Chapter 12 — Emergency Night Watchman

Three months later, I had Phuong Chinh Thanh as my instructor, had a topic from Chu Yen Binh, and had a fast track rate. It seems everything is moving in a good direction. But in my heart there is always a tight string— Because that power is still there. Every day when I walked into the EICU, my eyes scanned each hospital bed, my heart hanging in suspense. Most of the time, the patient's head is clean. From time to time, words appear, the countdown is measured in hours or days—worsening lung infection, progressive kidney failure—these are within the EICU's routine treatment scope, Phuong Chinh Thanh's plan is enough to cope. But I know, there will always be a next time. The countdown in minutes, there's no turning back, only I can see— Countdown. 【Chapter 8】 The seventeenth day of the December month. Three o'clock in the morning. I'm not on duty, but on overtime. The fast track application deadline is tomorrow, I'm editing the first draft of my thesis in the EICU duty room. Suddenly, in the hallway, there was the sound of hurried footsteps and the sound of bed wheels rolling across the ground.
“Get out, get out, get out!”
I put down my pen and stood up. The door of the duty room was pushed open. Tieu Lam stuck half of his body in, his face pale:
"Doctor Tham! There is a woman with postpartum hemorrhage transferred from the Obstetrics Department! DIC! Director Phuong is not here..."
“Where is Trinh Duc?”
“Tonight it's not Dr. Trinh, it's Truong Phong—but Dr. Truong said he can't handle DIC…”
Truong Phong is a second-year resident doctor. Normally, he only takes care of stable patients, but when faced with a critical emergency, he is truly flustered. I pulled the door open and rushed out. Bed number nine—the position that had just become vacant—had been pushed onto a young woman. She was about twenty-six or twenty-seven years old, her entire body was yellow, her eye sockets were sunken, and her lower abdomen was covered with many gauze, and the gauze was completely soaked in blood. The two IV lines are flowing at full speed, the heart rate on the monitor is 168, blood pressure is 61 over 33. Postpartum hemorrhage. DIC. I raised my head to look at the top of her head— Words appeared. Red as blood, jumping faster than ever before. 【Postpartum disseminated intravascular coagulation. Multi-organ bleeding. Death countdown: 22 minutes.】 Twenty-two minutes. My stomach cramped strongly. DIC is not a single disease, it is a chain reaction of death. Coagulation factors are massively activated and then massively consumed, microthrombosis blocks the microcirculation of organs, and at the same time, clotting factors are depleted, making the whole body unable to stop bleeding. This is a war the body fights with itself, both sides die. I glanced at the records transferred from the Obstetrics Department:
"Postpartum hemorrhage due to placental abruption, estimated blood loss was 3000 milliliters. A hysterectomy was performed to stop the bleeding, but during the surgery uncontrolled bleeding occurred, the blood clotting function completely collapsed. During the surgery, 12 units of red blood cells, 800 milliliters of plasma, 10 units of cryoprecipitate, 1 dose of platelets were still bleeding."
Having transfused so many blood products but still bleeding—indicating that DIC has entered the hyperfibrinolytic phase. The most difficult stage to handle.
“Truong Phong!” I call.
The on-duty resident doctor ran out from the corner of the room, still holding the treatment manual in his hand as he flipped it over: "Tham... Yen, I really..."
“You don't need to panic. I'm the boss Director, you cooperate with me.”
“But you are a recovery doctor…”
“When dean Phuong is not here, I am the patient manager appointed by him. You call him to report the situation, then do as I say.”
Truong Phong hesitated for a second, pulled out his phone and called Phuong Chinh Thanh. I didn't wait for him to call me and started giving orders.
“Tieu Lam! Add another ten units of precipitate! Fibrinogen concentrate two grams intravenous infusion! Tranexamic acid one gram intravenously!”
“Notify the Blood Transfusion Department for emergency cross-matching, prepare six units of red blood cells, six hundred milliliters of plasma!”
“Bed blood gas, get it now!”
Tieu Lam moved, another nurse also followed. Truong Phong's phone finally rang: "Director Phuong! There's a case of postpartum DIC here..." I didn't pay attention to him, squatted down to look at the woman's wound—the lower abdominal incision after hysterectomy, the gauze bandage was constantly soaked with blood, and pressure couldn't stop it. I opened the gauze, the blood inside was leaking in a diffuse manner—not arterial bleeding, not venous bleeding, but the tissue surface "crying blood". This is a characteristic of DIC. There were no obvious bleeding points. clear, but completely permeable.
“The blood gas results came out!” Tieu Lam passed it over.
I scanned my eyes: pH 7.19, lactate 8.7, fibrinogen 0.4 grams per liter. Acidosis. Tissue perfusion is severely lacking. Fibrinogen is as low as almost zero. Acidosis will continue to worsen coagulation disorders. This is the death spiral—the more you bleed, the more acidic you become, the more acidic you become, the more you bleed. It is imperative to simultaneously correct acidemia.
“Sodium bicarbonate 125 milliliters intravenously! Vasopressor norepinephrine starts at 0.1 micrograms per kilogram per minute of infusion!”
“Doctor Tham, director Phuong wants to talk to you…”
Truong Phong passed the phone over.