Chapter 12
The girl's name was Erica.
Shortened to Eri.
I learned that only after Wangcho's rough hands dragged her into the consultation room and I gave her a few pieces of bread.
“Munch, munch. It’s not candy, but it’s tasty, so I’ll take it.”
“So, Doctor. You’re saying this kid isn’t really a blood fiend?”
Wangcho asked suspiciously with his arms folded.
Eri, seated on the treatment bed, was still gnawing on the bread with wary eyes.
“She's not a blood fiend. She's a patient. The diagnosis is paroxysmal nocturnal hemoglobinuria (PNH).”
“What kind of magic term is that?”
“Something like that.”
I assembled several ways to explain PNH in my head.
An autoimmune hemolytic disease in which red blood cell membrane mutations make them vulnerable to complement...
Hmm.
No matter how I thought about it, they didn’t look like they’d understand.
So I explained it with a straightforward analogy.
“It’s a disease where the blood inside your body breaks apart.”
“Blood can break?”
“Just think of it that way. The black urine when you wake up and pee in the morning is because of that too. The blood leaks out through the urine, leaving you deficient.”
I pointed with my chin... no, my beak, at Eri, who was dutifully eating her bread.
“Just as beasts instinctively lick rock salt when they’re short on salt, that girl instinctively seeks pig’s blood because she’s short on blood.”
Such symptoms are called pica.
When people are short on iron, they try to put anything in their mouths—usually dirt, ice, or raw rice.
For this child, the object just happened to be blood.
“Ohhh... Tsk. And here I was, not knowing that.”
Wangcho clicked his tongue.
The fact that the child he had thought was a monster was really just a pitiful patient must have touched the last shred of conscience he had left.
Then, while chewing on bread, Eri asked me a question.
“Mister.”
“Call me Dr. Schnabel.”
“Doctor.”
Man, this kid really doesn’t have her forms of address straight.
I sighed and answered.
“Yeah. What is it?”
“How did you know the color of my pee?”
Eri’s red eyes stared straight through me.
“Can healers know what color your pee is just by touching your belly and rolling your eyes back?”
Oh.
I was honestly impressed.
Because she had pinpointed the leap in my diagnosis process that Wangcho had naturally brushed aside.
‘She’s smart.’
Diagnosing PNH outright from anemia, jaundice, and splenomegaly alone is close to a logical leap.
It could be cirrhosis, or leukemia, or malaria... there were just too many possibilities.
“You’re smart, aren’t you.”
I reached out and patted Eri’s tousled hair.
The child flinched and shrank her shoulders, but she didn’t avoid my hand.
“Actually, I just got lucky.”
“Ehh. That’s disappointing.”
“Deduction is basically a series of throwing darts toward the target most likely to be correct. In the end, it’s still just luck.”
Anemia, jaundice, and pica.
Those three alone weren’t enough to narrow it down completely.
But I had another clue.
“Wangcho told me.”
It was Wangcho, not Erica, who reacted to my answer.
“Me?”
“Wangcho said you come to drink blood every night.”
“Comes to drink blood every night.”
That means the child’s anemia is likely to worsen at night.
If you build a hypothesis from there, everything falls into place.
There was no glaring contradiction in that hypothesis. If so, you just go ahead and try it.
That’s deduction.
“How’s that?”
Eri’s mouth hung open blankly after hearing that explanation.
It must seem strange to hear me reel it off as if I’d been watching from the sidelines.
Seeing that, it was worth taking a bit of a gamble to make the deduction.
‘This is why taking a history matters.’
They don’t say doctors need to listen carefully to their patients for nothing.
Because even a tiny difference in wording can become a decisive clue.
Then again, I was in trauma surgery, so I almost never had reason to listen to patients.
‘Honestly, it was luck.’
Truthfully, if the color of her morning urine had been normal, I was planning to move naturally on to another question.
Probably the next thing I would have asked was whether her stomach hurt.
Thanks to the power of this misunderstanding-novel trope, I managed to hit it on the first question.
“Are you a little less curious now?”
After my explanation ended, a brief silence fell.
‘How’s that? Pretty slick, right?’
Genius-like, right?
Sherlock Holmes-like and all that, right?
As I was acting all smug in my head, Eri nodded blankly.
Wangcho gasped in admiration on her behalf.
“Hoh... As expected of you, Doctor. Now that I hear it, everything fits perfectly!”
Wangcho clapped like a seal, eyes shining.
