An Amusement Park with a One-Star Rating, Part 3
Lee Min-jae stood there, completely dazed.
Methemoglobinemia. Cyanosis. The oxygen saturation paradox.
They must have flashed through his mind in rapid succession.
"Ha... damn it..."
A hollow groan mixed with a curse escaped Lee Min-jae's lips.
"ABGA! Let's get an ABGA!"
Lee Min-jae shouted, practically screaming, as he grabbed an arterial blood gas kit from the emergency cart.
"Hyeon-jae, hold the baby's limbs tight. If he moves while I'm sticking the artery, we're in deep trouble."
I nodded and firmly secured the child's tiny body.
Lee Min-jae wiped the skin with an alcohol swab and picked up the heparinized syringe.
He inserted the needle and slowly pulled back the plunger. Blood began to surge into the syringe.
I held my breath.
Normal arterial blood should be a bright, vivid scarlet, rich with oxygen.
But the blood filling the syringe was not scarlet.
It was a bizarre, ominous dark brown.
Lee Min-jae and I gasped simultaneously at the sight of the chocolate-brown blood.
"Ah..."
This was it. Irrefutable proof. The color of dying blood.
Lee Min-jae pulled the needle out and applied firm pressure to the puncture site with gauze.
He handed the syringe containing the sample to a nurse and turned to the veteran charge nurse standing nearby.
"Nurse Jung, by any chance... do we have Methylene Blue in our ER drug inventory?"
"Methylene Blue...?" Nurse Jung's eyes widened. "I'm not sure... It's such a rare drug, we probably don't. I'll call the pharmacy department right away!"
Nurse Jung urgently snatched up the phone.
Anxious moments ticked by.
Methylene Blue. The only antidote for this disease, capable of converting methemoglobin back into normal, functioning hemoglobin.
If this hospital didn't have that drug, this child would...
"This won't do." Lee Min-jae bit his lip anxiously. "I'll call Pediatrics first. They need to know about this situation."
Lee Min-jae picked up the phone again and contacted the pediatric resident on duty.
"Yes, Pediatric duty doctor. This is Lee Min-jae, fourth-year resident in Emergency Medicine."
"...Yes. A twenty-four-month-old patient, diagnosed with methemoglobinemia. ...Yes, that's correct. There's a history of baby food ingestion, and the arterial blood is chocolate-colored. So we're about to administer Methylene Blue, and I was wondering about the pediatric dosage or protocol..."
Lee Min-jae listened to the voice on the other end for a moment, his brow furrowing.
"Yes. Yes, I understand. I will consult with the EM attending and proceed. Yes."
When he hung up, Lee Min-jae's face was grim.
"They want me to consult with the attending before giving it. Well, I suppose that makes sense from their perspective. It's crazy for a resident to make the final call on diagnosing and treating such a rare disease."
Swallowing a curse, he dashed toward the Resuscitation Room doors.
"Hyeon-jae, stay glued to the baby's side and keep monitoring his vitals! I'll find the professor, get confirmation, and be right back!"
With Lee Min-jae rushing out like that, only the child's shallow breathing remained in the Resuscitation Room.
How much time had passed?
The intercom at the station rang. It was the lab.
A nurse answered the call and began writing the results on the chart.
Then, she held up the paper for me to see.
The calculated oxygen saturation was 73%, clearly showing the child was in a state of hypoxia.
But the machine-measured oxygen saturation was 85%.
One of them was lying.
And the liar was definitely the 85%.
SpO2 85%. SaO2 73%.
'The machine is lying.'
A cunning disease that tricked the machine's eyes. Chocolate-colored blood flowing through the child's veins.
Just then, Nurse Jung shouted in an urgent voice. She had just finished her call with the pharmacy department.
"Doctor! The main building's pharmacy has Proveblue injection in stock! Fortunately, the expiration date is plenty long! We don't have it in the ER, though!"
It was a message of salvation.
I immediately turned my head and spoke to the intern, Choi Minseong, who had been watching everything over our shoulders, looking utterly lost.
"Hey, Intern! Minseong! You heard that, right?"
"Huh? Yes!"
"From this moment on, you have to be the fastest person in this hospital!"
I quickly pulled a piece of paper from my pocket and scribbled on it.
"Take this and sprint to the central pharmacy on the first basement floor of the main building! Don't even think about catching an elevator! If you wait for an elevator at this hour, you'll kill the kid! Run down the emergency stairs! With every ounce of strength in your body! Hurry! I'll put the order into the system under my name for now!"
I shoved the prescription into Choi Minseong's hand.
Choi Minseong stood dazed for a split second, but realizing the gravity of the situation, he nodded with a solemn expression.
Don't nod, just run.
Right after Choi Minseong vanished from sight, Lee Min-jae came running back into the Resuscitation Room, drenched in sweat.
