“Your next patient is waiting in Room Two, Dr. Emerson.”
Lori glanced up from the chart on her desk. Vanessa, the vet tech, stood under the doorframe of the small office, and held out a thick folder. Lori glanced at her over her glasses, then returned her attention to the chart in front of her and flipped the page of the thick volume of the Merck Veterinary Manual.
“I’ll be there shortly.”
The tech cleared her throat. “I think you’d better come now. Mrs. Billings is quite upset, and her little dog, Mr. Bubbles, doesn’t look so good. I took his temperature already, and it’s one-o-three point three.”
“That’s not unusually high,” Lori mumbled. In fact, for a dog, it was barely a fever. She was in the middle of figuring out the correct initial starting dose of anti-seizure medication for her first patient of the day, and the interruption was breaking her focus. The dog’s body temperature certainly didn’t indicate a life-threatening emergency, and could surely wait a few minutes.
Vanessa set the chart on the desk with a loud thud. “Mrs. Billings is a good client. She loves her dog to distraction. If he wasn’t so sick, she would have preferred to come another day when Dr. Johnson was in the office, but she’s agreed to see you. You should come now and not make her wait.”
Lori stared up at the technician, who seemed to glower at her. Vanessa was at least two decades older than she, and had been with the practice for at least that many years, if not longer. It was best not to get her angry, but at some point Vanessa would have to be told not to overstep her bounds. She wasn’t the doctor, after all, and if Doctor Johnson allowed her to talk like this to him, he had some serious staffing problems. It was always in everyone’s best interest to have a good working relationship with the staff, but they shouldn’t be allowed to call the shots.
“Then I guess I’d better not keep Mrs. Billings waiting.” Lori forced a smile and pushed her chair away from the desk to stand. She grabbed her stethoscope off the table, draping it around her neck, and snatched the chart before marching out of the office. Vanessa moved aside to give her room to pass. Hopefully this office call wouldn’t take long.
A low-grade fever could indicate an infection somewhere. Maybe some bloodwork to rule out any underlying issues, and a prescription of antibiotics would be all that was needed, and she could send the client and her dog on their way. Then she could go back to researching anti-convulsive doses for the beagle she’d admitted earlier for observation.
She inhaled a deep breath and squared her shoulders. Her heart began to pound faster in her chest, and she swallowed the sudden lump in her throat.
You’ve got this, Lori.
Diagnosing illness and conditions had been her strong suit in vet school. She was as familiar with textbook cases as she was with the back of her hand. Routine office calls shouldn’t give her this much anxiety.
Lori knocked on Exam Room Two, then entered. To cover up her nervousness, she smiled brightly at the gray-haired, round older woman sitting on one of two chairs in the room. This was the first time since she’d started this position a few days ago that Doctor Johnson was away from the office to do farm and ranch calls.
A Miniature Schnauzer with an impeccable classic Schnauzer clip that would put a Westminster show dog to shame stood on the other chair, slightly hunched over. The little silver-colored pooch’s body shivered uncontrollably. The client, Mrs. Billings, stood and swooped the dog into her arms.
Lori held out her hand. “I’m Dr. Emerson, Doctor Johnson’s new associate.”
Mrs. Billings had her arms full holding her dog. She eyed Lori with a skeptical look, her gaze seemingly drifting over every inch of her in a critical assessment.
“You’re the new vet?” she finally asked. There was no disguising her skepticism. “You’re just a little girl. How old are you?”
Lori bristled. She’d received remarks about her age and youthful appearance before, but no one had ever outright called her a little girl. Her smile widened.
“I’m old enough to have graduated vet school. How about we take a look at Mr. Bubbles?”
“I don’t know.” The old lady hesitated, shaking her head. She turned her body slightly to the side, preventing Lori from touching her pooch. “I usually don’t let anyone but Doc Johnson, or Doctor Taggart, look at my precious boy. Do you know if Mason is coming back to work soon? It’s just terrible what happened to him.”