That’s why I like Wangcho.
His reactions are so good.
Yeah. Clap more.
I’m the protagonist. I’m Doctor Schnabel, you know.
“Now that we know the cause, can you treat her too?”
At Wangcho’s question, Eri’s head shot up.
It felt like the first shade of hope had colored those red eyes that had been full of resignation and disbelief.
You could also see the expectation that a doctor who had dug into the curse tormenting her would surely have a solution.
Under the two of their heated gazes, I answered as if it were nothing.
“It’s impossible. It’s incurable.”
“...Pardon?”
The two of them froze in an instant.
***
PNH
Paroxysmal nocturnal hemoglobinuria
I don’t know if I remember this accurately from my past life as a trauma surgeon, but I remember the injection used to treat this disease being insanely expensive.
Was it Soliris?
I remember it as some crazy injection that cost about 500 million won a year.
Even the cheaper one was around 300 million won a year.
I remember it because it was said to be the most expensive treatment lineup in the world.
Maybe even more expensive than anticancer drugs.
Of course, I didn’t know what the ingredients were, let alone the composition, of those treatments.
And there was no way I could recreate them in this world.
So I said it honestly.
“I probably can’t treat the disease right now.”
“...I see.”
Eri’s eyes lost their light again as she nodded.
Those red eyes, which had just been tinted with hope, returned to the resignation they’d held before.
At that moment, Wangcho hurriedly tapped my shoulder with his finger.
“Doctor, say the rest!”
“?”
“Didn’t you say the same thing with gout?”
“Did I?”
At my reaction, Wangcho slapped a hand to his forehead.
“That habit of blurting out ‘It’s incurable’ and only much later adding ‘you can take medicine’—that’s a really bad habit!”
...Did I do that?
Come to think of it, I guess I did.
I think I might even have been called out for it by my seniors and the residents in my past life.
— “Yunho! Stop telling the guardians the bad news right away! It gives them heart failure!”
— “Professor. I think you’ve omitted the object again.”
Tsk.
Was I the one in the wrong?
But from a doctor’s point of view, if it’s incurable, it’s right to say it’s incurable.
Treatment and management are clearly different concepts.
Just as no one in this world says they’re curing diabetes, it’s simply a disease you manage.
“I can’t lie to a patient, can I?”
“This is why geniuses are impossible! There’s still an order and arrangement to how you say things, isn’t there! If you jump straight to the conclusion, ordinary people like us can’t keep up with you, Doctor!”
Wangcho sighed in exasperation.
But I had plenty to say about that too.
Back in school, we were taught not to give patients false hope whenever possible.
No one sues because they’ve resigned themselves to it, but plenty sue because they feel betrayed.
So I tend to tell them the bad news first, but that’s usually the conclusion, that’s all.
Without knowing any of that, Wangcho turned away from me and crouched in front of Eri.
“Kid. You have to understand. That doctor is just like that.”
When his huge body folded down, the hyena beastman’s golden eyes came to about the same height as Eri’s red ones.
“I’m the same as you. I have an incurable disease, but as long as I take my medicine, getting through life is no problem.”
Wangcho turned back to me.
“This kid too, right, Doctor? There’s more to it, right?”
Though it was phrased as a question, it carried more of a ‘there should be a follow-up’ nuance.
Under that silent pressure, I shelved the ‘180 principles behind why PNH is incurable’ I’d been sorting through in my head and gave my conclusion.
“Like Wangcho said, you’ll have to live with this disease for pretty much your whole life. But I’ll give you back your daily life.”
I can’t cure it, but I can manage it.
Actually, daily life will probably be less troublesome than with gout.
Wangcho looked relieved at my answer.
Light returned to Eri’s eyes again.
There was also a hint of dissatisfaction.
She seemed sulky, as if she thought I had deliberately played a word game.
I didn’t even need to read her expression; her lips were sticking out by a good three inches.
I pushed her lips back in with my finger.
“First, let’s check the blood. The symptoms are typical, but we still need to confirm it.”
I turned around and took the tools out of the treatment bed drawer.
Wangcho looked at me, puzzled.
“What else are we testing?”
“I told you. Deduction ultimately depends on luck. Unless it’s 100 percent, diagnosing from evidence alone is dangerous.”
If you suspect a disease, you have to test for it.
What I took out of the drawer was a glass, vinegar, and a syringe.
Holding the syringe, I gave Wangcho a look.
As if on cue, Wangcho grabbed Eri’s arm.
