A Little More Time
The kidneys filter waste from the blood. Of everything they strain out, the waste is passed as urine, while the components the body still needs are reabsorbed, keeping the balance of fluids and electrolytes within a healthy range.
They are called silent organs, and they earn the name: even when seventy percent of their function is gone, they give no sign at all. That is why, by the time something feels wrong and a patient is brought to a hospital, chronic kidney disease has often already taken hold.
That was exactly the case with Teun-teun-i.
Once his damaged kidneys could no longer do their job, waste began to pile up in his body without pause. That was why his BUN and creatinine — two of the key markers — had been so high.
"......The BUN's gone down."
Yoo Mu-hwan smiled faintly as he looked over Teun-teun-i's lab results. Teun-teun-i's BUN was 54 — lower again than it had been the day before.
But why would a falling BUN put a smile on Yoo Mu-hwan's face?
BUN stands for Blood Urea Nitrogen. Nitrogen enters the body through protein in the diet and is converted into ammonia; that ammonia is then transformed into urea and sent out of the body. The liver is what converts ammonia into urea. The kidneys are what send the urea out.
If, for any reason, that urea cannot be excreted, the BUN naturally rises. And there are plenty of reasons it might climb: increased protein intake, gastrointestinal bleeding, a course of steroids, even a fever. Vomiting and diarrhea can push it up too — and in those cases, once the underlying cause is gone, the number usually settles back where it belongs.
That was not Teun-teun-i's situation. Even with the cause addressed, kidneys that had already failed could not return to what they once were. The fluids and supportive care had simply helped filter his blood a little cleaner. So even though Teun-teun-i's BUN had dropped, it did not mean his kidneys had improved.
Still — if the numbers held at this level, he would be able to live comfortably for a while. A little further down, and he would start eating well again. He would have energy. That was what made Yoo Mu-hwan glad.
And in fact, Teun-teun-i took his liquid diet far more eagerly than he had the day before. When Yoo Mu-hwan held him and eased the syringe into his mouth, Teun-teun-i swallowed with a soft gulp. Then he licked the syringe. He wanted more.
A smile spread across Yoo Mu-hwan's face.
"Is it good?"
He gave him more than he had a moment ago. Teun-teun-i swallowed that too. Because he was eating so willingly, breakfast went much faster than it had the evening before.
Part of Yoo Mu-hwan wanted to pile it on while the little dog was willing — who knew when he might stop eating again? But if he vomited, everything he had just taken in would come back up, and the vomiting would start all over.
We only just got the vomiting under control. I can't do that to him.
An experienced clinician, Yoo Mu-hwan knew it was time to stop. Too much is worse than too little. Holding that thought, he set the syringe down and praised him.
"Good job, Teun-teun-i. We'll eat again at lunch."
"Woof!"
Teun-teun-i answered with a smiling face, as if his condition really had improved.
"You little guy."
Once again it felt as though Teun-teun-i had actually answered him, and Yoo Mu-hwan's mood lifted. It would lift even more once the owner arrived.
And just as he had expected, the moment she walked in, Teun-teun-i's tail began to wag in eager little flaps. After the visit ended he wilted again — but less than he had the day before. The change in his expression was enough to ease Yoo Mu-hwan's mind a little.
Smart boy. He figured out in a single day that she hadn't abandoned him.
Lee Jun had explained the concept of hospitalization to Teun-teun-i on the first day, so the little dog had never worried that his owner was leaving him behind. Yoo Mu-hwan, who knew nothing of that, simply found him admirable.
The next day's bloodwork was good as well. Better still — Teun-teun-i had started eating the liquid diet on his own. He had even taken a bite of wet food.
His owner is going to be so happy.
Force-feeding and eating of one's own accord were as different as heaven and earth. This meant his condition had improved dramatically. Yoo Mu-hwan waited to share the news.
Until now, the owner had always come in the evening. Today she arrived in the afternoon, so Teun-teun-i greeted her after being woken from a nap. In her arms he was far more lively — partly because he was feeling better, and partly, without a doubt, because she had come so much sooner than he had expected.
Watching Teun-teun-i beam, Yoo Mu-hwan felt his own spirits rise. He smiled as he greeted her.
