Chapter 59
I’d only just clocked in for night duty, but after being tormented by children’s crying, parents’ anxious sighs, and the nonstop blaring of monitor alarms, the hands on the clock were already nearing 11 p.m.
Even though only four hours had passed, it felt like my soul had aged forty years.
The pediatric ER was nothing short of a miniature hell.
A child convulsing with a fever seizure, a child wheezing for breath, a child with gastroenteritis vomiting and having diarrhea like a fountain.
And the parents, howling along with them, taking all of the children’s pain onto their own bodies.
That was when it happened.
One of the nurses at the station said,
"A bed opened up after the patient in Bed C-5 was admitted."
At that moment, Chief Resident Lee Minjae sprang to his feet behind me and roared,
"Finally...! Finally, a bed opened up!!"
I looked at Minjae with hollow eyes.
"Uh, is that really something to be that happy about?"
"Is it something to be happy about? Hyeonjae, you’ve completely lost it!"
Minjae gripped my shoulder hard and pointed toward the hallway.
"Did you forget we laid kids down on those makeshift stretchers in the hallway earlier? And you still think a bed opening up isn’t something to celebrate after seeing that? This is heaven! Now only nine beds are full! We’re at 90%, not 100%! This is a miracle in the pediatric ER!!"
His raucous shout drew anxious looks from nearby guardians.
"Doctor, if you could just lower your voice a little..."
"Ah!"
Only then did Minjae seem to realize the people around us; he coughed awkwardly and straightened up.
"Ahem. Han Hyeonjae. Thanks to the child who was just admitted, a ray of light has finally shone into the ER. We should commemorate this miracle. The kids have calmed down a bit, so the chief will treat us to canned coffee. Follow me."
"Oh, thank you, sir."
The cold night air brushed my cheeks in front of the ER’s main entrance.
For the first time in hours, I took off my mask and inhaled the fresh air to my heart’s content.
Minjae stood in front of the vending machine and put in coins.
Two cans of coffee dropped with a dull thud.
Ahh. This is exactly why we live.
That was when it happened.
Hmm, what’s that...?
Across the road from the hospital.
The pedestrian signal at the crosswalk was clearly red.
But two people were running across the road, ignoring that red light.
In their arms was something small wrapped in a blanket.
"Uh... uh? Sir, that..."
My voice came out trembling.
"Uh... looks like a kid?"
All the exhilaration vanished from Minjae’s face.
The two people ran toward the emergency medical center, shouting at the top of their lungs.
"Please save our son!"
The canned coffee in my hand slipped to the floor.
"Cyanosis..."
Minjae murmured under his breath.
That’s right.
The area around the child’s lips and nose had turned blue, as if it had been painted on with pigment.
We moved at the same time.
"I’ll take him!"
I ran to the man and took the child from his arms.
The child’s body was limp, his skin cold.
Why had this tiny body grown so cold?
Clutching the child, I ran into the ER with Minjae following behind me.
"How old is the child? Since when has he been like this?!"
Minjae ran alongside them, almost shouting the question at the parents.
"He’s two years old! He was fine just a moment ago, but then he suddenly started breathing strangely, and then he turned blue...!"
"Get the pediatric resus bed set up, now! Hurry! Call pediatrics on-call!"
The nurses hurried around to prepare the resuscitation bay, and someone came running with a pediatric emergency cart.
Holding the child, I ran toward the resuscitation room.
The weight of the small life in my arms felt as heavy as a ton.
I carefully laid the child down on the bed in the resuscitation room.
"Connect the monitor and get an IV line, quickly!"
The nurses attached ECG electrodes to the child’s tiny body and wrapped a blood pressure cuff around him.
Another nurse tried to find a vein in the child’s foot.
"He can’t breathe! Airway first!"
Minjae stood at the child’s head and secured the airway.
"Ambu bag! Where’s the Ambu bag!"
Cyanosis.
A sign that the body is not getting enough oxygen.
"Saturation! What’s the oxygen saturation!"
Minjae shouted. A nurse clipped a pulse oximeter probe onto the child’s tiny toe.
Everyone’s eyes were fixed on the monitor.
I swallowed hard.
80%? No, maybe even in the 70s.
In the worst case, it could be in the 60s.
The monitor screen blinked.
The number showing the heart rate jumped to 150.
And at last, the oxygen saturation number appeared on the screen.
[ SpO2 : 85% ]
...
Silence fell.
I didn’t trust my own eyes.
"......What."
Minjae muttered blankly.
"85%? He’s this blue, and it’s only down to 85%? We’re pumping oxygen in with the Ambu bag too, so why isn’t it going up? Is the machine broken? Switch the probe to the other foot! Hurry!"
