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From a pygmy hedgehog with mites to an elephant with an eye problem to the Dalmatian who must undergo disc surgery for his back ... from the close calls to the second decisions that can save a life, Animal ER is a moving testament to the healing powers of love and medicine -- and to the timeless bond between people and their pets.
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The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.
Chapter One
ICU 101
THE drive out through North Grafton, Massachusetts, is spectacular--once past the rows of modern Tudor-style developments, it is pure New England. Low, mossy stone walls gird hilly pastures. Green pines dot the corners of the vista, and maples loom large along the roadway. Cantankerous old farms stand in defiance of modern times--there's the Nourse Family Farm on the left, SINCE 1722 reads its understated sign. On the right, black and white Belted Galloway cows gather. On chill mornings they stand clustered, shrouded in the mist of their own breath.
No matter the season, the softly rolling fields, dressed in verdant greens of summer or the yellow ochre of winter, paint a scene of pastoral perfection. The meandering country road leads to a hilltop, where the open fields fall away on either side. Every day, just before sunset, everything here shimmers in a golden glow.
The soul-quenching beauty of the area, though, is lost on many of the road's travelers who are headed for The Foster Hospital for Small Animals. Set on the huge campus of the Tufts University School of Veterinary Medicine, it is one of the most sophisticated animal hospitals in the country, and the best hope for beloved pets in an emergency.
Here the cutting-edge field of emergency medicine for animals is pioneering new ground in a state-of-the-art, if cramped, department called the Intensive Care Unit.
Veterinarians travel that bucolic road every day, often before the sun comes up, gulping coffee and blinking themselves awake. They may very well not retrace their steps home till long after the sun has gone down. For patients making the pilgrimage to the ICU, they are likely in a heart-stopping panic to get help. The most they will notice is the DO NOT PASS signs that plague the entire twisted route.
Through the double sets of glass entryway doors is a typical bright waiting room, with the obligatory television set tucked high in a corner. Dogs, cats, birds, rodents, and reptiles wait to see veterinary experts in fields of internal medicine, dentistry, ophthalmology, and oncology.
It's not unusual to see an albino ferret getting an ultrasound, a cat a CAT scan, or a dog hooked up to EKG equipment. One could spy: a water dragon with a tummy ache; an African grey parrot with a prolapsed uterus; a cockatiel who had "aspirated," or breathed in a seed; and a pet rat with a swollen leg, bitten by a guinea pig. The staff of the Intensive Care Unit saves the lives of pets who have sustained the most terrifying traumas, animals who present the most puzzling and dire medical mysteries. Their stomachs have been perforated from swallowed sticks. Their systems are shutting down in shock. Their bones have been crushed by cars. They may be bleeding or choking or collapsing. Brave little animals make their way here, on the threshold of death, and it is up to a team of dedicated emergency vets and staffers to bring them back.
Frightened owners--experiencing what every owner dreads--race here hoping for miracles. Often enough, they get them. They enter the rarefied world of the emergency and critical-care veterinarian. Only three universities in the United States give this training, and Tufts is one of them.
Here, an elite team of doctors are solving cases that few others can. Their realm--the ICU--is truly a world unto itself, with its own rhythms, philosophy, and culture.
The rhythm is nothing less than frenzied. All the time.
The philosophy stems from compassion. That is the core. It colors everything that happens here and stands as a tribute to the bottomless capacity for kindness that some people possess.
The culture? Well, the culture is wild and quirky and intense.
Like any culture, it has its own dress code, diet, language, sense of humor. There's a talk and a walk that is particular to the ICU. Everyone writes notes to themselves on their hands--it's sometimes more convenient than paper. No one ever has scissors when they need them; they've always been left behind somewhere. And when a beeper goes off in a room, everyone looks down automatically at the pagers at their belts. The small cinder-block room of the ICU is lined with double-decker cages, each containing a melancholy fuzzy face. The ICU is crowded with high-tech equipment and high-energy people--three veterinarians are board-certified specialists in emergency and critical care. Under them are eleven residents--fully qualified vets themselves who are seeking to become specialists through a three-year training course. Currently there is one intern, a vet who will spend a year immersed in this kind of medicine. Then there are the fourteen technicians who hold everything together. They draw blood, monitor patients, give medicine (called "meds"), and yes, they clean cages.
