at her; instead, he flipped to the last page of the bedside blood pressure record.

"We're worried he won't be able to handle it, so we can't just put him in a regular ward. We'll put him on monitoring first, keep an eye on his blood pressure, and adjust the procedures as needed."

Lin Ye stood at the end of the flatbed cart, adding each time point to the record.

At 22:36, intensive care unit bed allocation was coordinated.

At 10:38 PM, the urology department supervisor called to suggest relieving the obstruction.

At 10:39 PM, the family members began signing the relevant information regarding the invasive procedure.

When he wrote the words "invasive operation", the blue text box at the edge of his field of vision lit up again.

[Current Risk: Delays in source control.]

[The evidence provided is as follows: continued decrease in blood pressure, increase in heart rate, increase in lactate levels, decrease in urine output, and CT scan indicating a risk of obstructive infection and perirenal infection.]

Key obstacles: number of beds, manpower, and operating conditions.

Lin Ye didn't make a sound.

He pushed the folder a little towards Qin Hai.

"Blood pressure went from 96.60 to 92.56. Heart rate was 138. Urine output is still low."

Qin Hai glanced at it.

"The urology, intensive care, and infectious disease departments should all be present. Make sure it's clearly written down. Who made the decision, who signed, and who took the patient away—don't leave anyone out."

Lin Ye nodded.

"clear."

Feng Jianping's wife finally signed her name.

The pen tip made heavy marks on the paper.

She didn't let go immediately after signing.

"Doctor, I kept saying it was an old ailment, could that have delayed treatment?"

Nurse Zhao pulled the signature board back.

"Now is not the time to chase after that. Make sure you know all the medications he's taken recently, how long he's had the fever, and how long he's been urinating infrequently—don't miss a single detail. That's more useful than standing here regretting it."

The woman paused for a moment, then quickly nodded.

She pulled out photos of medicine boxes from her phone and showed them to the infectious disease doctor one by one.

"This is for lowering blood sugar, this is for pain relief, he took it this afternoon, and this is for reducing fever... I don't remember what time it was."

Lin Ye added from the side.

"A rough timeframe is fine; just specify the scope first."

The woman bit her lip and thought for two seconds.

"I ate again around 3 or 4 pm, and again before coming to the hospital in the evening."

The infectious disease doctor wrote down the name of the medication.

"Your kidney function is poor, so the dosage of your medication needs to be adjusted. Don't increase the dosage on your own."

The woman nodded.

The urologist's phone rang again.

He glanced at the incoming call and answered it immediately.

"Interventional room?"

Several people in the corridor looked over at the same time.

The voice on the other end of the phone sounded urgent, and in the background, there was the sound of a medical cart being pushed over the paving stones.

The urologist's expression turned grim after hearing this.

"They just received a patient with bleeding, and the interventional table is temporarily occupied."

Feng Jianping's wife tightened her grip on her phone.

"So what do we do?"

The urologist didn't pass the buck.

"I'll go ask the operating room and the anesthesia department. If the stent can be placed, then we'll do it; if not, we'll find a way to drain it. We can't just leave it on an IV drip until dawn."

Qin Hai looked at him.

"What do you need from the emergency room?"

"Transferring personnel. And anesthesia assessment."

The urologist folded the film back into the film bag.

"He's shivering right now, and his blood pressure is borderline. We can't rely on his family to push him the whole way."

Nurse Zhao had already picked up the walkie-talkie.

"The red zone needs a transfer nurse, with monitoring equipment, a full oxygen cylinder, and a complete first-aid kit. Don't take that nearly empty cylinder; the one used on the bed with the dental infection just now."

A response came quickly from the other end of the intercom.

"receive."

No sooner had he said that than people arrived from the emergency intensive care unit.

The intensive care nurse pushed over the mobile monitoring stand and checked the blood pressure first.

"How much is it now?"

Nurse Zhao reported: "92.56, heart rate 138, lactate 3.8."

The ICU nurse's expression also changed.

"The bed near the door has been cleared out for temporary use. We are still coordinating for a permanent bed."

As Feng Jianping was being wheeled into the emergency intensive care unit, the elevator doors at the other end of the corridor opened.

The anesthesiologist on duty came out from inside.

She was still holding the handover form from the surgery for the dental infection, the corner of the paper folded and curled up.

"Another emergency room visit?"

Qin Hai glanced at her.

"You can start by cursing, then see who you're dealing with."

The anesthesiologist didn't actually yell at them.

She walked to the stretcher, first checking the monitor, then the patient's lip color and breathing.

"Her blood pressure is already borderline, and she's still shivering. If we really need to do it, let's not wait until it drops even lower. We need to decide on the pain relief method and dosage together with you."

The urologist nodded.

"The doctor wants us to evaluate a stent or a fistula. The interventional table is currently occupied."

The anesthesiologist tucked the handover form under his armpit.

"Then you guys decide on the approach first. Don't ask all three sides; you'll end up collapsing first."

Nurse Zhao pressed the intercom button again, and the urologist had already turned to make a second call.

Lin Ye followed behind, turning to a new page in his notebook.

He did not write "waiting for intervention".

What he wrote was:

The transitional beds for critically ill patients have been cleared.

Anesthesia arrival assessment.

The urology department continues to coordinate methods to relieve the obstruction.

The transfer nurse, oxygen cylinder, and mobile monitoring equipment were in place.

After Lin Ye finished writing, Qin Hai put a checkmark next to "mobile monitoring" and "anesthesia on site" with his pen.

Nurse Zhao had already shown him the oxygen cylinder pressure gauge.

"This bottle is enough."

When the bed near the door in the emergency intensive care unit was pushed open, Feng Jianping suddenly shuddered again.

The monitor alarm sounded briefly.

My blood pressure jumped to 88.52.

Nurse Zhao stared at the screen, her voice immediately rising.

"Director Qin, your blood pressure has dropped."

The intensive care physician took a step closer to the bedside.

"Retest."

The cuff was re-inflated.

Feng Jianping closed his eyes and mumbled a pained cry.

The retest results popped up.

Eighty-seven and fifty-one.

The urologist hadn't even hung up the phone when he relayed the results to the person on the other end.

"Director, the blood pressure has dropped again. We can't wait for the interventional unit to become available."

This time, there was no pause on the other end of the phone.

"Notify the operating room. If there's no time for a stent, proceed with ultrasound-guided nephrostomy. Decide now who will be on the operating table, who will record the data, and who will monitor the blood pressure. Release the obstruction first."

Feng Jianping's wife stood at the foot of the bed, holding the signing board in her arms.

The ink in the signature section was still wet.

She looked up at the doctor.

"Can't we wait any longer?"

Qin Hai pushed the mobile monitoring frame closer to the bed.

"right."

The urologist had already turned and walked out.

"I'll go get some people. Let's prepare to attract traffic."