The child's name was Erica.
Eri, for short.
It was only after she had been dragged into the clinic by Wangcho's rough hands and fed a few pieces of bread that I learned the truth.
"Munch, munch. It's not candy, but it's tasty, so I'll let it slide."
"So, Doc. You're saying this kid really isn't a blood fiend?"
Wangcho asked, his arms crossed, looking suspicious.
Eri, seated on the examination table, was still nibbling on the bread with wary eyes.
"She's not a blood fiend, she's a patient. The diagnosis is Paroxysmal Nocturnal Hemoglobinuria—PNH."
"Is that some kind of magic term?"
"Close enough."
I assembled various ways to explain PNH in my head.
Something, something, an autoimmune hemolytic disorder where red blood cell membrane mutations make them vulnerable to complement...
Hmm.
No matter how much I thought about it, they probably wouldn't understand.
So I just gave them an intuitive analogy.
"It's a disease where the blood breaks inside the body."
"Can blood break?"
"Just think of it that way. The reason your urine is dark when you wake up in the morning is because of this. Your blood is leaking out through your urine, so you don't have enough."
I pointed my chin—no, my beak—at Eri, who was eating the bread neatly.
"Just like how animals instinctively lick rock salt when they lack sodium, that child instinctively sought out pig's blood because she's deficient in blood."
This symptom is called Pica.
When people lack iron, they try to put anything in their mouths—usually dirt, ice, raw rice, and so on.
For this child, it just so happened to be blood.
"Hoo... Tsk, tsk. And here I didn't know."
Wangcho clicked his tongue.
The fact that the child he thought was a monster was actually a poor patient seemed to have touched the last shred of conscience he had left.
Then Eri, munching on bread, asked me a question.
"Mister."
"Call me Doctor Schnabel."
"Doctor sir."
What a kid who can't get the title straight.
I sighed and answered.
"Yes. What is it?"
"How did you know the color of my pee?"
Eri's red pupils stared right through me.
"Can healers tell the color of your pee just by rubbing your belly and flipping your eyelids?"
Oho.
I was inwardly impressed.
She had pinpointed the leap in logic in my diagnostic process that even Wangcho had taken for granted and glossed over.
'She's sharp.'
Diagnosing PNH immediately based solely on anemia, jaundice, and splenomegaly was closer to a logical leap.
It could be liver cirrhosis, leukemia, malaria... there were too many candidates.
"You're a smart one."
I reached out and ruffled Eri's messy hair.
The child flinched, her shoulders tensing in surprise. But she didn't avoid my hand.
"The truth is, I just got lucky."
"Ehh. That's disappointing."
"Deduction is basically a continuous act of throwing darts at the highest-probability target that might be the correct answer. In the end, its essence is never far from luck."
Anemia. Jaundice. And pica.
With just these three, I couldn't narrow down the candidates perfectly.
But I had another clue.
"Wangcho told me."
It wasn't Erica who reacted to my answer, but Wangcho.
"Me?"
"Didn't you say she 'comes to drink blood every night'?"
'Comes to drink blood every night.'
That meant it was highly likely the child's anemia worsened at night.
If I built a hypothesis from there, everything fit together perfectly.
There were no glaring contradictions in this hypothesis. So I just went for it.
That's deduction.
"Well?"
Eri's mouth fell open blankly at that explanation.
It must seem amazing that I could recite it as if I had watched from the sidelines.
Seeing her like that made the forced deduction worth it.
'This is why taking a history is important.'
It's not for nothing that doctors say listening to the patient is important.
Because sometimes this trivial difference in wording becomes the decisive clue.
Well, I was a trauma surgeon, so I hardly ever had to listen to patients.
'Honestly, though, it was luck.'
Actually, if her morning urine had been normal, I would've naturally moved on to another question.
I probably would've asked if her stomach hurt next.
Perhaps thanks to the power of delusion, I was able to hit the mark on the first question.
"Is your curiosity satisfied now?"
When my explanation ended, a brief silence fell.
'Pretty cool, right?'
Aren't I a genius?
Just like Sherlock Holmes, right?
While I was internally patting myself on the back, Eri nodded blankly.
Wangcho burst into admiration in her stead.
"Hoo... As expected of you, Doc. Now that I hear it, it all fits perfectly!"
Wangcho clapped his hands like a seal, his eyes sparkling.
This was why I liked Wangcho.
His reactions were always on point.
Yes. Clap more.