"Oh, we got confirmation! The attending professor said to trust our diagnosis and proceed! Put in the order..."
"I already did! The intern has already left to fetch the drug!"
At my reply, a faint smile spread across Lee Min-jae's face.
"Good! Great instincts!"
Lee Min-jae patted my shoulder and turned his gaze back to the patient's parents.
"Hyeon-jae, you go explain it to them. You basically made the diagnosis anyway."
Why did it feel like these seniors always dumped the patient explanations on me? Was it just my imagination?
I nodded and approached the couple.
"Ma'am, Sir. Let me explain what's happening."
I pulled up a chair and sat down.
"First of all, we found the cause. And fortunately, our hospital has the treatment drug."
With those words, the couple's expressions eased slightly.
"Your child has a very rare condition called methemoglobinemia."
I began to explain the disease, choosing the simplest terms possible.
"In our blood, we have things called hemoglobin, which act like delivery workers carrying oxygen. However, due to a certain ingredient in the meal the baby ate today, some of these workers suddenly went on strike. They look perfectly fine on the outside, but they can't load the most important cargo—oxygen. Because oxygen isn't being delivered to every corner of his body, his lips have turned blue. That's cyanosis."
I took a brief breath and explained the most crucial part.
"This disease usually occurs very rarely, and mostly in infants under six months old whose stomach acid secretion is still immature. It is incredibly rare for it to manifest in a child over two years old."
I took the father's hand.
"So, this is absolutely not your fault. Normally, children of this age don't have any issues even if they eat spinach or carrots. It was just extremely bad luck. Please do not blame yourselves."
Tears finally spilled from the mother's eyes.
"The antidote will arrive shortly. Once this medicine is administered, it will fix the broken hemoglobin so they can start delivering oxygen again. After the injection, you will see your child's blue lips gradually return to their normal color."
Finally, I added a few practical tips for their daily routine.
"Of course, he will need to be hospitalized. It's possible his body is exceptionally sensitive to that specific compound. Just to be safe, in the future, it would be best not to give him too many nitrate-rich vegetables like spinach or carrots all at once, but rather in small, divided portions."
As my explanation ended, the couple bowed repeatedly, thanking me.
Receiving their gratitude, I could only offer a bittersweet smile.
After Choi Minseong disappeared toward the emergency stairs, a grueling period of waiting descended upon the Resuscitation Room once more.
Lee Min-jae and I stood in silence, our eyes darting back and forth between the child's lips and the numbers on the monitor.
We had done everything we could.
Diagnosis? Made.
Treatment plan? Established.
Antidote? Currently rushing toward us from somewhere in this hospital.
Yet, those brief moments felt agonizingly long.
To alleviate some of this anxiety, I opened the gallery window once again.
...So it really is an incredibly rare drug.
Reading the comments, I realized once again just how thin of a tightrope I was walking.
If they hadn't had the drug, this child would...
Wait, now was not the time to think about that.
The most fundamental and important question popped into my head.
'So, how much of this drug do I need to give?'
I vaguely recalled the adult dosage.
But a two-year-old baby. Injecting the wrong dose into this tiny body, weighing less than 15 kilograms, would be no different than injecting poison.
I immediately picked up the phone and contacted the pediatric resident on duty.
"Yes, this is Han Hyeon-jae from Emergency Medicine. I'm calling to double-check the dosage for the methemoglobinemia patient regarding the Methylene Blue administration..."
When I told him the dosage I had calculated—or rather, cheated to get—the pediatrician on the other end of the line seemed slightly surprised, but quickly confirmed that my calculation was correct.
How much time had passed?
"Pant... pant... I brought it!"
The Resuscitation Room door burst open, and Choi Minseong ran in, looking like a walking corpse.
Clutched preciously in his hand was a small glass ampoule.
"Good job, Minseong! Seriously, great work!"
Lee Min-jae patted the intern on the back.
With that, the nurse connected the syringe to the child's IV line and began to inject the drug very slowly.
Everyone held their breath.
One minute. Two minutes. Three minutes.
There was no change.
The child's lips were still blue.
My heart began to beat anxiously again.
Was the diagnosis wrong? Is the drug not working?
Right then.
Starting from the very edges of the child's deep blue lips, a very faint pink hue began to spread.
Color returned to his pale cheeks.
His shallow, irregular breathing began to turn deep and steady.
Lee Min-jae swept his hair back.
Relieved smiles spread across the nurses' faces as well.
A short while later, the transport team from the pediatric intensive care unit came down to transfer the patient.
The child, now with a completely normal complexion, was moved onto the transport gurney.
I stared blankly at the scene from the doorway of the Resuscitation Room.
The child's parents bowed deeply to me.
I could only awkwardly bow back in return.
Only after their figures disappeared past the elevator was I finally able to let out a long sigh.
"Whew."
We saved him.