Chapter 1 — People Who Live in the Middle of the Process

I worked in the emergency department for eight years and once took a heart attack patient to the operating table without waiting for his family to sign. The person's life was saved, a complaint was also filed — "process violation". I was suspended from work without pay for three months. The Head of the Medical Department patted my shoulder and sincerely advised:
"The procedure is to protect you. Don't make any decisions on your own in the future."
I copied this sentence thirty times and then pasted it on the wall of the duty room. The day I returned to work, the eyes of everyone in the department looking at me were like looking at a time bomb. They guessed right. But I guessed wrong — I didn't mean to explode, I just wanted to let everyone know how scary it can be once you seriously follow the rules. My name is Trinh Lam. Chief treating physician of the Emergency Department, eight years of experience. People in the industry gave me the nickname "Trinh Nhat Dao", not because I cut people fast, but because I opened my chest very quickly. From the midsternal incision to the opening of the pericardium, my fastest record was forty-seven seconds. The instructor once said I was born to do this job. I used to think the same — until three months ago. That day, I was on night duty. Ambulance 120 brought in a fifty-six year old man with a massive myocardial infarction and a completely blocked anterior interventricular artery. When he was brought in, he was in ventricular fibrillation twice. Where are the family members? On my way. They said they were coming from a neighboring city, at the fastest it would take an hour and a half. One and a half hours. Patients with myocardial infarction, wait one and a half hours. I looked at the electrocardiogram on the monitor and it was almost straight. No hesitation.
“Prepare the operating room, take it to the intervention room.”
Nurse Ton Le looked at me: "The family still hasn't..."
"He won't need to sign until his family comes."
I remember saying this at the time. Very cool. Extremely cool. Cool for about… seventy-two hours. On the third day, the patient regained consciousness and was out of danger. A family member also came - a man in his thirties, dressed neatly in a suit and leather shoes, with slicked-back hair. As soon as he entered the hospital room, he glanced at the indicators on the ECG monitor, then took out his phone to take a photo. Not taking pictures for my dad. It's a photo for his lawyer.
"Without a family member's signature, why did you do the surgery on your own? What kind of hospital is this? Do you treat people's lives like trash?"
That day, I stood in the hallway and heard him making noise at the nurse's station. The first reaction in my mind was — Dude, your father's life was won by me. The second reaction was — Oh, what he cares about is not his father's life. On the third day, the complaint letter was sent to the Health Department. On Thursday, the Medical Department called me to work. The person sitting opposite me is Tien Duy Minh, head of the Medical Department. Over fifty years old, bald, small eyes, always speaking with the tone "I do this because I want to be good for you".
"Doctor Trinh, you were saved. We all saw this."
He turned over the complaint form on the table.
"But a process is still a process. You didn't have a written consent after being fully explained and had surgery, does this really exist?"
I said yes.
"So it's their right for family members to complain. Our procedures If it needs to be done, it still has to be done.”
He closed the file and smiled a smile that I still remember clearly to this day. How should I describe that smile... It's like he's clearly holding a knife in his hand, while his mouth still gently says "remember to let me know if it hurts".
“Suspended from work without salary for three months. Go home and reflect on yourself.”
Finally, he stood up and patted my shoulder.
“Doctor Trinh, remember, the procedure is to protect you. Next time, don't decide on your own."
Protect me. I pondered this statement carefully. Is to protect me. Not patient protection. Is to protect me. Okay, I remember. That day, when I walked out of the Medical Department, I met head nurse Ton Le in the hallway. She gave me a cup of coffee from a vending machine.
“Think about it for a moment, the rules are like that.”
I took a sip, it was incredibly difficult to drink.
“Miss Le, I think it's clear.”
"Really?"
“From now on, I will never make any decisions on my own again.”