I'm the protagonist. I'm Doctor Schnabel.
"Now that we know the cause, is it possible to treat this child?"
At Wangcho's question, Eri's head shot up.
For the first time, a tinge of hope settled in those red eyes that had been filled with resignation and distrust.
You could also see the expectation that a doctor who had dissected the curse tormenting her so thoroughly must surely hold the solution as well.
Receiving both of their heated gazes at once, I answered nonchalantly.
"Impossible. It's an incurable disease."
"...Huh?"
Both of their expressions instantly stiffened.
***
PNH
Paroxysmal Nocturnal Hemoglobinuria
I don't know if I remember this correctly since I was a trauma surgeon in my past life, but I recall the injection for treating this disease being insanely expensive.
Was it Soliris?
I remember it being a crazy injection costing about 500 million won per year.
Even the cheaper one was around 300 million won per year.
I remembered it because it was in the lineup of the world's most expensive treatments.
I think it was even more expensive than anticancer drugs.
Of course, I didn't know the ingredients, let alone the composition of these treatments.
There was no way I could reproduce them in this world.
So I spoke honestly.
"It'll probably be difficult to cure the disease right now."
"...I see."
The light died in Eri's eyes again as she nodded.
The resignation that had lain there before returned to those red eyes that had just brimmed with hope.
Then, Wangcho urgently tapped my shoulder with his finger.
"Doc, your words!"
"?"
"Didn't you say it like that with my gout too?"
"Did I?"
Wangcho put his hand to his forehead at my reaction.
"The habit of saying 'It's an incurable disease' right off the bat, then adding 'but you can take medicine for it' way later! That's a really bad habit!"
...Have I done that before?
Now that I thought about it, I think I had.
I think I was called out for this by my seniors and residents in my past life too.
— "Yunho! Stop delivering bad news to the guardians right away! They'll faint from shock!"
— "Professor. I believe you've omitted the object again."
Tch.
Am I wrong?
But from a doctor's standpoint, if it's incurable, you say it's incurable.
Treatment and management are clearly different concepts.
Just like no one in this world says they cure diabetes; it's just a disease you have to manage.
"We can't lie to patients, can we?"
"This is why geniuses...! There's still an order and arrangement to how you speak, isn't there! If you start with the conclusion, ordinary people like us can't keep up with you!"
Wangcho sighed.
But I had a lot to say about that too.
I was taught in school to avoid giving patients false hope as much as possible.
They say no one sues out of resignation, but plenty sue out of betrayal.
So I tend to deliver the bad news first, but that's mostly just the conclusion.
Not knowing my inner thoughts, Wangcho turned away from me and crouched in front of Eri.
"Kid. You have to understand. That doc is just like that."
When his large body folded down, the hyena beastman's golden eyes were at about the same height as Eri's red ones.
"I'm just like you. I have an incurable disease too, but as long as I take my medicine, there's no problem living."
Wangcho looked this way.
"That goes for this kid too, right, Doc? There is more to the story, right?"
Though it was phrased as a question, the nuance was closer to 'There had better be more to the story.'
Under that silent pressure, I folded up the '180 reasons why PNH is impossible to cure' that I was organizing in my head and presented the conclusion.
"As Wangcho said, you'll probably have to live with this disease for almost your whole life. But I'll give you your daily life back."
We can't cure it, but we can manage it.
In fact, daily life will be less problematic than with gout.
Wangcho was relieved at my definitive answer.
The light returned to Eri's eyes.
On top of that, a hint of displeasure could be seen.
She seemed sulky, perhaps thinking I had played with words on purpose.
I could tell without even reading her eyes—her lips were pouting out a mile.
I pushed her lips back in with my finger.
"First, let's check the blood. The symptoms are typical, but we need to confirm."
I turned around and took out tools from the examination table drawers.
Wangcho looked at me curiously.
"What do we need to test again?"
"I told you, deduction ultimately relies on luck. Unless it's one hundred percent certain, diagnosing based on evidence alone is dangerous."
If you suspect a disease, you have to test for it.
The tools I took out from the drawer were none other than a glass cup, vinegar, and a syringe.
I picked up the syringe and gestured to Wangcho with my eyes.
As expected, Wangcho grabbed Eri's arm.
"Hold still."
Wangcho covered Eri's eyes.
In that time, I quickly drew blood.
"Wangcho. Press down hard. It's a disease where clotting doesn't work well to begin with."
