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Emergency vets are always on the job.

By Hudson Sangree

Emergency vet Chris Wong, D.M.V. ’92, checks pooch Nicole after performing surgery to remove a mass around her heart.

On this Thursday night, nearly every exam room has a waiting patient, and staff veterinarian Chris Wong, D.V.M. ’92, an emergency specialist who recently finished a prestigious postgraduate residency at UC Davis, moves purposefully from one case to the next.

In Exam Room 2, there’s a 4-month-old Weimaraner puppy named T.J. with a swollen toe. The toe is red and tender, and he’s been licking it. The young couple who own T.J. talk to him in soothing baby voices and offer him his favorite stuffed toy. A bee sting is the likely cause for the swelling, Wong says. Soak the paw in warm water and Epsom salts, and everything should be fine in a few days. On the way out he tells T.J. he’s a good boy and gives him a quick kiss on the head. Then it’s down the hallway to Room 3, where a golden retriever needs its stitches removed, and Room 4, where a dachshund with diarrhea awaits Wong’s attention.

Those are the easy cases.

In Exam Room 5, Wong finds a 16-year-old black cat named Cuddles and her 20-year-old owner, a thin young woman whom Wong knows well from her work with rescued animals. Unfortunately the woman’s horses, dogs and cats have had a variety of serious health problems lately, and she’s become a regular at the clinic. Cuddles is the latest casualty in this string of bad luck. The old cat is suffering from a painfully bloated abdomen, which Wong gently probes and discovers is filled with fluid. Using a syringe he takes a sample; the fluid is pinkish in color, bloody. What the liquid is he can’t tell immediately, but most likely it’s a sign of cancer.

For now the urgent need is to remove the fluid from the cat’s abdomen. With the help of several assistants, Wong inserts a catheter through the skin and begins to withdraw the fluid by hand, one syringe at a time. Before he’s done, a steel bowl is filled with more than 20 ounces of liquid. “That’s a Coke bottle and then some,” he says. It’s also more than one-eighth of the cat’s normal body weight. Once he’s done, the cat is visibly smaller.

It’s been a busy night already, but for Wong the most difficult work is still ahead.

Earlier in the day a woman brought in her 9-year-old female black lab, Marley, who wasn’t eating and had been lethargic for days. An ultrasound and X-ray revealed the cause: a massive tumor attached to the spleen. The tumor had grown so big—in X-rays it appeared to be about the size of a softball—that it had compressed the dog’s stomach. Because internal bleeding is a common hazard with such tumors, emergency surgery was deemed necessary.

Splenectomies, Wong says, are among the most common forms of emergency surgery performed on dogs, both because the spleen is easily damaged and because a number of popular breeds tend to get splenic cancer.

In preparation for surgery, Marley is anesthetized and her abdomen is shaved. She is laid on her back on the operating table, with a respirator tube down her throat, and an associate of Wong’s makes a long incision, stretching nearly from the dog’s sternum to its pelvis.

Wong reaches into the dog’s abdomen and gently withdraws the spleen, a liver-like organ roughly the size and shape of a human hand. Its job is to filter blood, though dogs, like humans, can live without the organ. Wong also lifts out the tumor, realizing it is even bigger than he anticipated. “This is a really gigantic mass,” he says through his surgical mask. “It’s bigger than a softball, more like a decent-sized grapefruit.”

Over the course of several hours Wong and his associate go through the painstaking task of disconnecting the tumor and spleen from blood vessels and fatty tissue. As a pool of blood forms beneath the operating table, the vets struggle to find and clamp, cauterize and suture bleeding veins and arteries. Getting the bleeders stopped is the most crucial part of the operation, necessary to prevent excessive blood loss during the procedure and to ensure there’s no internal bleeding afterward.

Beads of sweat form on Wong’s forehead as he tries to find and close each one. Meanwhile, the “woosh-woosh-woosh” of the blood pressure monitor, the amplified sound of the dog’s blood flowing through its body, is like the ticking of a clock in the race against time.

