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

Nurse Zhao hadn't lowered her fingers from the stethoscope.

The sounds from the intervention room were muffled.

It's like being separated by a thick door.

Qin Hai had just taken off the glove stained with iodine when his movement froze in mid-air.

"How so?"

Nurse Zhao glanced at Shen Qingyuan's bedside.

The thoracic surgeon has already spread out the sterile drapes.

The drainage bottle was placed next to the bed, the transparent plastic tube not yet connected, the tube wall reflecting the green light of the monitor.

She lowered her voice.

"On Xu Jianmin's side, after the angiography, they found that the blood clot was longer than it appeared on the CT scan. The vascular surgery department asked the emergency department to send an updated coagulation and muscle enzyme test, and the family also needs to hear the risks again."

Qin Hai's brow furrowed instantly.

On Shen Qingyuan's end, the thoracic surgeon was on the phone explaining closed drainage to his mother.

Meanwhile, Xu Jianmin was still struggling with that leg in the interventional room.

The calls from the emergency room lobby were sandwiched between two ends, one after another, like an endless urging.

Sun Zhiqiang.

Qin Hai threw the gloves into the yellow medical waste bin.

The lid popped up and then snapped back on.

"You stay here and keep an eye on Shen Qingyuan. After the thoracic surgery team finishes the drainage, check his blood oxygen and blood pressure again, and record the time of the puncture decompression and the time when the thoracic surgery team takes over."

Sun Zhiqiang nodded.

He was still clutching Shen Qingyuan's chest X-ray in his hand.

The edges of the film were white from being pinched so hard.

"clear."

Qin Hai looked at Lin Ye.

"Come with me to the entrance of the intervention room."

Lin Ye closed the medical record.

The clip clicked.

He didn't ask why.

The color of Xu Jianmin's left foot and the intermittent rustling sounds from the bedside were still ringing in his ears.

In the corridor, the cold morning light had already spread out completely.

The cleaning truck was parked against the wall, and there was a ring of gray foam in the water in the mop bucket.

Qin Hai walked very fast.

The hem of the white coat swept across the fire extinguisher box at the corner.

Lin Ye followed behind, the supplementary test form in his hand trembling slightly in the wind.

The red light at the entrance to the intervention room was on.

Xu Jianmin's daughter sat on a bench by the door.

She was still wearing the same light gray coat, the cuffs of which she had clenched into a crease.

The medicated plaster packaging is no longer in my possession.

It was replaced with a photocopy of an informed consent form.

She folded the paper repeatedly, leaving a deep crease in the middle.

She heard footsteps and jumped up.

"Doctor, is it really going to be difficult?"

That sentence came out too quickly.

It was so fast that even she was startled.

Qin Hai did not answer immediately.

He first glanced at the time displayed on the door of the intervention room.

6:27.

More than ten minutes had passed since Xu Jianmin was pushed inside.

"We can't say no now."

Qin Hai lowered his voice.

"But the situation is more complicated than what we just saw in the video."

Xu Jianmin's daughter's lips trembled slightly.

What does "complex" mean?

Lin Ye handed the supplementary test form to the nurse at the entrance of the interventional room.

The nurse took it; there was still a little bit of clear disinfectant on her gloves.

"Coagulation and muscle enzyme retests have been completed in the emergency room."

The nurse at the door nodded, turned around, and went inside.

The sound of machinery inside leaked out the moment the door opened and closed.

drop.

drop.

There was also a very faint suction sound.

Xu Jianmin's daughter stared intently at the crack in the door.

Qin Hai stood in front of her, blocking part of her view.

"CT angiography of the lower extremity arteries only shows the approximate location. During actual interventional angiography, a much finer detail can be seen."

He pointed to the photocopy in her hand.

"The vascular surgeons are now seeing that the blockage is longer than previously estimated, and the blood flow to the distal end is also poor."

The daughter's hand tightened little by little.

She crumpled the paper, making a sound.

"Will it still be able to work?"

"Connecting now."

Qin Hai said.

"But it's not enough to just remove the blockage. If the blockage is long, the blood flow to the smaller blood vessels in the distal part is poor, and the leg has been ischemic for several hours. Even if the main blood flow is restored, we still need to continue to monitor the color, temperature, sensation, and muscle condition of the toes."

When the daughter heard the word "even if," her face turned even paler.

"Is amputation still a possibility?"

Someone pushed a medicine cart towards us from the end of the corridor.

The wheel was uneven, making a clattering sound when it went over the gap between the paving stones.

Qin Hai waited until the sound subsided before speaking.

"There is that risk."

The words had barely left his lips.

Xu Jianmin's daughter felt as if she had been pushed from behind, her shoulders swaying backward.

Lin Ye reached out and held onto the edge of the bench, moving the chair half an inch behind her.

"Please sit down."

She didn't sit down.

She stared at Qin Hai.

"But he could still talk just now, and he even scolded me for making a mountain out of a molehill."

"Being able to speak doesn't mean your legs can wait."

Qin Hai's voice did not rise.

"That's the most troublesome part of this type of disease. The person may appear conscious and their blood pressure may not be low, but blood can't get to their legs properly, and their muscles and nerves are constantly deprived of oxygen."