Wangcho pressed firmly on Eri's arm with cotton.
In the meantime, I divided Eri's blood into two glass cups.
And I dropped a few drops of vinegar into only one of the cups.
Ham's Test (Acid Hemolysis Test).
It's a test that uses the fact that PNH red blood cells easily burst under complement attack in an acidic environment.
The results appeared immediately.
The blood without vinegar maintained its red and cloudy state.
But the side with vinegar...
"Ooh...! The color...!"
It turned into a clear, transparent grape juice color.
It was a stark hemolytic reaction (red blood cells bursting) that even Wangcho, who was ignorant of medicine, could recognize immediately.
'Ta-da~ Magical.'
If it weren't for my character, I would've cracked a joke like that.
Instead, I held it in and patted Eri's head as if to say she did well.
Eri stared blankly at her own blood that had turned transparent.
"What... is this? Magic?"
"Let's call it a trick rather than Magic."
I prepared for the next step.
Since the diagnosis was done, it was time for treatment.
'Since we can manage it with transfusions.'
PNH is a disease that can be managed to some extent with transfusions even if it can't be cured.
However, before transfusing, we needed to find the most suitable blood.
I pricked Eri's finger again to get blood.
And I took out the blood samples I had stored in advance.
To be exact, they were collected this morning.
Since there was no technology to preserve blood, it was my habit to collect enough from a few people each time I came to the clinic to last until the next day.
"I'll borrow some of Wangcho's blood too."
Adding to these samples, I mixed my blood and Wangcho's blood with Eri's.
"Hmm..."
Conclusion.
The cross-matching test results showed that Eri's blood type matched mine.
"Good. Let's do the transfusion the day after tomorrow when the blood is ready. Until then, stay at the clinic and we'll just adjust your nutrition."
"Trans... fusion?"
Eri tilted her head at the unfamiliar word.
I left her be and spoke to Wangcho.
"Please look after Eri. Until the transfusion in two days."
Wangcho nodded.
***
Two days passed, and the promised day arrived.
In that time, 200ml of my blood had been processed into a washed red blood cell preparation.
I went to the trouble of making a washed red blood cell preparation because if you transfuse whole blood to a PNH patient, it can trigger a hemolytic crisis.
However, the process of making this preparation was somewhat complicated.
Draw the blood, have Wangcho's subordinates tie it with string and spin it round and round to separate the heavy and light parts, discard the light parts, rinse with saline, spin again, rinse again...
After working Wangcho's subordinates to the bone, I was finally able to complete it.
'As expected, the pyramids really were built by people.'
Sufficient labor can replace technology.
And that labor can be bought somehow with sufficient capital.
According to that formula, as long as you know the principles, even twenty-first-century pharmaceuticals can be recreated at a nineteenth-century level of civilization.
‘Looks like it came out well enough.’
Just in case, I held the washed red blood cells up under the magic-stone lamp.
A clear, clean red.
It passed.
“All right. Let’s begin.”
I laid Eri down on the examination table.
Thanks to two days of feeding her, a little color had returned to her face.
Though that was only natural, considering how much iron-rich food I’d stuffed into her.
Any beast becomes docile once its belly is full.
Unlike two days ago, Eri’s temperament had softened considerably as she asked,
“…Will it hurt?”
“It’ll sting a little. But bear with it.”
I pricked Eri’s arm with the needle.
There was no beginner’s mistake of fumbling around to find the vein.
How many years did I make my living through surgery, after all? I could find a vein half-asleep.
The red liquid slowly flowed into Eri’s blood vessels.
One minute. Five minutes. Ten minutes.
“…”
Eri stared blankly up at the ceiling.
“How do you feel?”
“…I’m not sure.”
No problems. Check.
“Tell me if you feel dizzy or short of breath.”
Come to think of it, it’s been a really long time since I personally did a transfusion.
After I finished my residency in my previous life, I never had to find veins myself.
The residents or nurses did it all.
And so an hour passed.
The transfusion ended without incident.
Two hundred milliliters.
It wasn’t a large amount, but considering this child’s build, it was enough.
“Rest well today. We’ll check your condition tomorrow and decide whether to give you more.”
Eri nodded.
She climbed down from the bed.
I asked her to confirm.
“How is it? Are you still thirsty?”
“It’s a little better.”
“Good.”
Pica is easy to correct, too.
Once iron and red blood cells are replenished, it’s a symptom that disappears quickly.
