Chapter 269 - 177: Time Waits for No One

Chapter 269: Chapter 177: Time Waits for No One

At the emergency room nurse’s station.

Nurse Xiaolin said, "Dr. Jiang, these are special tests. Interleukin-6 and procalcitonin in particular aren’t commonly run by the ER lab’s night shift. If we send them over now, they’ll have to start up a dedicated machine. It’ll take at least an hour and a half to two hours to get the results. Should we report this to the ER administration first?"

The hospital’s information system in 2008 wasn’t as intelligent as it would be in later years.

The lab’s night shift was short-staffed.

Forcing a rush on non-standard emergency indicators could easily get the order rejected by the lab.

Jiang He said, "Just put the order in under my employee ID. Once the sample is drawn, I’ll personally take it up and talk to them. You just focus on drawing the blood."

"Okay." Seeing Jiang He’s determined attitude, Xiaolin stopped wasting words and quickly turned to get the blood collection tubes.

Purple-top, red-top, and green-top tubes. After sorting them, he strode quickly toward the resuscitation bed.

As the vice dean, Zhang Sui of course knew what these indicators meant:

They were specific indicators only checked for in cases of severe infection or systemic inflammatory response syndrome (SIRS).

"Jiang He, what on earth is wrong with Jiaqi? Why are you testing her IL-6?"

Jiang He didn’t answer immediately.

’There’s no point in giving the vice dean a lengthy explanation right now.’

’Let’s get the results first.’

’It would be for the best if it isn’t SAP.’

’If it is... we’ll cross that bridge when we come to it.’

So, Jiang He answered conservatively:

"Dean Zhang, the initial palpation revealed tenderness in her upper abdomen with radiating pain to her back. Combined with her history of fatigue over the past two days and the stimulation from the cold drink tonight, I can’t rule out the possibility of pancreatic damage. Ordering these additional indicators is a precaution to rule out a very early systemic inflammatory response. It’s an extra step, just to be safe."

Zhang Sui nodded. "Okay."

With that, the vice dean, his heart burning with anxiety, ran directly to his daughter’s side.

The daughter was in pain, and the father was in even greater pain.

Jiang He remained silent, only continuing to urge the nurse to draw the blood.

A moment later, Nurse Xiaolin placed the collection tubes into a specimen bag. "The blood’s been drawn."

"Good," Jiang He said, finding Zhang Sui. "Dean Zhang, shall we head to the ER ultrasound room first?"

Zhang Sui wiped away a tear and nodded quickly while comforting his daughter.

It was a necessary examination.

The ER ultrasound room was at the end of the hallway.

The moment Zhang Sui entered, he said urgently, "Emergency case, squeezing them in. Abdominal pain, suspecting a pancreatic issue. Hurry!"

The on-call ultrasound doctor was drowsy and about to complain, as per protocol, about someone being squeezed in without any prior notice.

But then he looked up, saw the man’s face, and shot up from his chair in fright.

"D-Dean Zhang? What are you doing here in per..."

"Cut the chatter and get to it!"

"Yes, yes, of course!"

The ultrasound doctor grabbed the transducer, squeezed on some coupling gel, and pressed it against Zhang Jiaqi’s upper abdomen.

A black-and-white ultrasound image immediately appeared on the screen.

"Dean Zhang, the patie— the child has significant intestinal gas, so the view is slightly obstructed."

Beads of sweat formed on the ultrasound doctor’s forehead. He carefully moved the transducer, adjusting the contrast as he reported:

"I see no obvious abnormalities in the liver, gallbladder, or spleen. As for the pancreas... she’s quite thin, so I can see part of it. The head and body of the pancreas appear mostly normal. The tail is slightly thickened, and the echogenicity is slightly reduced, which could indicate mild edema. I don’t see any surrounding fluid."

Hearing "mild edema" and "no fluid," Zhang Sui finally felt a bit relieved.

He knew perfectly well what that meant, but he still asked, "So it’s just ordinary, mild pancreatic edema? Nothing serious, right?"

The ultrasound doctor nodded. "That’s what it looks like on the ultrasound for now. No signs of necrosis or peritoneal fluid. Considering the patient just drank ice water, it could be gastrointestinal spasms caused by the cold stimulus affecting the edge of the pancreas, or perhaps mild pancreatitis. We’ll have to see the amylase results from the blood test for a clearer picture."

