Part 2 

Critical Caring

On the emergency shift, just after 6 p.m. on a Friday evening, a distraught woman arrives with her cat, who may have ingested antifreeze. Van Beek, who arrived just moments before to start her weekend-long shift, meets the woman in one of VRCC's four exam rooms and examines the cat, Dolly. It is apparent that Dolly is already in renal and kidney failure. Van Beek explains that 95 percent of animals will not survive in cases like this one. They could try giving Dolly fluids for 24 hours, but the outcome doesn't look promising. As Dolly's owner digests the reality of the situation, it is like watching someone's worst nightmare play out. "I don't know what to do," the owner says, crying into a tissue. She leaves the room to make a phone call, and van Beek stays with Dolly, stroking her and observing. The woman returns and van Beek fixes her deep-set eyes on her until the woman gives the word to euthanize Dolly. Van Beek drops her eyes and shakes her head slowly. "I'm sorry," she says. The exam room door swings closed, and the muted sound of sobbing seeps into the waiting room.

Scenes like this one are common at VRCC, but never become commonplace. The staff takes its own emotional hit every time an animal dies. Catherine Carpenter, licensed veterinary technician, says it never gets any easier. "When it does, I'll quit," she says. "When I stop crying when an animal dies, I'll be done."

Photo by Stephen SalpukasCyndi Morris retrieves Sunny after his first day of chemotherapy. He'll come back every three weeks for more treatments. Morris says she and her husband agreed to chemotherapy after a "flood of tears." Unfortunately, chemotherapy can only slow down the aggressive tumor on Sunny's liver. When asked how long the doctor says Sunny has, Morris chokes out one word: "Months."Carpenter spends much of the morning tending to Casey, an 8 1/2-year-old yellow Lab mix, who lies on her left side in the corner of the ICU on a Tweety Bird comforter with her name and a heart drawn on it in marker. She wears a purple glow-in-the-dark collar with stars and crescent-moon designs. IV fluids pump into her through veins in her leg. A large incision traverses her abdomen from surgery to remove a mass from her spleen. She was sent from her veterinarian to VRCC shortly after the surgery when she began developing blood clots all over her body, and Fallin fears there may be a clot in her brain. She responds by lifting her head when techs come to check on her or to simply offer some affection. But mostly she lies there, her stomach rising and falling in quick heaves.

Veterinary Technician Emily Wyatt, who hopes to go to veterinary school after she finishes her undergraduate work, says the emotions of working in this environment are powerful, and every so often, overwhelming. There have been times when she's had to go outside, "bawling my eyes out and thinking, 'What am I doing here?' Then you come back in and see the ones you've helped make healthy, and they kiss you. And it's, 'OK, that's it. That's why you do it.'"

Photo by Stephen SalpukasVeterinary Surgeon Peter Trevor examines a broken bone before surgery as Veterinary Assistant Bonnie Small helps hold down the patient.The openness of the attachment between professional and patient is what makes animal medicine fundamentally different from human medicine. The natural physicality between people and animals — petting, kissing and nuzzling — continues through the medical process. While your family doctor would never think to give you a hug or a kiss or stroke you behind the ears while performing a blood test, this is skill No. 1 for vets and vet techs. It is constant. They even do it unconsciously, stroking anesthetized animals while prepping them for surgery. It seems almost as much for their own comfort as for the animal's.

The lack of verbal communication between people and animals breaks down another barrier. Again, your doctor would never say, "Oh, crap. A tumor on your liver" during an ultrasound. But here, all feelings come right to the surface. There is no need to mask emotion in front of these patients.

Photo by Stephen SalpukasVRCC's surgical services go beyond the normal spays, neuterings and repair of simple fractures. This Dalmatian was doing just fine after surgery to open his urethra.Though more than half of VRCC's internal medicine patients have only a six- to eight-month life expectancy, all is not doom and gloom. There are plenty of laughs behind the "employees only" swinging door, lots of horseplay with the dogs, lots of baby talk and ear scratching with the cats. There are a few adopted pets that hang around too: Elvis, the fluffy white office cat who serves as a blood donor in exchange for boarding and feeding; Megan, the golden retriever puppy with a juvenile bone disease who divides her time between the hospital and Fallin and van Beek's home. Then there are the two goats in the pen out back near van Beek's garden.

In the midst of much sorrow, there are plenty of reasons to smile. Within feet of where Casey is struggling for life, a yellow Lab puppy named Angel is providing all the comic relief. Angel is bloated because she ate too much. She may only be 6 weeks old, but she is a full-grown diva, demanding immediate attention with shrill little yips. "I AM the cutest thing in the room," she seems to be saying. "And I will NOT be ignored."

Then there are Shiloh and Missy, two dogs who are here for their monthly diabetes management. Techs will monitor their intake and output, and test their blood glucose. They are part of an insulin study being conducted at VRCC, among other hospitals.

Photo by Stephen SalpukasSpooky came to VRCC with so much fluid in his lungs, Fallin says "it looks like somebody started a smoky fire in there." After a few days in the oxygen cage, Spooky moved to a regular cage and is doing well.Missy is blind but both dogs are sprightly and cheerful, and seem otherwise in good health. Without access to this study, Shiloh and Missy would most likely have to take human insulin which, Fallin says, "is not as effective and makes it extra challenging for veterinarians, patients and families." More than half of diabetic dogs, he adds, are put to sleep in the first six months after their diagnosis. Many of the dogs involved in the study at VRCC have been doing well for as long as the study's been running — two years.