“Stay still.”
Wangcho covered Eri’s eyes.
In the meantime, I quickly drew blood.
“Wangcho. Press down firmly. This disease doesn’t clot well to begin with.”
Wangcho pressed cotton firmly against Eri’s arm.
While he did that, I divided Eri’s blood into two glasses.
Then I dropped a few drops of vinegar into just one of them.
Ham’s test (Ham’s Test/Acid Hemolysis Test).
It’s a test that uses the fact that PNH red blood cells readily come under complement attack and burst in acidic environments.
The result appeared immediately.
The blood without vinegar remained red and cloudy.
But the one with vinegar...
“Ooh...! The color...!”
turned into a clear, transparent grape juice color.
It was such a stark hemolytic reaction—red blood cells breaking apart—that even Wangcho, who knew nothing about medicine, could tell right away.
‘Ta-da~ Magical.’
If it weren’t for my persona, I would’ve joked like that too.
Instead, I patted Eri on the head and told her she’d done well.
Eri stared blankly at her now-clear blood.
“This is... what? Magic?”
“Let’s say it’s not magic, but a trick.”
I prepared the next step.
Now that the diagnosis was done, it was time to prescribe something.
‘If we transfuse her, we can manage it.’
Even if PNH can’t be cured, it’s a condition that can be managed to some degree with transfusions.
However, before transfusing, I needed to find the most suitable blood.
I pricked Eri’s finger again and collected blood.
Then I took out the blood samples I’d stored earlier.
More precisely, the ones collected this morning.
Since there was no way to store blood, it had become a habit to take only enough from a few people to last until the next day whenever they came in for treatment.
“Let me borrow some of Wangcho’s blood.”
In addition to these samples, I added my own blood and Wangcho’s, then mixed them with Eri’s blood.
“Hmm...”
Conclusion.
The cross-matching test showed that Eri’s blood was compatible with mine.
“Right. Once the blood is ready the day after tomorrow, we’ll do the transfusion. Until then, stay at the clinic and just focus on nutrition for now.”
“Trans...fusion?”
Eri tilted her head at the unfamiliar word.
Leaving her there, I said to Wangcho,
“Please take care of Eri until the transfusion in two days.”
Wangcho nodded.
***
Two days passed, and the promised day arrived.
In the meantime, a washed red blood cell preparation had been completed with 200 ml of my blood.
The reason I went to the trouble of turning it into washed red blood cells was because if a PNH patient received blood as-is, it could trigger a hemolytic attack.
However, the process of making that preparation was a little complicated.
After drawing the blood, I had Wangcho’s men tie it to a string and spin it around to separate the heavy from the light parts, throw away the light part, rinse it with saline, spin it again, rinse it again...
After thoroughly putting Wangcho’s men to work, I managed to finish it.
‘See? I knew people really did build the pyramids.’
Enough labor can replace technology.
And that labor can somehow be bought with enough capital.
According to that formula, once you know the principle, even 21st-century pharmaceuticals can be recreated at a 19th-century level of civilization.
‘It looks like it’s finished well.’
Just in case, I held the washed red blood cells up under the magic-stone lamp.
A clear, clean red.
Pass.
“All right. Let’s begin.”
I laid Eri down on the treatment bed.
Thanks to feeding her for two days, a bit of color had returned to her face.
Well, that was only natural after feeding her so many iron-rich foods.
Any beast gets tame when it’s full.
Compared to two days ago, Eri had softened a bit as she asked.
“...Does it hurt?”
“It’ll sting a little. Bear with it.”
I inserted the needle into Eri’s arm.
There was no rookie mistake of having to search for the vein multiple times.
I’ve made my living through surgery for years. I can find a vein in my sleep.
The red liquid slowly flowed into Eri’s bloodstream.
1 minute. 5 minutes. 10 minutes.
….
Eri was blankly staring at the ceiling.
“How do you feel?”
“...Not really sure.”
No issues. Check.
“Tell me if you get dizzy or short of breath.”
Come to think of it, it’s been a really long time since I last had to do a transfusion myself.
After I finished residency in my past life, I never had to find veins myself.
Residents and nurses did all of it.
And so, an hour passed.
The transfusion ended safely.
200 ml.
It wasn’t a lot, but considering this child’s size, it was enough.
“Rest well today. We’ll check your condition tomorrow and decide whether to add more.”
Eri nodded.
Eri got off the bed.
I asked her for confirmation.
