How I Get By: Three Days as an ER Vet During the Pandemic

The coronavirus pandemic has ushered in a surge in people acquiring pets, for better or for worse: Everyone wants more companionship, but it’s never been more difficult to take a new puppy to the vet. That’s where veterinarians like Sarah Mueller come into the picture. Mueller works as an ER veterinarian in Cincinnati, Ohio, and told VICE that she views providing comfort for her patients, and their “pet parents,” as an essential function of her job. But she has to balance that with the cost of care.

“I worry as the economy gets worse, what that's going to mean for my pets, my patients,” she said. “Right now, people have less disposable income to spend on their pets. They're not making very much money and there's no aid package in sight. Do they spend the little bit left they have in the reserves on the extra testing or treatment for Fluffy at the ER vet? Or does Fluffy have to take a backseat?” 

We’re all likely to be spending the next few months having difficult conversations, and Mueller says the conversations she has with pet parents every day are no exception. Here’s what it’s like to practice veterinary medicine right now. 

It’s 10:30 p.m., and I’m just getting into my car to leave work—my shift started at noon and ended at 8 p.m., but it’s pretty standard for me to be here for two or three hours afterwards because of paperwork or rounding over patients to the next doctors. We’re almost never out on time with this job. I can't complain too much today, actually. I had a normal (compared to pre-COVID) number of patients today, only six or seven. Sometimes there are, you know, 10, 20 patients waiting, and the doctor that's been there before you is already clearly overwhelmed and unable to take any more cases. 

In COVID world, all of the communication and discussion with the pet parents is over the phone. I work at an emergency and specialty-only hospital, not a general practice, so I show up and just start taking cases. Pet parents drive up to our front set of doors and they see our phone number posted there, they call in and our front desk staff takes the phone call to find out what’s going on with Fluffy. Then, one of our technicians or assistants will come out, get Fluffy from the car, and have a brief conversation with the owners, and then take Fluffy in and take her initial vital signs. If there's anything that deems the patient unstable, like a really fast heart rate or really pale gums, they’ll alert the doctors right away. 

Once they’ve done that initial triage, they call the owners back and then tell them the wait time. If the patient is unstable or in critical condition, hopefully that time is relatively short. But if they are stable, it’s going to be a while. We've had so many patients coming through since the beginning of COVID, that it used to be one, maybe two hours from the time an animal got there until a doctor picked up their case. Now, we regularly have six to eight hours of wait time between a patient arriving at the hospital and having a doctor pick up and take over their case. Since pet parents can’t wait in the hospital, they can either stay in the parking lot, or, as we encourage, go home, run errands, do something else. 

Before COVID, we wanted pet parents to sit with their pets in the lobby to keep them comfortable and keep an eye on them, and so we could call them in right away when we were ready for them. People often waited at our hospital for those periods of time and then waited again more for test results, etc, so it was much more like being at the human ER. We don't like separating these babies from their parents, but I’ve also seen some unintended benefits; one is that people aren’t as upset about wait times, because they can go home and wait there versus in our lobby. 

The other thing I see as a benefit is that pets just hang out with us in the triage area now; I get to know them a little bit better than I used to in ER medicine, because they’re sitting with me, I’m helping them be as comfortable as possible. We try to bond with them, and then we see their personalities come out a bit as they start to relax and settle in. I also get to see more of how they’re doing once that initial adrenaline rush wears off. Maybe their lameness is not as subtle as it was when they first got to the hospital, maybe their cough is a little more pronounced than when they first got to the hospital. Because I get to spend this time with them, I might get a better glimpse into what's wrong with them, too. 

My first patient of the day stuck out the most, because I had to diagnose something that the pet parents weren't expecting at all. This dog had some fluid around his lungs, which we caught by doing a quick ultrasound probe of his chest.