"Okay, thank you for your trouble."

The gurney was wheeled back to the ER observation room.

Zhang Jiaqi was placed in Bed 3. Following the doctor’s orders, a nurse started her on an IV drip with an acid suppressant and a basic saline solution for hydration.

Time ticked by, second by second.

Forty minutes had passed since Zhang Jiaqi was brought into the ER.

Jiang He sat at his computer, frowning as he constantly refreshed the lab results page on the HIS.

Finally, the first batch of results from the routine emergency chemistry and CBC panels came back.

Zhang Sui was also waiting nearby. He clicked open the report, and the two of them looked at it together.

White Blood Cell Count (WBC): 11.5 x 10^9/L (Slightly high, normal range 4-10).

Serum Amylase: 110 U/L (Normal, reference range 30-110).

Lipase: 145 U/L (High end of the normal range).

The data on the screen was clear.

Zhang Sui closed his eyes, and tears streamed down his face.

’This confirms it. There really shouldn’t be any major problems...’

His daughter had fallen into a deep sleep from the painkillers and antispasmodics, and his heart, at long last, settled back into his chest.

Zhao Yumin from the ER glanced at the results on the computer, then at the ultrasound report, and said to Zhang Sui:

"Dean Zhang, the amylase and lipase levels are basically normal, and the ultrasound only shows mild edema. The white blood cell count is a little high. I’d say it’s acute gastroenteritis with a minor early pancreatic reaction. Standard procedure is NPO, observation, and an IV with antibiotics and acid suppressants. We’ll monitor her for 24 hours. As long as her numbers don’t climb, she can be admitted to the gastroenterology ward for conservative treatment tomorrow."

Zhang Sui nodded, his voice hoarse. "Director Zhao, thank you for your hard work. Just follow the standard procedure. This girl’s lifestyle is just too chaotic. Maybe this will teach her a lesson..."

"Right," Zhao Yumin said, not forgetting to praise Jiang He. "Jiang He, your palpation skills are sharp, and your reactions are quick. Honestly, with this heavy rain, it reminds me of that other night... In any case, good work. You can head back to Hepatobiliary. I’ll keep an eye on things here in the observation room."

Everyone relaxed.

The imaging didn’t support a severe diagnosis, and neither did the biochemical markers.

According to the domestic and international medical guidelines of 2008, as well as the hospital’s own SOPs, Zhang Jiaqi was now just an ordinary patient under observation in the ER.

Not a big deal.

In an atmosphere of relief and celebration.

Only Jiang He was still frowning.

Three key data points had not yet come back:

IL-6, PCT, and CRP.

In the first few hours of its onset, Severe Acute Pancreatitis (SAP) can easily lead to a misdiagnosis.

This is because after the pancreatic acinar cells rupture, it takes time for amylase to enter the bloodstream; sometimes, it doesn’t peak until 24 hours after onset.

But...

A cytokine storm might have already begun in secret.

This was the value of the SAP paper Jiang He had written; this was why, if all went well, his paper could be published in one of the top four medical journals.

Because it was the kind of research that could completely rewrite medical guidelines and save countless lives.

"Jiang He, go on, you can get back to your work."

Zhang Sui’s voice was tinged with exhaustion. "Thanks to you being in the ER tonight. But the results are in. Just keep her for observation according to procedure."

"Dean Zhang, I’ll wait a little longer. There are still three special test results that haven’t come back."

"Her amylase levels didn’t even rise. A slight elevation in those inflammatory markers like interleukin would just be a normal stress response."

Zhang Sui clearly thought Jiang He was being overly anxious. "We just need to follow the guidelines. But still, I really owe you for tonight. When this is all over, I’ll come thank you in person. You’ve worked hard."

With that, Zhang Sui turned and left.

Zhao Yumin also went to attend to other emergency patients.

One hour and ten minutes had passed since Zhang Jiaqi’s arrival.

Jiang He grew impatient waiting for the results.

He walked over to Bed 3.

Zhang Jiaqi was sleeping soundly, the saline solution dripping, drop by drop, into her vein.

At the head of the bed was the vital signs monitor.

Blood Pressure: 110/70 mmHg. (Normal)

Blood Oxygen Saturation: 98%. (Normal)

Heart Rate: 95 bpm. (Elevated)

Respiratory Rate: 22 breaths/min. (Elevated)

Jiang He keenly observed:

Although her heart rate and respiratory rate were still within a barely acceptable range, they were not the baseline vitals of a sleeping girl.

