Later on, Little White Sable sold the building next to the commercial plaza and cut ties with her lover from the ethylene chemical plant. Rumor had it she went south to do business. Ai Chen looked up the 2005 Kweichow Moutai stock online—it was only fifty yuan back then, but now it’s over nine hundred.
While on duty, Che Mingming encountered a strange case. An elderly man named Old Li from Sifangtai Village was brought in by his family. At sixty-five, Old Li had been suffering from fever and coughing for two months, constantly spitting thick phlegm. His chest felt as if it were being hammered nonstop, like someone breaking large stones around the clock.
Eventually, he couldn’t hide it or endure it any longer, and his son, who lived in the same village, found out and brought him to the hospital. His blood oxygen level measured just 85%, which clearly indicated a lung condition. Upon hearing the number, Old Li’s daughter-in-law scolded her husband, "Look, it’s only 85%. Why are you panicking and scaring everyone?"
Without looking up from the CT scan, Che Mingming said, "At 70%, it’s often fatal. 85% is already very serious."
The daughter-in-law, embarrassed, muttered to herself, "I thought people only died at 0%. I’m not educated—sorry for the ignorance."
Old Li had been helped into the hospital by his son and was now slumped in the emergency waiting area, unable to get up. With great effort, his son carried him into the consultation room. The old man had been on IV drips at the local township clinic, diagnosed with tracheal inflammation, but after half a month, there was no improvement. Even licorice tablets and cough syrup hadn’t helped. The clinic advised transferring him, warning they’d issue a critical condition notice otherwise. Little Li thought, "Keep that notice—I’ll head to the Second Hospital first. If they can’t handle it, we’ll take a taxi to Shenyang."
Looking at the scan, Che Mingming recognized it immediately as pneumonia—the lung structure was a blur of white with ground glass opacity. But she wondered: for a typical bacterial infection, two weeks of antibiotics at the clinic should have shown some effect.
So what was this illness?
How should she treat it?
What medication should she use?
As Che Mingming pondered these three critical questions, Old Li began gasping for breath, on the verge of collapsing into a heap. Everyone was terrified. Che Mingming immediately called Liu Zhengliang for help.
Liu Zhengliang was chatting with Zhang Jiao, who had started squat training to rehabilitate her leg muscles. He rushed over as soon as he got the call and saw that Old Li was in respiratory failure. He told Che Mingming, "Get him to the ICU now. Breathing issues can’t wait—minutes can be fatal."
With that, Liu Zhengliang lifted Old Li onto a hospital bed. Che Mingming ran ahead to call the elevator, and two nurses assisted in rushing him to the ICU.
In the elevator, the daughter-in-law asked, "How much does the ICU cost?"Liu Zhengliang could tell from her attire that their family wasn't well-off, but financial constraints for treatment were a later concern—one shouldn't suffocate from despair. Jogging alongside the hospital bed, he said to Old Li's son and daughter-in-law, "Let's get inside first and stay prepared. If it comes down to it, you'll have to be willing to spend the money. We'll observe him inside, start with oxygen via mask, and be ready to intubate if needed. We can't afford chaos at a critical moment, scrambling for equipment last minute—that risks accidents. For now, it won't cost much, and we're not using many supplies."
Sure enough, once the oxygen mask was applied, Old Li's complexion improved noticeably.
However, the ICU's atmosphere frightened Old Li, and he asked his son, "Am I done for?"
His son quickly reassured him, "No, it's fine. There are plenty of machines here to treat you. Don't overthink it."
Since the mask was holding up, they avoided intubation if possible—intubation is risky and hard on the patient. Once in the ICU, Liu Zhengliang promptly arranged for a repeat scan. The CT results showed effusion in the right lower lung, confirming it as pneumonia. Che Mingming then asked the family for the medical records: the local clinic had initially prescribed cephalosporin and azithromycin, which didn't work, followed by minocycline. This suggested bacterial infection was unlikely, nor was it mycoplasma or chlamydia pneumonia—minocycline, often used by quacks for gonorrhea, is effective against mycoplasma and chlamydia. Fungal infection was also improbable.
Could it be lung cancer?
A contrast-enhanced CT was done, and the results ruled out lung cancer and didn't resemble tuberculosis.
Studying the scans, Liu Zhengliang said to Che Mingming, "See here? The patient has pulmonary embolism in the right middle and lower lobes. Besides pneumonia, there's pulmonary embolism—that explains his symptoms. Why else would he have chest pain? It's likely the cause."
Old Li's son asked, "What's pulmonary embolism?"
Che Mingming answered for Liu Zhengliang, "It means a blood clot is blocking the blood vessels in the lungs. Those vessels are supposed to exchange gases and carry oxygen, but the clot is obstructing the main pulmonary artery. If it stays blocked too long, it could cut off blood flow completely, causing severe hypoxia. At that point, no amount of intubation or oxygen would help—it could happen in a minute, and even a miracle worker couldn't save him."
