Chapter 193

Episode 193 Me? I'm a Detective (1)

Ziiing—

The automatic doors of the children's hospital, plastered with colorful stickers, slid open to both sides. The moment I passed through them, I walked with strides toward the elevator without a hint of hesitation.

‘What the hell is going on that they’re calling me?’

The Pediatrics chief had sent an S.O.S. to a resident from another department. On top of that, his counterpart was in Emergency Medicine. Our department only handles acute-phase patients. What on earth could be the reason?

Normally, if a problem arises with a pediatric patient hospitalized on a ward, the standard procedure is to either call a subspecialist professor within Pediatrics or formally request a consultation from other Internal Medicine or General Surgery professors. Yet, he went out of his way to call me?

‘Acute abdomen?’

Did the kid suddenly clutch his belly and collapse? Something like intussusception or acute appendicitis?

‘No.’

I dismissed that hypothesis immediately. If it were a surgical emergency, they would have called Pediatric Surgery. What if our hospital didn't have a pediatric surgeon or the on-call slot was empty? If so, they would have called the general surgery resident on duty instead, or transferred the patient to another hospital. They wouldn't have secretly summoned me—a mere Emergency Medicine nobody who isn't even a scalpel-wielding surgeon.

Then what at all could it be?

Beep—

[The doors are opening.]

The elevator doors slid open, and I stepped inside, pressing the button for the 6th floor.

[The doors are closing.]

Wiiiiiing—

While the elevator ascended, beads of sweat flowed down my forehead. Ugh, how sticky.

‘I felt on top of the world because I was wearing a freshly washed, fluffy hoodie, but now running here has made it all gross with sweat.’

The mix of the damp smell and my sweat was enough to drive me crazy.

‘Once this situation is resolved, I’m absolutely demanding compensation for damages from Son Jong-woon... beef, coffee...’

It was right when I was suppressing the irritation surging inside me with anticipation for material rewards.

Ding-dong—

[6th floor.]

Along with the elevator's announcement voice, the doors slid open smoothly. A familiar guide sign hung from the ceiling.

[Children's Hospital 6F]

[Ward 6P / Pediatrics Doctor's Office / Professors' Offices]

I rummaged through my hoodie pockets. Since I had taken off my gown before leaving the Emergency Room, there was no way my employee ID card would be hanging around my neck or chest.

"Where is it... Ah, here it is."

I clumsily pulled the ID card out of my pants pocket and held it against the ward's security reader.

Beep-beep—

Tring—

[The entrance door is opening.]

As the glass door opened, the station revealed itself along with the colorful interior characteristic of a children's ward. Just as I started heading inside, a nurse sitting at the station flinched upon seeing me and stood up from her seat. Her gaze swept over my hoodie.

‘Wait a minute.’

To anyone looking, this was the exact outfit of a jobless neighborhood bum out for a stroll.

"Excuse me. Are you a guardian? It’s not visiting hours right now, so how did you..."

It was at the exact moment the nurse tried to block me.

"Oh, Hyunjae!"

The doctor's office door further down the hallway burst open, and a zombie with sagging dark circles tumbled out. It was Son Jong-woon, his hair styled like a bird's nest and his gown wrinkled to high heaven. Though, seeing a doll attached to his ballpoint pen was a bit new.

"Come here, quickly."

Passing right by the nurse who was blocking me, Son Jong-woon grabbed my forearm out of nowhere and dragged me toward the inside of the station.

"Hey, no, wait a second. You're stretching my clothes!"

As I was dragged along, I looked around. I could feel the eyes of everyone at the station—from the nurse who had just tried to stop me to another pediatric resident checking charts—piercing right into me.

‘Who is that bastard in civilian clothes?’

Savoring(?) that burdensome gaze with my entire body, I was dragged to a corner spot in the back.

"Ugh, let go of me."

I shook off Son Jong-woon's hand and straightened my clothes.

"So, what is it?"

Let's draw the line first. Even if I came because a kid is in danger, my own well-being is still important.

"Let me tell you in advance, my department doesn't hold scalpels. If it’s a surgical emergency, call surgery quickly. If you want me to rip a belly open, go get approval from the hospital director right this second."

Jong-woon turned pale and waved both hands frantically.