"You're here early today."
"Ah, yes. I didn't have to go into work."
She answered with a faint smile.
She looks so much more exhausted than yesterday, though.
Her face was drawn and puffy; she must have been up all night worrying about Teun-teun-i. That was what Yoo Mu-hwan thought as he began to explain the little dog's condition.
"Today, Teun-teun-i ate on his own."
"Really?"
Her face lit up. The exhaustion from a moment ago vanished. Seeing it, Yoo Mu-hwan knew he had been right, and he went on in more detail.
"Teun-teun-i!"
Having heard the explanation, she hugged the dog in her arms even tighter. Then she went on.
"Doctor, thank you so much."
"Haha, I didn't do anything. Teun-teun-i is the one who found the strength. All right — go on and take him for his walk. I think you can stay a little longer today. About forty minutes? Hahaha."
"Thank you. We'll be back."
She carried Teun-teun-i toward the second floor.
Just then Lee Jun stepped out of the operating room and caught sight of Teun-teun-i and his owner from behind.
"Teun-teun-i's owner is here early today."
"Yes, it seems like it's her day off."
"Is that so? Teun-teun-i must have been thrilled."
"He seemed to be. His face was so bright."
Lee Jun watched until Teun-teun-i's owner stepped into the elevator and went up. The sound of Teun-teun-i fawning over her drifted back, and the look in Lee Jun's eyes was complicated — glad, and sad, all at once.
Watching the two of them, he wished, silently, I hope that smile lasts a long time.
Whether Lee Jun's wish had been heard, or whether Yoo Mu-hwan's treatment had simply done its work — on the sixth day of hospitalization, every one of Teun-teun-i's numbers returned to normal.
"Director, would it be all right to discharge him at this point?"
"He can't stay here forever. Let's do that."
"Understood."
"Ah — and please make sure his owner can care for him at home. If we run subcutaneous fluids, we can buy a certain amount of time. If we're lucky, it could hold for quite a while."
"You think so?"
"We have to hope so. Ah, let's do it this way. Don't discharge him today. Spend today and tomorrow on training, and send him home tomorrow. She's bound to feel uneasy about giving injections herself."
That he would think even of that — Yoo Mu-hwan bowed at the waist.
"Thank you."
"There's nothing for you to thank me for, Dr. Yoo. If anything, I'm the one who's grateful."
He meant it. It would have been easy enough to look the other way. Because of Yoo Mu-hwan's care, a dog named Teun-teun-i had found his strength again. And because of that, his owner was happy.
That was enough.
Lee Jun smiled faintly, remembering why he had opened Mongmong Animal Hospital in the first place. Then he added,
"And send her home with all the supplements. People get stingy about those things and end up missing the window for treatment. Pack plenty of the liquid diet and the canned food too. Ah — I'll speak to Manager Jang about the prescription diet, so you just take care of the supplements and the fluids."
And last of all, he said the thing he most wanted the owner to hear.
"And tell her — if he gets sick, she must bring him back."
"Understood, Director."
That evening, when Teun-teun-i's owner arrived at Mongmong Animal Hospital and heard from Yoo Mu-hwan how she would need to care for him going forward, she was stunned.
"S-so you're saying I have to give him injections?"
"Yes. Teun-teun-i's kidneys don't have much ability left to filter waste. So we help them along with fluids. You've heard of people doing peritoneal dialysis at home, haven't you?"
"I heard a distant relative did something like that."
"It's that kind of thing, done at home."
At Yoo Mu-hwan's words, she shook her head hard.
"I-I can't. How could I put a needle in Teun-teun-i's belly..."
"Ah, not the way it is with people. We give the fluids here, at the scruff of the neck. There's plenty of space, so it isn't difficult. I'll show you how I do it."
Before placing the subcutaneous fluids, Yoo Mu-hwan explained it to Teun-teun-i the way Lee Jun always did with the animals.
"Teun-teun-i, the doctor's going to give you a shot right here. And this watery stuff? It's going to go into the scruff of your neck. Don't be scared."
"Woof!"