Eventually the spleen and abnormal mass are connected to the dog’s body by just a single bit of tissue. An assistant is ordered to get a towel. “Get ready to catch the spleen,” Wong tells her. The organ and tumor fall with a heavy plop and are carried away to be examined later for cancer. The incision is closed, and Wong pulls off his mask and collapses into an office chair. It’s midnight, and he’s exhausted. Now he’ll finally get to have his dinner of a submarine sandwich bought earlier in the day. “She should be fine for now,” he says of the dog. The owner will be called to let her know the operation was a success. (Testing determined the mass wasa non-cancerous splenic hematoma, and Marley was expected to make a full recovery.)

Wong grew up in Los Angeles and attended UCLA before entering veterinary school at UC Davis. After graduation he accepted an internship at Angell Memorial in Boston, one of the nation’s oldest and most renowned veterinary hospitals. Eventually he returned to the UC Davis Veterinary Medical Teaching Hospital to pursue an emergency medicine residency, a highly specialized training for practicing veterinarians. As part of his residency, Wong lectured to vet students, performed research and cared for patients during clinical rounds. But his residency was also an “alternative” one in which he split his time between the UC Davis hospital and the Carmichael clinic.

His six years at the clinic and the VMTH, along with his two years at Angell, have taught him a lot about emergency medicine but also about the interactions between humans and their pets. Sometimes, Wong says, you see the worst of humanity. “I hate trauma that’s occurred from humans—people who beat a dog or shoot it. That’s the worst because it didn’t have to happen.” But “most people treat their pets like kids,” he says admiringly. “I almost feel like a pediatrician sometimes.” Saving the life of a much-loved pet, while bringing hope and relief to the owner, is the highest satisfaction of his job, he says.

As an example, Wong tells the story of a 7-year-old boy and his golden retriever. The boy’s parents had both recently died in a car accident, and the golden retriever was all that was left of his immediate family. One day the dog suddenly collapsed. An abnormal mass attached to the dog’s spleen had ruptured, causing severe internal bleeding. If Wong hadn’t acted quickly the dog would have surely died. Fortunately he was able to perform surgery, clamp off the bleeder and remove the splenic mass. “If we had lost the dog, it would have been horrifying,” he says.

The bad news was the dog had the worst form of splenic cancer, which in nearly all cases is incurable. The cancer was so aggressive that the boy’s grandmother elected not to pursue radiation or chemotherapy. She didn’t want to put the dog through such difficult measures when they were unlikely to be successful. Yet the dog made a miraculous recovery. “Eight months later he was running around without a hitch,” Wong says, calling the case “rare and amazing.”

“When pets are really sick, you need someone who can do something quick,” he says. “That’s what I like, and that’s what I’m good at.”

Currently there are only about 125 board-certified ER specialists in the country. But their ranks are growing along with other kinds of veterinary specialists, as owners seek more advanced care for their pets.

Yet the vast majority of injuries and illnesses needing urgent care are still seen by general-practice veterinarians. Pia Tucker ’80, D.V.M. ’87, is a good example. Until recently, when she opened her own practice in Woodland, Tucker worked as a staff veterinarian at the only animal clinic in West Sacramento. Her clients ranged from millionaires in Clarksburg to the indigent residents of the city’s mobile home parks. Cases in which animals were hit by cars were common, she says. So, too, were cases in which hunting dogs were injured by dangerous garbage strewn along the waterways of the Sacramento Delta.

In one case Tucker recalls vividly, a big yellow lab named Jake was hunting with his owner when the dog sliced open the main artery in his leg on a piece of glass or metal. The owner had wrapped the leg in a shirt, but nevertheless the dog had bled profusely. “The shirt was soaked with blood,” she says. “There was blood all over the car. There was blood covering the entire hospital.”

The owner, a big, normally robust man, came in carrying his injured best friend.

“He looked almost worse than the dog,” Tucker says. “He was white as a sheet, with sweat pouring off him, and shaking.”

Tucker quickly stopped the bleeding and surgically repaired the artery. But the dog’s leg tendon had also been partially severed—an injury that could not be repaired by surgery. Instead Tucker splinted the leg and hoped for the best. Jake eventually made a nearly full recovery. “He was back hunting the next season,” she says with a smile.