Lin Ye looked at the photocopy in her hand.

She pressed half of the words "acute lower limb ischemia" on the paper with her thumb.

She seemed to finally understand.

The tears didn't fall immediately.

She just slowly pursed her lips.

"Then what else can I do?"

"Keep your phone accessible."

Qin Hai said.

"If the vascular surgery department needs to switch from interventional to surgical procedures, or if additional treatment is required, they will contact you and the patient again to confirm. Don't leave now, and don't forget any other medications the elderly patient has taken. Especially anticoagulation, bleeding, and surgical history; if you remember anything, please mention it immediately."

She nodded.

He tapped very hard.

"He had taken aspirin before."

Lin Ye looked up.

"When?"

"A long time ago."

She frowned as she thought.

"The physical exam showed high cholesterol, and the neighbor suggested he take aspirin to prevent blood clots. He took it for a while but then felt stomach discomfort, so he stopped. He also stopped taking warfarin because he found it too troublesome."

Qin Hai looked at Lin Ye.

"remember."

Lin Ye had already opened the medical record folder.

There was a dried coupling agent mark on the edge of the paper, which was rubbed off when I was doing Doppler earlier.

He wrote down the time, source, and family history of supplementary medication.

The pen tip scratched across the paper, making a soft, rustling sound.

This is not a list.

This is evidence of whether or not this leg can be saved.

The intervention room door opened again.

The vascular surgeon leaned out halfway.

The hat was pulled down low, and there was a layer of fog on the goggles.

"Director Qin."

Qin Hai immediately stepped forward.

"How is it?"

The vascular surgeon removed his goggles, revealing two red marks on the corners of his eyes from the pressure.

"The thrombus extends from the superficial femoral artery to the popliteal artery, and it's longer than the CTA showed. We just had an aspiration, and the blood flow in the main trunk has improved a bit, but the distal contrast is still poor."

Xu Jianmin's daughter cannot understand any of the words.

But she understood that "it's still not good enough".

She pressed her hand to her chest.

Vascular surgeons don't beat around the bush.

"There are two questions now."

He held up one finger.

"First, continue with thrombectomy to see if the distal end can be reopened."

The second finger then stands up.

"Secondly, if the effect is not enough, surgery to remove the thrombus may be necessary, and it may even be necessary to prevent increased pressure in the fascial compartment. If the leg has been ischemic for a long time, even if blood returns, it is not entirely safe."

Lin Ye's heart sank.

Even if the blood returns, it doesn't mean everything is completely fine.

This is even worse than "blocking".

Xu Jianmin's daughter stared at him blankly.

"Will there still be problems after the blood returns?"

The vascular surgeon nodded.

"When ischemic muscles regain blood flow, they may swell up, increasing pressure and potentially damaging nerves and blood vessels. There may also be muscle damage, acidosis, and electrolyte imbalances. We monitor urine color, muscle enzymes, potassium, lactate, and calf muscle tone."

He spoke very briefly.

This is not a lecture.

It's about presenting her with the risks that will come next.

Qin Hai added a sentence.

"So it's not safe to leave the interventional room now. Even if blood flow is a little better, we still need to keep monitoring them."

The daughter slowly sat down.

The plastic surface of the bench creaked as she sat on it.

"I'll listen to you."

She looked toward the door of the interventional room.

"Never give up as long as there is a chance."

The vascular surgeon glanced at her.

"We are fighting for this opportunity now."

He turned and went back.

Before closing the door, he left another sentence.

"Please keep an eye on the tests for me in the emergency room. Potassium, muscle enzymes, and lactate should be injected as soon as they arrive."

Qin Hai responded.

"Know."

The door closed.

The red light remains on.

Lin Ye looked down at the medical record folder.

Time, blood pressure, blood oxygen, foot color, skin temperature, dorsalis pedis artery, atrial fibrillation anticoagulation, imaging, interventional angiography, and poor distal contrast after aspiration.

One by one.

None of those things could be written for them by that prompt.

Just then, the light blue border bounced against the corridor wall.

[Current Status Update: Acute ischemia in the left lower extremity has entered the continuous limb salvage procedure.]

[Risks remain: insufficient distal perfusion, reperfusion injury, and increased compartment pressure.]

[Result: Still under evaluation.]

Still under evaluation.

Lin Ye put the pen cap back on.

Click.

The sound was very soft.

But he heard it very clearly.

Qin Hai's phone vibrated at that moment.

Sun Zhiqiang's name popped up on the screen.

Qin Hai answered the call.

"explain."

The background noise from the emergency room on the other end of the phone was very chaotic.

You can vaguely hear the thoracic surgeon counting off, and Nurse Zhao telling people not to touch the drainage bottle.

Sun Zhiqiang's voice was muffled.

"Shen Qingyuan's closed drainage has been connected. There are air bubbles in the water seal bottle. The oxygen saturation is maintained at 95, and the blood pressure is stable. The thoracic surgery department has asked him to stay in the emergency monitoring room for a follow-up scan."

Qin Hai glanced at Lin Ye.

