Seven Years Old
The unique antiseptic tang of the emergency room was laced with the faint, sweet scent of strawberry-flavored antipyretic syrup. It was two o’clock in the afternoon. Baek Ijun, who had come down after receiving an emergency consult from the surgical department, yanked open the curtain of Bay 3.
A small pair of sneakers sat neatly at the foot of the guardian’s bed. Inside, a child wearing a patient gown was curled up tightly, hugging his knees to his chest. It was seven-year-old Park Ji-ho. The boy’s face was deathly pale, and cold sweat beaded on his forehead. His mother, who had been keeping vigil beside the bed, spotted Ijun’s white coat and shot to her feet.
“Doctor, my son says his stomach hurts so badly.”
Ijun checked the chart, then carefully knelt beside the bed so he was at eye level with the child.
“I’ll be examining the patient. You’re Park Ji-ho, correct?”
Before the boy could answer, his mother jumped in.
“When did the pain start? Has he been hurting since morning?”
“Yes. At first I thought it was just an upset stomach.”
“Was he complaining of discomfort around the epigastrium?”
“That’s right. He kept pointing at his solar plexus and saying it felt like indigestion.”
“The location of the pain probably shifted after lunch.”
The mother’s eyes widened slightly.
“How did you know? Since a little while ago he’s been crying that the lower right side feels like it’s being torn apart.”
“When did the fever start?”
“About thirty minutes before we got to the ER. I gave him fever medicine, but it hasn’t come down at all.”
It was the classic migratory pattern of appendicitis pain. Ijun slipped on a pair of latex gloves and spoke to the boy in a much gentler voice.
“Ji-ho, I’m going to press on your tummy a little, okay?”
The child squeezed his eyes shut instead of answering. Ijun’s fingertips began at the upper abdomen, moved carefully around the umbilicus, and then headed toward the right lower quadrant. The moment he applied gentle pressure, the boy’s small body stiffened.
“Ji-ho, did it hurt more when I was pressing, or does it hurt more now that I’m letting go?”
“When you let go…” the boy answered with a whimper.
Rebound tenderness positive. Ijun immediately withdrew his hand and consciously activated the Archive in the corner of his vision.
E-01 'Bian Que' — Visual Penetration Diagnosis Activated
Suddenly, the translucent shapes of the child’s internal organs appeared layered beneath his abdominal skin. Everything else was quiet, but only the right lower quadrant—at the tip of the cecum where the appendix was attached—flashed a deep, angry red. The faint spread of inflammatory exudate around it was clearly visible.
Status: Signs of peritoneal irritation. Progressing toward pre-perforation stage.
Ijun immediately closed the Archive layer.
No time to waste. A child’s omentum isn’t developed enough to wall off inflammation like an adult’s. If it ruptures, it’ll cause immediate generalized peritonitis.
Ijun stood and reassured the guardian.
“Ma’am, please keep Ji-ho NPO. I’ll take care of this right away.”
The moment he stepped out of the curtain, Ijun strode quickly toward the station. He stopped behind Oh Jae-hyeong, a third-year resident who was sitting in front of a monitor flipping through charts from other departments.
“Sir, reporting an emergency-room pediatric abdominal pain case.”
Without lifting his eyes from the screen, Oh Jae-hyeong answered curtly.
“You put the chart up?”
“Positive tenderness in the right lower quadrant with rebound tenderness as well. Classic signs of appendicitis.”
“And?”
“I suspect we’re looking at a pre-perforation stage. We should get a CT and book an OR.”
Only then did Oh Jae-hyeong swivel his chair to look up at Ijun. His face was filled with displeasure.
“Did you go through pediatrics?”
“Not yet.”
“We need to rule out intussusception or mesenteric lymphadenitis first. Don’t you know that’s hospital protocol?”
“This doesn’t match the usual pain pattern for lymphadenitis. The peritoneal irritation signs are far too clear.”
“And how the hell are you so sure? A first-year already making solo diagnoses?”
“I’m not making a diagnosis. The patient’s symptoms are telling us this.”
Ijun’s voice was calm, but there was no yielding in it. “While we route through pediatrics and wait for an ultrasound, a perforation could happen. We don’t have time.”
Oh Jae-hyeong shot up from his seat roughly.
“I’ll see the patient myself. Come with me.”
The two men pulled back the curtain of Bay 3 and entered. Oh Jae-hyeong placed his hand on the boy’s abdomen and applied pressure. Thirty seconds of palpation. The child cried silent tears. Every time the hand lifted, the boy’s body arched like a bow. Oh Jae-hyeong’s face tightened imperceptibly. He withdrew his hand and walked out past the curtain. Ijun followed.
“Order an emergency CT.”
“Yes, sir.”