Like Wong, Tucker was also trained at the UC Davis veterinary hospital, where the programs in small- and large-animal emergency care are generally considered among the best in the field.

The small-animal program has produced its share of the top emergency specialists. Ken Drobatz ’83, D.V.M. ’85, for example, runs what is probably the busiest animal emergency room in the country at the veterinary hospital of the University of Pennsylvania in Philadelphia. “We’re right down in the city, so we see a lot of gunshot wounds and hit-by-cars and animals bitten by other animals,” says Drobatz. In the world of animal emergency rooms, “ours would probably be the closest to the TV show ‘ER.’ We see some 11,000 cases a year. There are few places like Penn, as far as the caseload and the whole range of emergencies that come in off the street.”

One program that comes close, however, is at Angell Memorial in Boston, where Wong did his internship. There, Sharon Drellich, who also completed a residency at UC Davis, is a staff veterinarian doing emergency and critical care in what she describes as a “big gritty urban hospital.” It also has one of the busiest ERs in the nation. “Sometimes it’s an endurance game to see how you get through your day,” she says.

Because the UC Davis veterinary ER is in a small town, the pace tends to be much slower than at Penn or Angell. Whereas Penn averages 30 cases a day, Davis might see five. But its ER is also staffed 24 hours a day, and the medicine is no less sophisticated. The emergency room and intensive care unit are on the second floor of the vet hospital, where vets and technicians dressed in green scrubs and students in blue congregate around tables for lessons in treating the sickest of patients.

Karl Jandrey (left), an ER expert at the UC Davis veterinary hospital, discusses his feline patient’s urinary blockage with resident Nancy Scott (center) and veterinary student Kristy Doyal.

Students who perform postgraduate internships at animal hospitals receive even more ER training. A select few go on to complete specialized residencies in emergency medicine. Of those, a portion attain board certification in emergency medicine and critical care. Board-certified specialists can often be found on the staffs of teaching hospitals such as UC Davis.

At the VMTH, few cases come in off the street; most are referred by veterinarians from across the western United States. UC Davis is known for its expertise and equipment to treat respiratory problems, cancer, blood illnesses, kidney failure and other types of acute disease, according to Jandrey. UC Davis, he says, is known for having advanced technical equipment, such as an MRI machine, not available elsewhere.

But for all the technical equipment available to veterinarians these days, the job of emergency medicine is still about dealing with suffering creatures and their human caretakers, he says. “It’s hard to teach how to deal with people in crisis,” notes Jandrey. “You just have to be a role model.” One option available in animal medicine, after all, is euthanasia. That most difficult of decisions must often be made in a very short time. Another factor is the cost of treatment. Limited financial help for clients is available, but many owners must make the decision between spending thousands of dollars on their pet or putting it to sleep.

Harold Davis, the supervising emergency technician at UC Davis, says that in his 20 years in veterinary medicine he’s come to think of emergency practice as being as much about humans as it is about animals. Among his duties, Davis teaches a course that introduces vet students to hospital work. “I always try to remind students of the human element,” he says. “You have to realize you’re caring for the patient and the owner as well. The patient is really an extension of the owner.”

And while Davis says he’s handled too many cases to count, one still stands out in his mind as an affirmation of his life’s work.

When he was working the graveyard shift one night, a dog that had undergone surgery earlier in the day began bleeding into its stomach to the point that its abdomen was visibly swelling. A veterinarian quickly got the dog on the operating table and made an incision in its belly to relieve the pressure. As blood gushed everywhere, the dog went into cardiac arrest. The vet told Davis to stick his hand through the incision, into the dog’s chest cavity, and begin massaging the heart. “All of a sudden I felt the heart start beating in my hand,” Davis recalls. “Two hours later that dog was standing up in his cage, barking at me.

“That,” he says, “was one I’ll always remember.”

Hudson Sangree is a freelance writer based in Davis, where he shares his house with a shaggy dog named Homer and an orange cat named Milo. Photography by Debbie Aldridge/UC Davis Public Communications.