Yes, I Am a Talentless Hack (6)
The moment I heard Song-woo's report, I headed straight for the intensive care unit.
When we arrived at the Trauma ICU, the nurse in charge came out to meet us, and her expression told me everything was not well.
"Professor, this is the gunshot patient in bed 5. His fever is holding at 38 degrees and won't come down, and his urine has turned dark. Hemoglobin is at 8 now, and we sent off an urgent bilirubin panel, but the results haven't come back yet."
"What about the ABGA and lactate?"
"The ABGA we just ran shows a pH of 7.30, PaCO2 of 33, HCO3 of 21 — a mild metabolic acidosis. Lactate is slightly elevated at 2.5."
The instant I reviewed the numbers, the diagnosis crystallized.
"Understood. This is a classic presentation of DHTR — Delayed Hemolytic Transfusion Reaction."
DHTR. Delayed Hemolytic Transfusion Reaction.
Among the complications that arise when transfused blood doesn't quite match the patient's own, this was the most insidious kind — one that waits days before rearing its head. It had nothing to do with the ABO blood types everyone knew about; instead, it stemmed from incompatibilities in minor antigens the general public had never heard of. Rh, Kell, Duffy, Kidd... an entire labyrinth of obscure blood typing systems. It was also vanishingly rare — roughly one case in every ten thousand transfused patients.
"Of all the times for a DHTR to show up..."
I let out a bitter laugh. This was a patient who'd already stared down death from a gunshot wound, and now a DHTR had to pile on top of it. If ever a man's luck ran rotten, it was this one's.
"Send a STAT order to the blood bank right now for a DAT — a direct Coombs test — and an antibody screen. And we need to protect his kidneys from acute injury, so open up the IV fluids to a wide-open drip and keep his urine output above 100 cc per hour."
"Yes, Professor. Requesting the immediate tests from the blood bank..."
The nurse and Song-woo scribbled furiously, echoing each order back to me as I gave it. I let them catch up on their notes for a moment, then continued.
"And until the blood bank identifies the offending antibody, do not order a transfusion for him — even if his hemoglobin drops further, into the 7s."
"Yes, Professor."
The fact that a DHTR had occurred at all meant we had never fully mapped this patient's blood type. We could survive one mistake, but there would be no second one. If we pumped another mismatched unit into him in this state, it would amount to killing him with our own hands.
"Call me the second those results come in, and ask the blood bank to prep units that are negative for the antigen in question."
"Um... Professor?"
At that point the nurse, who'd been diligently taking down my orders, raised her hand cautiously.
"Actually, part of the reason we contacted you was... about the blood bank."
"?"
"It's just that... the blood bank... has run out of blood."
"I'm sorry — what?"
A chill crawled up my spine. Surely the hospital hadn't sprouted a blood thief. A chupacabra, a vampire — any number of blood-hungry Echoes could have resonated with the patients here. But before the paranoid fantasy could take root, her explanation let me exhale, if only slightly.
"Apparently every transfusion pack in the blood bank was used up over the past week."
So no blood-thieving Entity after all.
Being trapped in a hospital with vampire-type Echoes on the loose is not an experience I care to have, thank you very much.
But the relief lasted only a breath before I realized the truth: we had merely dodged the worst-case scenario. Nothing about our situation had actually improved.
"Hold on. That makes no sense — there shouldn't be a blood shortage. The stock gets replenished on a schedule. That's one of the Echo's laws, isn't it?"
This hospital, shrouded in fog, was governed by a handful of inexplicable rules. One of them was that medical supplies and provisions were periodically restocked. Nobody knew who restocked them or where they came from — only that by the time the weekend ended and someone checked the inventory, the shelves had somehow filled themselves again. As far as I could tell, it was a property of the Echo, a mechanism for maintaining the narrative of a hospital. Granted, the quantities were absurdly stingy compared to before the fog swallowed us, but as long as we rationed carefully, a steady trickle kept us afloat.
The transfusion packs in particular — just last week, the blood bank had told us there was no shortage whatsoever. Which was exactly why the nurse's words were so hard to swallow.
"All that blood, gone in a single week?"
"To be precise, they say only the AB blood — his type — and type O are completely depleted."
"Only those two, exactly? That's enough to make a ghost weep."
"Well... it seems one surgical department in particular has been burning through transfusions..."
The moment I heard it, a single fact blazed across my mind.
Of course. Orthopedics.
Since transforming into Entities, the orthopedic surgeons had been hacking off patients' limbs at random and guzzling transfusion packs like water. Break a healed bone to keep a patient a patient forever, then patch the resulting hemorrhage with transfusions — a closed loop of manufactured carnage. However large our hospital's blood bank was, no stockpile could survive Orthopedics bleeding it dry like that.
"Tch... Then all we can do is pray this patient doesn't develop a situation that actually requires a transfusion..."
"P-professor, does that mean no new blood is coming in at all?"
"It gets replenished every weekend. All we can do is hope he holds on without complications until then."
I looked down at the soldier on the bed. A young face gone sallow and yellow-tinged. Sweat trickled steadily from his forehead, and low moans escaped him now and then — who knew what he was dreaming. It was what people would call wandering the border between life and death.
Wait. Wandering the border between life and death?
Something was off. Yes, DHTR was rare and dangerous — red cells destroyed, kidneys damaged, bilirubin surging into jaundice. But it was not a disease that deteriorated this fast.
"Song-woo."
"Yes, Professor."
"This patient was fine last night, right?"
"Yes. At evening rounds yesterday there was nothing abnormal at all. If anything, we noted he was improving."
I stared at the patient's monitor. Compared against yesterday's records, his blood pressure was creeping down — slowly, but unmistakably, tick by tick. Nobody looking at this would call it a simple DHTR.
