ONE: A NORMAL TUESDAY
I wasn’t even working on that Tuesday in April when a dog named Ocean came into our emergency hospital. I heard Ocean’s story days later with my mouth hanging open. It was one of those tales that can’t possibly be true, where you see it play out in your mind like a movie, and one that stuck with me as a defining moment of my veterinary career.
Even though I experienced this amazing case vicariously, it reminds me of all the others I have been there for – the countless quieter triumphs, the ones we tend to forget. Ocean’s story embodies the particular experience of working in a veterinary ER – the heavy lows, the slippery highs – and the people behind the scenes, whose victories fade into the background as they move onto the next emergency.
But let me get back to Ocean. Just so you can picture her: she is a Staffordshire Terrier, 65 pounds, that tawny color that is somewhere between gray and tan. She has a wide smiling face and squat, wiggly body. She is – to put it mildly – adorable.
Like many other dogs during the months between winter and fall, when the grass turns brown and prickly foxtails are everywhere – clinging to fur, poking into ears and noses, burrowing between toes – Ocean had been running in a field and, several sneezes later, mom and dad thought she might have a foxtail in her nose.
TWO: A NORMAL PROCEDURE
They brought her to our ER, where a plan was proposed to sedate her so our doctor could probe her nostrils. We explained the standard risks of sedation, which for most pets is negligible, but for some can be dangerous. Ocean’s parents consented, and why wouldn’t they? Foxtails can’t be left in noses; they do too much damage. We sedate patients safely every day. Ocean’s physical exam showed no abnormalities. We had no medical reason to suspect what would happen next.
THREE: AN ABNORMAL DEVELOPMENT
Ocean is sedated and our doctor probes her right nostril, which is clear. Then the left, also clear. We are disappointed not to have found a foxtail (it’s always good to have a definitive cause of symptoms) but hopeful we can give Ocean’s owners peace of mind with a clear search. Before the team can reverse the sedation, Ocean‘s heart rate slows. Then slows some more. She stops breathing.
A routine procedure has become a life-threatening emergency.
FOUR: TIMING IS EVERYTHING
The doctor calls a “code,” medical language for announcing a patient in cardiac arrest. Every able body within earshot runs to her, sneakers squeaking on linoleum. A lot happens in the span of seconds, then minutes, and time stretches sickeningly.
As Ocean’s heart flutters, the human hearts around her speed up as if to compensate, thumping in their chests as they work to bring her back.
FIVE: PERFORMING UNDER PRESSURE
The doctor yells out orders. Fluids. Intubation. Ultrasound-guided injections into her heart. A nurse climbs onto Ocean’s table and straddles her thick, strong body, starting chest compressions. Veterinary assistants stand by with pen and paper, recording numbers and medications for the medical record that must be written accurately later, no matter what happens now. After 45 seconds, they can’t feel a discernible pulse.
SIX: THINKING OUTSIDE THE BOX
The doctor calls for the defibrillator. The hospital has just upgraded to the latest, state-of-the-art model and a senior nurse on the floor has found herself in the right place at the right time.
She sees a box in her mind, the brand-new defibrillator, which is sitting upstairs awaiting its official introduction to the team. This nurse, who was a supervisor at the time (and now clinical manager, no surprise there) is in a unique position at this moment, not just because she remembers we have the new defibrillator, but because she has just read the 100+ page manual in preparation for writing a Defibrillator Standard Operating Procedure for the staff.
She doesn’t hesitate. She runs upstairs while the team continues to work on Ocean. She feels the kind of panic one feels when performing anything physical under the cold pressure of time. She finds the box and opens it, yanking it out of its plastic sleeve, throwing aside cardboard and those little twist ties that keep bread fresh. She runs with the defibrillator, about the size of a small microwave but heavy, clutched to her chest. Back down the stairs, where Ocean lies, unresponsive.
She recalls the manual as she plugs the machine in, remembers the correct joules setting, puts the gel on the paddles. She hands the paddles to the doctor, who yells for everyone to stand clear, and zaps Ocean’s chest. We’ve all seen this procedure on television medical dramas but what those shows don’t accurately portray is that it is rare that defibrillators revive an unresponsive patient.
They can work, but it’s rare.
SEVEN: AS SEEN ON TV
Ocean’s body, full of electricity, flies up off of the table! Sixty-five pounds of dog catapults into the air. A vigilant nurse, focused on Ocean like a wide receiver tracking a dog-shaped football, catches her and pushes her back onto the table. The team barely has time to recover from what has just happened before Ocean’s heart – faintly, unbelievably – starts beating.
Ocean is alive.
EIGHT: KEEP IT MOVING
There are no high fives. There are no screams of victory. Even though Ocean has come back, the team doesn’t stop to celebrate. They keep their heads down, doing the next thing, and then the thing after that: keeping her intubated, monitoring her vitals, waiting to see if Ocean will be able to breathe on her own, eat, walk, recognize her family.
The sad truth of veterinary medicine is that we’ve learned not to celebrate until the patient walks out of our doors. By that time we’ve moved onto the next patient who needs us, and our hearts race and stomachs drop in this way several times a day, and celebrating becomes an afterthought.
This is why I am telling this story. Because what happened that day, and every day, deserves celebration.
NINE: THE UNTOLD STORY
Ocean’s medical record reads like a medical record should. It records all the data, it states each event accurately and in the order in which they happened. What it doesn’t capture is what it must have felt like in the moment when, through an odd mixture of bad luck, solid preparation and quick thinking, a miracle happened.
TEN: THE THINGS YOU HOLD ONTO
Every time I am tired, or frustrated, or want to quit (the idea occurs to me from time to time, especially during these tough pandemic years) I remember Ocean.
I think of my teammates in the humble trenches of a veterinary hospital, doing the unglamorous work of patient and client care: cleaning up bodily fluids, explaining expensive estimates, working through lunches with their stomachs growling and morale running low.
I think about how Ocean disrupted this seemingly endless slog of medical minutiae, needing a miracle, and how these people rose to the occasion. And continue to do so, despite unhappy endings, holding out hope that such miracles can happen again, simply because we are willing to keep trying.
I think of how the doctor’s stomach must have sank when Ocean’s heart stopped under sedation.
I think of the many doctors I work with who advise owners to the best of their ability and how sometimes things just don’t work out. How heavy that must weigh on their hearts, which must be taught to break and repair themselves as they get up each morning to do it all over again.
I think of the sudden choreography of veterinary staff when a patient codes – something I’ve witnessed many times – bodies animating, jolted into action, operating on muscle memory and adrenalin, creating a messy and beautiful dance that doesn’t always end in applause.
ELEVEN: THANKS OCEAN
So here’s to Ocean, who happened to make a full recovery, and to this day remains happy and healthy, playing in the backyard with her brother, Poet. Here’s to Ocean’s family, who are aware of her heart condition and can have it monitored, treated, and taken into account for future medical procedures. Here’s to Ocean’s team – not only the Emergency crew – but our Internal Medicine and Cardiology teams who followed up on her aftercare. Here’s to the resourceful nurse, who remembered that box and read a long manual, having no idea how spectacularly her work ethic and attention to detail would pay off. Here’s to veterinary workers in general: the fast thinkers, the preparers, the cleaners, the walkers, the caregivers. The heroes I eat lunch with, and joke with, and occasionally cry with, who happen to be pretty darn good in an emergency.
I shouldn’t be surprised. We don’t work in an ER for nothing.
Vickie Jean DeHamer is the Client Care Hospital Service Manager at PESCM. She helps pet parents by day and writes by night.