The techs have made a fine art of animal care. Once, there was a dalmatian named Dickens who had just come through disc surgery for his troublesome back. He lay on a thick dog bed moaning and crying out. While many would have thought he needed an increase in his pain meds, one of the experienced techs came over and moved him a bit, speaking to him in reassuring tones. "Mostly, these dogs who have had back surgery are not so much in pain as they are anxious about not being able to move quite yet. Sometimes just repositioning a bit and talking to them does the trick." As she readjusted his limp limbs, Dickens relaxed, looking up into her face as she spoke. When she left the run, he closed his eyes and dozed.
The dress code here is simple: wear today what you will still be comfortable in tomorrow, since the shifts tend to spill over into the next day. That means clean blue scrubs; polar tech fleece tops; big, chunky boots.
The diet is simple too. The food is as fast as the pace here: subs, Chinese food, pizza. The residents working around the clock don't require a restaurant to have four stars, only that it own a delivery truck.
The language is interesting, a product of a unique culture.
"What's the best disease we can give him?" doesn't mean "Let's make this dog ill," but, out of all the possible things this dog could have, which would be the best, the most easily treated?
"I just killed her," translates into "I just euthanized that cat."
"Zap some rads," is to take X-rays (as in radiographs).
The extent of bone damage an animal sustains after being hit by a car might be expressed as the level of "crunchiness."
"Ataxic in the hind" means uncoordinated movement of the rear legs. If you hear about a "disease of middle-aged bitches," they are probably talking about something like pyometra, an infection of the uterus that tends to affect older, non-spayed female dogs.
If you want to get fluids into an animal fast, you don't use the slow IV drip, you "bolus" it in--injecting them fast. Suturing an organ in place is to "pexy."
"Icteric" dogs are jaundiced. Like little Brigitte, the cute dachshund whose eyeballs and gums were a strange, sickly yellow. Her red blood cells were being destroyed, probably by an idiopathic immune disorder. Idiopathic means of unknown origin, or as one vet says, "idiot medicine, because we don't have an answer."
On the quickie board outside ICU, the day's cases are written in erasable magic marker. The shorthand is in constant use under the complaint section. "HBC" is hit by car. A "down dog" is one that can't get up (a very serious situation). BDLD or "big dog little dog" means a little dog got chewed up by a big one.
At a sophisticated animal hospital such as this, sentiments like "Oh, it's just an animal" are rarely heard. Owners, though, sometimes balk at the estimate for treating pets. "I could buy four dogs for that much money," one grumbled. Yet many react like a hardworking owner of a cat with a mysterious, persistent anemia. The projected care could come to $2,000. The owner quietly said, "Oh, my God," but she went forward with treatment nonetheless, no matter the hardship.
Here, veterinarians have completed the same kind of medical training as physicians. All those arduous years of training were endured because of a passion for animals, certainly not for money (the average first-year vet in this kind of environment earns $18,000). Most veterinarians here say they knew all their lives this is what they wanted to do.
Dr. Nishi Dhupa, one of the heads of the ICU, recalls her decision to become a vet. In her soft British accent, the graceful, slight specialist talks about growing up in Nairobi. She was surrounded by the wildlife of Africa, but the culture certainly did not view animals as members of the family. Nevertheless, in the evenings, she would step outside to bid the guard dogs a good night. Once, while hugging one of them tightly, her mother reminded her that she should always love people more than animals. "Not me," she said without hesitation. And her fate was sealed.
Gregarious ICU resident Lisa Powell can also tell you the exact moment she decided to become a veterinarian. "When I was seven years old, I walked up to my dad after school one day and said, `Daddy, I want to be an animal doctor.' And I never changed my mind after that."
