Chapter 61
“...Uh, Hyeonjae.”
A cautious voice came from behind me.
It was Lee Minjae.
“Yes, sir.”
“How did you know?”
“Uh... um... well...”
My mind went blank for a moment.
What was I supposed to say?
‘A dead ghost living in my head told me’?
“Go on. It's fine. I'm just curious.”
“Well, um... at first I thought about the other possibilities too. But...”
I paused and pretended to replay the earlier situation in my head.
“I tried to somehow connect the meal history the parent mentioned—spinach and carrots—to the child's obvious cyanosis. Then I saw the oxygen saturation reading and became certain.”
“Hmm. Because it was 85%?”
Lee Minjae asked.
Exactly.
“Yes. That number was just too strange. A pulse oximeter normally has to show something very close to the actual arterial oxygen saturation. But in methemoglobinemia, no matter what the real saturation is, the device tends to stick at around 85%.”
“Mm-hmm, that's true. That's the pulse oximeter's limitation. But still, this must be incredibly rare, right? I've only seen it in books too; this is the first time I've seen it in real life.”
“Yes, that's my understanding too. In pediatric cases in Korea, I believe fewer than five are reported each year. Most occur in infants who were fed baby food or contaminated water.”
Of course, that was a complete lie.
There was no way I actually knew that.
I just knew it was rare, so I made up a number that sounded as plausible as possible.
But my absurdly specific answer wiped away even the last shadow of doubt lingering in Minjae's eyes.
“...You knew that too?”
Yeah, this is how you hook them.
If you act like you know everything this perfectly, no one can doubt you.
They'll just assume I'm some vicious study freak and genius who stays up all night studying, combs through papers, and memorizes the prevalence of every rare disease.
Minjae stood up.
“...As I thought, you belong in the ER.”
“Haha, is that so?”
I gave an awkward laugh and scratched the back of my head.
He isn't making a fuss today.
“Hey.”
“...Yes?”
“You...”
Minjae grabbed both my shoulders hard.
And started shaking me like crazy.
“You bastard!!! You're the real deal!! The real deal!!!”
The theatrics had finally begun.
“While I was barking up the wrong tree! You! You were already seeing the truth beyond it!!”
Minjae showered me with praise, using exaggerated gestures and a booming voice.
The nurses and interns glanced at us with expressions that said, 'There he goes again.'
“Uh... yes, yes...”
The enthusiastic shaking was starting to rattle my brain.
“You're not just a genius! You're... you're a medium! The ER shaman who sees the spirit of disease in the symptoms of dying patients—something ordinary people can't see!”
Shaman? What kind of bullshit is that?
Well, he wasn't exactly wrong, though...
Please, somebody come take this guy away.
“Anyway, good work, our ER shaman. I'm off to see another patient.”
I was left alone in the empty resus room, mulling over Minjae's last words.
Shaman...
This is why I hate overlapping shifts with that guy.
Of course, Minjae was a capable doctor.
As a fourth-year resident.
As chief resident.
There was no doubt about his judgment or his technical skills.
But Minjae's problem lay elsewhere.
He was too hot-blooded.
With empty eyes, I pictured next month's work schedule.
Please.
Please, just don't schedule me with that guy.
***
And so, countless patients passed through my hands.
“Doctor, my kid swallowed a coin!”
The X-ray showed a 100-won coin lodged squarely in the middle of the esophagus.
I explained that it needed to be removed endoscopically.
“His head got split open!”
A five-year-old who had tumbled down.
I put on an animated video for the child, gave local anesthesia, and stitched it up with three sutures.
“The fever... the fever's back up again!”
A child whose temperature wouldn't drop below 38.5°C even after taking antipyretics.
We did a flu test, started IV fluids, and sent out a urine test to rule out a possible urinary tract infection.
And after floundering around amid the children's cries and the parents' sighs, the clock hand was already heading toward 3 a.m.
“Dr. Hyeonjae!”
A nurse at the station called me urgently.
“Um, a 15-month-old baby boy was riding a walker, got his chin caught, and fell. Since then he hasn't been able to put any weight on his left leg and has been crying nonstop...”
“Huh? Got it. I'll go right away.”
I set down the instant coffee I was drinking and hurried toward Bed C-7.
A walker fall. One of the most common mechanisms in pediatric orthopedic trauma. But the words 'can't bear weight' always put me on edge.
On the bed, a small boy was screaming his lungs out until his face was red.
I reassured the parents first and approached the child.
“Let me take a look. It's okay.”
I soothed the child in the gentlest voice I could and carefully examined his left leg.
At first glance, there was nothing wrong.
No swelling, no bruising, and no deformity that would suggest a broken bone.
A perfectly normal baby's leg.
Very carefully, I started gently pressing with my fingers.
Thigh.
Fine.
Knee.
Fine.
Ankle... fine.
And the shinbone.
The moment my finger lightly pressed the shinbone.
“Waaahhhhhh-”
The child started crying.
Found it.
Classic tenderness that appears when there's a tiny hairline crack in the bone, even though everything looks fine on the outside.