That led to the kinds of conversations I have to have with Mom and Dad, explaining fluid that the concerns we’d have would be cancer, heart failure, and potentially infection. Unfortunately with this little guy, cancer had to be my top thought. So then we had to talk about what the “next steps” are. My goal is always to make sure that I'm explaining things as best that I can, so that people can make the best decisions for their pets, because my job is not to make the decision for owners. They are the ones who know, their dog or cat, or other animal best. I work to make sure they understand all of their options and give them as much of my medical expertise as I can, then let them make a decision from there.

For this little guy, and I don’t think it was the wrong decision because he’s breathing comfortably for now, they just elected to take him home and keep an eye on him, and fill his life with as much love and happiness and good food as they can until his breathing gets worse, which it will. And then ultimately they'll have to elect euthanasia. 

Those are conversations that I have several times a shift, at least, how to handle and manage that -  but with all that also comes the cost. I always tell people, if you don't have pet insurance, get it as soon as possible. I don't think a lot of people recognize how expensive testing and treatment is. That has to be part of the decisions and conversations I have with clients. On the flip side, I work at a place where I can offer testing just like human hospitals do which includes things like MRI and ultrasounds. So it's a constant balance between, “I can do all these things, but should we?” and “Can my clients afford those tests and treatments?” It’s all about finding best case scenarios, balancing finances and treating pets appropriately. 

I'm lucky enough to bring my own little dog to work with me, which is helpful when I'm having tough moments or tough cases; I can snuggle my little one. The day started off pretty sad: We had an owner whose dog suddenly couldn’t walk the night before, and unfortunately, the best decision for that dog was euthanasia. 

I wasn't the doctor who had walked through that path with the owner, initially - they were coming back this morning to euthanize. We often do connect closely with the owners and pet parents that we’re walking through everything with, we have very specific shifts. If it's a matter of just staying a little bit longer to be there with a family for euthanasia after we talked and connected with them, absolutely, we do that.  But if it's gonna be a couple hours, we have to kind of rein that in. If you stayed several hours for every family that happens to, you'd almost never leave.

It's always a little weird to walk into a room with an owner who you've never met and introduce yourself and say, “Hey, I'm Dr. Mueller, and I'm so sorry. I'm here with you to euthanize your little one.” Their first meeting of you, and probably their only association with you is to be with you for that moment, one of their worst moments. 

A lot of people wonder if (and probably assume) euthanasia is the worst part of my job as a veterinarian. Especially working in ER medicine, I do a lot of euthanasia, just by the sheer nature of it. We see the worst of the worst, the sickest pets who cannot wait another day, another minute, another hour for their vet at a regular scheduled appointment. We also see the ones that have had trauma. Plus, we have people who, even though they've known for months that their pet is walking towards that moment, that moment comes whenever it comes. That can be on a Saturday, it can be at 2:00 in the morning. 

But it isn't the worst part of my job, by any stretch. I think that it is one of the kindest options I have available for a lot of my patients. I get to provide a scenario in which a pet gets to be with the people they love the most in the world, hopefully, mostly relaxed. I give them medications that are the same medications people get when they're going under anesthesia, and then just heavy sedation medications as well. They don’t feel anything.They mostly just fall asleep, comfortably, instead of what death looks like for many animals and people, which is agonizingly drawn out. If I can change that narrative, if I can make that different for that pet and for their family, that is an honor, and it is kindness, and it is not the worst part of my job.

It is sad, though. I’m always sad but not always for the pet; I'm always sad for the family they leave behind. Having recently lost a dog of my own, it's sometimes really hard to get through it without infusing the process with my own emotions. But it's not my dog. And it's not my grief. It's the family's grief. It's family sadness. Keeping that first and foremost always helps.

So that was the start of my morning: meeting someone for the first time to euthanize a pet that he loved, considered his best friend. And it was traumatic. The dog was young. It's not ideal.