Lori frowned. Doctor Johnson had told her when he’d hired her that he had another associate, but he’d been in an accident involving a horse, and had sustained a spinal injury that had left him paralyzed. Whether he would be able to return to work with that kind of a handicap was doubtful.
“I’m not sure,” Lori answered vaguely. “But if it will put your mind at ease, I graduated top of my class at Colorado State University, and I assure you, I passed all my boards.” Her cheek muscles hurt while trying to maintain her smile. She looked younger than her twenty-six years, no doubt because she was short in stature and liked to wear her long hair tied back in a ponytail. Maybe she should try putting it up in a bun. That might make her look older and gain her some respect. The glasses didn’t seem to be helping.
Neither the clients nor the staff took her seriously because of her youthful appearance, but other than prove she was capable of the job and projecting confidence that she didn’t feel, especially after what had happened a few months ago during her internship, there was nothing she could do about the way she looked. Lori mentally shook her head and pushed the self-doubt aside.
“I understand Mr. Bubbles has pyrexia and isn’t feeling well. I’d like to take a look at him so we can figure out the cause. You were clearly concerned enough to bring him in for an exam.”
Mrs. Billings stared at her with a blank look on her face. She petted the Miniature Schnauzer’s head, holding the dog’s trembling body in her arms.
“What is pyrexia? It sounds like Mr. Bubbles is going to die.”
Lori shook her head. “I’ll need to do an examination, if you could set him on the table. Vanessa told me he was running a slight fever. That’s all that pyrexia means.” She kept her voice even to calm the old lady.
Mrs. Billings scrutinized her for another long minute, then seemed to have reached a decision. She set the little Schnauzer on the table.
“He’s been throwing up and not feeling well. He wouldn’t even eat the fried chicken I made him for breakfast this morning.”
Lori’s brows rose. “Fried chicken for breakfast?” That could be the problem right there.
“It’s his favorite.” Mrs. Billings beamed. “He won’t eat anything else most days. Unless I give him his fried chicken, he won’t eat his regular dog food that Doc Johnson has told me he needs to eat.”
Lori gave the little shivering dog a pat on the head. The dog had a distended, bloated-looking abdomen and a hunched-over appearance. Clearly, this was not going to be a quick case of prescribing some broad-spectrum antibiotics and sending the client on her way.
She ran her hand down the dog’s stiff back, then pushed on either side of his belly with both hands. The little dog tensed and let out a quiet groan. She checked his gums, his eyes, then held her stethoscope to Mr. Bubbles’ chest. His heart sounded normal, but beat fast. Most likely due to fear and pain.
Lori draped the instrument around her neck when she was done. She glanced up at Mrs. Billings, whose eyes were wide with worry.
“What’s wrong with him? Can you fix him?”
“I’m glad you brought him in. I’m afraid Mr. Bubbles is very ill.”
The old lady’s hand flew to her mouth and she gasped. “Will he die?”
Lori shook her head. “He’s presenting with classic symptoms of pancreatitis. He’s got abdominal distension and pain, a low-grade fever, you told me he’s been vomiting and not wanting to eat. I’m going to have to run some tests, but I’m pretty sure they will confirm my diagnosis.”
Mrs. Billings looked more confused than ever. “What can you do for him?”
“I’d like to start him on an IV drip, and give him some antiemetics to prevent any further vomiting and dehydration. I might also give him some pain medication to make him more comfortable.”
This was a classic clinical case, even though pancreatitis was not always easy to diagnose. Going down the list of symptoms and a treatment plan, just as she’d done in school when presenting cases to her professors, came like second nature. Hopefully she came across with enough confidence and sounding knowledgeable that Mrs. Billings would trust her with the dog’s care.
“We’ll have to keep him here at least a day or so, and also give his pancreas a chance to rest. That means he won’t be getting anything to eat or drink for at least the next twenty-four hours. I’ll do an x-ray to rule out bloat, and send some bloodwork to the lab to confirm my diagnosis.” Sounding professional should put this pet owner’s mind at ease that she was capable of treating her dog.
