The extra shift that transformed my outlook on veterinary medicine

Rachel, the shi tzu-bichon mix that completely changed Dr. Joung's perspective on veterinary medicine. Photo courtesy of Emily Fahey The alarm sounded at 4:30 a.m. and I hit the snooze button for the third time with a sleepy, uncoordinated fist. Why did I agree to work this extra shift? I stumbled out of bed and then headed to work, black coffee in my veins fighting a losing battle against exhaustion.

Along the way my left eyelid started twitching-a sign of foreboding, according to my superstitious mother. I sighed. I've never been a morning person, but I've found ways to cope. I knew what I needed.

As I headed into work at the BluePearl Veterinary Partners hospital in Rockville, Maryland, I walked toward a cage in the ICU and was greeted by the gracious meow of a large gray cat. I offered my hand and he returned the favor by pressing the side of his face into my palm as I scratched behind his ear. Better than a Starbucks venti triple shot. I was now ready for the day.

The shift started as any other. I saw the usual variety of emergency cases: a dog with fetid burgundy diarrhea, an overweight blocked cat, a playful kitten with an upper respiratory infection.

And then I saw my next patient.

Her name was Rachel, a beautiful 13-year-old spayed female brindle shih tzu-bichon mix that presented for mild dyspnea. An initial physical exam revealed a heart murmur and fine crackles. I placed her in an oxygen cage and we locked eyes through the Plexiglas. She breathed more comfortably in oxygen and “smiled” at me while panting, excited to get any attention.

The veterinary nurses and I stopped for a minute to adore Rachel's sweet demeanor and the lashes that fluttered above her dark eyes.

I met Ms. Emily Fahey, the owner, in the exam room. She was a warm woman with peppered gray hair, a kind face and a gentle personality. She expressed concern for Rachel, but there was a tranquility about her that I admired. I felt easily connected to her.

I discussed my plan for Rachel: oxygen, furosemide and an echocardiogram. As we chatted, we shared stories of our former pets, and she enlightened me on Rachel's story. “The breeder called her the ugly one, so I picked her,” she told me.

Ms. Fahey glanced down at her watch. “You know, I'm the type of person who believes in signs and that divine force is inevitable. Things happen for a reason.”

She held out her wrist and pointed. “My watch stopped last night at 5:55 p.m., and I feel it's a sign. I don't want to lose Rachel, but I have a feeling I will today.”

I answered, “Interestingly, my eye has been twitching today and my mother would say that's a sign. But I don't really believe in signs and I'm hopeful for Rachel. Her prognosis depends on the diagnosis, but she seems stable at this point with only mild signs.” To prove my point, I escorted her to the oxygen cage to show her Rachel's improved comfort.

On the way out, Ms. Fahey chuckled. “She does look better. But just in case, I'm going to pick up a new watch battery on the way home.”

To my dismay, Rachel's clinical status declined quickly. Within three hours, we had a diagnosis of severe pulmonary hypertension and, despite treatment, Rachel progressed to severe dyspnea. She became recumbent and her mucous membranes turned a dark muddy pink. I called Ms. Fahey. “We're doing everything we can, but Rachel is having much more difficulty breathing. I want you to have the opportunity to visit with her in case she declines further.” Ms. Fahey rushed back to the hospital.

I met her at the front door, her eyes red and brow furrowed. Amazingly, Rachel, who had been recumbent, conserving her energy for respiration, recognized Ms. Fahey through the Plexiglas, sat up and panted, showing that familiar “smile.” With flow-by oxygen, Rachel sat in Ms. Fahey's arms and licked her face with delight despite her respiratory distress. It was an emotional moment between pet and guardian, and the love and devotion were heartbreaking. I recognized the sorrow in Ms. Fahey's eyes.

After a few moments she said with resolve, “I know she's suffering. It's time to let her go. We've said goodbye.” We let Rachel rest back in the oxygen cage as I escorted Ms. Fahey to our comfort room and set up an oxygen line.

I couldn't take her pain and sadness away, but I needed to say something. “Ms. Fahey, thank you for loving Rachel and giving her a wonderful life. You're making the right decision.” She sobbed harder, unable to speak, but smiled and squeezed my hand.

I walked back to the ICU and cleared my head with a deep breath. I looked inside the oxygen cage and found Rachel agonal, barely conscious. The room around me seemed to dim. Sound faded into low echoes. My heart sank as I scooped up her limp body and raced to the comfort room. With each step I whispered, “No, no, no.” Twenty steps felt like a nightmare.

When I opened the door to the comfort room, color returned to my vision. I vividly recall Ms. Fahey's red blouse, the orange couch in the comfort room, and warm lighting. Rachel took her last breath just as I gently placed her on her owner's lap. Ms. Fahey caressed the soft head as we both wept, hand in hand. Breaking the silence, Ms. Fahey said, “Look at the time.”

Through blurry tears I checked the clock. 5:55 p.m.

I gasped. I wasn't supposed to work today, and I'd awakened with my eye twitching. And exactly 24 hours after her owner's watch stopped, an angel took her last breath. I did not believe in signs, but I could not deny this extraordinary moment.

As veterinarians, we are often immersed in science, convinced by evidence, programmed by facts. But 5:55 p.m. will now forever remind me that I need to take the time to notice and appreciate the marvels that occur outside of logic.

Early in my career I was often fraught with the burden of sorrow, pain and loss. I suffered the misery of compassion fatigue, which plagues many in the veterinary field. My remedy? Take the time to connect with clients and accept their wonderful memories as an antidote. Our focus should be on the goodness of what we do. Though Ms. Fahey and I were saddened by the loss of Rachel, we were grateful to have experienced the moment together. We were connected by the bond between her and her dog.

Rest in peace, sweet Rachel. Rest in peace, beautiful angel.

Dr. Karena Joung is a senior clinician in emergency medicine and the medical director at BluePearl Veterinary Partners in Rockville, Maryland.