Song-woo, who'd been watching beside me, spoke up carefully.
"Um... Professor? It's possible this isn't a DHTR at all."
"I was thinking the same. What's your read?"
"Resonance?"
"..."
I nearly nodded along on reflex. The presentation was too similar to Gu Jihye the streamer's case — textbook symptoms, attached to a wildly untextbook speed of progression. Just as her heart had died out at terrifying pace, this soldier could be being devoured by Resonance, deteriorating by the hour.
But.
"Which Echo?"
"Sorry?"
"Which Echo do you think he's resonated with?"
"Uh..."
I lowered my voice and fixed Song-woo with a level stare.
"Song-woo. I get it — you've been under me long enough, seen enough Entities, that Echoes feel like old friends now. But you can't pin every difficult case on an Entity just because it's hard. That is not how a doctor thinks."
Blame the supernatural whenever the picture doesn't fit, and there would be no end to it. It's hard, so blame Resonance. It's atypical, so blame an Echo. It's a hassle, so blame an Entity. The first shirking of responsibility is the only hard one; after that, you simply grow careless, and callous, one case at a time.
"Unless you can say exactly which Echo he resonated with, you don't get to invoke one because the case is difficult. Same goes for this patient."
I pointed to the arm where his IV line ran. Dark crimson blotches spread outward from the injection site, vivid against his skin.
"There it is..."
I checked his temperature, then his blood pressure again. High fever, blood pressure sliding lower. His consciousness was clouded, his breathing growing ragged. And every one of these changes had unfolded in a single night.
"Song-woo — yes, it's a DHTR, but prep antibiotics too. I think this patient has gone septic."
"I'm sorry — what?"
Song-woo jolted and pointed at the monitor.
"But his blood pressure isn't that low yet, Professor. Systolic is 108."
It wasn't low enough to call sepsis by the numbers. I shook my head anyway.
"It's still dropping, isn't it? He was 120 last night; he's 108 now. Keep falling at this rate and he'll be under 100 by this afternoon."
Along with the explanation, I pointed again at the mottled patches spreading up the patient's arm.
"You see these lesions? Classic DIC. Disseminated intravascular coagulation. Pair that with the falling blood pressure and it's a definitive signal that sepsis is in full swing. Within hours, this man's pressure is going to fall off a cliff."
"That can't be..."
The color drained from Song-woo's face.
Sepsis. DIC. And a DHTR on top.
The instant he grasped what that combination of words meant, Song-woo too saw where this patient's story ended.
He opened his mouth, lips trembling with something he wanted to say — and I quickly pressed my index finger to my own. Behind me, at the bedside, the soldier's comrades sat keeping their desperate vigil for him to wake, watching us with anxious eyes. Slowly, so slowly they wouldn't catch it, I shook my head. Don't let them see how bad this is. Not yet.
"Keep the fluids wide open for now, and page me the moment the labs come back. Start antibiotics immediately, too. Piperacillin-tazobactam, 4.5 grams IV every eight hours."
"Understood, Professor."
After my final instructions to the nurse, we slipped quietly out of the ICU. The moment we hit the corridor, Song-woo's dam burst.
"Professor, this patient—"
"Let's talk in the residents' office."
I glanced around us.
"Not here."
Once we reached the office and shut the door, I finally let the weight of it out.
"That patient probably won't survive the night."
Song-woo nodded. On its own, the DHTR wasn't the killer — some kidney damage, a deepening anemia, but manageable with the right response. Caught early and treated with antibiotics, sepsis carries a decent prognosis too; with aggressive fluid resuscitation, most patients pull through.
The problem was that both of them had arrived dragging DIC along behind them.
"The femoral artery... it's going to rupture again, isn't it?"
"Highly likely."
DIC. Disseminated Intravascular Coagulation.
A state in which massive hemorrhage or overwhelming infection has burned through the body's entire supply of platelets — leaving the blood unable to clot on its own. No more stopping the bleeding. And the catch was that this patient was a trauma case who'd already survived major surgery on a torn femoral artery.
"If rebleeding starts at the surgical site..."
I let the sentence die.
"An anemia that was already dangerous becomes absolutely lethal."
"If only we could transfuse him..."
Song-woo muttered, his face grey.
"But the AB blood is all gone, and even the ordinary O units trigger a hemolytic reaction..."
And on top of it all, the patient carried a rare blood-type constitution that made transfusion itself a minefield. He was too difficult a patient. A patient with, essentially, no way to save him.
A patient with... far too few options left.
"Professor... this man..."
"I honestly don't know either..."
I rubbed my face, dry and hollow. Not exactly the image a professor should project in front of a resident — but I was past the point of having reserves left to spare. The reality was sinking in that this was how people died now: slowly, inside a sealed hospital, while we watched.
"Haah..."
Grasping at straws, I reached out to the Department Chair. To a true genius — a man who had seized a professorship on nothing but raw, uncut diagnostic talent, unlike hacks like me.
Tilting my head, I pulled up the patient's chart. I opened the electronic record and tapped the basic information tab, and the address on his resident registration appeared.
What on earth was he talking about? I raised my fingers to the message window, ready to push back. But right before I hit send, a single fact flashed through my mind like lightning.
Gwangju. Jeolla Province. Type AB. A rare blood type.
And a delayed hemolytic reaction.
"Aha!"
The instant the Department Chair's meaning landed, I frantically deleted the message I'd been typing and hammered out something entirely different.
The Chair's reply came light and breezy, as if it were nothing at all.
Geniuses, it seemed, were always like this. While hacks like me ground our teeth over a patient for days on end and still lost them, men like the Department Chair saw through everything in the space of a few seconds. I let out a wry chuckle and dialed the intensive care unit.
"Yes, Doctor. Sorry to trouble you, but could you add one more test? Yes, it's just that..."