The blue window shade pulled down over the narrow, vertical window blocks out the bright afternoon sun and casts a strange glow inside the tiny, darkened room. The only other light comes from the display monitor and illuminated keys of a $107,000 ultrasound machine.
Sunny, an 11 1/2-year-old golden retriever, obliges his doctor, Ed Fallin, by lying very still on his right side. A licensed veterinary technician and a veterinary assistant pat and kiss Sunny and talk to him affectionately as they hold him in place. "Oh, Sunny, I know, honey. You're a good boy," says Veterinary Assistant Bonnie Small.
Fallin brings the ultrasound paddle to Sunny's shaved abdomen and in less than a second or two he blurts out, "Oh, crap. A tumor on his liver." Fallin drops his head slightly and the air seems to drain from the room, leaving the human beings deflated. "This sucks," the veterinarian says as he guides the paddle along the dog's abdomen to get a better look at the mass. "I'm not supposed to find it that fast."
Licensed Veterinary Technician Gail McDermott seems to be trying to console Sunny. "It's OK, buddy," she says, as she nuzzles his face to her own. Sunny, however, seems unfazed. Ever the good-natured gentleman, he is still wagging his tail as he is lowered from the table and led back to his cage.Photo by Stephen SalpukasVeterinarian Ed Fallin and Veterinary Technician Karen Grove check on the progress of Snowden, a corgi with bladder stones, benign tumors and pancreatitis. "His mom is really worried," Fallin says.
The Veterinary Referral & Critical Care animal hospital sits in what may seem an unlikely place in rural Manakin-Sabot, just off Rt. 250 within a stone's throw of the Red Oak Cafe. This privately owned, two-year-old facility with all its sophisticated technology is the only one of its kind in the Richmond metro area. Yet here it sits, just up the hill from Tom's Barber Shop, which opens two days a week.
It's a pleasant enough setting, but one can only imagine the hundreds, if not thousands, of lumps-in-the-throat produced by the turn up the winding driveway, past the St. Francis of Assisi birdbath to the two-story cinderblock building. This place is often the last resort for the sickest of the area's companion pets. Before it opened in 1997, dogs and cats in need of chemotherapy, complex surgery, and other high-tech diagnostic tests and treatment had few options: the Veterinary Teaching Hospital at Virginia Tech in Blacksburg three hours away, or facilities in North Carolina and Maryland, each about two-and-a-half hours away. Now, cats and dogs from all over the region are brought here for critical care treatment for diabetes, heart disease, cancer, trauma and a host of other illnesses.Photo by Stephen SalpukasBernly Bressler, veterinary assistant, checks the pulse of an emergency patient. The cat died later that night.
Sunny was brought here to VRCC earlier in the day by his owners, Ken and Cyndi Morris. The dog has had four tumors removed from his skin, the last two of which were found to be malignant. When his owners dropped him off with kisses and few tears earlier in the day for his ultrasound, Cyndi Morris had declared hopefully, "They're gonna make sure there's nothing else in there."
It is the kind of optimism one hears a great deal at VRCC, despite tremendous odds facing most of the patients. There are no yearly checkups or vaccinations, no puppy and kitten shots, no routine spays and neuters. No inherently happy cases.
Then again, this is no ordinary veterinary practice. To borrow a phrase from human medicine, VRCC is not a primary-care practice. The medical staff includes the three partners Fallin, a board-certified internist, and partners Olga van Beek, an emergency critical-care veterinarian, and Peter Trevor, a board-certified surgeon as well as board-certified internist Charlotte Davies and emergency critical-care veterinarian Julie Buzby. Animals see VRCC veterinarians only with a referral from a primary-care veterinarian. More than 300 local vets refer cases to VRCC. Photo by Stephen SalpukasFallin reports to Jenna Tyler the findings of an echocardiogram performed on Tyler's schnauzer, Bailey. Tyler makes no bones about her attachment to Bailey: "It's weird how connected we are."
One of them is Carole Dugan of Gayton Animal Hospital, who refers about three patients a month to VRCC. "In the past, [patients] had to go all the way to Blacksburg to Virginia Tech," for more extensive treatment, Dugan says. The presence of VRCC, she says, "has increased the excellence of our care in this area tremendously."
In addition to 24-hour critical care, the hospital also offers around-the-clock emergency care. (During regular business hours emergency cases are also taken on a referral basis, but after hours, it's your basic walk-in ER.) While VRCC sees its share of swallowed golf balls, fish hooks in the paw and broken bones, it is the referral and critical-care cases that constitute the bulk of the practice.
In its first year, Fallin says, the group expected to see no more than 1,600 cases. After the first year, the doctors had seen 4,500 patients in 9,000 patient visits. Photo by Stephen SalpukasJenna, a 7-year-old yellow Lab, has cancer of the cartilage. Her owner, Debbie Rhoads, has decided not to go forward with chemotherapy. Her pain is being managed with pain-medicine patches attached to her skin. "She's a pretty good patient," Rhoads says of Jenna. "A lot more patient than I would be."
For Fallin life is "the hospital and our kids." He and van Beek, who are married, live less than a half-mile from the hospital and easily pull 36-hour stretches at a time. Fallin estimates he works "only about 90 hours a week" and van Beek about 120. Their two children spend a great deal of time in the upstairs employee day-care center.
Fallin, 36, spent much of his boyhood on his grandfather's small dairy farm in Floyd County. "I knew I wanted to be a vet from when I was 11," he says, when his grandfather, who suffered from rheumatoid arthritis, needed his grandson's help giving the calves their antibiotic injections. "This is kinda cool," Fallin remembers thinking. At 13, he worked for a veterinarian in his hometown of Martinsville. Later, his mother worked for a large group of physicians, who encouraged Fallin to go to medical school human medical school, that is. "I wasn't interested in it at all," he says. Photo by Stephen SalpukasAfter their death, animals are weighed and sent to a local company for cremation, or the family may take the body for burial. Staff say they never get used to the many losses they deal with here. More than half of VRCC's internal medicine patients have a life expectancy of just six to eight months. Less than 10 percent of patients are admitted with non-life-threatening illnesses.
Instead, he went to Virginia Tech for both undergrad and the four-year veterinary medicine program. He went into private practice in Charlottesville and later in Martinsville. But he found himself frustrated when he could take cases only so far in terms of diagnosis and treatment. He went back to Virginia Tech to do a three-year residency in internal medicine while studying for his master's degree.
Fallin's experiences on the farm and in the classroom exist harmoniously in one personality, which toggles breezily between gregarious, plain-talking country-boy and skilled, knowledgeable physician.
Even with a packed house in the intensive-care unit, a day's worth of tests and procedures ahead of him and two unexpected emergencies on the way, Fallin never seems to lose his cool. His emotions are a different story.
"There's not a person here that doesn't get upset and teary-eyed," he says after Sunny's ultrasound. "We see so much death and illness. It's hard to watch somebody lose something that is very close to them."Jump to Part 1, 2,Continue to Part 2