"No, no, it's nothing like that. It's not something that needs surgery. This... this is just. Honestly, it's..."

Jong-woon stammered, wiping his dry face with his hands.

"This isn't something I should be getting help from you for. You're not in Pediatrics, you're not in Internal Medicine, you're Emergency Medicine... it's not even your specialty... Haa, shit."

"What kind of problem is it for you to be like this?"

Jong-woon bit his lip hard, then spat out unbelievable words.

"The kid hasn't had a diagnosis for a week now."

"...What?"

A week?

"Then you should ask the professors, why are you asking me..."

"You know what it means that a diagnosis hasn't come out for a week."

Jong-woon cut me off.

I knew. Of course I knew.

‘No diagnosis for a week at a university hospital...’

This wasn't a local clinic. Even if it wasn't the absolute top hospital in South Korea, it was a tertiary general hospital where cutting-edge CT and MRI machines, along with other diagnostic equipment, ran 24 hours a day. It had a laboratory that could extract hundreds of values from a single drop of blood, and dozens of renowned experts in every field were stationed here.

For such a place to not know the name of an illness after more than a week of hospitalization meant...

‘It means it has completely bypassed every single standard algorithm of modern medicine.’

"The professors don't know either?"

When I asked cautiously, Jong-woon messed up his hair wildly.

"It's driving me insane, seriously. We ran consultations with pediatric cardiology, pediatric rheumatology, and even pediatric infection professors, but they all say they don't know! There are plenty of suspects, but nothing fits perfectly into the criteria to make a definitive diagnosis! I don't know either!"

Jong-woon grabbed my shoulders desperately.

"So, my genius gentleman, your eyes see things differently. Let me clutch at a straw here. The kid's mom cries and begs every day, but as the attending doctor, the only thing I can tell her is to wait. You know how agonizing that is."

"...Haa."

Normally, I would have brushed it off playfully, asking if I looked like some master detective, but Jong-woon's gaze was too serious for me to bring myself to do that.

"Where's the chart?"

When I asked briefly, a small color finally returned to Jong-woon's face.

"Here. Sit here."

He offered me a computer chair at the station and had me sit down. Grabbing the mouse, I began to examine the EMR records displayed on the monitor.

[6Y / M / Heo Do-yoon]

"Let's see... Admitted through the Pediatric Emergency Room? May 17th? But today is the 25th..."

It was a whopping 8 days. For a young child to be lying in a hospital bed for 8 days without even knowing the cause.

Turning my head, Jong-woon's expression looked terrible. It was obvious he had been digging into the chart for several nights straight.

"Um... alright for now."

If I ask him one more thing, he might actually die of overwork. I fixed my gaze back on the monitor.

‘Let's collect the information roughly first, then ask the Gallery.’

I planned to neatly aggregate the details and post them. For now.

I quickly scanned down from the initial admission records.

"Fever spiked up to 40°C, and he already had a fever for over 5 days before admission. A local pediatrics clinic diagnosed it as simple pharyngitis and prescribed amoxicillin and antipyretics, but they didn't work..."

The fever was hovering around 40°C, yet penicillin-class antibiotics—the primary weapon—had no effect at all. This meant it wasn't a simple bacterial infection or a mild cold.

Scroll.

While rolling the mouse wheel down, my eyes stopped at the past history section.

[Past History: Pneumonia]

"What's this history of pneumonia from 2 years ago?"

At my question, Jong-woon answered as if frustrated.

"You don't need to care about that... actually, I don't know. A genius like you might see something in it. Apparently, he was treated at a local clinic. There's nothing special on the record. He just received inpatient treatment at a secondary hospital and recovered."

"Hmm."

Let's pass over it for now. I'll aggregate it later. I clicked on the lab results conducted in the ER at the time of admission.

[Abdomen CT: Suggestive of Acute Acalculous Cholecystitis (AAC)]

"On the CT... AAC?"

‘An acute acalculous cholecystitis finding...’

Cholecystitis in a young child. It was an uncommon case. But what was even stranger were the blood test values.

[WBC: 6,200 / CRP: 12.5 ▲ / ESR: 85 ▲]

Narrowing my eyes, I pointed at the numbers with my finger.

