Chapter 3 — Emergency Night Watchman

Several times the patient came to ask about his illness. I clearly had a preliminary judgment. He stood next to me and directly denied: "Tham Yen, you've thought too much, there's no need to check that." Then turn around and give the patient a test in a completely different direction. I kept my mouth shut. Hold on. One is that I have no right to speak up, two is that there are no words on the top of those patients' heads. That's right, not everyone has words on their heads. Only those who are approaching death will appear alerted. A common cold and fever will not appear, and minor external injuries will not appear. Only when it's really dangerous. Those words are like a kind of death countdown. I don't know where this ability comes from. Three years ago, after a high fever, it appeared. I had a brain CT scan and a psychological evaluation, and there were no abnormalities. I just—can see. The first time I saw it, I thought I was crazy. During her university internship at the clinic, a young girl came in for a headache, with the words on the top of her head floating: 【Cerebral aneurysm, rupture countdown: 6 hours】. I panicked, stammered and told the instructor that this patient needed a cerebrovascular examination. The doctor said I was thinking too much. Six hours later, that girl died in the rented room. When my roommate found out, he was already cold. That was the first time I couldn't be saved. It was also the first time I knew—this ability was useless unless someone believed in me. From then on I learned to be smart. No more directly saying “I feel like this person has a problem” anymore. It's about looking for objective signs, looking for a basis for clinical examination, looking for any reason that could make the superiors order an examination. Most of the time, I find it. The problem is—they don't listen. What a medical doctor said, who considers it important? So that night, I chose the most extreme way. Level pass. The price is as it is now. Being inconvenienced. Isolated. But at least that person is alive. How this debt is calculated, I know in my heart. October twenty-fifth. Eight days from that. It's the night shift again. The night shift of the Emergency Department, the person on duty is either an unlucky person, or it's me. Both are enough today. On Trieu Due Minh's shift schedule, it was written very clearly—Shen Yen, on duty alone. There is no resident doctor on duty. According to regulations, medical doctors are not allowed to work the night shift alone. But Trieu Due Minh's words were: "Didn't you handle it alone very well last time? Practice more." Ms. Luu looked at the shift schedule and wanted to say it again, but in the end she just threw back one sentence: "If you have something to do, call me." Two o'clock in the morning. The emergency room is still cold as usual. A few people gave intravenous fluids, a drunk man snored in the corner, night nurse Tieu Manh at the triage table bowed his head and bit melon seeds. I just finished stitching a skin wound and am washing my hands. The door was stabbed open. Not pushing open, but stabbing open. A man carrying a little boy rushed in, sweat covering his face, and two buttons on his shirt collar were pulled off.
"Doctor! Doctor! My son is not okay!"
The boy was about five or six years old, his whole body was limply hanging on the man's back, his lips were purple, his breathing was shallow and rapid. I threw away my gloves and quickly walked up to pick him up. His eyes just touched that child— Words appeared. 【Acute epiglottitis → laryngeal obstruction. Suffocation countdown: 11 minutes.】 Eleven minutes. My scalp immediately explode.
"Put it to bed! Quick!"
The man put the child down, his hands shaking: "Last night he said he had a sore throat. I thought it was tonsillitis. I gave him an anti-inflammatory pill. As a result, he suddenly couldn't breathe—" I turned on the flashlight and looked into the child's mouth. The base of the tongue is swollen, the epiglottis is so congested that the glottis is almost invisible. The airway was more than seventy percent blocked. The child's chest rose and fell violently, making a hissing sound when inhaling, like a straw that was about to be flattened and struggling for the last time. I turned around and shouted: "Tieu Manh! Prepare the tracheostomy kit! Dexamethasone 5 milligrams intravenously! Adrenaline nebulizer!" Tieu Manh's melon seeds fell all over the ground, she jumped up and ran immediately.
“Uncle… doctor.” The father's voice was lost, “Is… will he be okay?”
I didn't answer, because I was opening the child's mouth to assess—whether or not I could intubate him. Impossible. The swelling was so severe, the glottis cleft was less than two millimeters. Ordinary endotracheal intubation is basically impossible. The aerosol does not have time to take effect. Corticosteroids take at least ten minutes to take effect. It's only eleven minutes. No, now there are only nine minutes left. Open the cricothyroid membrane. This is the only option. But I am a retributive doctor. I have done this operation on a simulated person, no less than twenty times. Real people—ever. Furthermore the subject is a child. A five or six year old child's trachea is much smaller than an adult's, the thyroid cartilage is not yet fully developed, making it even more difficult to locate the cricothyroid membrane. The surgical blade emits cold light under a shadowless lamp. When I picked it up, the hand was very steady.