Chapter 2

The critical care and severe trauma group had originally been led by one director and two senior associate directors, with a total of 25 physicians and 62 nurses. This June, to facilitate academic research and scheduling, the large group was divided into three smaller groups. Lin Ye was entrusted with the important task of becoming the leader of Group 2.

Their Group 2 had few members, but the two attending physicians who had worked with Lin Ye for years were experienced and could help share much of the pressure. So for more than two months, no new members had joined. About ten days ago, Director Gao had told Lin Ye that a new colleague would arrive at month’s end. At the time, she was busy and didn’t ask for details.

Director Gao introduced her cheerfully. “This is the capable assistant I found for you. A top graduate of Heidelberg University, Doctor Tang Feiwan.”

“Hello, Doctor Tang.” Lin Ye’s voice was like a breeze, gliding lightly past Tang Feiwan’s ear, carrying no discernible tone, yet enough to wake her.

Tang Feiwan’s throat tightened, and she forced out four words: “Hello, Director Lin.”

The conversation, like that between strangers, ended, leaving an awkward atmosphere. Lin Ye broke the silence. “Director Gao, please carry on. I’ll show her around.”

Director Gao knew how heavy the emergency department’s workload was, and nodded. “Good. You two go ahead.”

The two left the director’s office. Tang Feiwan still hadn’t recovered from the dazed shock of their reunion after so long. She could only follow Lin Ye silently, listening as she introduced the break room, duty room, resuscitation room, and EICU ward. Finally, they arrived at the office area.

“Doctor Tang, this is our Group 2 office.” Lin Ye pointed to a spot to the left of the water dispenser. “Your desk is over there.”

Tang Feiwan responded woodenly, “Okay.”

“Can you start right away?” Lin Ye didn’t look at her, walking to Wang Can’s desk to flip through medical records.

“M-maybe.” Why did she completely lose her confidence in front of Lin Ye? Tang Feiwan bit her lip in frustration.

“Wang Can was originally following Old Liu, but starting in September, Old Liu will be teaching at the medical school. From now on, you’ll take her.” Lin Ye handed a stack of patient files to Tang Feiwan. “These are her patients. Familiarize yourself first.”

Tang Feiwan took the files and heard Lin Ye say, “WeChat.”

“What?” Tang Feiwan was dazed for the third time today.

Lin Ye’s slender brows drew together slightly, showing a hint of puzzlement. “You don’t use WeChat?” She had assumed that Tang Feiwan, returning from abroad, wouldn’t use WeChat as her primary chat tool.

“I do, I do.” Tang Feiwan took out her phone, opened her personal QR code, and held it forward, waiting for the other to add her.

Lin Ye scanned the QR code. A few seconds later, a red dot appeared in her contacts. Tang Feiwan sniffed imperceptibly and tapped on it.

“I’m Lin Ye.” The four words were both unfamiliar and familiar. She still remembered eleven years ago, in the first semester of her sophomore year, October 12, when Lin Ye had also proactively added her on QQ with the same four words.

It was as if everything had returned to the starting point.

After the verification passed, Lin Ye sent her Wang Can’s contact card.

“Wang Can’s WeChat. If you have any questions, you can talk to her.” It was completely the tone of an ordinary colleague.

“Thank you.”

Lin Ye returned to her seat and lowered her head to work. Tang Feiwan also sat down at her desk and began organizing materials. During this time, colleagues came in, exchanged brief introductions, and went back to their tasks. When she finished organizing the medical records, Tang Feiwan chatted briefly with Wang Can, who had returned from rounds. Only then did she have time to look up at Lin Ye, who sat by the window with her back to her.

The person before her was a typical southern woman, with naturally cool fair skin and delicate features. Tang Feiwan had often praised her eyes back then, saying that even comparing them to spring water wouldn’t do justice to their gentleness. So she didn’t dare look directly into those eyes for now. Instead, she took this opportunity to quietly savor the sight of her back.

She was still the same as before, too thin, as if a breeze could knock her over. But Tang Feiwan knew how much strength this person had. She could lift a dummy and carry Tang Feiwan, who was four centimeters taller, in a princess carry.

Tang Feiwan’s thoughts were drifting when someone barged in and pulled her back to reality. “Lin Ye, the patient who came in at 6 a.m., ECG shows slight ST elevation, troponin is also elevated. I strongly suspect an MI. But the cardiology department did a coronary angiography and found no obvious lesions, not even coronary artery disease, let alone an MI. Will you take a look?”

“Okay.” Lin Ye left her seat and walked toward the door, remembering Tang Feiwan just as she was about to speak. But the person was already standing beside her. “I’ll go too.”

The three hurried toward the catheterization lab. The patient was still lying on the operating table.

Lin Ye asked, “The patient’s symptoms?”

Liu Zhinan replied, “Severe chest pain and tightness.”

Tang Feiwan followed up, “What kind of chest pain? The suffocating tightness from lack of oxygen, or the knife-like tearing pain?”

“Tightness. You suspect an aortic dissection?” Both were clinically experienced doctors, and Liu Zhinan immediately understood Tang Feiwan’s speculation. However, aortic dissection usually caused tearing pain, and rarely tightness.

Tang Feiwan gave an “Mm.”

Liu Zhinan turned and asked, “Should we do a thoracic aortic angiography while we’re at it?”

