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

As soon as the door to the CT room opened, a blast of cold air from the air conditioner rushed out.

Feng Jianping was still trembling when he was pushed to the examination bed. A thin blanket was covered to his chest, the edges of which he had crumpled up.

The imaging personnel first checked the monitor.

My heart rate is over 130.

Blood pressure is 96 or 96.

The first dose of anti-infective medication had already been attached to the IV stand next to it, and the liquid level in the drip chamber was dropping drop by drop.

"Who makes the decision on enhancements?"

The imaging technician didn't rush to push the person in; his eyes were still fixed on the kidney function test report.

Elevated creatinine levels.

These four words are there for all to see; no one can pretend they didn't.

The urologist tucked the film bag under his armpit and held the phone to his ear.

"The nephrology department is also listening. Plain CT scan isn't enough, we'll do contrast-enhanced CT. I've explained the risks to the family, don't treat it like a regular stone and let it pass slowly."

The voice of a nephrologist came through the phone; it sounded a bit muffled through the speakerphone.

"Clearly state the risks of contrast agents. Don't rush the IV fluids; monitor blood pressure, urine output, and cardiac function simultaneously. If the source of infection can't be contained, delaying testing is even more dangerous."

Feng Jianping's wife stood at the door holding an old film bag and a medicine box.

Upon hearing the word "risk," she took a half-step forward on her toes.

"Doctor, can this test also damage my kidneys?"

Qin Hai did not soften his tone.

"There is a risk."

The woman's hand, which was clutching the old film bag, froze in mid-air.

Qin Hai continued, "There is a risk of kidney damage, but if we don't find the source now, the person is in even greater danger. With his fever so high and his blood pressure so low, it's not just a matter of taking another X-ray."

The urologist handed over the information sheet.

"Look here. Contrast agents may worsen kidney problems, and we will handle it according to emergency procedures. But if it's a stone blocking the urinary tract, and the infection can't be drained, IV fluids and painkillers alone won't be enough."

The woman looked at the signature column, and the old film bag in her hand drooped down.

"Then I'll sign."

When she picked up the pen, the tip drew a line outside the grid.

Nurse Zhao moved her a step to the side.

"Don't block the door. Sign up and wait here. Don't turn off your phone. It's not that you can't come in, it's just that you can't help even if you go in next to the machine."

Feng Jianping was moved onto the examination bed.

When his right side hits a hard board, he shrinks to the side.

"It hurts, don't press there."

Lin Ye helped hold onto the bed railing without touching his waist.

"Don't move around, watch the film carefully."

At the edge of my field of vision, a blue text box silently lit up.

[Emergency Room Alert: The window for confirming the source of infection has shortened.]

[Current publicly available evidence: high fever and chills, persistently rapid heart rate, borderline blood pressure, elevated lactate, oliguria, history of diabetes, and tenderness upon percussion of the right costovertebral angle.]

[Risk areas: obstructive infection, perirenal abscess, sepsis progression.]

[Key limitation: Imaging results and specialist evaluations are incomplete.]

Lin Ye shifted his gaze from the blue text back to the monitor.

He didn't mention the abscess.

They didn't simply expose the risks of that line of work to others.

He only noted down the time on his watch.

At 10:21 PM, I entered the CT room.

The door to the CT room closed.

Outside the door, only the low hum of the machine before it started running could be heard.

Feng Jianping's wife stood by the door, still holding the pen she had left. She looked down at the old film bag, the date on the film from three years ago gleaming from her touch.

"It used to hurt too."

Her voice was very soft, as if she were speaking to herself, not to the doctor.

Nurse Zhao didn't respond to her comment.

She placed the medicine boxes one by one on the small table next to her.

Blood sugar lowering drugs.

Painkillers.

Antipyretics.

One of the painkiller boxes was already half empty.

Nurse Zhao looked up.

"How many slices did you eat tonight?"

The woman froze for a moment.

"He was in a lot of pain, so he took two pills himself. He also took fever reducer in the afternoon."

Lin Ye wrote down the name of the medicine and the time.

Qin Hai glanced at it.

"Don't miss any. Your kidney function, bleeding risk, and medication adjustments will all depend on these."

The woman then realized what had happened and hurriedly checked her phone.

"I took a picture of the medicine box; I'll show it to you."

I tried to unlock my phone twice but failed.

Her palms were sweaty.

Inside the CT room, the voices of the radiology staff could be heard through the crack in the door.

"Let's start scanning."

Nurse Zhao put the medicine box back on the small table and didn't ask any more questions.

Qin Hai stood at the door of the control room, his eyes fixed on the half-open door.

Lin Ye stood by the door, the folder in his hand pressed down by the sheet beside the bed.

The old film bag was still in the woman's arms, but this time no one responded with the words "old problem".

A few minutes later, the door to the CT scan room opened a crack.

The CT technician peeked out.

"The radiology doctor on duty asked the urology department to come in and take a look."

The urologist went in immediately.

Qin Hai followed to the door but did not squeeze in.

The light from the screen fell on the face of the radiology doctor on duty, revealing layers of cross-sections flipping downwards.

"There is a stone shadow in the upper segment of the right ureter."

The radiology doctor on duty paused for a moment.

"Dilation of the upper renal pelvis and calyces."

The urologist's face darkened.

The radiology doctor on duty continued flipping through the pages.

"The perirenal fat space is blurred, and there is obvious exudation. This low-density area does not look like simple edema."

He adjusted the window width.

The gray shadows on the screen have uneven edges.

The urologist took a half-step closer.

"Perinerenal abscess?"

The radiology doctor on duty did not give a definitive answer.

"This doesn't seem like simple edema. The high fever, white blood cell count, and lactate levels all match. My initial assessment is a possible renal abscess or perirenal abscess, so that the clinicians can address it as soon as possible."

