A One-Star Amusement Park (2)
It felt like I had clocked in for my night shift only moments ago, but after being battered by the crying of children, the anxious sighs of parents, and the relentless beeping of monitor alarms, the clock hands were already pointing toward 11:00 PM. Only four hours had passed, but I felt like my soul had aged forty years. The pediatric emergency room was, quite literally, a miniature version of hell.
Children having febrile seizures, children wheezing for breath, children with enteritis projectile-vomiting and emptying their bowels like fountains. And the parents, absorbing all their children's pain, wailing right alongside them.
Right then, one of the nurses at the station spoke up. "Bed C-5 is being admitted, so we have an open bed now."
At that exact moment, Chief Resident Lee Min-jae sprang up from behind me and roared, "Finally...! Finally, a bed has opened up!!"
I stared at him with hollow eyes. "Uh, is that really something to celebrate that much?"
"Something to celebrate? Hyeon-jae, you've lost your mind!" Lee Min-jae grabbed my shoulders firmly and pointed toward the hallway. "Did you already forget that we had to lay kids on temporary cots in the hallway earlier? You saw that, and you still think an open bed isn't a big deal? This is heaven! We only have nine beds filled now! We went from one hundred percent capacity to ninety percent! This is a miracle for the pediatric ER!!"
At his boisterous shouting, nearby guardians began staring at us with anxious eyes. "Um, Doctor, maybe you should lower your voice a bit..."
"Ah!" Realizing his surroundings, Lee Min-jae cleared his throat and quickly adjusted his posture. "Ahem. Han Hyeon-jae. Thanks to the pediatric patient who was just admitted, a ray of light has shone upon our emergency room. Shouldn't we commemorate this miracle? Since the kids have stabilized a bit, your chief will graciously buy you a canned coffee. Follow me."
"Aigoo, thank you, sir."
In front of the ER's main entrance, the cool night air tickled my cheeks. For the first time in hours, I pulled down my mask and took a deep, satisfying breath of fresh air. Lee Min-jae stood before the vending machine and dropped in some coins. Two cans of coffee fell with a heavy thud. Ah. This is what makes life worth living.
It was at that moment. Wait, what is that...? On the street opposite the hospital, the pedestrian light at the crosswalk was clearly red. Yet, two people were sprinting across the road, completely ignoring the red light. In their arms, they held a small bundle wrapped in a blanket.
"Uh... Uh? Sir, look over there..." My voice trembled. "Is that... a child?" Every ounce of joy vanished from Lee Min-jae's face.
The two ran toward the emergency medical center, screaming at the top of their lungs. "Please save our son!" The canned coffee in my hand slipped and clattered onto the pavement.
"Cyanosis..." Lee Min-jae muttered under his breath. He was right. The area around the child's lips and nose was a deep, bruised blue, as if painted with dark ink. We moved at the exact same time.
"I've got him!" I rushed toward the man and took the child from his arms. The child's body was completely limp, and his skin felt icy cold. How did this tiny body get so cold? Cradling the child close, I sprinted back into the ER with Lee Min-jae hot on my heels.
"How old is the baby! When did this start?!" Lee Min-jae shouted at the parents as he ran alongside me.
"He's two! He was perfectly fine just a moment ago, but then he suddenly started breathing weirdly and turned blue...!"
"Set up a bed in the pediatric resuscitation room, hurry! Fast! Call the pediatric resident on duty!" The nurses scrambled to prepare the resuscitation room, and someone came rushing over pushing a pediatric crash cart. Clutching the child, I ran toward the resuscitation room. The weight of the tiny life in my arms felt heavier than a mountain. I carefully laid the child down on the resuscitation bed.
"Hook up the monitor and get an IV line started, quickly!" The nurses attached ECG electrodes to the child's tiny chest and wrapped a blood pressure cuff around his arm. Another nurse desperately searched for a vein in the child's foot.
"The kid can't breathe! Airway first!" Lee Min-jae positioned himself at the head of the bed and secured the airway. "Ambu bag! Where is the Ambu bag!" Cyanosis. A clear sign of oxygen deprivation. "Saturation! What's his oxygen saturation?!" Lee Min-jae barked.
A nurse clipped a pulse oximeter probe onto the child's tiny toe. Everyone's eyes locked onto the monitor. I swallowed hard. Eighty percent? No, it might even be in the seventies. In the worst-case scenario, the sixties. The monitor screen flickered. The heart rate flashed at 150. And finally, the oxygen saturation level appeared on the screen.
