Chapter 60
Chapter 60
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Translator: crow
Chapter Title: A One-Star Amusement Park (3)
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Lee Min-jae stood there in a daze.
Methemoglobinemia.
Cyanosis.
The paradox of oxygen saturation.
Those terms must have flashed through his mind in that exact order.
“Ha… shit…”
A hollow groan escaped Lee Min-jae’s lips, followed by a curse.
“ABGA! I’ll draw the ABGA!”
Lee Min-jae practically screamed as he grabbed the arterial blood gas kit from the crash cart.
“Hyun-jae, you hold the kid’s arms and legs tight. If they move when I puncture the artery, it’s a disaster.”
I nodded and firmly secured the child’s tiny body.
Lee Min-jae swabbed the skin with an alcohol pad, then picked up the heparinized syringe.
He inserted the needle and slowly pulled back the plunger.
Blood surged into the syringe.
I held my breath.
Normal arterial blood should be a bright, vivid scarlet, brimming with oxygen.
But the blood filling the syringe wasn’t scarlet.
It was a bizarre, ominous chocolate brown.
The sight of that brown blood made me and Lee Min-jae sigh in unison.
“Ah…”
It was exactly what we thought.
Undeniable proof.
The color of dying blood.
Lee Min-jae withdrew the syringe and pressed a gauze pad firmly against the puncture site.
He handed the syringe with the sample to the nurse, then turned to the veteran nurse nearby.
“Nurse Jeong, uh… do we have any methylene blue in the ER’s stock?”
“Methylene blue…?”
Nurse Jeong’s eyes widened.
“Well… it’s so rare, probably not. But I’ll call the pharmacy right away!”
Nurse Jeong snatched up the phone in a panic.
Anxious minutes dragged on.
Methylene blue.
The only antidote for this disease, capable of converting methemoglobin back to normal hemoglobin.
If this hospital didn’t have it, this child…
“No good.”
Lee Min-jae bit his lip impatiently.
“I’ll call pediatrics first. They need to know about this.”
Lee Min-jae grabbed the phone again and dialed the pediatric on-call.
“Yes, Pediatrics on-call. This is Lee Min-jae, fourth-year EM resident.”
“…Yes. Twenty-four-month-old patient, diagnosed with methemoglobinemia. …Yes, yes, that’s right. History of weaning food, arterial blood is chocolate-colored. So we’re about to give methylene blue, but just checking on pediatric dosing or protocols…”
Lee Min-jae listened for a moment, then furrowed his brow.
“Yes. Got it. We’ll consult the EM attending and proceed. Okay.”
Lee Min-jae hung up, his expression sour.
“Consult the attending first, they said. Makes sense from their perspective. No way residents decide on diagnosing and treating a rare disease like this.”
He swallowed a curse and bolted out the resuscitation room door.
“Hyun-jae, stay right by the kid and keep monitoring vitals! I’ll get confirmation from the professor and be right back!”
With that, Lee Min-jae rushed off, leaving only the child’s shallow breaths in the room.
How much time passed?
The station intercom buzzed.
It was the lab.
The nurse took the call and jotted down the results on the chart.
She held up the paper for me.
The calculated oxygen saturation was 73%, clearly indicating hypoxemia.
But the pulse ox read 85%.
One of them was lying.
And the liar was the 85%.
SpO2 85%.
SaO2 73%.
‘The machine is lying.’
A cunning disease that fools the machine’s eye.
Chocolate-brown blood flowing through the child’s veins.
Just then, Nurse Jeong shouted urgently.
She’d just finished talking to the pharmacy.
“Doctor! The main building pharmacy has Proveblue injection* (*methylene blue formulation sold in our country) in stock! Shelf life is good too! None in the ER!”
Salvation had arrived.
I whipped around to Intern Choi Min-seong, who’d been hovering awkwardly, peeking over shoulders.
“Hey, intern! Min-seong! You hear that!”
“Yes? Yes!”
“From now on, you’re the fastest person in this hospital!”
I yanked a paper from my pocket and scribbled furiously.
“Take this and sprint to the main building basement level 1 central pharmacy! No elevators—waiting now would kill the kid! Stairs only! Give it everything you’ve got! I’ll enter the order in the system under my name for now!”
I shoved the prescription into Choi Min-seong’s hand.
He stood frozen for a second, then realized the gravity and nodded solemnly.
No time for nodding—go!
Moments after Choi Min-seong vanished from sight, Lee Min-jae burst back into the room, drenched in sweat.
“Yeah, it’s confirmed! The attending trusts our diagnosis—go ahead and order it…”
“Already done! Intern’s off to get it!”
A faint smile crossed Lee Min-jae’s face at my reply.
“Good! You’ve got instincts!”
He clapped my shoulder once, then turned to the parents.
“Hyun-jae, you explain it to them. It’s basically your diagnosis.”
Why did it feel like everyone was dumping patient explanations on me?
Was I imagining it?
I nodded and approached the couple.
“Mom, Dad. Let me explain again.”