Dr. Nick Dodman, a Tufts vet and somewhat of a celebrity through his behavior books and TV appearances, didn't always know he wanted to be a vet. But the deep-feeling doctor was aware he was made for medicine. "I loathe suffering," he says. "I still am very upset by any stories of abuse. I've always had this tremendous empathy with people who are suffering and animals who are suffering, and to me it isn't any different." A pivotal moment in his career came when, as he was considering a veterinary education, he went to work for a veterinary practice in Surrey, England. The youngest vet there careened around country roads, traveling from farm to farm in a sleek sportscar. The droll Dodman says, "The turning point, for some curious reason, was that someone wrote in the dust on his car `Vet 100.'" The ability of this young, hotshot vet impressed Nick. "It was like magic, and I wanted to do that kind of magic too and make the animals well. And it seemed like such a healthy and honorable life."
For resident Ari Jutkowitz, the turning point came with the death of a beloved little parakeet named Charlie. At the time, Ari was six years old, and distraught at the loss of the bird. "In retrospect," he says, "I can figure out exactly what the problem was--he must have had psittacosis [parrot fever], which is common in parakeets. But anyway, from that point on, I was convinced I either wanted to be a pet store owner or a vet." Over time he "realized being a vet was the only way to go."
The clients can be just as committed. Often they have come for a second opinion or a more sophisticated diagnostic test, because their general-practice vets either couldn't decipher the problem or were ill-equipped to treat it. In any event, these people are seeking a higher level of medical care, and have already made an emotional investment to proceed even before they are asked to make a financial one.
The bills can be staggering. People may pay $2,500 for a dog's leg amputation with a follow-up chemotherapy. A dog hit by a car and requiring surgery, a long stay, and perhaps a ventilator can cost $4,000. Some bills have topped $10,000, and few clients carry pet health insurance, though it is available in most states. Out of 120 million pet dogs and cats in the United States, only about 75,000 are covered. With all the sophisticated and costly procedures, owners are increasingly asked to put a price tag on love.
The bond between pets and owners is immeasurable. And there probably is no real comparison--this love stands squarely on its own. The majority of American households--60 percent--include at least one pet. We'll spend $22 billion on those pets this year alone. We love them like family members, the polls tell us. We carry their photos with us and take them on vacation. When they die, the vast majority of pet owners report, the pain of losing them is as intense as it would be if a close relative had died.
Because of the intensity of that responsibility, the humor in the ICU can be as black and earthy as it is in any place on the front lines of sickness and death and tragedy. Like-minded wits are found among EMTs, cops, journalists, and undertakers.
For example, body fluids can inspire much merriment. When a rabbit urinated voluminously (a bright orange color) onto the white pants of a technician, and in the worst location possible, there were no politely averted eyes. Everyone unmercifully teased the tech about her "accident." Laughing all the way through the telling, exotic animals vet Rose Borkowski, a slim blonde who is normally very quiet, says with delight, "We got a lot of mileage out of that one!"
Scatological humor is abundant. Every year for the holidays, one staffer makes what is known as kitty litter cake. Though edible, it looks just like a pan of kitty litter, and a couple of Tootsie Rolls are placed on top for good effect. Everyone digs in with relish.
When a collie stood in a caged run that had just been vacated by a diminutive but similar-looking sheltie, someone laughs, "Hey, that dog is half the size he was this morning." Another tech shouts, "Quick! Add water!"
The joking is not always so innocent. One of the most compassionate "softies" of the ICU once walked away from a dead dog everyone had tried to resuscitate for a half hour. "Hope that owner didn't pick up dog food on the way home," she said, to hisses and shocked gasps. It wasn't her patient, and she could distance herself from this one, so she did. In this case, her joke simply said, I've had it with death and dying, and at least one of them isn't going to get to me.
Sometimes one has to wince at the unfortunately named dogs who come in. There's Lexus, who was hit by a car. Streaker had a leg amputated. Lucky was a pup who was first hit by a car and then slated for euthanasia when his owners could not afford his medical expenses. He was lucky enough to be adopted instead of put to sleep, after all.
Indeed, humor is the saving grace, because tragedy can be measured by the number of body bags on the gurney just outside the ICU doors. Some animals simply cannot be saved, like the husky whose entire internal workings were shut down by a massive infection. Some have the potential to be saved, but the owners cannot afford the care, like a Labrador retriever whose bladder was ruptured when he was hit by a snow plow. He had a good prognosis, but the owners could not afford the bill, which would have been at least $800. In other cases, owners give up even when the animal is getting better. One pit bull who had his skull fractured by a car came in with blood dripping from his ear. One eye was rolling around independently of the other, in what is known in medical parlance as nystagmus (rapid, involuntary eye movement, which can indicate a problem with the central nervous system). After several days of intensive care, just when his brain swelling was coming down, his owners pulled the plug. They were daunted by the amount of care he may have needed at home.
