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

The projector light faded from Xie Guangyi's electrocardiogram.

The white wall was empty for a second.

Zhou Li pulled out the stack of old materials at the bottom of the folder; the edges of the papers were already frayed.

The top one is the emergency triage record.

Name: Chen Jianguo.

Age: 49.

Chief complaint: Upper abdominal pain.

The triage time column is very clear.

2:17 a.m.

Expert Du's pen stopped on that line of time.

"Who makes the first contact in the first minute?"

Just as Qin Hai was about to speak, Expert Du had already looked towards the wall.

"Lin Ye, tell me."

The chair against the wall wobbled again.

Lin Ye placed the registration board at his feet and just as he braced himself against the edge of the chair, Chen Shouyi turned his head to the side.

"Speak while seated."

Lin Ye sat back down.

The chair back pressed against my back, feeling cool.

"Triage nurse Zhao Fang made the first contact. The patient's family complained of stomach pain, and the patient himself pressed his upper abdomen, covered in cold sweat."

Zhou Li moved the pre-inspection form under the projector.

When the gray-white scanned document is enlarged, the text becomes somewhat blurry.

But the words "upper abdominal pain" still catch the eye.

Dr. Du's pen stopped next to "upper abdominal pain".

"Is it okay to treat the stomach pain first?"

"no."

Lin Ye answered quickly.

"At that time, the initial diagnosis was upper abdominal pain. Blood pressure was measured, an electrocardiogram was performed, and amylase and troponin were drawn. All of these should have been done."

Someone at the table bent down and made a note.

Expert Du moved the pen tip downwards.

"Then where should we start?"

Lin Ye looked at the supplementary line at the bottom of the pre-inspection form.

Upper abdominal pain, tearing pain in the back.

"The patient himself said that his back also hurt, like it was being torn apart."

The meeting room fell silent for a moment.

There are too many people in extreme pain in the emergency room.

This is how you scream when you have a stomachache.

Pancreatitis can also cause this sound.

Myocardial infarction can sometimes occur in the upper abdomen.

Expert Du tapped the notebook with the tip of his pen.

"Is this sentence enough to warrant a CT aortic angiography?"

"not enough."

Lin Ye did not hesitate.

Qin Hai's gaze swept over him and then fell back on the medical record.

Lin Ye continued.

"So we didn't immediately order tests. We checked vital signs first. Blood pressure in the right arm was 189 and 102."

Zhou Li switched to the next page.

The guardianship records were magnified.

Blood pressure in the right upper limb: 189/102 mmHg.

There is one more line for supplementary testing below.

Blood pressure in the left upper limb: 143/88 mmHg.

When the two lines of numbers appeared, Expert Du paused for a moment.

"Was the left arm a replacement?"

"Yes."

Lin Ye looked at the record.

"I requested a retest of my left arm. The systolic pressure in my left arm was over 40 cm lower. The pulse in my left radial artery was also weak. Coupled with the cold sweat all over my body and the pain moving down my back, it can't be explained by ordinary gastritis."

Tang Zhendong moved his chair back half an inch.

The chair leg scraped against the floor tiles with a short, sharp sound.

"This combination can no longer be used for tests such as those for stomach problems."

Expert Du looked at him.

"Director Tang, this is a cardiac and vascular surgery condition."

Tang Zhendong put down his pen.

"Chest pain, upper abdominal pain, and sweating are common symptoms that prompt a visit to the cardiology department. If the emergency room only waits for an elevated ECG before considering the aorta, the patient may already have ruptured."

The young officer's paper slipped down a little, but he quickly pressed it back down.

Expert Du then turned his attention back to the forest.

"and then?"

Lin Ye looked at the medical record.

"I reported these abnormalities to Teacher Sun Zhiqiang."

Qin Hai pushed a medical record to the center of the table.

The copy is black, and the ink is blurred together, but a few key lines are still legible.

A tearing pain in my back.

There was a significant difference in blood pressure between the two upper limbs.

The pulse in the left radial artery is weakened.

Highly suspected aortic dissection; emergency aortic CT angiography was performed.

Sun Zhiqiang was present and the matter has been reviewed.

The bottom right corner also shows the time when Sun Zhiqiang signed the supplementary document.