I pulled up a chair and sat.
“We found the cause. And luckily, we have the treatment right here in the hospital.”
Their faces brightened slightly at those words.
“The child has methemoglobinemia, a very rare condition.”
I chose the simplest words possible and began explaining the disease.
“Our blood has these friends called hemoglobin that deliver oxygen. But something in the food the child ate today caused some of them to suddenly go on strike. They look fine on the outside, but they can’t carry the most important cargo: oxygen. So oxygen isn’t getting delivered to every corner of the body, causing the lips to turn blue—cyanosis.”
I paused for breath, then hit the key point.
“This usually happens very rarely in infants under six months whose stomach acid production isn’t mature yet. It’s incredibly uncommon in a child over two.”
I took the father’s hand.
“So it’s absolutely not your fault. Kids this age can eat spinach or carrots without issue. This was just incredibly bad luck. Don’t blame yourselves.”
Tears finally spilled from the mother’s eyes.
“The antidote will be here soon. Once it’s in, it’ll fix the broken hemoglobins so they can carry oxygen again. After the injection, you’ll see the child’s blue lips gradually return to normal color.”
Finally, I added some home care advice.
“Of course, admission is necessary. The child’s body might be especially sensitive to that ingredient. From now on, to be safe, don’t give too much nitrate-rich veggies like spinach or carrots at once—split it into small amounts.”
As I finished, the couple bowed repeatedly, thanking me profusely.
I accepted their gratitude with a bittersweet smile.
***
After Choi Min-seong dashed off down the emergency stairs, the resuscitation room fell into another agonizing wait.
Lee Min-jae and I silently alternated glances between the child’s lips and the monitor numbers.
We’d done everything we could.
Diagnosis?
Made.
Treatment plan?
Set.
Antidote?
Racing toward us somewhere in this hospital.
But even that short time felt eternal.
To ease the tension even a little, I opened the gallery window again.
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Title: Intern’s off to get methylene blue.
Poster: HellJoseonSlave1
Main building pharmacy has it in stock. Proveblue 0.5%, so I sent the intern sprinting. About to administer.
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Anonymous (210.94): Oh, methylene blue in stock? Your hospital’s ER manages meds well?
LatteIsJustWords: Damn, nice hospital. I saw the same methemoglobinemia case as you once—no stock here, called every university hospital pharmacy around, still nothing.
BloodClotsAreHell: Yeah, super rare drug. Most big hospitals don’t even stock it. Lucky break.
…So it really is that rare.
Reading the comments drove home how razor-thin our margin was.
If there’d been no drug, this child…
No, not the time for those thoughts.
The most crucial, fundamental question popped into my head.
‘So how much of this drug do I give?’
I vaguely remembered adult dosing.
But for a two-year-old.
Wrong dose in this tiny body under 15kg was as good as poison.
HellJoseonSlave1: How do I calculate the order exactly? Pediatric dose is fuzzy. Didn’t want to bug the chief while he’s busy, so asking you guys first. 12kg patient.
My honest question brought a savior online, right on cue.
Re: PediatricsGhost77: Asking now?! 1-2mg per kg! Patient’s 12kg, so start with 12mg safest! Your vial’s 0.5%, right? That’s 5mg per 1ml, so draw 2.4ml, dilute in normal saline, give VERY slowly over 5+ minutes.
From calculations to infusion rate and precautions.
PediatricsGhost delivers.
Solid.
Re: HippocratesHeir: Mortal one, PediatricsGhost is right, but children’s doses always demand utmost caution. Your chief’s swamped, so call peds on-call again and double-check the dose.
Re: HellJoseonSlave1: OK OK, got it. Thanks.
I immediately called peds on-call.
“Yes, EM Han Hyun-jae here. Calling to double-check methylene blue dose for methemoglobinemia patient…”
I recited my calculated—no, cheated—dose. The peds doc sounded surprised at first but confirmed it was spot-on.
How much time passed?
“Pant… huff… got it!”
The resuscitation room door flew open as Choi Min-seong stumbled in, face pale as a ghost.
In his hand, a precious little glass ampule.
“Good job, Min-seong! You killed it!”
Lee Min-jae patted the intern’s back.
The nurse hooked the syringe to the child’s IV line and began injecting the drug excruciatingly slowly.
Everyone held their breath.
1 minute. 2 minutes. 3 minutes.
No change.
The lips stayed blue.
My heart started pounding with anxiety again.
Wrong diagnosis?
Drug not working?
Right then.
A faint pink tint began creeping in from the tips of the child’s cyanotic lips.
Color returned to the pale cheeks.
The shallow, erratic breaths deepened and steadied.
Lee Min-jae ran a hand through his hair.
Relief spread across the nurses’ faces.
Soon after, the transfer team from pediatric ICU arrived.
The child, now with fully normal color, was moved to the stretcher.
I stared blankly from the resuscitation room doorway.
The parents bowed deeply to me.
I awkwardly bowed back.
Only after they vanished into the elevator could I exhale.
“Ha.”
Saved.