While the experienced veterinarians have learned to steel themselves (mostly), residents plunge headfirst emotionally into every case. Because they are on the front lines--admitting patients, meeting the owners, and managing the care--the emotions are raw all the time.
Ari Jutkowitz, the twenty-seven-year-old resident who is the dictionary definition of compassion, has his feelings battered during nearly every shift. "I tend to treat emotionally," Ari says. "It seems to me, more emotionally than a lot of the people I see here. I think it gets me into trouble a lot. I latch on to the animal. It's harder to function that way." The slight vet, with wavy dark hair pulled back in a thick ponytail, points out that others are eager at the prospect of solving a tough case, but he sees the agony of a patient before the thrill of medical science. "People who see it as a medical case get interested," Ari says, "but I think, `Oh, no! Another sick animal, this is really bad.'"
Ari says sometimes he can forget, but not for long. "In the rush of seeing the next case you can kind of turn off what you just saw in your last. But it catches up with you, so that two weeks later, when you have a day off and you're sitting around in your house, something reminds you. And I do get pretty upset by it."
Remembering traumatic cases, Ari gets teary-eyed and his lips tremble. He says, "I'm thinking back to one case in particular, a dog named Apollo. He was a rottweiler. He came in with a mass on his leg and also had some problems with his platelets, and with clotting blood. Probably what's called paraneoplastic syndrome [effects of tumor secretions on some body systems] related to the cancer. His owners were really great people who were trying to accept that their dog needed to have his leg amputated. But then we gave them worse news, that now he's got a clotting problem, and they ultimately decided to put him to sleep. I was pretty upset." It was an older couple, and they wanted to be in the room when Apollo was put to sleep. "I helped them take him out to the car, and I remember the owner saying, `It's okay, Apollo, we're going home now.'"
Gretchen Schoeffler, another ICU resident, also gets caught up in her cases. Every time the earthy redhead sees a pet, she believes in the animal, falls in love with it, roots for its recovery. After every case she turns to anyone close by and says, as though passing along a confidence, "This is a really great dog," or "This is a really great cat."
Dr. John Berg is the head of clinical sciences, and the hospital's top surgeon. At the age of forty-four, he is one of the senior staffers. Though this dark-haired vet looks like he should play the romantic lead in a movie, he sees the decrease of emotional involvement as a part of professional maturation.
"The younger the people, the more emotional they're going to get. The more fond they are of the animal, the more upset they get when the animal dies. Have you ever seen any of the doctors, the professional staff, crying over an animal being put to sleep?" he asks. "Not that they don't care, it's just they've gotten past it."
Though the humor is a palliative, what really sustains the vets are the successes. The blue merle collie, in for a toxic reaction to heartworm medication, who bucks the odds and comes back to life after having been resuscitated. (It's estimated that fewer than five percent of animals who need to be resuscitated will ever walk out of an animal hospital.) The Irish setter who battled pneumonia after having a leg amputated and lived to go home, wagging that bright red tail all the way. The cat suffering from complete renal failure who triumphed over one medical hurdle after another. The cat "should have died fifty times" his vet said--but didn't.
The size of the room is tough to work in, but it also leads to an incredible intimacy. All the staffers know about all the cases, even the ones they have nothing to do with. So everyone participates in the emotion. You won't exactly see a group hug, but the humans do often react as one organism.
When Chelsea, a big, sweet St. Bernard, has her X rays clipped up on the light panel, everyone standing around groans in unison. The moth-eaten appearance of one joint indicates osteosarcoma, a painful, tough bone cancer.
But when Rufus, an outgoing yellow lab who was hit by a car and paralyzed in the rear legs, stands up for the first time, it is a big event. "Hey, everyone! Rufus is up!" someone yells, and a cheer goes up in the room. The vets suspected that his spine was just bruised and not permanently damaged, but you can never tell until a moment like this. "It's great to have to tell him to `stay!'" an ecstatic tech says as she leans over him to adjust his IV line.