Teun-teun-i answered softly. He had already heard this from Lee Jun the day before. Once again, the corner of Yoo Mu-hwan's mouth lifted. When Teun-teun-i met his eyes and answered, it really did feel like a conversation.
"You have a hanger at home, right? If not, you can hang it from a doorknob or anything similar. You just need to be able to draw the fluid from the bag."
Yoo Mu-hwan walked her through hanging the fluids, step by step.
"This is called a butterfly needle. The key is getting the air bubbles out of the line first. If air goes in, it hurts."
"Eek!"
"Ah, it's not that hard. See the air here?"
"Y-yes."
"You just push it out like this. After that, you disinfect Teun-teun-i's scruff with alcohol. Ah — I shaved the fur here so it'll be easier for you to give the injection at home."
As he said it, he unwrapped the scarf from around Teun-teun-i's neck. Only then did the owner realize he had been wearing a scarf at all. The moment she had arrived and heard she would have to give him injections, everything had gone distant and hazy.
"Y-yes. Thank you."
Yoo Mu-hwan disinfected the scruff, explaining as he seated the needle.
"You insert it like this, then press the plunger. If the fluid goes in smoothly, you've got it in the right place."
She put her hand on the plunger and pushed. A smooth slide — no resistance. Yoo Mu-hwan nodded.
"That's the feeling. You see?"
"......Yes."
"All right. Now I'd like you to try it yourself."
"M-me?"
"Yes. That's the only way you'll be able to do it at home."
"I-I suppose so."
Her hands were trembling. He would have asked if there was another family member at home, but something told him she and Teun-teun-i lived alone. He couldn't be sure — but these were the kinds of things you treated carefully. So he waited until she found her resolve.
Had Teun-teun-i sensed her anxiety? The little dog's face suddenly fell.
He really loves her.
Yoo Mu-hwan stroked Teun-teun-i's head. He simply wanted to.
A moment later, she spoke in a voice that barely made it out of her throat.
"D-Doctor... I'll try."
"Yes. Once you've done it once, it'll be easy. Other owners say the exact same thing you did at first — that they absolutely cannot do it. And later they do it better than I do."
"Oh, come on. But... are there many children like our Teun-teun-i?"
She left out the word sick. Watching her, Yoo Mu-hwan thought that she loved Teun-teun-i a great deal too.
"There are. Plenty of dogs, and a great many cats as well."
"......I see."
She fumbled a little at first, but soon got the hang of it. The next day she had an even better feel for it, and Yoo Mu-hwan was relieved.
Over those two days, he explained everything she would need to know to care for Teun-teun-i at home.
"You must be so busy, and you went through it twice. Thank you. Honestly, when I heard it yesterday, everything went dark. It was so complicated — so many medications to give. But hearing it a second time, I think I understand."
"I'm glad. I've written out the order and the times here, so you can just follow that. Check them off as you go and you won't forget anything."
"Thank you, Doctor."
"And if anything's confusing, call anytime."
"I will."
As he handed her the photocopied instruction sheet, Yoo Mu-hwan thought, The Director was right. Two days of training is better than one.
She took the fluids and supplements Yoo Mu-hwan had packed, and the prescription diet Jang Sora had prepared, and went out. There was more to carry than she had expected, so she couldn't take Teun-teun-i and the bags all at once.
Until she came back, Yoo Mu-hwan held Teun-teun-i and looked out the window.
"Teun-teun-i. Go home, eat well, and stay healthy."
And he wished, silently, Get well — and please, let's not see each other this month.
That was why he had packed a full month of supplements and fluids. But Yoo Mu-hwan knew. Sooner or later, Teun-teun-i's condition would decline again. He knew. He only hoped that day would come even one day later.
Until the owner returned, he kept stroking Teun-teun-i's forehead — small, firm, and warm to the touch. It hadn't felt like he had been petting him for long at all, and then there she was outside the window.
Did she run?
She hadn't. Forty minutes had already passed. The time he had spent with Teun-teun-i had simply felt that short.
Yoo Mu-hwan waved as Teun-teun-i was carried away in her arms.
From the cat tower beside him, Hoesaegi and Gkamnyangi raised their front paws and waved too.