A week from now, she probably won’t go looking for blood anymore.
“Let’s have you receive transfusions regularly like this. You’ll probably have to do it for the rest of your life, but that alone should let you live day to day without issue.”
Of course, it was impossible to make Eri’s illness disappear with transfusions alone.
If that were possible, those injections worth hundreds of millions would never have been developed.
Besides, PNH was a disease that required additional management from a doctor even while receiving transfusions.
But I didn’t bring that up in this hopeful atmosphere.
‘Managing those risk factors is my job anyway.’
Living an ordinary life shouldn’t be much of a problem.
She no longer needed to shove her head into a bucket and devour blood like a starving animal.
There would be no reason for people to point fingers and call her a blood demon, and no reason for people like Wangcho to kick her around.
Perhaps that fact still hadn’t sunk in.
Eri fiddled with the bandage stuck to her forearm.
As if her body, now beginning to circulate warm blood, still felt unfamiliar, the child repeatedly clenched and unclenched her fist.
Then she raised her head and met my eyes.
“…Why are you doing this much for me?”
“What do you mean?”
“I don’t have any money.”
Eri muttered in a voice that seemed to crawl back into her throat.
“All I have is these clothes. Mister… no, Doctor Schnabel, I don’t have the ability to repay what you’ve done for me.”
The child understood the rules of this back alley better than anyone.
There was no goodwill without a price.
Especially in Limbus Pit, kindness without a reason usually demanded a far more terrible price later.
Distrust and anxiety showed through her.
Usually, what was needed to dispel that was not sincerity.
“Then run errands for me.”
“What?”
In cases like this, what was usually needed was give and take.
I pointed at the clinic floor with my finger.
“You’ll have to be managed by me regularly anyway. So you can work here. I’ll take care of your meals and a place to sleep.”
“…Here?”
“I happened to need an errand runner. Picking up medicine, contacting patients, cleaning now and then. Can you do that?”
“…All right. I’ll accept.”
Her nod was stiff.
It was the kind of nod one gave when stamping a pledge.
But compared to just a few seconds ago, her wariness had clearly faded.
‘Strange, isn’t it?’
Just by turning charity without compensation into a transaction, a person’s guard can crumble this easily.
Whether it’s free or the price of a coffee.
Compared to the quality of treatment, it’s essentially the same as being free, but simply setting up this worthless little threshold changes the reaction.
It was the same in Korea.
“Wangcho.”
After concluding the deal,
I called Wangcho, who had been waiting outside.
“Starting today, I think this child will be the new errand runner. Could you teach her what she needs to do? The same way the other children did.”
“Understood, Doctor.”
Wangcho gave Eri a light push on the back.
As Eri crossed the threshold, she looked back once.
When I jerked my chin, telling her to go, Eri turned her head and left.
After the two of them went out, I was left alone in the treatment room.
As I put away the transfusion tools, I chewed over the conversation from just now.
— “All I have is these clothes. Mister… no, Doctor Schnabel, I don’t have the ability to repay what you’ve done for me.”
“Well. I don’t think so.”
I muttered to myself, words no one would hear.
Erika valued herself only that much, but I thought differently.
Now, let’s organize this.
It’s a rare disease.
And not just any rare disease, but one that only I can diagnose in this entire world.
On top of that, her blood type matches mine.
For a disease that requires regular transfusions, no less.
Here’s the question.
Would anyone who has read even a little web fiction consider this child an ordinary extra?
Of course not!
‘On top of all that, who knows? She might be a polymorphed dragon.’
She might be the future Sword Saint, or a childhood friend who becomes the strongest under heaven.
In other words, this is an event.
A buy-the-dip event.
‘Well, maybe not.’
Of course, she isn’t the first child I’ve taken in like this.
A year ago, there was testicular torsion; eight months ago, phenylketonuria; half a year ago, congenital clubfoot; three months ago, congenital diabetes…
All sorts of children have passed through my hands.
Each time, I treated and hired them, then explored their talents.
Among them, there wasn’t the SSR or five-star I wanted.
‘Still, this time feels a little different.’
It’s just different somehow. Hard to explain in concrete terms.
But what if, after saying all this, she turns out to be a dud again?
That would be disappointing, I suppose.
They say rain rituals are meant to be performed until it rains, after all.
‘For now, let’s start with errands.’
Just like the other kids did.
If we keep at it, one or two talents are bound to show up.
I just hope they’re the talents I want.