Tachypnea and tachycardia.

With no obvious external stimulus, the body was compensatorily speeding up cardiopulmonary function.

This was one of the early warning signs of Systemic Inflammatory Response Syndrome (SIRS).

Her body seemed to be mobilizing all its resources to face an unseen, catastrophic disaster.

The probability of SAP was getting higher and higher...

A sense of foreboding washed over Jiang He.

He jogged to the nurse’s station.

"Xiaolin, tighten the alarm thresholds on the cardiac monitor for Bed 3. If the heart rate goes over 100 or the systolic pressure drops below 90, call me immediately. Also, move the crash cart next to Bed 3 and have it ready."

Xiaolin was taken aback. "Dr. Jiang, Director Zhao just said there was nothing seriously wrong with Bed 3."

"Just do as I say. I’m going to the lab!"

The urgency in Jiang He’s voice made Xiaolin hesitate for a second before he instantly complied. "Understood."

After giving his orders, he rushed to the lab.

On the night shift, only two people were on duty.

"Excuse me," Jiang He asked a technician, "the special test sample for Zhang Jiaqi in Bed 3 from the ER, what’s its status?"

"Oh, that rush order? The CRP is almost done, maybe another ten minutes for the result. But the IL-6 and PCT are run on the ELISA machine. We just put the microplate in to incubate. Washing the plate, adding the substrate—it all has to be done on a strict schedule. You can’t rush it. The absolute fastest will still be another forty minutes."

In 2008, fully automated chemiluminescence immunoassay analyzers hadn’t yet become standard for rush orders on the ER night shift.

These special tests were run at night using semi-manual methods and old ELISA readers.

Time is life, but machines have their physical limitations...

"Can’t it go any faster?" Jiang He asked, looking at the clock on the wall.

Nearly an hour and a half had passed since her arrival.

"Dr. Jiang, this is already the fastest process," the technician said helplessly. "If you don’t incubate it for long enough, the color development will be incomplete, and the data will be useless."

After a moment of silence, Jiang He said, "Okay, I’ll wait here."

He pulled over a small stool and sat down next to the ELISA reader.

The lab’s light was a stark white. Jiang He closed his eyes, replaying Zhang Jiaqi’s vital signs and potential prognoses in his mind.

The wait felt infinitely long.

At 12:10 AM, a full two hours after the patient’s arrival, the technician took out the microplate and placed it in the reader.

The attached printer spat out a strip of thermal paper.

Jiang He snatched it up and his eyes scanned the data section.

CRP: 28 mg/L (Normal

PCT: 3.8 ng/mL (Normal

IL-6: 850 pg/mL (Normal

Clearly, this was no ordinary inflammation.

The immune cells in her body were frantically releasing inflammatory mediators, which were tearing at the vascular endothelium, causing systemic capillary leakage. A massive amount of fluid was rapidly escaping into the interstitial space.

That was why her blood pressure was still temporarily normal, but her heart rate had begun to soar—her heart was desperately trying to pump a severely depleted effective circulating blood volume.

There was no time to waste. Jiang He bolted out of the lab.

He ran to his office, opened his laptop, and launched the [SAP Early Multi-Biomarker Prediction Model].

Input Patient Age: 17.

Heart Rate: 95.

WBC: 11.5.

Amylase: 110.

Ultrasound Features: 1 (Mild Edema).

CRP: 28.

PCT: 3.8.

IL-6: 850.

Run!!

A red warning box instantly popped up on the screen.

[System Determination: Probability of Severe Acute Pancreatitis (SAP): 87.8%]

[Risk Level: Critical]

[Recommendation: Immediate ICU admission. Initiate targeted intervention for Systemic Inflammatory Response Syndrome.]

Jiang He snatched the printed model report, along with the original lab results, and rushed out of the doctor’s office.

His worst fear had come true.

It really was Severe Acute Pancreatitis!

He had to find Zhang Sui.

While he was waiting, Jiang He had already run through the possible future scenarios.

If it was truly diagnosed as Severe Acute Pancreatitis,

then the hardest part would be convincing Zhang Sui to approve a treatment method that went beyond the standard SOP.

Time was of the essence.

He had to convince that stubborn old stick-in-the-mud.

Otherwise... he would never see his daughter again.