"The weird thing is this, right? While the CRP is at 12 and the ESR is piercing the sky at 85, the WBC is casually playing in the 6,000s."

Inflammation was boiling inside the body, yet the white blood cells—the immune cells that should be fighting the inflammation—were peacefully maintaining a normal level. If it were a bacterial infection, the white blood cells should have skyrocketed like crazy first. The pieces didn't fit.

"Well, that was the problem. Keep looking."

Jong-woon sighed and gestured with his chin.

Click.

I opened the inpatient progress notes.

"On day 2, the pain in the right upper abdomen was severe... and the fever isn't dropping?"

"It dropped a little bit when we gave Denogan, but it was only temporary. It quickly rose back to the high 39s."

"From day 1 onward, you gave metronidazole and ceftriaxone straight through."

"Right."

"Since cholecystitis was suspected, you also sent a surgical consult to Pediatric Surgery, but Pediatric Surgery rejected it, saying surgical treatment wasn't indicated."

"It got rejected."

It seemed Pediatric Surgery also judged that the risk of opening the belly was too high, or that it wasn't a gallbladder issue.

"But on day 5 of admission, it shot up to 39.8°C? Even though you changed the antibiotic to meropenem?"

To think the fever couldn't be caught even after pouring in meropenem. It had escaped the realm of bacteria that could be killed with antibiotics.

"Yeah," Jong-woon nodded.

‘Information collection complete.’

Placing a hand on my forehead, I pretended to be deep in thought while naturally pulling up the Gallery window in the void.

[Dead Medic Gallery]

Pediatric experts, it's urgent

Author: Korean Slave 1 (Male)

A 6-year-old male admitted through the ER with suspected AAC.

Had a continuous fever for 5 days before admission and 5 days after admission. The fever won't drop even after blasting him with full antibiotics up to meropenem. WBC is normal, but only CRP and ESR are abnormally high. What is this?

[Comments]

Latte is Mine: Why are you looking at an inpatient?

Mes of the God (Male): Could be an acquaintance.

Pop the Head Open: Isn't it yourself?

Mes of the God (Male): Cut the bullshit.

Pediatric Ghost: Atypical Kawasaki. If CRP and ESR rise, antibiotics don't work, and the fever persists.

‘...So that's it.’

A prolonged fever of unknown origin that doesn't respond to antibiotics, an AAC-like finding due to hydrops of the gallbladder, and a phenomenon where only inflammatory markers skyrocket without leukocytosis. If all of this was Kawasaki disease—specifically, atypical Kawasaki where not all typical symptoms manifest—the pieces fit together with chilling precision.

"Jong-woon. Then could this be... atypical Kawasaki?"

The exact disease where you have to pour in intravenous immunoglobulin if antibiotics don't work.

"Yeah," Jong-woon replied in a completely unsurprised voice. "Even without you saying it, from day 5 onward, we diagnosed it as atypical Kawasaki per protocol, and started treatment by administering IVIG and high-dose Aspirin."

"Huh?"

I stared at Jong-woon with a dumbfounded look. What did he say? They already treated it?

The specific remedy for Kawasaki disease isn't antibiotics. It's intravenous immunoglobulin and high-dose Aspirin. Normally, when you administer this, the fever plummets and the inflammation subsides.

"We started the treatment..." Jong-woon continued in a dry voice. "Right now, the IVIG is finished and it's the day after we used steroids, but there's no improvement."

"...What?"

For a moment, I felt like I had been struck on the head with a hammer.

In cases of refractory Kawasaki disease that doesn't respond to IVIG, steroids are aggressively poured in as a second-line treatment. Yet, even after using steroids, there was absolutely no improvement? This meant one of two things: it was an ultra-malignant, intractable Kawasaki disease that needed to be reported to the medical community, or it wasn't Kawasaki disease in the first place.

Jong-woon pointed weakly at the monitor.

"That's why I called you. We've tried everything we can think of, but no answer comes out."

I urgently turned back to the comment section I had kept open in the void.

Korean Slave 1 (Male): They say it's not Kawasaki. They already slammed him with both IVIG and steroids, but there's zero improvement.

A few seconds flowed by after posting the comment.

Pediatric Ghost: Oh... oh shit.