One Week On Call

He looks well rested... must be his first night back on call.

Emergency work is part of what we do at Branchville Animal Hospital. We do it on a limited basis only, for several different reasons.  The on-call doctor stays plenty busy when they’ve got the phone.  How busy, you ask?  Well, it’s really unpredictable.  I have spent a full week on call without the telephone ringing (but that hasn’t happened in the last year or so).  On the flip side, I vividly remember my busiest emergency call day ever: I got 11 emergency phone calls between 7:30AM and Noon one Sunday.

The odds are that within our client base, something is bound to happen outside office hours.  I figured that I’d do one blog as a chronicle of what happens during a random week on call.  This blog is being written as the calls happen, and I’ll cover follow-up  care for those cases….. wish me luck.

Monday: My first day back on call. My associate takes the phone every other weekend- sharing coverage gives us both a chance to spend time with our families.  Just one call tonight- a depressed mastiff mix puppy that the owner suspected might have parvo.  She was correct.  Parvo, if you’re not familiar with it, is a devastating disease of puppies that is frequently fatal.  It’s a viral infection that usually kills via dehydration and secondary infection.  To treat the puppy, I placed an I.V. catheter and started antibiotics and antinausea medications.  I set the puppy up with a round of fluids dosed by a constant rate infusion pump.  The pump would ensure that the puppy would receive 50 milliliters per hour of I.V. fluids throughout the night to help prevent dehydration. If there’s an unsung hero in parvo treatment, it’s whoever invented the fluid pump.

Tuesday:  one HBC at about 6:30PM. “HBC” is veterinary shorthand for “Hit By Car”.  This dog was hit in the face and was hurting.  It had a broken jaw (it was difficult to determine the severity at this point) and what I suspected was a significantly bruised lung when I listened through my stethoscope.  We elected to stabilize for the night, get it out of pain, and deal with the jaw the next morning.  I’m cautious about diving into surgery to treat major trauma at night when I’m working solo. Trauma patients can be unstable under anesthesia. That’s the kind of thing you want to take on when there are plenty of other folks in the building to come running if you scream for help.  And yes, I’ll admit it…. I’ve had to swallow my pride and yell for help before.  It doesn’t even hurt my ego to think about it anymore.   Well, at least not as much as it used to.

Wednesday: Once the clinic opened, we started sorting out the jaw damage from the HBC incident.  We sedated the dog for X-rays and further diagnosis.  At BAH, we have the ability to wire jaw fractures back together if the fracture occurs in about the first 2/3 of the length of the jaw.  If the fracture is further back than that, then it gets beyond our expertise and surgical equipment and we refer out to a specialist. Well, this dog had it all: 2 fractures in the front of the jaw, and one fracture so far back that I knew better than to go after it.  Did you know that Birmingham has one of only 19 certified veterinary dental specialists in the nation?  We referred the case to him with an appointment made for Thursday.

On a different note, the parvo puppy from Monday started to turn the corner on Wednesday.  I was getting a little more optimistic about his chances.  No after hours calls, but I still had to go back to the clinic late that night to check on this little guy.

Thursday: one call. The case was disturbing enough that I feel that it might be better not to write about it.  Some things are best forgotten.

On the upside, Monday’s parvo case was looking a lot better, and Tuesday’s HBC dog got its jaw fixed by the specialist.

Friday: Cat fight with eye injuries:  An owner came home to find that their cat had returned from some sort of misadventure with a swollen eye. The eye looked pretty odd on physical exam, because the membranes around the eye were so enlarged that the eyeball itself was completely covered by puffy, pink tissue.  I could tell that it hadn’t been that way for long. I sedated the cat and found that some of the membranes were actually stuck to an abrasion on the eyeball.  I separated that, checked the eye again, and treated it with a painkiller and antibiotics.  Although it may sound odd, it is actually a very common type of injury.

The parvo puppy from Monday was doing well enough to go home Friday as well, feeling much better. Score one for the fluid pump.

Saturday: A good day.  We heard from Tuesday’s HBC dog, and it was back at home after being treated by the specialist. The cat with the eye injury went home looking better.  The cat’s owner even brought me a chicken biscuit for (second) breakfast as a thank you for seeing him the night before.  She had no idea how grateful I was for this.  We hosted a tour and Q+A session with a local Girl Scout troop just after we closed for business so there was no time for lunch in between.  The biscuit came in handy.  As an added bonus, the Girl Scouts gave me Thin Mint cookies (my favorite) as a thank-you for the tour, so I ate well.  Thanks, everybody!

Saturday night, I got a call from a family that was pet sitting a dog with a long-term illness.  The dog was not doing well. She had been diagnosed with cancer several months ago, but has had more than adequate quality of life up until now.  Things were changing now.  During the day, she had started having seizures, indicating that the tumor had likely reached the brain. I talked to the petsitter, but stopped short of taking any action until I could talk to the owner. The owners called me a few minutes later and we discussed what they wanted us to do.  They were coming back into town in less than 24 hours, and they really wanted to see their pet again before they had to say goodbye.  I understood.  The dog had been their companion for more than a decade. We settled on giving her a medication to eliminate any pain she was feeling and to stop the seizures.  I hoped we could buy enough time to get them back into town to see her one last time.

Sunday: I started off the morning following up with a case from Saturday.  I had run bloodwork on a sick dog during regular business hours on Saturday; the results were back from the lab Sunday morning.  The kidney values were worse than I expected.  I called the owner at about 8 AM, and things had not gone well overnight at home.  We brought that pet in for treatment early Sunday afternoon.  I also took a call to arrange for the cremation of an elderly cat that had passed away peacefully during the night.  While I was at the clinic handling bloodwork and the cremation request, another family made the decision to let a pet go that was suffering from rapidly progressive heart disease.

Mid-afternoon, I got a call from a lady who had taken over care for a VERY elderly dog after his owner had passed away.  He was having a rough time and had become dehydrated, had some vomiting troubles, and would not eat or drink. I could see that he had lost a significant amount of weight since I last saw him.  He was running a fever of 104, which explained a lot. We gave him a fever reducer and half a liter of fluids.  We talked about antibiotics and decided to give him some time to see what happens.  Given some other recent developments with him, it seems likely that he may have cancer. At his age, cancer is a tough diagnosis.  If we do wind up losing him, I will say this: he has had a long life, and a good one.

So there it is, one week on call at Branchville Animal Hospital. Emergency work isn’t the most cheerful part of what we do- if anybody’s calling you after the clinic closes, then something has gone wrong.  But thankfully, that’s just a small part of what veterinary medicine is to me.  Inside normal operating hours, I did routine surgeries, gave puppy shots, joked with clients, and wrestled with kittens.  There are certainly worse jobs out there to be had... I’m happy with mine.