As Ari says, to see a healthy patient go home after battling incredible illness is the best feeling in the world.
That's what they fight for. The ICU vets are ace pilots with a top-gun mentality. These vets see the most urgent cases, and often they have only minutes to think it through and act. Hesitation can cost lives. And you can't ask your patient any questions. Their unique combination of encyclopedic medical knowledge, quick reflexes, and confidence saves animals. A certain kind of person is attracted to the ICU.
"Some of it is intellectual," Gretchen explains. "Some of it's the high, the adrenaline rush. I'm a junkie for that. Some of it's probably ego if you're honest with yourself. It's a very powerful position to be in. These are life-and-death situations." Gretchen says so many of these animals are so near death that no one could possibly blame you if lose them. But if you save them, you're automatically a hero. "We do lose a lot and that's tough, but when they go home, that makes it all worthwhile."
Lisa Powell thrives on the high-voltage atmosphere. "I like the challenge of an emergency, having [an animal] come to you and you don't know anything that's going on with it. You have this animal lying on the table and you go through your head: what could be going on?" she says. "It's immediate satisfaction. I like wound care and trauma--to me it's challenging. What could be wrong and investigating those things and fixing them."
Much of what these animal doctors do is medical sleuthing. Oftentimes, a dog will have run away and come home sick. Was she hit by a car? Did she eat poison? In one case, a dalmation named Spot was displaying strange neurological signs--shaking and trembling. Given the evidence at hand, the vets wondered whether he had eaten some moldy old meatballs that were tossed out, or if he had been hit by a car and a blood clot migrated to his brain. These are remarkably disparate scenarios, yet each one is a possible fit for what they're seeing. The problem is that each requires a very different course of treatment.
The case load can be overwhelming for the small staff. The residents work grueling shifts, rarely leaving when their actual time is up. The week before Christmas, Gretchen worked a two p.m. to midnight shift, but found herself still treating animals in the ICU at six forty-five the next morning. They are scheduled to work every day for weeks on end, and even when they get a coveted day off, they find themselves coming in to check on a dear patient or to call clients.
The ICU is so captivating, it's almost like a cult. "It's always on my mind. Every day when I wake up, I'm like, `Hey, I'm going to work today. What about this case or that case?' I think that you get really attached to certain cases. I'm totally involved all the time," Lisa says.
An especially busy time for the ICU is Christmas. Other vets' offices are closed for the holiday, and the ICU at Tufts is open twenty-four hours a day, 365 days a year. Also, there seem to be more patients in distress.
"How many ways can you make a dog throw up?" Gretchen asks the fourth-year students who are in the current ICU rotation the week before Christmas. Although there is laughter, this is serious holiday planning. With all the chocolate and toxic mistletoe around, plenty of dogs will be heaving their stomach contents out onto the floor of the ICU. The preferred method turns out to be a dose of apomorphine--a morphine derivative--in the eye. This causes an immediate reaction and, just as important, the process can be halted quickly by simply washing out, or lavaging the medicine from the eye.
There's another, sadder reason the ICU gets so busy, though. Resident Maureen McMichael says, "In my old practice, they told me that the week before Christmas we euthanize more animals than at any other time during the year. And I thought they were nuts. It didn't make any sense to me. But the logic that they came up with is that people try really hard to hold on to these pets they love through the holidays, but often they finally realize that they just can't, the animal is too ill, and so they all come in, they sort of give up. The week before Christmas in my old practice I once euthanized fifty cases!"
In one sad example, an owner in a red holiday sweater with little embroidered packages on the front learned that her beloved old cat Bobo was dying. The woman visibly crumpled at the news, her tears falling on the festive sweater.
The training, the technology, the expertise, are all comparable to that in a human hospital. But is this like a human hospital? Patients should be so lucky.
When's the last time a physician crawled into bed with a patient and told him in a baby voice how cute he is? When has a nurse rubbed her charges' bellies and sung to them?
The animal ER is a place like no other.
Copyright © 1999 Tufts University School of Veterinary Medicine. All rights reserved.