She looked at me, wanted to say something, then stopped. Maybe she saw something unusual on my face. But she didn't ask further. That night when I returned home, I couldn't sleep. Not because I feel unjust. Working in the emergency department for eight years, I have never suffered any kind of injustice, have I? Having been scolded by family members, having been beaten by patients, at three o'clock in the morning I still had to do chest compressions until the patient's sternum broke. I don't feel unjust. I just suddenly felt — I was awake. Before, I always thought that to be a doctor, I only needed good technique and a good conscience. That night, lying in bed, I thought about something. Not enough. Far from enough. She must survive first before she can save others. But in this system, the standard of "survival" is not how many people she has saved. It's about how many words she signed. How many seals? How many procedures to perform? Okay. I learned it. During the three months of my suspension, I did a few things. First, memorize the "Regulations on medical facility management" three times. Second, copy down word by word the entire "Diagnosis and Treatment Regulations of the Emergency Department" in the hospital. Third, use a red pen to highlight all the provisions related to “informed consent”, “process approval” and “shift handover regime”. Fourth, print it out, laminate it and hang it on the wall of my duty room. Later, Ton Le said that wall looked exactly like the crime scene of a fanatic. I feel like she's exaggerating. It is clear that it is a model learning area for compliance with regulations. The day I returned to work was a Monday. I wore a faded white blouse and arrived at the department at exactly 7:55 a.m. Just enough time to change clothes and prepare before shift. Don't arrive even a minute earlier than necessary. Because Article 3 of the "Regulations on employee timekeeping management" clearly states: Working hours start at eight o'clock in the morning, arriving early is considered voluntary. I don't volunteer. When I entered the dressing room, the eyes of the young doctors in the Emergency Department looked at me a bit complicated. There is pity, there is curiosity, there is also a wariness like "Doctor Trinh is back, will she go crazy?" Rest assured. I'm not crazy. I comply with the regulations. Compliance to the point of making people afraid. Morning shift handover ceremony. Dean Tran Kien Quan stood in front of the whiteboard, said a few simple sentences, and finally casually mentioned: "Trinh Lam is back, everyone just keep working as before." As before. Okay, just like before. After handing over the shift, I walked into my clinic, sat down, pulled out the desk drawer, and took out the shift notebook. On the cover of the notebook, I used a black marker to write four large words — DO RIGHT WITH THE RULES. Then turn the first page and neatly write the date. Intern Tieu Chu stood next to him and stuck his head out to take a look and then quickly pulled back. Maybe he found me a bit scary. The morning was relatively peaceful. I receive a few mild cases, stitching skin wounds, alcohol poisoning, all are routine cases. For each informed consent form, I ask the patient or family member to sign it neatly. I carry out each operation according to regulations, not one step is left out, not one step is missing. Tieu Chu followed behind me, watching me explain the risks of the suturing procedure for a patient with a cut hand.
"Miss Trinh... just two stitches, no need to explain in such detail?"
I didn't even look up: "Article 7 of the 'Informed Consent Management Regulations' requires any invasive procedure to be informed of the risks and signed for confirmation."
“But… in the past, wasn't it just a matter of saying a word and…”
“Before was before.”
I raised my head to look at him.
“Now, we follow the rules.”
Tieu Chu said no more. Two o'clock in the afternoon. It's coming. 120 called, someone was injured in a traffic accident, a large truck overturned and fell on an electric motorbike. The driver was a man over forty years old, suffered multiple injuries, the initial assessment was broken ribs with hemothorax, possible abdominal hemorrhage. Vital signs are unstable. The ambulance will arrive in seven minutes. When Ton Le ran to report the situation to me, her speaking speed was very fast, her eyes carried an urgency that I was extremely familiar with.
“Trinh Lam, this case may require emergency chest resuscitation —”
“Have you contacted your family yet?”
“On call, the registered emergency contact is his wife.”
“Have you been contacted yet?”
“Not yet…”
“Wait.”
Ton Le was stunned for a moment.
“Wait until we can make contact and then calculate.” I turned over the duty book, wrote a line in the "Notes" column: Waiting for my family to agree and sign the paper.
Seven minutes later, the ambulance arrived. The moment the patient was pushed in, I took a glance — The condition was indeed very bad, his face was white, his consciousness was vague, his abdomen was clearly bulging. Just installed monitor, blood pressure 84/52, heart rate 126, SpO2 89. Continuing to drop. I stared at those numbers. The old me had already shouted for the operating table to be prepared. The present me, standing next to the monitor, records the data in the file.
“Where are the family members?”
"Called okay! She said she's rushing over, in twenty minutes!"
"Good." I pulled up a chair and sat down, "Wait."
Ton Le's expression at that time, I will never forget for the rest of my life. She gasped, her eyes widened, that fear was not an act - It was a surprise like "I've known you for eight years, what the hell are you doing".
“Trinh Lam… His blood pressure is still dropping…”
“According to the rules According to regulations, invasive procedures that are not within the scope of life-sustaining emergency care require a family member's signature." I didn't look at her, picked up the pen and continued to write in the duty book, "Currently the family is on the way, the patient is still within the waiting time."
“What is the range that can wait? His SpO2 is down to 89!”
“Do you feel like you can't wait?” I raised my head and looked at her, "Then would you please sign here, as head nurse, to confirm the activation of the emergency emergency priority flow?"
I pushed the form in front of her. She stared at that line for five seconds. Do not sign. Of course I won't sign. I'm not the only one who remembers what Tien Duy Minh said three months ago.
“The procedure is to protect you.”
Protects everyone but the patient. But these are the rules. Rules are set by people. Ten minutes later, the family arrived. Not one person, but four or five people, rushed in from the emergency department door, some crying, some screaming.
“Doctor! How is my husband?!”
I stood up and handed over the surgery consent form.
“Are you a patient's family member? Please review this contract in advance, I will explain to you the risks of the surgery —”
“Doctor, save people first!”