“I expect his white blood cells will be outside normal range, and I’m also looking for elevated levels of amylase and lipase in his blood chemistries. There is a newer test available to diagnose pancreatitis in canines, but Doctor Johnson doesn’t have it available. It would have been easy to do an in-house test for pancreas-specific lipase for a definitive diagnosis, but sending bloodwork to the lab will be sufficient. Do you have any questions?”
If anything, Mrs. Billings’ blank stare had only increased. She blinked, and a tear ran down her face. “I don’t want my little Bubbles to die. What you’re telling me sounds horrible.”
Lori continued to smile in reassurance and shook her head. “I don’t think he’s at the stage where his life is in immediate danger, as long as we get started on his treatment. If we hold off, it could potentially become life-threatening.”
The woman began to sob. Lori stared at her. She’d explained the case thoroughly. There shouldn’t be anything to cry about.
“Let me send Vanessa in. She’ll have some paperwork for you to sign. With your permission, I’d like to take Mr. Bubbles to the treatment area and get started.”
Mrs. Billings nodded. She bent forward and gave the dog a hug and a kiss.
“Mama loves you, Bubbles. You’re going to be all better soon,” she crooned.
Lori picked up the dog and turned to leave. She stopped when Mrs. Billings called out.
“When will Doctor Johnson be back?”
Lori stiffened slightly. She plastered her practiced smile back on her face. It was understandable that this woman would be slightly hesitant to allow her to treat her beloved pet. She was new, and to older people, she didn’t look old enough to have graduated high school. It would take some time to gain the trust of the pet owners in this small community.
As long as she didn’t have to do more than routine surgery, everything would work out fine. Coming to Burnt River was still the best decision she could have made. Here, she could gain the practical experience and self-confidence she needed.
Landing an internship at a large and prestigious animal hospital in Denver after graduation had been a huge accomplishment and testament to her academic excellence. Unfortunately, it hadn’t lasted more than a few months. The stress and work load had taken its toll on her and shattered her confidence, especially after –
“Doctor Emerson?”
Lori turned around. “I’m sure Doctor Johnson will stop by later today. He’s out making farm calls. I’ll be sure to discuss Mr. Bubbles’ case with him, but I’m confident he will concur with my diagnosis.”
It was time to get this dog to treatment, or his condition could worsen quickly. She was not about to have another tragedy on her hands, and certainly not so soon after starting over.
“Vanessa will be in shortly with your estimate.”
Lori rushed out of the room and down the hall. Vanessa set Freckles, the little convulsing beagle, back in his cage at that moment.
“How is he?” Lori called, setting Mr. Bubbles on the treatment table.
“No more seizures. His vitals are normal.”
Lori nodded.
“We need to start an IV on this dog and draw bloods. I’ll write up his treatment plan and you can figure out an estimate to give to the owner. Then I’ll need a chest and abdominal x-ray, two views.”
Vanessa held Mr. Bubbles while Lori drew blood from the dog’s neck, then shaved his front leg and placed the catheter.
“What’s wrong with him?”
Lori glanced up to see Vanessa studying her with the same look of doubt in her eyes as Mrs. Billings. She gritted her teeth and ignored it.
“The dog has pancreatitis. I’m glad the owner brought him in. It could have been life-threatening if she’d have waited another day.” She shook her head and scoffed. “She’s been feeding him fried chicken. No doubt that’s the cause.”
“I hope you reassured Mrs. Billings that you’ll take good care of her dog,” Vanessa mumbled.
Lori looked the tech in the eye. “Of course I did. I told her exactly what the dog’s condition was and how I plan to treat it.” She started a bag of fluids with electrolytes and carried the patient to an empty cage. When she turned around, Vanessa was no longer in the treatment room.
Lori sighed and ran her hand over her face. She glanced at her newest patient.
“You’re going to be fine, Mr. Bubbles. I may have to let Doctor Johnson explain to your owner that she shouldn’t feed you any more fried chicken. She probably won’t take my word for it.”
For the moment, the dog was stable. Lori labeled the blood tubes and filled out the lab order, then returned to her office. Hopefully her next office call would be nothing more than a routine physical.