Liu Zhengliang stood frozen, feeling Che Mingming made some sense, but he had no better plan.
Che Mingming didn't idle either, immediately arranging intravenous administration of the antiviral drug without a moment's delay—the sooner the better. The earlier this medication was administered, the higher the survival probability. Where to treat could be discussed later, but foundational treatment must not be postponed.
After the onset of fulminant myocarditis, immune-mediated mechanisms intensify inflammatory damage to various organs. Put plainly, dead myocardial cells send signals to their companions, essentially saying, "Since I'm dead, why are you still working? Let's all rest." At this point, high-dose steroids are crucial.
Liu Zhengliang instructed Li Qingcheng to quickly prepare the steroid Methylprednisolone. This drug suppresses immune responses—essentially telling the dead myocardial cells to stop spreading messages and letting the surviving cells continue working. Seeing the life-or-death medications Liu prescribed, Li Qingcheng didn't dare say another word and immediately prepared for injection.
Looking at this junior who shared both his shift schedule and student ID number, Liu Zhengliang seemed to see himself. They had sat in the same classroom seat, grown up in similar family environments sixteen years apart, and lived parallel lives in the same space. Perhaps this child would face more hardships in life, but everything depended on today's decision. Whether this child became Liu's experience or lesson no longer mattered—someone had to decide whether to take the risk.
Liu Zhengliang picked up the phone to summon the ambulance.
The ambulance arrived directly outside the emergency department. Several people quickly wheeled the child aboard, accompanied by Li Qingcheng and Wang Bao, while Che Mingming remained at the emergency station. With oxygen available in the vehicle, Li Qingcheng immediately administered it to help the child hold on a bit longer. Just as the ambulance started moving, synchronized electrocardiogram monitoring showed the child had developed ventricular fibrillation. Liu Zhengliang promptly performed AED defibrillation using biphasic defibrillation at 200 joules, providing slight stabilization. After defibrillation, Liu immediately began chest compressions—even if the heart's autonomous pumping capacity was insufficient, external force could temporarily circulate some blood. As long as the brain received 30% of its normal blood supply, there was still hope. Li Qingcheng called ahead to prepare the cardiac intensive care unit while the ambulance raced toward the hospital. When ventricular fibrillation recurred, they could only defibrillate again while administering Amiodarone, an antiarrhythmic drug.
The ambulance took the North Ring Road, using the outer beltway to enter Shenyang and avoid traffic congestion. Wang Bao made another call to the child's parents updating them and urging their immediate arrival. Having detected severe heart failure, Liu Zhengliang continued compressions while instructing Li Qingcheng to administer Dopamine and Dobutamine—both medications for combating heart failure.
Liu Zhengliang said: "Dobutamine dosage must not be too high nor infusion too slow. Set the infusion pump at 15 micrograms per kilogram per minute. The child appears to weigh 65 kg, so administer at 1000 micrograms per minute."
Li Qingcheng responded: "This exceeds standard dosage. The drug has significant side effects."
While performing cardiopulmonary resuscitation, Liu Zhengliang shouted: "Just administer it as instructed. I'll take responsibility."Li Qingcheng didn’t say anything. Since childhood, who had ever dared to speak to her like that? But she was just a freshly graduated intern and had never experienced such a situation before. Missed diagnoses of fulminant myocarditis were common, and very few patients survived long enough to receive a confirmed diagnosis. So, whether Liu Zhengliang was right or not, she had no clear answer at the moment and could only carry out his orders despite her doubts. After adjusting the infusion pump, she kept her eyes fixed on the ECG monitor. Liu Zhengliang said, "Keep a close watch on the ECG and observe how the child responds to the medication."
The ambulance drove directly from the overpass into downtown Shenyang. As soon as it exited the ramp, it entered Shengjing Hospital, where the critical care physicians immediately came out to receive the patient.
Without a moment’s pause, Liu Zhengliang continued performing chest compressions to ensure the child’s brain received a relatively adequate blood supply. Li Qingcheng held up the antiviral infusion as the team hurriedly pushed the stretcher at a jog, rushing the patient straight into the ICU. The attending physician asked, "Have you confirmed it’s myocarditis?"
Liu Zhengliang had been performing chest compressions for half an hour, only stopping when they reached the ICU entrance to take a brief rest. Stepping away from the bed, he said, "We haven’t done viral tests or a pericardiocentesis—our hospital isn’t equipped for those. But based on all the signs, it’s almost certainly myocarditis."
Only then did the attending physician quickly escort the child into the ward.
Wang Bao asked Liu Zhengliang, "What’s the difference between these two treatment plans? Why couldn’t we just use the IABP in Fushun? It was such a risk—if something had happened on the way, you’d be held responsible. A human life—that’s a huge responsibility."
Liu Zhengliang replied, "The IABP is just a backup plan. With fulminant myocarditis like this, the heart can shut down completely. Even if we use the IABP, if ventricular tachycardia or ventricular fibrillation occurs, with an irregular heart rate and low pulse pressure, blood pressure can’t be maintained, and the device becomes useless. Imagine working hard to nurture a promising student, only to save them but leave them with severe brain damage. This child was the family’s hope. If hypoxia causes widespread brain cell death, they could become a burden to their parents. What kind of life would that be?"
Wang Bao nodded.
Liu Zhengliang continued, "The IABP is like a manual water pump in the countryside. When you pump steadily, the IABP can recognize it and function. But if you pump the handle rapidly in small strokes, water won’t flow easily, and the IABP won’t recognize it either, rendering it useless. It’s just an assist device—if the heart is beating, it can boost pumping capacity by twenty percent. But if the heart stops, it’s like a student who gives up on studying—no amount of extra tutoring will help."