One of the patients that I saw and ended up hospitalizing was another dog that came in for trouble walking. What he really needs is an MRI, which is why he came to my hospital, but unfortunately, we can’t schedule that until Monday. I had to walk through that with the family and let them know he can hang out here with us until then. We're going to get him the testing he needs in two days, and I feel pretty lucky to be able to help both that dog in that family with that.

I used to rely on body language cues more, to make sure that people really understood the weight of the decisions they were making. Since I'm having to do all of my communications by phone, except for when I go into euthanasia, it does take away from the both the relationship I end up making with the client and making sure that everything I'm saying is being understood. I feel like I sound a little bit like a tape on loop, because I ask so  many times now in conversations with pet parents: “Do you have any questions? Have any concerns? Do you have any more questions?” 

I used to feel really bad about saying this, but when you have really bad news, you feel weird if you leave and the family isn't crying, because you worry that maybe they didn't understand and that maybe you didn't get your point across. 

We're also starting to see more people resistant to the COVID policies we have in place, which they weren't at the beginning of the pandemic. I think as other areas of our communities start to get more lax, they're expecting that we are too. But I think as scientists and medical professionals, we're still following the numbers. It's hard for us, especially here in Ohio, to feel comfortable in any way letting our guard down. 

We have a hospital already kind of short-staffed, that we have to keep running 24 hours a day, seven days a week. It's already hard enough to do that without having a bunch of people either have to get either sick or go on quarantine because of COVID. 

It’s 11:30 p.m. I got here at 8 a.m. I still have a good two hours worth of paperwork to do, but I'm gonna go home and do it from home. These days are just so long, especially when you're the doctor on duty. I ended up having a lot of patients today, and the one who stuck out to me the most was a dog who fractured his leg. 

His best chance at going back to being a normal, happy, healthy dog is to have surgery to put in plates and rods and stuff, just like when people break their legs. But the problem we often run into is, that kind of treatment doesn't come at a low cost.

I know a lot of people who think that with the cost, veterinarians are obviously padding our pockets. But we’re actually seeing a pretty small percentage of that, when all is said and done, because the stuff we use is human medical grade. A lot of the cost is from the medical supply side of things. We're doing the same surgeries, we're doing the same treatments that a person would get and we can’t skimp on how sterile the supplies are, how sturdy the equipment is, a veterinary surgeon still has to use medical-grade implants.

Later in my day, I saw several pets that came in for vomiting, and they all took different treatment courses. Then I had a cat who previously had some nasal bleeding, the family had come in and seen a specialist. We talked about options - they decided that both with the cost and the risk that they were not super excited about doing the next steps of testing. But one of the things that could cause bleeding from the nose and a dog or a cat is a nose tumor, cancer inside the nose. 

When the cat was presented to me today, it seemed fine at first, but then I saw the eyes: the pupils were two different sizes. That can indicate something's going on with the brain. I'm much much more concerned now that this is cancer. I had to try and decide what are some treatments that may help the cat feel better for now, and then make sure that I'm being very upfront that these are probably temporary, this is palliative care. 

At the end of my day, in the evening, I rounded all my patients over to the overnight doctor. Each pet here today, I know what their treatment protocols are. We try to even mention the little things, like “Mom says he really only likes to drink out of plastic bowls,” or “that's his blanket in the corner, Mom says he doesn't sleep well without it.” Part of rounds also ends up being things like, “Hey, this is so-and-so, I really like him, he's a really great dog.” That’s not supposed to be an official part of rounds, but it becomes one. When you're when your patients aren't human, you get to say which ones are your favorites right in front of them. 

Now, at midnight, I'm gonna go home and eat dinner, because that's my life sometimes. I'm going to try and get through some of the rest of these records and fall asleep, and just stay off. I work very hard at turning off when I am not at work. I had to learn that early on that no one's paying me to worry about my patients in my off hours. It's not gonna help any pets for me to worry about them when I'm not there—I just have to trust my colleagues and co-workers. 

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