Chapter 13 — Emergency Night Watchman

I held the phone in one hand and checked my pupils in the other: "Director Phuong."
“Tell me the situation.” Phuong Chinh Thanh's voice came from the other end of the line, so calm that it didn't sound like someone who was woken up in the middle of the night.
"Postpartum DIC is in the hyperfibrinolytic phase. Blood loss is more than 3000 milliliters, the removed uterus is still bleeding. Fibrinogen 0.4, pH 7.19, lactate 8.7. Currently supplementing coagulation factors, antifibrinolysis and acidosis."
“Where are the five coagulation indices?”
"Waiting for results, about five minutes later."
“The direction is not wrong.” He said, “But if after thirty minutes of tranexamic acid and cryoprecipitation the bleeding still persists, consider starting rFVIIa—recombinant activated factor VII.”
rFVIIa. That is the last card in the DIC emergency. A blood tube costs tens of thousands, the entire hospital's inventory is limited, and use requires the dean's signature.
“Is there enough inventory?” I asked.
"The toilet probably has two pipes. I'll leave the house right away, I'll be there in twenty-five minutes. You hold on first."
“Clear.”
Hang up the phone. I glanced at the countdown above my head. 18 minutes. Tranexamic acid injection completed. Cryoprecipitate is transmitting rapidly. I stared at the data on the monitor. Heart rate 170. Blood pressure 58 over 30. Still dropping.
“Increase norepinephrine by 0.2!”
“It's increased!”
I squatted next to her, examining the abdominal incision again. Bleeding speed— Seems to be a bit slower. The speed of red absorbent gauze from thirty seconds per layer to one layer per minute. But still flowing.
“Is the fibrinogen concentrate finished infusing?”
"Done!"
“Two more grams!”
“Only two grams left in stock…”
“So double the speed of freezing!”
Tieu Lam's hands are shaking but her movements are not slow, she adjusted the infusion speed. I stood by the bed, staring at that text. 16 minutes. 15 minutes. 14 minutes— Doesn't last long. Still counting down. What I did wasn't enough. The rate of clotting factor replenishment cannot keep up with the rate of consumption. The death spiral has not yet been broken. Mandatory use of rFVIIa. Can't wait for Phuong Chinh Thanh to arrive before using it. Twenty-five minutes—she couldn't wait. I turned to Truong Phong.
“Doctor Truong, I need your signature to use recombinant activated factor VII.”
Truong Phong's face turned even whiter: "This... this needs the principal's signature..."
"Director Phuong agreed over the phone. You are the most senior doctor with a medical certificate at the scene, you can sign on my behalf."
“But…”
“She only has fourteen minutes left.”
This word popped out of my mouth before I could think. Truong Phong was stunned.
“How do you know…”
“Her vital signs are continuing to deteriorate, at this rate, within fifteen minutes there will be cardiac arrest.” I looked straight at him, "Are you signing or not?"
He looked at me for three seconds. Then gritted his teeth and nodded: "Sign."
"Tieu Lam! Call the hospital urgently, order two rFVIIa tubes! Send it through the aerodynamic system, arrive within five minutes! Tell the hospital director Phuong has verbally agreed, doctor Truong Phong will sign on his behalf!"
Tieu Lam rushed out to make a call. I returned to the bed and placed one hand on the woman's wrist artery—a pulse as weak as a mosquito's wing flapping. Her eyelids trembled slightly. Consciousness still remains. I bent down and said in her ear: "Hold on. Your child is waiting for you." Don't know if she has Can you hear me? But her finger moved a little. 12 minutes. The aerodynamic transport tube made a "pop" sound and released a sealed box. Tieu Lam took it and opened it—two rFVIIa tubes. I grabbed it, mixed the potion.
“90 micrograms per kilogram, how much does she weigh?”
“The transfer records say 52 kilograms.”
"So that's 4680 micrograms—about 4.8 milligrams. One tube is 4.8 milligrams, just one tube."
I finished withdrawing the blood and pushed it into the intravenous line. Done pushing. Then wait. This is the most torturous wait. The effective duration of rFVIIa is ten to twenty minutes. But she only had twelve minutes. Are not. Now there are only ten minutes left. I watched the countdown jump every second. Look at the heart rate on the monitor—168, 170, 173… Still increasing. Blood pressure—55 over 28. Still dropping. Nine minutes. Eight minutes.
“Doctor Tham…” Tieu Lam's voice trembled, “Do you need to prepare for cardiopulmonary resuscitation…”
“No need.” I said.
My eyes stared at the wound on her abdomen. The streaks of blood seeping through that gauze— I'm waiting for a change. Seven minutes. Six minutes. Five minutes. Antlers— No more red. The previous layer of gauze has been changed for two minutes, and the blood-soaked area has not expanded. The bleeding is slowing down. Four minutes. I raised my head to look at the monitor. Heart rate—166. It's reduced. Blood pressure—57 over 30. No more drops. Three minutes. Heart rate 160. Blood pressure 62 over 34. The text above started flashing. The countdown stopped at 2 minutes and 47 seconds—it stopped decreasing. Then the number starts jumping backwards. 3 minutes. 5 minutes. 10 minutes. 30 minutes. 1 hour. The color of the text changed from blood red to orange, then to dark yellow, and finally faded little by little— Disappeared. Instead, there is a small line of light gray text: 【Blood clotting function begins to restore. Escape from the danger of instant death.】 My knees were weak, I had to hold on to the bed railing.