The attending physician asked for the family members. Wang Bao immediately stepped forward and explained that the family hadn’t arrived yet but were on their way.
The physician said, "That won’t do. We can’t afford to wait—the child’s condition is extremely critical. We need a family member to sign the consent form, and the critical condition notice also requires a signature."
Wang Bao said, "I’m the child’s teacher."
The doctor replied, "A teacher can’t sign—the responsibility is too great."
Wang Bao insisted, "As the teacher, I am like a parent. Since the child fell ill at school, I am the guardian. I can sign."
The attending physician muttered under his breath, "If you’re not afraid of the legal risks, then go ahead and sign. Consider yourself warned."
After signing both documents, Wang Bao sat down. Liu Zhengliang, still uneasy, disinfected and followed the team into the ICU.The child was immediately placed on an IABP upon arrival. Liu Zhengliang, being relatively unfamiliar with critical cardiac care, left this task to the physicians from Shengjing Hospital. One on-duty doctor managed the electrocardiogram monitoring, administered vasopressors, and assisted with intubation and ventilator support. Another doctor, after the nurse disinfected and prepped the skin, promptly inserted a catheter into the child’s left femoral artery—an intra-aortic balloon counterpulsation catheter—threading a mesh balloon into the vessel to rhythmically assist the heart in pumping blood. The 3D angiography equipment displayed the procedure nearby, while Liu Zhengliang and Li Qingcheng watched the screen intently, not daring to look away. The child’s blood pressure hovered around 60, with an irregular heart rate and a pulse pressure of just 21 mmHg, barely above the critical threshold. If the pulse pressure narrowed further, the IABP would require manual operation, as the machine would fail to detect it. The two watched closely, ready to step in at any moment to manually squeeze the balloon, fearing a single lapse could prove fatal.
A nurse handed over adrenocortical hormone dexamethasone to improve ventricular function. At this stage, hormonal stimulation was the last resort. Just as the attending physician was about to administer it, Liu Zhengliang quickly intervened, saying, "Don’t use this IV line. Insert a new needle farther from the current access."
The attending physician asked, "Why?"
Liu Zhengliang explained, "We just administered dobutamine through this line. If you add dexamethasone now, one drug is acidic and the other alkaline—they’ll neutralize and form a black precipitate. Dobutamine and dexamethasone cannot share the same IV pathway."
The attending physician fell silent, giving Liu Zhengliang a second glance, realizing he was dealing with someone unusually sharp—unlike the typical doctors from municipal hospitals.
Over an hour passed, and everything possible had been done. Liu Zhengliang and Li Qingcheng finally relaxed, sitting on the floor against the operating room wall to rest with their eyes closed. Suddenly, a nurse cried out, "Something’s wrong!"
The child’s blood pressure became undetectable, consciousness was lost, and cardiac arrest followed.
The electrocardiogram showed a flatline. Without waiting for the attending physician’s instruction, Liu Zhengliang rushed forward to perform chest compressions on the child, pressing rhythmically, hoping sheer force could restore life. The attending physician checked the pupils with a flashlight and shook his head, saying, "The pupils are dilated. It seems hopeless."
Liu Zhengliang shouted urgently, "That’s not pupillary dilation from brain death! I administered atropine to the child—the same atropine sulfate used in eye drops. This is drug-induced mydriasis, not pathological dilation."Atropine not only treats gastrointestinal pain, spasms, and low heart rate, but is also a key ingredient in eye drops. If someone is nearsighted and needs an eye exam, going directly to an optical shop without pupil dilation will yield inaccurate results. For instance, if you actually have 200-degree myopia but get tested without dilation, they might prescribe 300-degree glasses. Wear those long enough, and you'll genuinely become 300-degree nearsighted. Many Western drugs work on tissues—take Sildenafil citrate, for example. Originally developed for cardiovascular diseases, it helps keep smooth muscles relaxed. Don't get unnecessarily tense about it. The human body has abundant smooth muscles that act like valves: when tense, they open to allow blood flow; when relaxed, they shut tight. Patients eventually noticed that while taking it, looking downward revealed it could concentrate blood exactly where they wanted—valves sealed shut for a solid hour or two without dispersing. So why bother treating cardiovascular issues? Emergency aid first! This drug has a common name: Viagra.
The attending physician asked, "Who told you to use atropine?"
Liu Zhengliang replied, "I misdiagnosed it as intestinal spasm."
Seeing the attending physician regain some confidence, Liu Zhengliang urged, "Initiate ECMO, no hesitation."
The attending doctor said, "We can proceed, but can the patient's family handle it?"
Liu Zhengliang responded, "I'll cover the cost."
The attending physician asked, "What is this child to you?"
Liu Zhengliang said, "He's the first patient I misdiagnosed."
The attending doctor shook his head, thinking this guy was genuinely decent, but such a major decision couldn't rest on his word alone—it had to be discussed with the family. The attending physician immediately took Liu Zhengliang out to consult the relatives. No responsible doctor would tear open supplies and activate equipment based on a shout; this set of materials cost over 50,000 yuan, and if unpaid, it would be deducted from his salary. Just then, the parents—two pickle vendors—arrived by intercity bus. These honest folks waited with tearful eyes for the doctor's verdict, an agony anyone with life experience recognizes. One such event in a lifetime can knock you flat, leaving you struggling to get up for three years. Trembling, they awaited the final judgment from the doctor.
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