Shiloh's owner, Carole Welsh, says, "They really saved him over here. We would have lost him."

Spooky, a black cat whose lungs are filling with fluid ("It looks like someone started a smoky fire in there," Fallin says as he examines Spooky's X-rays.), seems to be rallying, and he is moved out of the oxygen cage and is eating.

Snowden, a Pembroke Welsh corgi, is here just for a follow-up visit after having had bladder stones, benign tumors and pancreatitis. "His mom is really worried," Fallin says. There are no owners here — only "parents" or "mom and dad."

Photo by Stephen SalpukasEmergency vet Olga van Beek removes a barbed fishhook from the paw of a 3-year-old dog named Khaki. "She's not an experienced fisherman," her owner jokes.Meanwhile, surgeries go on all day long, with surgeon Peter Trevor moving silently through his schedule: ear surgeries on a cat and a dog, repairing the severely broken front left leg of Rosie, a 2-year-old border collie, and opening the urethra of a Dalmatian — and neutering him in the process.

This level of care requires a high commitment for pet owners, who must manage medications and special diets. The commitment is a financial one, too. Welsh, the owner of Shiloh, the diabetic springer spaniel, says she pays $24 each month for the management of Shiloh's diabetes. She estimates she's spent about $1,700 in medical expenses for him.

That is fairly typical. A recent survey by the American Animal Hospital Association revealed that 38 percent of pet owners are willing to spend any amount to save a pet's life and 77 percent said they'd spend at least $500.

Pet owners at VRCC use a lot of the same phrases to explain their devotion: "He's part of the family." "She's like my baby."

Photo by Stephen SalpukasWhist seems unconcerned with her current back problems. She bounces around the ICU playfully after her myelogram — a procedure in which dye is injected into her spinal cord to diagnose the source of her back pain.Jenna Tyler, 34, of Charlottesville has three babies — Bailey, Baxter and Asta, all miniature schnauzers. She jokes that Bailey, the oldest at 13, is her "million-dollar dog." It may be an exaggeration, but Tyler estimates she has spent $1,000 in the last two weeks on Bailey, who has an enlarged heart and went into shock suddenly a week or so earlier. He's at VRCC for a follow-up echocardiogram, which will cost her $165. She says she has spent thousands more on Bailey and her other dogs. "It's not like I have the money," says the Ph.D. student. But she adds, "I'd sell my car. I'd do anything." Tyler confesses that she has booked more expensive direct flights when traveling with Bailey, so as not to put him through extra stress and travel time. Now, since the shock episode, she won't fly with him, so on a recent car trip to Pittsburgh, she mapped a route that would keep her no more than 30 minutes from 24-hour emergency veterinary clinics.

"It's weird how connected we are," she says.

Sunny's owners, Ken and Cyndi Morris, food brokers who live off of River Road in Goochland, have decided to go through with chemotherapy for Sunny. They estimate they have already spent nearly $6,000 in medical care costs for Sunny and his sister, Dusty, whose life, the owners say, was saved here when she was near death. But they agree that finances don't enter the picture when deciding how far to go. "As long as he's functioning and not in pain, we'll do what we need to," says Cyndi Morris.

Photo by Stephen SalpukasCasey's owners leave VRCC after their 8 1/2-year-old yellow lab mix is put to sleep.Winston, a 6-year-old chocolate Lab, also is racking up quite a bill. He's been here more than three weeks, and his owners have spent thousands trying to diagnose and treat his problems. At first, doctors thought it was kidney failure but the kidney problems are just masking the root of Winston's problems: his liver. Now, Fallin is walking a tightrope trying to stabilize Winston's liver without damaging his kidneys.

Winston's owner, Cameron Raquet, has decided with her husband to go forward with the expensive treatment. "We made the decision because he's our dog," she says while she and daughter Adeline spend time with Winston during hospital visiting hours. "We had him before our kids. He's like our first child."

The same day Raquet decides to go forward, Debbie Rhoads decides not to. She has brought her 7-year-old yellow Lab , Jenna, to VRCC for a second opinion. Jenna has been diagnosed with cancer of the cartilage. One option is amputation at the shoulder and chemotherapy. Two rectangular plastic patches are stuck to a shaved square on Jenna's right side. They are delivering fentanyl, a painkiller, which is making her more comfortable, Rhoads says: "Jenna wouldn't walk a month ago." But today, though clearly impaired, she bounces playfully and wags her tail nonstop.

After a closed-door chat with Fallin, Rhoads emerges, quiet and subdued. The pain seems to rise from her throat as it shoves the words through her reluctant lips: "I can't do it to her. I'm just going to let her go."

Meanwhile, Casey, the dog struggling in ICU, is a bit calmer thanks to some heavy sedation. She is covered with a fleece blanket and is sleeping peacefully. But the results from her blood work indicate she is going downhill. There are arrhythmias in her heart. Fallin speaks with Casey's owner by phone and the decision is made to euthanize her. The owner comes in with his young son, and they are taken to the consultation room, a small but comfortable room with a sofa and chairs where people often visit with their dogs. Casey is wheeled in on an exam table and gently lowered to the floor on her blanket. The boy's round cheeks redden as he sees his dog and he breaks down in tears, wiping them away with the collar of his Tommy Hilfiger T-shirt.

After it is over, Fallin darts from the room and heads straight back through ICU and out the back door, speaking to no one. He returns quickly — composed and ready for his next case.

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