Chapter 7 — The One Who Keeps The Venom Saves People

Son Trach district hospital at two o'clock in the morning was quiet in every hallway, only the emergency room was still lit, the heart rate monitor whirred steadily between the sound of rain tapping on the corrugated iron roof outside. Tieu Anh Thu stood next to the hospital bed, his hand adjusting the infusion speed, his eyes never leaving the screen monitoring Giang Bao Nhi's vital signs.

Blood pressure eighty over fifty-five. Heart rate one hundred and twenty. Oxygen saturation ninety-four percent — lower than the safe threshold but not high enough to require intubation.

The vial of Mist-Scaled Viper specific serum sent from the camp was injected nearly an hour ago, diluted in infusion fluid according to the recommended dose Du sent via text message. Initially, the bleeding at the bite wound seemed to slow down for about twenty minutes, enough to give Thu a glimpse of hope. But then, the baby's gums started to bleed again, more slowly but not completely.

"One vial is not enough to neutralize all the venom in the baby's body." Thu spoke to the assisting nurse, her voice trying to keep it professional even though a worry was rising in her heart that she couldn't completely hide. "Have another IV ready, in case more serum or plasma arrives."

She repeated the twenty-minute coagulation test right at the bed - a simple but reliable method that the district still uses when there is no specialized coagulation testing machine: take a few milliliters of the patient's venous blood and put it in a clean glass test tube, without anticoagulant, leave it for exactly twenty minutes, then tilt the tube to see if the blood has clotted or is still in liquid form. Blood will normally clot within ten minutes. If after twenty minutes the blood is still liquid or just clots into a loose, fragile clot when the tube is tilted, that's a clear sign of venom-induced coagulation disorder — and that's exactly what Thu saw when she tilted the test tube under the table lamp: baby Nhi's blood was still bright red, thin, flowing freely like water.

"Still not crowded." She muttered, recording the results in the medical record. This was the fourth test of the night, and all four returned the same worrying result.

She walked out of the emergency room, took off her gloves, and walked toward the corner of the hallway where the phone signal was more stable. Giang Tan Luc and Luong Thi Bong were still sitting there, on long plastic chairs close to the wall, neither of them slept for a minute.

"Doctor, my child..." Luc stood up as soon as he saw Thu, his voice hoarse from asking this question countless times during the night.

"The baby is still stable, his blood pressure is maintained thanks to the infusion, but the blood has not completely clotted yet." Thu said, trying to choose words that were both truthful and not extinguishing all their hope. "We are waiting for more plasma from the provincial hospital and more serum if the snake farm can find more."

"So you're not sure yet?" Bong asked, his voice trembling, his hand still clutching the small pink plastic slipper.

Thu didn't want to lie, but she also didn't want to say everything she was most afraid of — the risk of internal bleeding if the blood clotting disorder persisted for many more hours, the risk of kidney damage due to the accumulation of red blood cell breakdown products, the complications she had learned about in books but had never faced directly with such a young patient.

"We're doing everything we can." She said, placing a hand on Bong's shoulder gently. "You can trust the team, I will notify you as soon as there is new information."

Luc nodded, but his hand still gripped the plastic chair so tightly that his knuckles turned white. He wanted to ask more, wanted to know the exact percentage of the chance, wanted something certain to hold on to, but he also understood, looking at the eyes of the young doctor in front of him, that even she was waiting for something that was beyond the reach of both of them.

She turned and walked away, pulled out her phone and called Du again. The phone rang for a long time but no one picked up — Du was in the middle of a flood zone, outside the coverage area.

Dai Khac Thanh's digital letter.

"Mr. Thanh, the baby's condition has not improved completely after injecting the first bottle of serum." She said as soon as he picked up the phone. "The blood flow has slowed down but has not completely clotted. I need to know if the farm has found more individuals to extract additional venom, or if the provincial hospital has had any feedback about the plasma."

"Du and Khiem just reported back via the rescue team's radio that they caught one and is on their way back to camp." Thanh said, his voice clearly showing tension even though he tried to stay calm. "When we get there, we have to handle it immediately. They are expected to arrive in thirty minutes. The provincial hospital and Pharmacy Department have received your request in writing and are submitting it to the leadership for approval. There has been no official response yet."

"And how long does it take for that document to be approved?"

"I don't know for sure, maybe half an hour, maybe longer if I have to go through many levels." Thanh sighed over the phone. "I will call Dr. Khang over there to speed up the progress. You can keep the baby stable as long as you can."

Thu hung up the phone, stood with her back against the hallway wall for a moment, closed her eyes for a few seconds to regain her composure before returning to the emergency room. She had only been out of college for four years, this was the worst snakebite case she had ever handled, and the feeling of helplessness that all the right professional decisions were still not enough to change the situation — because of a lack of resources, not a lack of knowledge — made her more tired than any night shift before.

She entered the room and checked the bite mark on Nhi's ankle. The skin around it had swollen and spread almost to the thigh, a dark purple color spreading, and when she gently pressed the adjacent skin to check, the baby moaned softly in a coma, a pain reaction was still present, at least that showed that the nervous system had not been seriously affected.

That's the only thing that keeps Thu a little optimistic tonight - the venom of the Mist-Scaled Viper, although causing serious blood clotting disorders, is not in the group of neurotoxins like cobra or krait venom, and does not cause respiratory muscle paralysis. The baby still breathes on his own, still responds to painful stimuli, there's still time — it's just that time is shrinking at a rate she can't control with her own expertise.

"Come on, kid." Thu whispered, even though she knew she couldn't hear. "I'm trying my best, please wait a little longer."

Outside the emergency room window, the rain continued to fall, and farther away, in the flooded fields twenty-two kilometers from the hospital, a motorboat was plowing through the night, carrying what could be the last hope for the night — although the people on board were not yet sure whether what they had just brought back was enough.

*

On the boat, Du sat clutching the cloth bag containing the snake, still wet and shivering, but her mind had already turned to the next steps she needed to take as soon as she got back to camp. Venom extraction. Check the volume obtained. Calculate whether it is enough to supplement Kieu's horse's immunity, or whether it must be used directly to prepare temporary plasma.

"Miss Du." Khiem called, his voice was still a bit shaky but he had regained some composure. "Is this one enough?"

"Doubt." Du replied honestly. "But this is all I have right now. Go back to camp and figure it out."

She opened the waterproof bag and checked her phone again — there was still no signal, just the words no service in the corner of the screen. She imagined Thu standing in the hospital hallway, calling her over and over again but no one picked up, and that feeling of helplessness was more uncomfortable than the cold that was seeping into every fiber of her body right now.

"Mr. Nguyen, how far is it to the meeting point?" She asked, trying to push the thought away by focusing on what she could control right now.

"In about ten minutes, the water in this section will be less swirly." Nguyen replied, his voice less tense than when he left the temple mound. "You and this guy are really good, I thought it would take longer to find."

"Thanks to the fresh traces." Du said, his eyes still watching the rain ahead. "If it had been half an hour later, it might have crawled away, or the water would have flooded that corner."

Khiem sat still, holding his knees with both hands, trying to hide the tremors that remained in his body. He looked at Du from behind, realized that her figure was still straight, still alert in direction even though she had just experienced a moment when she was almost swept away, and in his heart there was a mixture of respect and worry - he wondered if one day he had to face a similar situation alone, would he be able to maintain such composure.

Nguyen accelerated, the boat's bow moved faster toward the distant lights of the gathering point, where the pickup truck was still waiting in the rain.