Chapter 1 — Emergency Night Watchman

Tham Yen is the most obscure female doctor in the Emergency Department. When you talk, no one listens. If you ask about your illness, you'll be seen as making too much of a big deal. The first time she was on a night shift alone, she saw a row of blood-red letters hovering above the head of the patient who had just entered—
"Risk of aortic dissection rupture is 99%. Countdown of lives: 33 minutes."
The superior on the other end of the line told her not to take care of it, and her family members pointed at her nose and scolded her for many things. She made a direct phone call to the office of the head of the Department of Cardiovascular Surgery. From then on, the whole hospital spread a saying: It's okay if you don't know Tham Yen during the day. But she called in the middle of the night, he better pick up the phone in a second. 【Chapter 1】 My name is Tham Yen, first year of training, assigned to the Emergency Department of Thanh Dong First People's Hospital. What is the status of the attending physician in the Emergency Department? Say it like this. The nurse called me "that person", the doctor instructing Trieu Due Minh never remembered my full name. Every time I went to the room, he said "Tieu Tham, I'll go get the test results", "Tieu Tham, I'll go talk to my family", "Tieu Tham, I'll add a little to this medical record". Do the most trivial tasks, take on the least responsibility. I asked the patient, the patient did not believe me. I was just about to check, but my family scolded me. I reported my medical condition, but Trieu Due Minh didn't even bother to look up.
"Shen Yen, what kind of people don't exist in the Emergency Department? You have to speak in moderation, don't make the slightest move and say the situation is very serious to people, making chickens fly and dogs bark."
He said this sentence eight times in one month. I hold back. In return, at the top of the word forbearance there is a da.a.o blade. Until that night. On October 17, I was on night shift alone for the first time. Trieu Due Minh should have been present, but his wife made a phone call, he just threw back a sentence: "Don't worry, Tham Yen can handle it, if you have a problem, call me", and then disappeared. One forty-three in the morning. The emergency room is sparsely populated with a few elderly people lying on intravenous fluids. Ms. Luu at the sorting desk was scrolling through her phone, occasionally yawning. I leaned behind the nurse's station to add medical records, my eyes were so teary that I could barely open them. The door opens. A middle-aged man walked in, about forty-five or forty-six years old, wearing a gray coat, slightly hunched over, one hand behind his waist. Next to him was a woman in her thirties, probably his wife, with an expression of impatience on her face.
"Doctor, my husband said his back was sore and sore all afternoon. Previously, applying plasters at home didn't help."
I put down my pen and stood up. The moment I raised my head to look at him— My pupils constricted violently. On top of that man's head, a line of words appeared. Red like blood. Since three years ago I have been able to see this type of writing. Other people don't see it. Only I see it. Those words flashed, like the last warning sound on an electrocardiogram monitor: 【Back fatigue, weakness? Risk of aortic dissection rupture 99%】 【Countdown of lives: 33 minutes】 Thirty-three minutes. My fingertips immediately turned cold.
“Sir, please immediately lie down on the bed and push.” My voice was low, but each word felt as heavy as if it were thrown to the ground.
The man was stunned. His wife's face became even more confused: "Doctor, it's just tired Just your back… to that extent?”
“Sister Liu! Push bed!” I didn't answer her, turned directly to the sorting table and called out.
Ms. Liu's phone almost fell to the ground, she looked at me blankly. I didn't wait for her to react, I rushed forward and pushed the bed out myself.
“Sir, do you feel a tearing sensation in your back now? Even just a little?”
The man hesitated for a moment: “It seems… a little, but not serious—”
“Come on, lie down, now take my blood pressure immediately.”
I pulled the blood pressure monitor over and wrapped it around his right arm. When the results appeared, I gritted my teeth. Systolic blood pressure 210. I measured my left arm again. Systolic blood pressure 162. The difference in blood pressure between the two upper limbs is nearly 50 millimeters of mercury. This is a typical sign of aortic dissection.
“Ms. Luu, order an emergency CT angiogram, cardiac enzymes, D-dimer, blood count, inform the CT room to do it now, open the emergency green channel!”
“Uncle… Doctor Tham… are you sure?” Ms. Liu was clearly scared by my tone, "Doctor Trieu said there's no big deal tonight—"
“Sure.” I stared into her eyes, “Do it now.”
The blood-red countdown text is still dancing. 31 minutes. At this time, the man's wife pulled my sleeve: "Doctor, doctor, wait, he's just tired! She did another CT and took blood, how much did it cost? Do you want to order more tests?”
“Sister.” I removed her finger and looked at her, "If my judgment is wrong, I will bear the entire cost of the examination. But if I guess right, within thirty minutes your husband will die in this chair.”
Her hand let go. Lips trembled a bit, speechless. I didn't look at her anymore, turned around and called Trieu Due Minh. Tut— Tut— Tut— Don't answer the phone. Call back. Tut—
“Hello? Tham Yen? Do you know what time it is—”
“Mr. Trieu, the Emergency Department has a patient suspected of having a Stanford type A aortic dissection, the blood pressure difference between the two upper limbs is nearly 50, systolic blood pressure is 210, tearing pain in the back, I have ordered CTA—”
“Wait.” From Trieu Due Minh's side, the sound of turning around in the blanket was heard, "Is that the one with back pain?" Didn't I tell you to prescribe some painkillers and then monitor?
"Master Trieu, I highly suspect it's a rip-off."