The words were written very low, almost touching the edge of the paper.

Expert Du stared at that column.

Who ultimately submits the inspection request?

The young staff member quickly pulled out the application form from the materials.

The words "Emergency Aortic CT Angiography" appeared on the projector screen.

The final doctor listed was Sun Zhiqiang.

In the medical record, Lin Ye's name appears after the abnormal evidence.

Du's pen paused for a few seconds.

"This is better than having a resident trainee handle the application form all by themselves."

Qin Hai's expression finally relaxed a little.

"It was indeed chaotic in the early days. Sun Zhiqiang didn't believe him back then either."

Upon hearing this, the tension in the meeting room eased slightly.

Sun Zhiqiang wasn't here today, but the people around the table all knew what kind of person he was.

Expert Du did not laugh.

"You can disbelieve me, but make sure it's clearly written down."

He then looked at Lin Ye.

"If the aortic CT angiography didn't detect the dissection, but the family complains of excessive testing, how do you explain that?"

Lin Ye looked at the application form on the projector.

The white light outside the CT room in the early morning seems to have fallen before my eyes again.

The radiologist, still grumpy from being woken up, asked, "Who made the emergency room application?"

Sun Zhiqiang stood at the end of the corridor; the water in his teacup had gone cold.

Back then, the medical record folder I held was just as heavy as this registration board is now.

"I can't explain the result."

His voice was not loud.

"I can only explain what I saw before I applied."

Expert Du looked at him.

Lin Ye continued the conversation.

"The patient's pain wasn't just a simple upper abdominal pain. He had a tearing pain in his back, cold sweats, high blood pressure, poor blood pressure in both upper limbs, and weakness in the left radial artery. Aortic dissection doesn't always present with typical chest pain; it can also be mistaken for stomach pain, pancreatitis, or a heart attack. Missing this disease would have very serious consequences."

"So you can bypass your superiors?"

Expert Du asked very quickly.

The sound of pens falling silent around the conference table.

Lin Ye did not answer immediately.

Qin Hai's face darkened.

Chen Shouyi gently tapped the table with the glasses case in his hand.

Lin Ye's gaze fell on the old medical record.

"I didn't bypass the emergency room supervisor at the time. Teacher Sun was present, Nurse Zhao was present, and the family members were present. There was evidence in the medical records, and it was also reviewed by the supervisor."

He paused for a moment.

"The head of cardiac and vascular surgery was only given the injection after the aortic CT angiography results came out."

Zhou Li switched to the next page.

Screenshot of aortic CT angiography.

The intima of the ascending aorta is circled in red.

Next to it is a temporary report from the videographer.

Consider Stanford type A aortic dissection.

Inspection completed at 2:57 AM.

Zhou Mingyuan's phone record: 2:59 AM.

Zhou Mingyuan himself is sitting on the other side of the conference table today.

Since he entered the room, his cup of tea has barely been touched.

Expert Du looked at him.

"Director Zhou, who were you listening to on the phone at the time?"

Zhou Mingyuan flipped his phone over, then flipped it back over.

"Linye."

"Why should you trust a resident trainee?"

Zhou Mingyuan finally looked up.

"I don't believe in resident trainees."

The young officer's pen froze in mid-air.

Zhou Mingyuan pushed the screenshot to the center of the table.

"I believe in films."

He then moved the medical records aside.

"He also believed in these physical signs. Poor blood pressure in both upper limbs, weak left radial artery, tearing pain in his back, and cold sweats. He reported all of these over the phone."

Zhou Mingyuan's voice was cold.

"If he only said, 'I feel like I have a comminuted fracture,' I wouldn't open the operating room; I would have yelled at him ten times first."

Tang Zhendong coughed lightly, looking down.

Qin Hai's lips twitched, but he didn't laugh.

Expert Du wrote two lines in his notebook.

Did he influence your treatment decision?

Zhou Mingyuan frowned.

"The treatment decision was made by the cardiac and vascular surgeon. Anesthesia, cardiopulmonary bypass, blood preparation, and the surgical procedure were not his responsibility."

His gaze swept across the woods against the wall.

"At most, he would just drop the patients off at my door."

Lin Ye pressed his palm against the edge of the registration board, and the tension slowly eased.

Deliver it to the door.