"Record the time of takeover, don't let him pull out the tube himself, and don't let the family raise the bottle."

"Know."

Sun Zhiqiang paused for a moment.

"Also, Nurse Zhao put away that regular outpatient registration slip, saying she would remind the triage staff."

Qin Hai hummed in agreement.

"A reminder is fine, but don't write it all over the wall."

On the other end of the phone, Nurse Zhao seemed to hear it.

He cursed from afar.

"Who has time to write on the wall?"

Qin Hai hung up the phone.

His tense face finally relaxed a little.

Just a little bit.

In the corridor, Xu Jianmin's daughter was sending messages to relatives with her head down.

The phone's keyboard clicks very softly.

She would type a few words, then pause and glance at the red light in the intervention room.

Lin Ye stood to the side and suddenly felt that this light was even more agonizing than the light in the emergency room.

The danger in the emergency room loomed before them.

The danger in the intervention room is behind the door.

It's invisible.

We can only wait for a phone call.

We can only wait for the data.

All that could be heard was the sound of machinery leaking through the crack in the door each time.

6:41.

The lab called the nurses' station, but Nurse Zhao directed them to the entrance of the interventional radiology room.

Lin Ye picked up.

"Xu Jianmin from the Emergency Department."

The person on the other end of the phone reported it very quickly.

"Potassium 4.9, lactate 3.3, creatine kinase is starting to rise, myoglobin is significantly high, coagulation results are available and are being sent to the testing platform."

Lin Ye's fingers stopped.

"Recite the myoglobin level again."

The person on the other end of the phone repeated it.

The numbers were written down on paper.

It's much heavier than before.

Qin Hai saw his expression and reached out his hand.

"Give me."

Lin Ye handed over the record.

After Qin Hai finished scanning, he immediately pressed the call button next to the door of the intervention room.

"The vascular surgery department has the latest test results. Myoglobin is significantly elevated, lactate is 3.3, and potassium is 4.9."

There was a moment of silence inside.

The vascular surgeon's voice came through the loudspeaker.

"receive."

The next second, someone inside shouted.

"Now let's look at the tension in the calves!"

Xu Jianmin's daughter suddenly looked up.

"What's wrong now?"

No one could give her a good answer right away.

Qin Hai simply released the call button and turned to look at her.

"Now they are assessing whether the pressure in the leg has increased after blood flow has been restored."

She gripped her phone tightly.

What happens when you get under pressure?

Qin Hai remained silent for half a second.

"If it's severe, incision to relieve pressure is necessary."

The daughter's face immediately turned pale.

"Do we need to cut it again?"

"It's not about taking one more step."

Qin Hai said.

"This is to make room for the swollen muscles. Otherwise, if the blood vessels are open and the inside is damaged, the leg still can't be saved."

The daughter lowered her head.

Her fingernails made a soft scratching sound on the phone case.

"I see."

She took a breath.

"I'll sign if he should. If he's sober, let him sign. I won't stop him."

Lin Ye looked at her.

The person who was just using the plaster packaging as evidence has finally learned not to argue with the doctor.

They no longer ask, "Is this making a mountain out of a molehill?"

The footsteps inside the intervention room suddenly became more frequent.

There was a collision between metal discs.

A nurse repeated the name of the medication.

The vascular surgeon gave the instruction to lower the pressure.

Lin Ye's gaze fell on the crack in the door below the red light.

There was white light coming through the crack in the door.

It was blindingly white.

A few minutes later, the door opened.

The vascular surgeon came out.

This time, the top edge of his mask was soaked with sweat.

"The blood flow to the main trunk is a little better than before."

Xu Jianmin's daughter's eyes had just lit up.

His next sentence silenced the light.

"But the tension in the calf increased. We prepared to transfer the patient to the operating room for myofascitising to relieve the pressure and continue limb preservation."

The daughter held onto the wall for support.

"Does he...do he know?"

"The patient is still conscious."

"That's what the vascular surgeon said."

"He's in a lot of pain, but he can still communicate. We've already talked to him, and he's agreed to continue."

The daughter nodded.

Halfway through the meal, tears finally fell.

"Then let's continue."

The vascular surgeon handed her a new information sheet.

The paper was still warm from the printer.

"Family members simultaneously sign a consent form indicating their awareness."

She took the pen.

My hand trembled violently as the pen tip touched the ground.

The first character is written crookedly.

She paused, pressing her wrist with her other hand.

Write it again.

Lin Ye did not look at her autograph.

He watched as the intervention room door closed again.

There are no new prompts at the edge of the field of vision.

No results found.

Only the red light remained on.

At the other end of the corridor, the sound of a new trolley could be heard from the emergency room lobby.

The wheels rolled over the grout lines between the floor tiles.

One at a time.

It's even more urgent than before.

Nurse Zhao's voice came through the intercom.

"Director Qin, an ambulance brought in a patient with abdominal pain and low blood pressure. The family says it's food poisoning."

Qin Hai looked up.

Lin Ye also looked up.

Neither of them responded.

Qin Hai simply stuffed a copy of the new notification form back into the medical record folder.

"Walk."

He walked toward the emergency room lobby.

"Look at the person first."