Upon hearing this, Qin Hai turned to look at Lin Ye.

"Record."

Lin Ye's pen had already fallen.

22:29.

Preliminary CT findings.

Stone in the upper segment of the right ureter.

Dilation of the right renal pelvis and calyces.

There was significant perirenal exudation.

The formation of a renal abscess or perirenal abscess is possible.

The source of infection has not been eliminated.

When he typed the words "source of infection," the system window lit up again.

The basis for public disclosure has been established.

[Correction of Misdiagnosis: Common kidney stones/lumbar muscle strain -> Obstructive infection with risk of perirenal infection.]

[Current Risks: Delays in source control, progression of sepsis.]

Lin Ye did not look up.

The pen tip continued to move downwards.

A call came in from the nurses' station, and the young nurse ran over while listening to it.

"White blood cell count is over 21, and procalcitonin is also high. We're still waiting for the CRP results."

The infectious disease doctor took the phone, asked a couple of questions, and his brows furrowed even more.

"The blood culture has been drawn, and the first dose of antibiotics has been administered. Further adjustments will be made based on kidney function and culture results, but right now the most important thing is to address the source of infection."

Upon hearing the word "abscess," Feng Jianping's wife leaned closer to the door.

"Isn't it the pain from kidney stones?"

The urologist came out of the operating room and took off his gloves.

"You have kidney stones."

A glimmer of hope had just appeared in the woman's eyes.

The next sentence was cut short.

"But the biggest problem now isn't the pain, it's the infection that's blocking the way behind the stone. Because of the difficulty urinating, the infection can't be expelled, causing a persistent fever, chills, and potentially a drop in blood pressure."

The woman's lips moved.

"Wouldn't an IV drip of anti-inflammatory fluid work?"

The infectious disease doctor looked at her.

"The medicine has been applied. But it's blocked inside, and there's still pus. Medicine alone might not be enough to suppress it. The door is blocked, so water can't get in and the fire can't be lit."

The woman didn't ask any further questions about what "sepsis" was; she simply placed the old film bag slowly on the table next to her.

"So what do we do now?"

The urologist looked at Qin Hai.

"We need to assess the need to relieve the obstruction. Ureteral stenting, nephrostomy, or interventional puncture drainage may be options, depending on the size of the abscess and whether his current blood pressure can handle it. This person cannot be admitted to a ward as a regular kidney stone patient."

Qin Hai responded directly.

"Has the intensive care unit arrived?"

Nurse Zhao glanced down the corridor.

"I called, they're at the elevator."

No sooner had he finished speaking than a doctor from the Intensive Care Unit rushed over with his consultation kit.

He didn't check on the family members first, but checked the monitor first.

What is your blood pressure?

"Ninety-four or ninety-eight."

After reporting, Nurse Zhao added another sentence.

"It was ninety-six or sixty just now."

The intensive care doctor reached out and took the blood gas strip.

"Lactate level is 3.8, blood pressure is borderline, and the source of infection is not yet under control."

He looked up at the urology department.

"This is not a normal observation period. Either you deal with the source as soon as possible, or you can put the person in a place where you can monitor their blood pressure."

When Feng Jianping was pushed off the examination bed, his eyes were half open.

He saw his wife standing at the door, her voice hoarse.

"You found out?"

The woman opened her mouth, but didn't utter the word "kidney stones".

Qin Hai answered it for her.

"Partially, they found some. There are stones on the right side, and also an infection. The most important thing now is to prevent the infection from continuing to seep into the bloodstream."

Feng Jianping reached his hand out from under the thin blanket, intending to touch his right waist.

Nurse Zhao grabbed the bed railing.

"Don't touch it. Even if it hurts, don't turn over, the monitoring lines are all on your body."

Lin Ye followed the flatbed cart and completed the results from the previous steps.

At 22:33, the preliminary CT findings were communicated to the urology, infectious disease, and intensive care departments.

Blood pressure is 94-95 or 98.

Heart rate 136.

Lactic acid 3.8%.

White blood cell count was slightly over 21.

Urine output is still low.

After he finished writing the last item, his finger paused on the edge of the paper.

Lin Ye's pen stroked from blood pressure to lactic acid, then stopped after "urination is still low," leaving a white mark on the edge of the paper.

Qin Hai scanned the data, his finger pausing on the blood pressure line.

"This is not simply caused by pain."

The urologist has already called his superiors.

"Director, there's a 56-year-old man in the red zone with diabetes. He has a stone blocking the upper segment of his right ureter, and the CT scan looks like a kidney abscess or perirenal abscess. His blood pressure is borderline, and his lactate is 3.8. The infectious disease department and the intensive care unit have already taken him there."

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

Send me the video.

The urologist sent over a screenshot of the image.

In the corridor, only the soft sound of a successful send could be heard.

A few seconds later, the voice on the other end of the phone became shorter.

"Don't treat it like a regular kidney stone. Assess emergency treatment to relieve the obstruction, and if necessary, perform a nephrostomy or percutaneous drainage. Have the family prepare to sign the consent form, and inquire about ICU beds first."

Feng Jianping's wife suddenly grabbed the medicine box.

The medicine box was dented from her grip.

"Do I need to sign anything?"

Qin Hai looked at her.

"want."

The woman's throat moved slightly.

"Is it very dangerous?"

Feng Jianping's wife did not lift the old film bag again.

The infectious disease doctor checked the drip rate of the anti-infective drug again.

The intensive care doctor has already picked up the phone to ask about available beds.

The urologist pulled the newly printed preliminary films from the imaging room.

The edges of the film still retained the heat of the machine.

He pressed the film onto the signing board.

"The question now is not whether the pain can be stopped."

"I'm asking if this pus inside can be drained as soon as possible."