Toddler's fracture.
It happens when young children, whose bones are still weak, fall or twist their feet and get a tiny spiral crack in the tibia.
I explained to the parents that we needed an X-ray.
Then I went back to the station and reported to Minjae.
“Sir, for the C-7 pediatric patient, I suspect a toddler's fracture, so I ordered tibia/fibula AP/Lateral view
(*anteroposterior and lateral views of the tibia and fibula)
I put in the order.”
Minjae, who was looking at the chart for another minor patient, tilted his head and asked.
“An X-ray too? You said it wasn't even swollen. Can't you just put a half-cast on it and give painkillers? Do you really need to?”
Taking an X-ray on a child who looks fine, even at the cost of radiation exposure, can seem like over-treatment.
But I was sure of my diagnosis.
“The tenderness is too clear. I don't think this is just a sprain.”
“Right! Our genius is different! Right! Eyes that see the unseen! A sixth sense that can spot even microscopic cracks in the bone! Good! Go ahead and take it!”
Minjae once again slipped into his own world, marveling and convincing himself at the same time.
Well, I'm fine with that.
It would take about fifteen minutes for the results to come back.
I sat in a chair and closed my tired eyes.
Haaam.
I yawned so hard it felt like my mouth would split open.
‘Come to think of it, I broke bones pretty often when I was young.’
When I was in elementary school, I was a VVIP at the neighborhood orthopedics clinic.
I broke my arm jumping off a wall, broke my ankle playing soccer, and cracked my collarbone after falling off my bike.
Walking around with white plaster bandages wrapped around my limbs like casts was the trademark of my childhood.
The memory of snickering while looking at the doodles my friends left on the plaster bandages.
The musty smell of the cast that stung my nose.
Back then, I didn't know.
How much more painful it must have been for my parents, having to rush to the hospital clutching the broken bone, than the pain of the broken bone itself.
Becoming a doctor may be a process of overlapping other people's pain with my own past and learning its weight.
Just as I was lost in thought, an alert popped up on the EMR screen.
It was a signal that the X-ray had been completed.
Minjae and I headed to the station monitor at the same time.
The screen showed a tiny, white image of the 15-month-old's shinbone.
“Let's see...”
Minjae clicked the mouse and enlarged the image.
After carefully scanning the outline of the bone from top to bottom, Minjae let out a rueful laugh.
“Hyeonjae. Look at this.”
He nodded toward the monitor.
“It's clean, not a single fracture line. It's just a little sprain. What did I tell you? Even geniuses make mistakes sometimes! Haha!”
Sure enough.
The bone on the monitor looked clean to anyone.
‘Ah, he isn't hurt. Thank goodness...’
I let out a sigh of relief.
My relief that the child wasn't seriously injured was much greater than the embarrassment of being wrong about my diagnosis.
I had made a fuss for nothing and put the kid and his parents through trouble, but even so, nothing being wrong was a hundred times better.
I was about to go explain to the parents that there was nothing wrong with the bone and that we should put on a half-cast and observe it for a few days.
Just as I was about to turn around.
...Wait a second.
I grabbed the mouse and zoomed the image in as far as it would go.
Then I started adjusting the screen's brightness and contrast.
The screen darkened, then turned bright white again.
The outline of the bone blurred, then became clear again.
The very end of the shinbone, just below the kneecap.
A faint area near the growth plate where cartilage and bone meet in children whose bones have not finished growing.
There, I could make out one faint line that was far too ambiguous to call a fracture line.
‘What is this?’
Was it a shadow? Or just a normal shadowing seen in the growth process?
I tilted my head and enlarged that part once more.
But the more I looked, the more confusing it became.
I was about to brush it off, but the nagging feeling in my mind held me back.
In the end, I turned to my last resort.
============
Title: 15-month-old boy can't bear weight after a fall, and the X-ray looks like this. What is this?
Author: Hell Joseon Slave 1
He looks fine on the surface and only has tenderness, but on the X-ray the end of the shinbone just below the knee looks a little weird. It's not a fracture line, but it kind of looks smudged. Is this a normal finding, or is there something else I don't know?
The first person to jump in on my question was, unexpectedly, not a bone nerd.
PediatricsGhost77 : Report it.
The moment I saw that comment, something cold slid down my spine.
I suddenly got a seriously bad feeling.
What?
Is it some rare bone disease?
A new infectious disease?
So I'm supposed to report it to the Korea Disease Control and Prevention Agency?
With trembling hands, I typed out a reply.
ㄴ Hell Joseon Slave 1 : ?? What? Is this some sign of an infectious disease or something? Report it to the Korea Disease Control and Prevention Agency?
ㄴ PediatricsGhost77 : Not the disease agency.
ㄴ PediatricsGhost77 : The police.
……The police?
notes":"Aligned the chapter title to the nearby English chapter-title pattern; kept 'Hyeonjae' as a name reading in context. No meaningful repetition issues beyond preserving the split-line quoted order around the X-ray order."}