Liu Zhengliang added, "But in your father's case, it's a branch embolism in the lung vessels, so the situation is relatively better."If the pulmonary embolism were more severe, thrombolytic injections would be necessary. However, thrombolytic injections have a drawback. The main active ingredient is called urokinase, which is extracted from fresh human urine. It doesn't dissolve clots directly but activates the cleavage of arginine molecular chains in the thrombus, converting it into plasminogen to dissolve protein-based clots. Yet, this method has limitations: it requires highly specific conditions—patients must have no history of cerebral hemorrhage, severe heart, liver, or kidney diseases, or serious diabetes. During administration, extreme care is needed, combining vascular angiography with infusion. Sometimes, a micro guidewire is used to poke the thrombus, much like Cantonese chefs needle-roast pig skin to enhance flavor. A slight misstep could trigger sudden cerebral hemorrhage, turning the operating room into a chaotic scene as multiple departments rush in for consultation.
That would be too troublesome, and we're not at that stage yet—thrombolysis shouldn't be used lightly. Anticoagulation therapy is relatively safer; it's akin to targeted drugs in cancer treatment, which don't eliminate tumors but inhibit new growth and prevent metastasis. By preventing new clots from forming, the condition won't worsen, allowing the body's innate thrombolytic mechanisms to work slowly but safely.
After discussing with the young ICU doctors, Liu Zhengliang found consensus: they'd use low molecular weight heparin anticoagulation. The old man's daughter-in-law asked, "How much does this medicine cost? We're farmers—hospital stays, oxygen, and medications are too much for us to handle."
Liu Zhengliang replied that it only cost fifty yuan, not expensive. The daughter-in-law countered, "Fifty yuan is like eight or nine jin of eggs. One jin has seven eggs, so nine jin would take a hen three months to lay."
Patients and families often calculate costs this way; every doctor encounters such comparisons, though the units vary—some count eggs, others pork, taxi fares, painting areas, or even dumpling counts. People in all walks of life scrape together their livelihoods bit by bit. Doctors don't argue back or mention their performance metrics, departmental budgets, or costs—such topics are off-limits and only lead to complications, so they often respond with a stern demeanor, which can seem unfriendly.
Director Zhao advised Liu Zhengliang and Che Mingming to persuade the patient to transfer, saying, "We're a Level 2C hospital without a respiratory critical care department, and our ICU staff are all juniors with less than five years of experience. I'll talk to the family; if necessary, they should go to Shenyang for treatment. Liu Zhengliang, you're an interventional neurosurgeon—how dare you dabble in respiratory issues? You're clever and eager to learn with a wealth of knowledge, but respiratory diseases require specialized care. Let's just ensure the patient's vital signs are stable."After speaking with Liu Zhengliang, Director Zhao went to talk with the family, explaining that the doctors had done their best, and that the emergency physician was the one treating them. For those not in the medical field, an emergency physician might be hard to understand—they’re essentially like tour guides in a hospital. If you have a serious illness, you still need to see a specialist in the relevant department. But our hospital doesn’t have a respiratory intensive care unit, so it’s best not to delay here. Going to Shenyang as soon as possible is your best option.
By the time he finished speaking, it was already dark. When they inquired about the price of a private ambulance, they found it would cost two thousand yuan to travel just forty kilometers. The daughter-in-law hesitated at the expense. After discussing it, the couple decided to wait until the next morning when things might stabilize. If they absolutely had to go, they would use a public ambulance for the transfer—it was cheaper.
But in the middle of the night, Old Li started having trouble breathing again, and his blood oxygen levels began fluctuating wildly. His son called for the doctor several times, but the ward’s on-duty physician was unsure what to do and asked Liu Zhengliang, who had rushed over, whether intubation was necessary.
Liu Zhengliang, a neurosurgeon specializing in interventional surgery, rarely had opportunities to perform neurosurgical procedures. It was like an artilleryman seldom setting foot on the front lines—you couldn’t say he wasn’t in the fight, since he fired plenty of shells, but you also couldn’t say he’d seen the enemy up close, since he was always far away. Nowadays, even these surgeries had been absorbed into the interventional department’s domain, with many hospitals separating interventional surgery entirely from neurosurgery. So, being asked to intubate now was like having seen a pig run but never eaten pork. Although he had practiced during rotations at Peace Hospital, it was only in an assisting role. Relying on knowledge learned years ago in school, he felt a bit nervous—if not for his good memory, he’d have been even more apprehensive.
Liu Zhengliang explained to the family, “During intubation, we may need to lift the epiglottis. This area normally acts like a switch, ensuring breathing and eating don’t interfere with each other by alternating between the trachea and esophagus. But it’s prone to triggering a vagal reflex, which can easily cause cardiac arrest, especially since your father is severely hypoxic. I’m telling you this in advance—please sign the consent form. Once you’ve signed, I’ll proceed.”
Old Li’s son immediately signed while urging, “Hurry up and do it. If you keep talking, my dad might not make it.”
OpenNovel