Further inside, it involves cardiac and vascular surgery.

Expert Du took out the application form and placed it separately in the middle of the table.

"In this case, I acknowledge that it's not some kind of mystical phenomenon."

The chair backs moved slightly, then stopped.

Because his hand was still pressing on the paper.

"But this piece of paper cannot be used as a reason for all resident trainees to request enhanced examinations in the middle of the night or to call on the director of a higher-level department."

Qin Hai answered quickly.

"Won't."

"Why not?"

Expert Du looked at him.

"If another young doctor says, 'I have back pain, low blood pressure, and cold sweats, and I suspect a dissection,' can he also operate on it?"

Qin Hai pushed the thermos aside.

The bottom of the cup left a ripple on the table.

Whether it can be opened depends on the evidence and who takes the fall.

He glanced at the chair against the wall.

"Staff members can call out or report abnormalities. If a superior is present, they will handle the situation. If the person is truly unstable, prioritize saving their life; the phone call and record-keeping will follow later."

"But don't let him rush forward alone with a single order on his shoulders."

Zhou Li placed a blank template next to the application form.

Emergency high-risk aortic dissection risk record.

The following is not a treatment plan.

There are only a few columns.

Location and nature of the pain.

Blood pressure in both upper limbs.

Pulse in the limbs.

Neurological symptoms.

Image application basis.

The time when a senior physician takes over.

Specialist consultation time.

Qin Hai frowned as soon as he saw the paper.

"Don't add another stack of forms to the nurses' station."

Zhou Li did not allow it.

"No additions. Used for high-risk debriefing. When you're really busy, don't write nonsense; leave out the key points and add them electronically later."

Chen Shouyi raised his hand.

"Let's try three types first: aortic dissection, stroke, and acute coronary artery disease."

He looked at the blank sheet of paper.

"Don't use it as a command board. It only serves one purpose: don't let the evidence be scattered across several sheets of paper, making it impossible for anyone to find it all afterward."

After reviewing the template, Expert Du drew a circle on his notebook.

"The direction is right."

Lin Ye remained seated by the wall.

He had no nameplate and no microphone.

The papers on the table were pushed around one by one, names were thrown on the wall, questioned, torn apart, and then put back into the process.

When Liu Zhenhua put Chen Jianguo's stack of materials back into the folder, a thin piece of paper slid out from the bottom.

The corner of the paper was curled up, and the upper right corner was stamped with the outpatient follow-up stamp.

The young staff member bent down to pick it up, and his expression changed as soon as he saw the name.

"This is a follow-up report from the Department of Cardiac and Vascular Surgery."

Zhou Mingyuan reached out to take it.

The young officer looked at Chen Shouyi first.

"Chen Jianguo's family members came to the hospital this morning."

The slight creaking of chair backs in the conference room stopped again.

Zhou Mingyuan frowned.

"What happened to him?"

The young staff member handed over the follow-up form.

"The patient experienced chest tightness for a while on the way to the follow-up appointment. The community hospital recommended returning to the First Municipal Hospital. The family members were at the outpatient department and said they wanted to ask the emergency room a few questions."

Qin Hai's face immediately darkened.

"Looking for emergency care?"

The young officer's voice was a little lower.

She said the person was saved in the emergency room. She didn't know who to ask about what happened after that.

The follow-up form was placed on the table.

The name Chen Jianguo once again appeared at the center of the conference table.

Just then, Zhou Mingyuan's phone vibrated.

The caller ID was displayed on the screen, and he answered it directly.

The person on the other end of the phone was an outpatient nurse; her voice sounded strained through the background noise.

"Director Zhou, Chen Jianguo just said he felt tightness in his chest again. His family is afraid to let him leave, so he's sitting outside the Cardiac and Vascular Surgery outpatient clinic."

Zhou Mingyuan stood up.

"Don't let him go downstairs by himself. Push the wheelchair over there and keep him there for now."

His hand had already pressed the follow-up form into his palm.

"Bring out your blood pressure readings for both upper limbs, ECG, discharge summary, and medication box. I'm coming over now."

Expert Du closed the notebook, then slowly opened it again.

"Perfect."

He looked at the follow-up form that had just been crumpled.

"And then what happens after they're rescued?"