Ijun immediately pulled out the in-hospital phone and placed an emergency call to radiology. It took exactly twenty minutes for the results to upload to the EMR. The text on the reading report matched perfectly with what Ijun had seen through visual penetration: dilated appendiceal diameter, surrounding fat stranding, and imminent perforation.
After confirming the findings, Oh Jae-hyeong entered an emergency order for the operating room. Ijun returned to the ER curtain holding the surgical consent form. The mother approached, studying his expression. It was the desperate look unique to parents who already sensed bad news was coming.
“Ma’am, the test results are back.”
“What do they say? Does he need surgery?”
“Yes. There’s severe inflammation in the appendix area.”
“Is it very dangerous?”
“It could have been, but we caught it relatively early, which is fortunate.”
Ijun calmly unfolded the consent form. The mother’s hands were trembling finely.
“Our Ji-ho is only seven years old. Can he handle general anesthesia?”
“We’ll follow pediatric-specific anesthesia protocols and proceed safely.”
“Will he recover well?”
“Children have far better healing capacity than adults. Once the surgery goes smoothly, he’ll be up and about in no time.”
With shaking hands, the mother signed the consent form. Ijun gathered the documents and looked down at the child. Ji-ho was staring back at him with eyes full of fear—the eyes of a little boy desperately trying to be brave despite being terrified.
“Ji-ho.”
“Yes…”
“There are bad germs inside your belly, and that’s why it keeps hurting.”
“Germs…?”
“Yeah. The doctor uncles are going to catch all those germs in the operating room, so don’t worry.”
Only then did a faint look of relief appear on Ji-ho’s face.
The surgery took one hour and ten minutes. Ijun was not allowed into the OR. Oh Jae-hyeong had assigned another resident to the first-assist position and removed Ijun from the roster. Ijun didn’t protest. He simply sat on a chair in the hallway outside the operating theater and waited in silence.
When the automatic doors opened and Oh Jae-hyeong emerged after removing his sterile gown, Ijun stood up.
“How is the patient?”
“It was about to burst. He got lucky.”
“That’s a relief.”
“You explain the situation to the guardian. I have to head down—outpatient clinic is backed up.”
With a tired expression, Oh Jae-hyeong disappeared down the end of the corridor. Ijun opened the door to the family waiting room beside the OR. The mother jumped to her feet at the sound.
“Ma’am, the surgery went very well.”
“Really? Is our Ji-ho okay?”
“Yes. We removed the inflamed area cleanly. He’ll be transferred to the ward as soon as he wakes from anesthesia in the recovery room.”
The mother’s legs gave out and she sank back into her chair. Then she grabbed the end of Ijun’s coat sleeve with both hands. She couldn’t speak a word; only silent sobs escaped her. Her shoulders shook violently.
Ijun did not pull his sleeve away. No medical textbook had a manual for handling a guardian’s emotions. He simply stood there in silence, accepting the mother’s complete sense of relief with his own warmth.
At that moment, Jeong Dain, a nurse from the surgical ward who happened to be passing by the hallway outside the OR, witnessed the scene by chance. She stopped walking and stared at Ijun’s back for a moment. Then, for no particular reason, she opened the empty chart in her hand, closed it again, quietly turned around, and returned to the station.
It was six o’clock in the evening when Ijun returned to the on-call room. The faint glow of dusk was settling outside the window. He sank into the chair at his desk and pulled up the EMR screen. It was time to write the progress note for the pediatric appendectomy case he had handled that day.
But the fingers resting on the keyboard wouldn’t move. The patient’s basic information blinked on the monitor.
Age: 7 years old.
Ijun stared at those characters for a long time. The Archive did not activate. There was no need to turn it on. The emotion gripping him right now had nothing to do with system errors or the hospital’s irrational hierarchy.
I was scared.
Only now did Ijun clearly recognize his own feelings. He hadn’t been afraid that Oh Jae-hyeong would ignore his opinion. He hadn’t been afraid of losing face if his diagnosis was wrong. He had simply been terrified that the small child would be in pain. Terrified that those frightened eyes would have to endure suffering any longer.
In the face of a living being’s pain, all precise engineering calculations collapsed helplessly, leaving only primal fear behind. It had taken until exactly six o’clock that evening for Ijun to fully accept that brutal truth.
In the silence, Ijun’s motionless fingers finally began striking the keyboard.
Pre-appendectomy findings: Positive right lower quadrant tenderness and rebound tenderness.
Clear signs of peritoneal irritation. CT confirms pre-perforation stage.
Emergency surgery completed. Patient prognosis good.
The words and sentences were etched onto the chart in dry, clinical language. After pressing save, Ijun turned away from the monitor’s glow and gazed out the small window of the on-call room.
One tiny variable left alone inside a system that had to be perfectly controlled.
It was seven years old.