...Silence fell over the room. I blinked, doubting my own eyes. "......What?" Lee Min-jae muttered blankly.
"Eighty-five percent? He's this blue, but it only dropped to eighty-five? We're bagging him with pure oxygen, so why isn't the number going up either! Is the machine broken? Swap the probe to the other foot! Hurry!"
The nurse hurriedly pulled off the probe and clipped it onto a toe on the other foot. The numbers on the monitor vanished for a moment, then flashed back on.
Everyone in the resuscitation room froze. The child's lips were undeniably blue. The child was clearly struggling to breathe. The child's body was completely limp. Every single physical sign pointed to severe, classic hypoxia—a critical lack of oxygen in the body. Yet, the machine hovered stubbornly around the ambiguous mid-eighties, even though we were pumping high-concentration oxygen directly into his lungs.
I looked at Lee Min-jae in utter confusion. He was staring at the monitor with an equally dazed expression. "A cardiac issue? Congenital heart defect? Or severe pneumonia? Sepsis?" The most terrifying words that could cross a doctor's mind when facing a pediatric emergency tumbled out of Lee Min-jae's mouth.
"No, this makes no sense." Lee Min-jae shook his head. "First, get a probe! A new one! Bring a brand new one!" At his shout, a nurse bolted out of the resuscitation room.
"Mother! Father! Focus and listen to me! Right before he ended up like this, what was he doing? Did he eat something, bump into something, anything at all? Even the smallest detail matters!"
"B-Baby food..." the mother answered in a trembling voice. "For dinner, I pureed carrots and spinach and mixed it with rice to feed him. But while eating, he suddenly started choking and coughing..."
"Baby food? Choking?" Lee Min-jae's eyes flashed. A new possibility. "Aspiration?" he muttered, rushing back to the head of the bed. He quickly grabbed a small laryngoscope and carefully examined the inside of the child's mouth, checking to see if any food debris was blocking the entrance of the airway.
But the child's throat was completely clear. He inserted a suction tip and cleared out the deeper passages, but nothing came up except clear saliva. "It's not aspiration either... Then what on earth is it?!" Lee Min-jae ran his hands wildly through his hair.
Just then, the nurse rushed back in with a brand new pulse oximeter probe. Lee Min-jae practically snatched it from her hands and clipped it onto the child's toe. Once again, everyone's eyes locked onto the monitor.
Nothing had changed. Lee Min-jae whipped out his phone. "...Is this the pediatric resident on duty? Yes, this is Lee Min-jae, fourth-year resident in Emergency Medicine. We have a twenty-four-month-old patient who just came into the pediatric resuscitation room with cyanosis... but his oxygen saturation is stuck at eighty-five. Even though we're continuously bagging him with oxygen. Yes, you heard that right."
With the newly measured saturation level turning out like this, there was no longer any reason for me to hesitate. I can't solve this with my own brain. Pretending to listen to the child's breathing by pressing my stethoscope to his chest, I pulled up the blue interface.
A 2-year-old baby has cyanosis but SpO2 is showing 85%.
It's not a machine error, and it's not aspiration. We're continuously bagging him with oxygen, though.
As I waited anxiously for a reply, new comments popped up.
Ah! Cyanosis, a bizarrely fixed oxygen saturation level, and baby food made of spinach and carrots. Every single piece of evidence was screaming toward a single diagnosis: methemoglobinemia.
I lifted my head. Lee Min-jae had just finished his pointless call with the pediatric resident and was about to slide his phone back into his pocket. I cautiously opened my mouth to speak to him.
"Sir."
"What is it?"
"Could it be that?"
"What?"
"Methemoglobinemia."
At that moment, Lee Min-jae froze solid. "Uh... hm... right... methemoglobin... wait... what?" he muttered.
Inside his head, the faint memories of hematology lectures from medical school were likely roaring back to life. The discrepancy between cyanosis and pulse oximetry. Nitrates. Baby food. The look in Lee Min-jae's eyes, which initially read What kind of nonsense is this guy spouting?, transformed into sheer shock in the next instant.
"Huh? Oh?! Holy shit, that's it!" A curse of belated realization burst from Lee Min-jae's mouth. He stared back and forth between me and the child on the bed with disbelieving eyes. "Hey, Han Hyeon-jae! How on earth did you...!"