Chapter 9 — The One Who Keeps The Venom Saves People

The second snake of the night — the first and only one caught from the earth god temple mound — rested in Du's grip, much less ferocious than when it was first caught, perhaps thanks to the twenty minutes of rest in the dark quarantine cage. She gently pressed its head down to the mouth of the collection bottle, her movements precise to the millimeter even though her hands were still a bit numb from the cold.

"Keep the membrane straight, don't let it slack." She reminded Khiem, who was standing opposite, that his hands were much steadier than the first time tonight.

The snake bit into the rubber membrane, two fangs piercing through the thin membrane. Du gently stroked both sides of the jaw, forcing the venom gland to empty its contents. The venom flows down, thick and viscous, continuously dripping to the bottom of the glass jar.

"Look." Khiem whispered, not taking his eyes off the amount of liquid that was accumulating. "Much more than you did in the afternoon."

"This one is bigger, the venom glands are more fully developed." Du continued to stroke the animal's cheeks, not missing a second of the process even as her mind was calculating other numbers — time, required volume, dilution ratio.

Thirty seconds passed. Forty seconds. Finally, the last drop of venom fell, and Du released the snake back into the container, gently but firmly.

"How much?" She asked immediately.

Tilt the bottle under the light and read the scale on the wall of the specialized measuring bottle. "Five point eight milliliters."

Du did the math in his head, comparing it with the data table on the dose of venom needed to create a unit of serum with enough neutralizing titer. Five point eight milliliters, plus four point two milliliters from the snake collected earlier in the evening — a total of ten milliliters of raw venom. Not much, but enough to get started.

"Mr. Thanh, we need to immediately use this part of the venom to give additional injections to Kieu's horse, speed up the increase in antibody titer, and at the same time extract a small portion to test the cross-reactivity with the plasma already available from the previous immunity round." Du said, took off his gloves, and went straight to the sample refrigerator.

"How long do you think it will take for the cross-reaction test results to come back?" Khiem asked.

"The fastest is two hours, if the centrifuge doesn't malfunction." Du took out a bottle of horse plasma Kieu had stored from the previous harvest, the label clearly stating the date and the most recently measured antibody titer. "Ngua Kieu reached a sufficient titer five days ago for common viper venoms in the area. But Mist-Scaled Viper has a different toxin composition, we need to check to see what percentage of the newly collected venom its existing antibodies can neutralize, before deciding on the dosage for the patient."

She began the process of diluting the sample, working quickly and accurately even though her biological clock was signaling an almost white night. The micropipette draws up each microliter of solution and drops it into test wells on the reaction tray, each well containing a different plasma concentration to determine the neutralization threshold.

"In the meantime, I'll prepare the crude plasma filtration process." Thanh said, has begun taking out the necessary equipment — centrifuge, 0.22 micron filter membrane, sterile kit. "If the test results are positive, I need to process it immediately so it can be sent out tonight."

"What do you think the success rate is?" Khiem asked, unable to hide his concern.

Thanh stopped for a second and looked at him. "I don't dare to promise any numbers, because this is not a standard process that has been tested many times like fully purified serum. But Kieu's horse plasma already has anti-Mist-Scaled Viper antibodies at a certain level, although not optimal. In this situation, an imperfect serum is better than nothing."

All three people worked silently, only the sound of the centrifuge whistling steadily and the sound of rain continuously tapping on the corrugated iron roof. Du kept glancing at the clock, every minute that passed in her mind was associated with the image of baby Nhi lying in a hospital bed twenty-two kilometers away.

Her phone lit up on the table, finally receiving a signal when she was close to the area with the camp's broadcast tower. A series of messages from Thu appeared, each message a few minutes apart, clearly showing that the level of impatience had gradually increased over the past two hours.

"Please read Thu's message." Khiem said, glancing at the bright screen. "It seems very urgent."

Du picked up the phone and scrolled through each line. The blood has not yet completely clotted. Blood pressure is maintained thanks to infusion but is not stable. The provincial hospital has had positive signals about the transfer of fresh frozen plasma, and the ambulance is expected to depart within an hour if the road does not flood further.

She called back immediately. Thu picked up the phone after one ring.

"Miss Du, finally contacted." Thu's voice sounded relieved even though she was still tense. "The province has agreed to send plasma. A lady named Tram from the Pharmacy department called me directly ten minutes ago. How about your side?"

"We just collected another ten milliliters of venom from two individuals, and are processing Kieu's horse plasma to make a temporary serum." Du glanced at the still spinning centrifuge. "Initial test results show that sixty-five percent of the venom is neutralized. Combined with the fresh plasma sent from the province, the total effectiveness can reach eighty percent or more. I will send the first dose as soon as the treatment is finished, about an hour from now."

"Can the baby still endure another hour?" Thu asked, her voice unable to hide her worry.

Du did not answer immediately, because she also did not have a certain answer. "You keep the baby as stable as you can. I'll do it as fast as I can here. That's all we both can do right now."

Thu was silent for a second, then spoke, her voice regaining some of the steadiness of a doctor trying to hold his own. "I trust you. Call me as soon as the serum is available."

Du hung up, put the phone down, turned to look at Khiem and Thanh, both of whom were waiting for news.

"The province has agreed to send plasma." She reported back. "The bus leaves within an hour."

"So we have two sources at once." Thanh said, his eyes flashing with a ray of real hope for the first time tonight. "The serum is temporary from here, the plasma is from awakening. If both of them arrived in time, the situation would be completely different."

"The problem is that both have to cross the same flooded road to get to Son Trach." Du reminded them not to be optimistic too early. "I haven't passed the most difficult level yet."

Thanh nodded, the excitement that flashed across his face subsided into more serious concentration. "Then we can process the plasma and immediately calculate the transportation plan. We can't wait until we have the goods in hand before struggling to find a way."

At four thirty in the morning, the first cross-reactivity test results appeared on the spectrometer. Du stared at the number, then let out a long breath.

"Sixty-five percent." she said. "Kiao horse plasma neutralized sixty-five percent of the Va Suong venom tested at standard concentrations."

"Is it enough?" Khiem asked.

"Not enough to use alone, but enough to combine with previously injected polyvalent serum, plus supportive therapy with fresh frozen plasma to compensate for clotting factors from the provincial hospital." Du began calculating the specific dosage, carefully writing down each number on paper. "If all three sources are combined, the total neutralization effect can reach eighty, even eighty-five percent — enough to stop further progression of the coagulation disorder, giving the baby's body time to recover the rest."

"So how do we handle this plasma now?" Thanh asked.

"Centrifugation removes cells and large debris first, then filters through a 0.22 micron membrane to remove bacteria and some unnecessary protein impurities." Du stood up and put on new gloves. "This process cannot remove all impurities like the standard F(ab')2 purification method, so the risk of allergic reactions during infusion is still higher than usual. We must clearly write down this warning when sending, so that the hospital can prepare anti-anaphylactic drugs and monitor closely for at least the first thirty minutes of infusion."

She began operating the centrifuge, placing the test tubes containing plasma in the correct balanced position, closing the lid, and starting the rotation program at the pre-calculated speed and time. The machine hissed, and during that waiting period, Du stood leaning against the table, closed his eyes for a moment, allowing himself to rest for exactly thirty seconds before moving on to the next step.

"Are you okay?" Khiem asked softly.

"I'm fine." Du opened his eyes and looked at the countdown timer on the centrifuge. Twelve minutes remaining. "Just trying to figure out if there are any missing steps, before I run out of time to correct them."

She stood up straight, stretched to wake herself up, then turned to her desk and began preparing the next steps while waiting for the centrifuge to complete its cycle.