“Shen Yen.” His voice carried obvious impatience, “You're a regression doctor, do you know what an aortic dissection looks like? A person over forty years old, walking in on his own, you dare to make such a judgment?"
“The difference in blood pressure between the two upper limbs—”
“Maybe I measured wrong? I changed the bandage and measured again. Okay, don't make a fuss anymore, the CT scan is fine, wait until tomorrow morning to do it, don't drag the person in the CT room up in the middle of the night."
Tomorrow morning? I glanced at that line of text. 29 minutes.
“Master Trieu, can't wait until tomorrow morning.”
“Shen Yen, listen to me—”
“Master Trieu.” I interrupted him, "If this patient dies tonight in the Emergency Department, I will be on duty this night shift, I will write the medical record, but the person who signs the instructions above is your name."
The other end of the line was silent for two seconds.
“… You can do it if you want to do it. If something happens, don't say I told you to do it.”
Hang up. I tightened my grip on the phone, my knuckles turning white. Okay. I searched the phonebook and found a phone number. Dean of the department Cardiovascular surgery—Chu Yen Binh. This phone number was the month before the surgery and I secretly memorized it. A retrial doctor called the head of the Department of Cardiovascular Surgery. This story spread out, and I could be laughed at at this hospital until the end of the retrial. But I looked at that countdown text. 27 minutes. I pressed call. After two rings, the call is connected.
"Who is that?" The voice was not too sleepy, carrying the low alertness typical of middle-aged men.
"Hello Director Chu, I am a attending physician in the Emergency Department, Tham Yen. I am very sorry to bother you at this hour. I have a patient with suspected Stanford type A aortic dissection, male, forty-six years old, with sudden pain in the lumbar and back area, systolic blood pressure difference between the two limbs is over 48 millimeters of mercury, the high side is 210. I have arranged an emergency CTA, I would like to ask you to evaluate whether surgery is needed or not."
The other end was quiet for a moment.
“What is the difference in blood pressure between the two upper limbs?”
“48.”
“Is the D-dimer there yet?”
“Just sent for tests, still not—”
“Don't wait any longer.” Chu Yen Binh's voice suddenly changed, from lazy to sharp, "After completing the CTA, send it straight to my phone. Now you prescribe esmolol to lower heart rate, nitroprusside sodium to lower blood pressure, target heart rate below 60, systolic blood pressure from 100 to 120. Don't let the patient exert himself, don't let him cough, don't let him get excited."
"Yes."
"I'll leave now, I'll be there in twenty minutes. Notify the operating room to wait for orders."
“Yes, thank you, Director Chu.”
“Wait.” He paused for a moment, "You are a remedial doctor, why do you judge it as dissection?"
I opened my mouth. I couldn't tell, I saw the countdown floating above his head.
“… The difference in blood pressure between the two upper extremities, combined with tearing pain, is a textbook indication.”
"YES." He didn't ask any more questions and hung up.
I let out a breath, my palms were sweaty. Back next to the rolling bed, the CT room's phone called back—agreeing to do it urgently. When I pushed the man to the CT room, his wife followed, the look of impatience on her face turning into fear.
"Doctor... is it really that serious? Just now he said it wasn't that painful..."
“No pain does not mean safe.” I pushed the bed, my steps didn't stop, "When the dissection is tearing, some people, on the contrary, don't have pain anymore, because the tear is expanding, pressing on the nerve."
She made an "ah" sound and her steps staggered a bit. The CT room door opened. Technician Mr. Truong's hair was disheveled, he had clearly just gotten up from the bed in the on-call room, and his face was not very good.
"Which medical examiner ordered this urgent examination? In the middle of the night—"
"Mr. Truong, suspected type A dissection, the head of the Department of Cardiovascular Surgery is on his way, need to watch a movie."
The three words Chu Yen Binh are more useful than anything. Old Truong's face immediately changed. Without saying a word, he began to adjust his posture. I stood guard outside the control room, staring at the screen. The countdown text is still jumping. 19 minutes. The contrast agent is pushed in, the image is reconstructed layer by layer. From the ascending aorta to the descending aorta—a clear intimal flap divides the true and false lumens into two halves. The tear extended from the aorta up to the abdominal aorta. Stanford type A. DeBakey type I. The range is much wider than I expected. Old Truong inside took a cold breath, the voice on the intercom also changed: "Doctor Tham, come take a look at this... damn, how could this person even walk in on his own?" I don't answer. Because the countdown text suddenly sped up and jumped. 14 minutes. I rushed to the bed and pressed the man who wanted to turn over: "Don't move! Absolutely don't move!"
“Doctor, I want to turn over—”
“No way!” I pressed firmly on his shoulder, "Now your blood vessel wall only has a thin membrane left, turning over can break it. You just lie like that, don't move, your wife and children are still outside waiting for you."
He was stunned and stopped moving. Fear finally appeared in his eyes. I took my phone and took a picture of the CTA and sent it to Chu Yen Binh. Ten seconds later, there was a reply. 【Immediately transferred to the operating room, I arrived at the hospital gate.】 The hallway where I pushed the bed and ran to the operating room was one hundred and twenty meters long. That was the fastest time I've run since the regression. Without having time to call the paramedics, I pushed the bed alone, Ms. Luu trotted behind to hold the infusion. The elevator door opens. Chu Yen Binh stood inside. He was wearing a black life jacket, still wearing house pants and slippers inside, but his gaze was already cut into the surgical state.