Lin Ye pursed her lips, visibly hesitant. Aortic angiography was an invasive test and no longer a common method for diagnosing aortic dissection. But the patient was already on the operating table for coronary angiography, so adding an aortic angiography wouldn’t increase the discomfort. She discussed it with the cardiology attending physician in the cath lab through the microphone, got the family’s consent, and finally nodded. Do it.

Then, several pairs of eyes stared unblinking at the screen. The contrast agent flowed through the thoracic aorta unobstructed, with no signs of dissection.

Liu Zhinan frowned. “Could it be a pulmonary embolism?” With no trauma and having ruled out myocardial infarction and aortic dissection, doctors generally considered pulmonary embolism.

“Have we ruled out abdominal organs?”

“Have we excluded abdominal diseases?”

Lin Ye and Tang Feiwan asked simultaneously. They didn’t lose focus due to their long-lost tacit understanding, still staring at the operating room.

Liu Zhinan shook his head. “I’ve examined him. The abdomen is soft and there’s no tenderness. It shouldn’t be an abdominal organ issue.”

Lin Ye observed the patient’s condition on the screen, considering whether to send him to the CT room for a scan or to place a new line on the table for a pulmonary angiography. Fortunately, the patient’s blood pressure was still stable, though his heart rate was fast at 108. Sending him for an emergency CT should be fine. Out of a desire to save the patient money, she asked Liu Zhinan to order a chest CTA.

The patient was wheeled to the CT room. They didn’t go far, waiting for the results. When the results came out, the pulmonary artery was also clear.

Having ruled out the three deadly diseases, all three of them, along with the cardiology attending physician, felt a weight lift. However, the patient’s chest pain was still unexplained and symptoms hadn’t improved. What should they do next? Everyone was momentarily stumped.

“What about an echocardiogram? Was one done?” Tang Feiwan, who had studied and worked at Heidelberg Hospital’s cardiac center for five years, asked.

Liu Zhinan said, “Done at the very beginning. No pericardial effusion.”

Just when they were at a loss, a nurse suddenly rushed over. “Bad news. Bed 2’s blood pressure has dropped. It’s only 85/42.”

The three of them felt their hearts jump. They hurried after the nurse to the ward. Pulling open the curtain, they saw the patient frowning tightly, crying out, “I’m in pain, doctor. I feel terrible.”

The family member also asked nervously, “Doctor, what’s going on? The more you treat him, the worse he feels. You’re the best hospital. What if you can’t cure him?”

Tang Feiwan stood on the right side of the bed and saw the patient clutching his chest with one hand and his stomach with the other, sweating profusely. She asked him, “Does your stomach hurt?”

“It hurts! It was just chest pain at first, but after the exam just now, my stomach started hurting too. This is killing me.”

Tang Feiwan didn’t hesitate. She reached out and pulled back the patient’s blanket, noticing his stomach had swollen.

Liu Zhinan was surprised. “Huh? It wasn’t swollen when he first arrived!”

Tang Feiwan lifted the patient’s clothes slightly, pressed her right hand on the surface of his abdomen to palpate. It felt like fluid. This is bad. She turned her head and said urgently, “Do a bedside ultrasound.”

“Right.” Liu Zhinan instructed people to prepare. Lin Ye watched Tang Feiwan’s accurate judgment and methodical movements, her eyes lowering slightly, the corners of her lips unconsciously curving up.

The bedside ultrasound took time, but the patient couldn’t wait, crying out constantly, “It hurts so much! I’m dying! Save me!”

His stomach grew more and more swollen, and his face turned increasingly pale. The family member suddenly said, “Did he hurt his stomach yesterday?”

Liu Zhinan quickly asked, “Hurt? How? Where?”

“He slipped in the shower and hit the sink, right here.” The family member pointed to the left side of the abdomen.

Spleen.

“But I asked if he needed to go to the hospital, and he said he was fine.”

“Could be a delayed splenic rupture.” The condition was critical and couldn’t be delayed. Tang Feiwan immediately proposed, “Perform an abdominal paracentesis directly.”

Lin Ye nodded, signaling Tang Feiwan to do it. She then explained the condition to the family, calming them and having the consent form signed.

Everything was ready. She located the site, disinfected it, and administered local anesthesia. Tang Feiwan held a 50 ml syringe and, without hesitation, inserted the needle into the abdominal cavity. She pulled back forcefully. In an instant, dark red blood was drawn from the abdomen.

Liu Zhinan exclaimed, “Wow, it really might be a splenic rupture.”

Lin Ye arranged follow-up: “Fluid resuscitation to stabilize blood pressure first.” She contacted the emergency surgery department, informing them that once the patient’s vitals stabilized, exploratory laparotomy might be needed.

Five minutes later, the associate director of the emergency surgery department arrived, assessed the situation, and immediately had the patient wheeled into the emergency OR for an open abdominal exploration.

The patient was sent to the OR, and the resuscitation room crew finally caught a breath. Liu Zhinan leaned against the wall and chugged half a bottle of water. He turned his head. “So you’re the new colleague in our group.”

“Hm?” Tang Feiwan wiped the sweat from her forehead.

Liu Zhinan smiled. “I was wearing a mask and hat at the time, so you might not remember me.” He lightly patted Lin Ye’s shoulder. “Hey, Lin Ye, I’m sure she’s a great helper.”

“I suppose so.” Lin Ye’s voice was flat as she turned to leave, but there was a smile in her eyes she hadn’t even noticed. She added under her breath, “Let’s see.”