“How is it? Are you still thirsty?”
“A little less.”
“Good.”
Pica is easy to correct too.
It’s a symptom that disappears quickly once iron and red blood cells are replenished.
In about a week, she’ll probably stop craving blood.
“Let’s get transfusions regularly like this. It’ll probably be this way for the rest of your life, but that alone won’t interfere with daily life.”
Of course, it was impossible to erase Eri’s disease with transfusions alone.
If that were possible, those multi-hundred-million-won injections would never have been developed.
Besides, PNH was a disease that still required additional management by a doctor even while receiving transfusions.
But I didn’t bring that up in the middle of such a hopeful mood.
‘Anyway, handling those risk factors is my job.’
There shouldn’t be much trouble living a normal life.
She no longer had to stick her head into a bucket and greedily drink blood like a savage.
She wouldn’t have any reason to be pointed at as a blood fiend, and she wouldn’t get kicked around by people like Wangcho anymore.
Maybe that still hadn’t sunk in.
Eri fiddled with the bandage on her forearm.
As if her body, now that warm blood had started flowing through it, still felt unfamiliar, she kept clenching and unclenching her fist.
Then she looked up and met my eyes.
“...Why are you going this far for me?”
“What are you trying to say?”
“I don’t have any money.”
Eri mumbled in a tiny voice.
“All I have is this outfit. I can’t pay back what you did for me, mister... no, Dr. Schnabel.”
She knew the nature of this back alley better than anyone.
There is no such thing as kindness without a price.
Especially in Limbus Pit, kindness for no reason usually meant a far more terrible price would be demanded later.
I could see distrust and unease in her.
Usually, what you need to strip that away isn’t sincerity.
“Then do errands for me.”
“Huh?”
What you usually need in cases like this is give and take.
I pointed at the clinic floor with my finger.
“You need regular care from me anyway. So you’ll work here. I’ll handle your food and lodging.”
“...Here?”
“I happened to need an errand runner. Pick up medicine, contact patients, clean now and then. Can you do that?”
“...Okay. I’ll accept.”
Her nod was stiff.
It was the kind of nod you make when stamping a pledge form.
But compared to a few seconds earlier, her wariness had clearly softened.
‘How strange.’
Just by turning a favor with no price into a transaction, a person’s guard crumbles this easily.
Zero won or the price of coffee.
Compared to the quality of treatment, they’re practically free either way, but simply setting up a threshold that’s worse than having none at all changes people’s reactions.
It was the same in Korea too.
Wangcho.
After finishing the deal,
I called Wangcho, who was waiting outside.
“Starting today, I think this child will be the new errand runner. Could you tell her what she needs to do? The same way the others did.”
“Understood, Doctor.”
Wangcho gave Eri’s back a light push.
Eri looked back once as she crossed the threshold.
When I motioned her onward with my chin, Eri turned away and left.
With the two of them gone, I was left alone in the treatment room.
While organizing the transfusion tools, I mulled over the conversation from just now.
— ‘All I have is this outfit. I can’t pay back what you did for me, mister... no, Dr. Schnabel.’
“Well. I don’t think so.”
I muttered to myself, knowing no one would hear.
Though Erica only values herself that way, I thought differently.
All right, let’s sort this out.
A rare disease.
A rare disease so rare that I’m the only person in the world who can diagnose it.
On top of that, her blood type matches mine.
And it’s a disease that requires periodic transfusions.
Question.
Would someone who’d read even a little web fiction really see this child as a plain extra?
No way!
What’s more, who knows if this kid might be some polymorphed dragon.
Maybe she’s the future sword saint, or a childhood friend who becomes the strongest in the world.
In other words, this is an event.
A buy-low event.
Well, maybe not.
Of course, this isn’t the first kid I’ve taken in like this.
A year ago, testicular torsion; eight months ago, phenylketonuria; half a year ago, congenital clubfoot; three months ago, congenital diabetes...
A variety of kids had passed through my hands.
Each time, I treated them and hired them, then looked into their talents.
There wasn’t any SSR or 5-star I wanted among them.
Still, this time feels a little different.
There’s just something different. Though it’s hard to explain exactly.
But what if I say all that and it’s a dud again?
Then I’ll just be disappointed, that’s all.
A rain ritual is supposed to continue until it rains, after all.
Let’s start with errands first.
Like the others did.
If I keep at it, I’ll probably land one or two talents.
I just hope it’s the talent I want.