The Graveyard Shift

I’m dressed like the Michelin man and I can’t leave this room. Sweat drips down my back from this bunny suit, complete with full white foot covers and an elastic banded hood. I’m not required to wear the hood, thankfully. The isolation gear here isn’t the worst I’ve used, but it does get you hotter faster than the blue gowns that simply tie in the back that I’m used to elsewhere.

It’s one in the morning. I’m in hour three of my living hell: a two-month-old parvovirus puppy who is fading fast.

Parvo is a tricky illness: once you catch it, it has to run its course. The vomiting and diarrhea aren’t fun…but they’re better than the hypotension and hypoglycemia. We regularly provide supportive care for those suffering through this preventable disease. It’s early for parvo season to begin, yet here we are, battling another case.

It’s almost always the babies who suffer the worst. I’ve had a few adults hospitalized in the past, but most haven’t even reached six months before we see them. Barely having spent any time in this world and here they are already fighting to keep living.

Natural selection is cruel.

We began to supplement this little creature with a norepinephrine CRI, before the start of my shift, when it became impossible to even find a blood pressure. The CRI is nearly maxed out to the highest dose allowed now. He’s dull and fading faster than I can stop. It’s a personal strike: I’m good at keeping creatures who should be dead alive. A gift I consider my curse; I am good at my job.

Unfortunately.

As I take his blood pressure with the doppler at my side, I am heartbroken.

Forty.

He’s becoming obtunded.

I grab my pager, an iPod that my job loaded with Teams so we can communicate with each other. I report the vitals to my doctor. Before he can even ask, I gently stab the soft ear in my hand with the tip of a needle. I use the drop of blood that appears for a glucose reading: 74.

Not good. He’s already on dextrose supplementation; his sugar should be stable, not crashing. It was previously normal. I relay this as well, awaiting what dextrose bolus dose that is coming. My norepinephrine CRI is going to be at its limit when I increase it next. We’ll have to add another pressor if this doesn’t improve.

Take the time to place a third catheter and continue on… Or, is it time to call this? Neither feels wrong at this point.

My pager beeps quietly over the soft radio playing in the background. The soundtrack to my day is a local alternative station. A small benefit to being unable to walk away from this critical case – to being trapped in this small room for hours on end: I can choose my own background music. As I pet the fragile baby before me, I’m watching his breathing carefully. Every longer than normal pause, I hold my own breath. The first sign of arrest in animals tends to be apnea.

Thankfully, his heart rate is still normal.

For now.

But things happen so fast at critical moments. Even quickly catching an animal arresting doesn’t guarantee a positive outcome. The green sticker on his cage card warns me that I’ll have to initiate CPR if his tiny body gives out on my shift.

A sad face is the reaction my message gets. Then comes the rapid fire replies: dextrose bolus, change his fluids, increase his CRI. The final message gives me the dose for the second pressor we’ll start when he doesn’t respond to the norepinephrine. I’ll start the math now, so when I need it in fifteen minutes, it’ll be ready to prepare.

I page to the rest of the team my needs: I don’t have all that I need in here. Hopefully, one of my coworkers has a few minutes to gather supplies for me.

Closing the cage door after putting the innocent creature back, I hear the heavy door creak open behind me. My doctor peeks in, “Welcome to the party,” I tell him flatly. We’ve been in close communication all night.

There’s forty inpatients tonight. Ten are critical enough that they need an assigned friend to care for them. Guilt always courses through me when I’m on a table case or otherwise stuck by any animal’s side. There’s only five of us tonight. That’s four people for thirty-nine patients.

I will dedicate my night to keeping this creature alive, despite itself. It’s not the first, or last, time I’ll spend all twelve hours of my shift in isolation.

The doctor slips in as a friend appears with my sugar water. “Thanks,” I tell her as the exam starts. I hook it up to the IV catheter and slowly push it over the next five minutes. Careful not to interrupt my doctor’s assessments.

He nods as he listens. “How long until the next blood pressure?”

I glance at the timer on my pager, “Seven minutes.”

“Let me know what the next one is. If it’s not improving, we’ll add another pressor.”

I nod in reply as he makes his way to the door. “I’ll go call his owners,” he starts to tell me, “but I was rounded that they’re all in.”

Sighing, I reply, “That was what I heard, too. Full code.”

He shakes his head as I page out again. This time for someone to check my lifesaving math, so I can request the supplies to prepare my second pressor. We can’t afford to make a mistake.

It’s coming.

It always does.

 

Anne Dougherty resides in the suburbs of Philadelphia, PA with her husband, Jonathan, their dog, Ruby Tuesday, and her cat, Theodore. She’s worked in the veterinary field for over a decade. When not working, she can be found biking, reading, or writing.