The nurse frantically removed the probe and clipped it onto another toe.
The numbers on the monitor disappeared for a moment, then reappeared.
[ SpO2 : 86% ]
Everyone in the resuscitation room froze.
The child’s lips were clearly blue.
He was clearly not breathing properly.
The child’s body was limp.
Everything was showing the classic signs of severe hypoxia caused by oxygen deprivation.
And yet the machine kept hovering around that ambiguous number of 85%.
Even though we were forcing high-concentration oxygen into his lungs.
I looked at Minjae with a bewildered expression.
Minjae, too, stared at the monitor, looking dazed.
"Heart problem? A congenital heart defect? Or severe pneumonia? Sepsis?"
Out of Minjae’s mouth spilled the most horrifying words a doctor can think of when facing a pediatric emergency patient.
"No, that doesn’t make sense."
Minjae shook his head.
"First, the probe! A new one! Bring me a new one!"
At the shout, one of the nurses ran out of the resuscitation room in a panic.
"Mother! Father! Pull yourselves together and listen to me! Right before the child got this bad, what did he do? What did he eat, or did he hit something, or anything! Anything at all, however small!"
"Ba... baby food..."
The child’s mother answered in a trembling voice.
"For dinner, I blended carrots and spinach into rice and fed it to him, and while he was eating he suddenly started coughing..."
"Baby food? He started coughing?"
Minjae’s eyes flashed. A new possibility.
"Aspiration?"
Minjae muttered and rushed back to the child’s bedside.
He quickly picked up a small laryngoscope and carefully examined the child’s mouth.
He was checking to see whether food debris might be stuck at the entrance to the airway.
But the child’s throat was clear.
He inserted a suction tip and sucked deep inside, but nothing came out except clear saliva.
"So it’s not aspiration either... Then what the hell is it!"
Minjae roughly raked a hand through his hair.
Just then, a nurse came running with a brand-new pulse oximeter probe.
Minjae nearly snatched it away and clipped it onto the child’s toe.
Everyone’s eyes were once again fixed on the monitor.
[ SpO2 : 85% ]
Nothing had changed.
Then Minjae took out his phone.
"Pediatrics on-call? Yes, this is Lee Minjae, a fourth-year resident in emergency medicine. A 24-month-old just came into the pediatric resus room with cyanosis... but the saturation’s staying pinned at 85%. Even while we’re pumping oxygen in nonstop. Yes, you didn’t mishear me."
Now that even the new reading had come back like that, I no longer had any reason to hesitate.
‘I can’t solve this one on my own.’
I pressed a stethoscope to the child’s chest and pretended to listen to his breathing while pulling up the blue interface.
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Title : Guys, pediatric ER is insanely urgent, atypical
Author : Hell Joseon Slave 1
Two-year-old kid with cyanosis. SpO2 is at 85%. It’s not a machine error, and it’s not aspiration either. We’ve been pumping oxygen in nonstop.
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Just as I was waiting anxiously for a reply, a new comment popped up.
HematomaIsHell: Suspect methemoglobinemia. Did you take a history?
Met... what?
BackInMyDay: That’s it. It’s a disease where hemoglobin in the blood turns into a form that can’t bind oxygen. The blood is still circulating through the body, but it isn’t delivering even a single bit of oxygen. So the child turns blue from oxygen starvation...
CardiologyGhost: Could the kid’s mom have fed him well water or spinach or something?
Ah!
Cyanosis, the bizarrely fixed oxygen saturation, and the spinach-and-carrot baby food.
All the evidence was shouting the same diagnosis: methemoglobinemia.
I raised my head.
Just then, Minjae had finished a pointless call with pediatrics on-call and was about to put his phone back in his pocket.
I cautiously opened my mouth toward Minjae.
"Doctor."
"Why."
"Could it be that?"
"What."
"Methemoglobinemia."
At that moment, Minjae’s body froze in place.
"Uh... um... right... methemoglobinem... uh... what?"
Minjae muttered.
Even in Minjae’s mind, the faint memory of a hematology lecture from medical school was probably coming back to life.
The discrepancy between cyanosis and pulse oximetry. Nitrates. Baby food.
At first, Minjae’s eyes held suspicion—like, 'What the hell is this guy talking about right now?'—but the next moment they shifted to shock.
"Huh? Huh?! Shit, that’s it!"
The profanity-laced cry of belated realization burst out of Minjae’s mouth.
Minjae looked back and forth between me and the child on the bed, as if he couldn’t believe it.
"Hey, Han Hyeonjae! How the hell did you figure that out...!"