Chapter 6 — Emergency Night Watchman

The first day, after taking me to the eight-bed hospital room, he stood at the nurse's station, his hands in his blouse pockets, and asked me: "Do you feel you are different from other medical doctors?" I thought a bit.
“I judge faster.”
“Why so fast?”
Because I can see the countdown. But this cannot be said.
"... Intuition plus evidence. When encountering an unusual combination of signs, I will prioritize considering potentially fatal diseases before ruling out."
Phuong Chinh Thanh stared at me for a few seconds.
“Your intuition is not normal.” He said, "Last week it was dissection, this week it was acute epiglottitis, both times someone else saw it wrong. What did you see that other people didn't see?"
My heart beat loudly.
“…Different experiences, different perspectives.”
“You're only a first year student, what experience do you have?”
I kept my mouth shut. Phuong Chinh Thanh did not inquire. He changed the subject: "In my place, I will watch everything you do. Doing right is your responsibility, doing wrong is my responsibility. But there is one thing—do not hide it from me. Any judgments, any doubts, must be told to me immediately."
“Clear.”
"Okay. Starting tomorrow, I'll be in charge of bed number three and bed number seven."
Bed number three is an old woman in septic shock, bed number seven is a young man with a severe brain injury. I went to their bedside. There are no words on the head of bed number three. There is also no word on the head of bed number seven. Temporarily safe. The next two weeks, the days in the EICU were much more enriching than I expected. Phuong Chinh Thanh's teaching is not sloppy like Trieu Due Minh's—he really teaches. How to monitor hemodynamics, how to adjust ventilator parameters, how to adjust vasopressor doses, when to do bedside ultrasound to assess circulating volume... He lectured very quickly, did not repeat, and after lecturing, he tested. If I couldn't answer, he wouldn't scold me, but he would look at me with a look like "you should go read a book." That look is scarier than being scolded. I risked my life reading books, risking my life taking notes. Sleep four or five hours every day. But the opposite state is even better than being in a regular Emergency Department. Because here no one looks down on me. Phuong Chinh Thanh used me as half of a resident doctor. He dared to let go and let me do the invasive operation—under his full supervision. Deep vein puncture, arterial catheter placement, closed drainage of the pleural cavity...
“Very steady hands.” He once said, “The kind of natural player.”
That was the highest praise from a superior I've ever heard. November eight. Twelfth day in EICU. That morning, Phuong Chinh Thanh was not present. He came to the province to attend an academic conference, leaving a resident doctor with three years of experience named Trinh Duc to look after the department. Trinh Duc is thirty-one years old, has a long face, wears glasses, has a gentle personality, and is the type of good person who neither stands out nor makes mistakes. He told me: "There should be nothing going on today. The case of chest pain admitted last night has been ruled out for ACS, just waiting to be transferred back to the regular ward." I said "yes" and went to change the medicine for bed number seven. Half past ten. The emergency room called, wanting to transfer a new patient to the EICU. Multiple organ failure, suspected poisoning. Trinh Duc answered the phone and frowned: "Poisoned? What poison?"
“Undetermined. Patient is female, thirty-two years old, this morning was discovered by a colleague in a coma in the office. Currently, there is low blood pressure, arrhythmia, and a complete collapse of blood clotting function. The emergency department couldn't stabilize it anymore, so they asked to be moved up."
“Okay, accept.”
At eleven o'clock, the transfer bed was pushed in. The patient was wheeled to bed number nine. I went behind Trinh Duc to hang the fluid and connect the monitor. I raised my eyes a little. A young woman, thirty-two years old, her makeup was delicate but smudged by sweat and an oxygen mask. Her lips were white, her limbs were cold, her heart rate on the monitor was 143 times a minute, her blood pressure was 72 over 45. Then I saw the words on the top of her head. 【Poisoned with rat poison bromadiolone. Depletion of clotting factors. Multi-organ hemorrhage countdown: 4 hours and 17 minutes.】 Four hours and seventeen minutes. Not too urgent. But if you judge wrongly, four hours will pass in the blink of an eye. Key information: bromadiolone. This is a second generation antifreeze rat poison. The half-life is extremely long, up to several weeks. It will deplete vitamin K-dependent clotting factors, leading to systemic bleeding in organs. If you don't know it's toxic, treat it according to normal poisoning procedures—it's basically too late. And this information, if based on conventional toxicology testing, would take at least a day or two to get results. I looked at Trinh Duc. He was flipping through the transfer file from the Emergency Department, his eyebrows furrowed: "Coagulation disorder of unknown cause... INR greater than 10? This is also too unreasonable. DIC? But DIC often has an infectious or traumatic cause…”
“Master Trinh.” I opened my mouth, “Could it be poisoned by antifreeze rat poison?”
He raised his head to look at me, stunned for a moment: "What?"