Congo Kinsasha RPCV Clarissa Engstrom is emergency room veterinarian
The Price of Pet Care: Emergency clinic a fast-paced worldof ailing animals, emotional owners
Nov 7, 2004
Las Vegas Review-Journal
by Sonya Padgett
By SONYA PADGETT
REVIEW-JOURNAL
It takes the veterinarian only seconds to know the cat is beyond her help.
Clarissa Engstrom palpates the animal's neck, paying close attention to the part where it curves unnaturally. She checks the eyes: One pupil is dilated, the other constricted and both dart from side to side.
"Yeah, this is massive subluxation of the cervical spine with a transection of the spinal cord," she says, stooping over an exam table in the intensive care area of the Las Vegas Animal Emergency Hospital. "A broken neck."
Then, wrapping an arm around her patient, Engstrom talks to her while measuring vital signs.
"I can't save you, kitty," she says, her voice tinged with regret. She doesn't know the cat's name, Dana, and she doesn't want to.
"I try not to know their names when they're this messed up," Engstrom says, showing a crack in an otherwise solid clinical demeanor.
What she does know is that Dana, a good cat by all accounts, made a run for an open door at home and was stopped by a father worried that his daughter's cat would get loose. He frantically shut the door, too fast for Dana to escape, but not fast enough: The door slammed on her neck.
Engstrom goes into a private exam room and tells the owner, in a businesslike manner but not without compassion: "Sir, I'm not going to (mince) words. I can't save your cat. She needs to be euthanized."
Several minutes and a painless injection later, Dana's suffering is over.
Uphill battles
It's a Thursday night at the emergency clinic on West Charleston Boulevard, where no shift is really typical. This is the place people come when their pets take ill after their regular veterinarian closes, or when a dog has been hit by a car in the middle of the night, or a cat's neck is slammed in a sliding-glass door after supper.
Dana the cat's case has raised the staff's adrenaline levels, as do all such emergencies. It happens to varying degrees several times during any shift. But along with the surges of excitement come the mundane cases, which are welcomed by the staff because they mean good news for a pet. In those instances, the owners often need more care than the animal.
Although the building appears stark -- with its dull walls, sloping floor and functional waiting-room chairs -- animals receive state-of-the-art care here.
Engstrom's job as a veterinarian for the emergency hospital is to care for pets that are sometimes in a fight for their lives, at a time when perhaps their owners can't bear the sight of them for all the blood or apparent suffering.
Engstrom has to examine, assess and recommend treatment for animals she probably hasn't seen before, as well as deal with an owner she's never met.
In many ways, every case is an uphill battle. The emergency hospital's veterinarians have to give advice to people who might doubt their expertise and who have no reason to trust them, except that the hospital is recommended by their regular veterinarian.
"My people skills have to be four times greater than a regular practice veterinarian. Sometimes, I have to tell them the worst news that's hard to hear from a stranger," explains Engstrom, a former Peace Corps volunteer. "The hardest part sometimes is consoling the owners."
Treating the patient while dealing with the owner requires a delicate balancing act: from the assistant who takes clients into exam rooms, to the person who asks for payment, to the veterinarian who stakes her reputation on every case.
Engstrom, who worked for a daytime practice until a year ago when she joined the emergency clinic, is as much a people person as an animal lover. A North Carolina native, she exudes a Southern charm and relies on self-deprecating humor to form at the least a tenuous bond with worried pet owners.
Sometimes clients, such as Martha Edwards, understand.
Edwards brought her 7-week-old puppy, Buttercup, to the hospital after she found the dog lying behind the sofa in a puddle of vomit and diarrhea. A longtime dog owner, Edwards knows that puppies often contract parvo, a life-threatening virus.
When Engstrom, her blond hair pulled back in an efficient braid, charges into the room and orders a parvo test, Edwards listens. She readily hands over Buttercup for treatment, even when told by a vet technician that the cost would be $106 for the exam and test.
Emergency costs
Pricing is the No. 1 complaint workers receive at the hospital, says practice manager Christine Stafford. Emergency care isn't cheap and people often balk. An exam before midnight costs $65; afterward it goes up to $85.
Emergency care costs usually run 15 percent to 25 percent more than the same care at a daytime practice, Stafford notes. Prices are based on national averages.
Rates are higher at the hospital because it costs more to run an emergency facility compared to a day practice, Stafford says. Staff salaries and benefits cost more because of the hours involved, 6 p.m. to 8 a.m. and 24 hours on holidays and Sundays. There's also the rent or mortgage, insurance and utilities to consider, not to mention the cost of equipment, medical supplies and medications.
Edwards earns a modest living as an administrative assistant at a Strip hotel, so she cringes at the charges. But she understands her responsibilities as a pet owner, she says, and that includes paying for health care.
"The thing you have to realize is this is a business. They have to charge," she says.
Edwards is even more understanding when Engstrom comes back into the room with test results and a request for more tests.
"I love delivering good news. We're negative for parvo," Engstrom says. She high-fives the puppy, earning a laugh from a relieved Edwards. "Unfortunately, we have to take a picture of her tummy."
"And how much is that going to cost me?" Edwards asks.
"I don't know," Engstrom says. "Unfortunately, they won't let me handle the finances. Someone will come in with an estimate."
The hospital veterinarians don't discuss money, Stafford says, because it puts them in a precarious position: Advocating care for the animal could appear self-serving. Or, the veterinarian might take pity on a hard-luck story and offer care for a reduced rate or even free, as they've been known to do, Stafford explains.
Edwards OKs the X-ray, $146.57 including medications to take home, hoping it reveals that Buttercup hasn't ingested a foreign object and if she has, that it's small enough to pass unaided through her system.
"As long as the credit card will take it, we're OK. It'd be good if you didn't need surgery," she says, resting her forehead against the puppy's. "I don't know if my credit card can handle that."
Sometimes, clients aren't as understanding as Edwards. That's why the facility has what the closed circuit television, security cameras and door buzzers. Staff members have suffered verbal abuse and have had guns drawn on them by irate clients, Stafford says.
"We see so many different types of reactions from people. People yell and spit at us. Throw things. When you tell someone it's going to cost $1,000 to fix their pet and they don't have any money, they get upset. We tell people, 'I'm really sorry about your financial situation but this is what it costs.' Sometimes I wish I had riot gear on when I go into the room to talk to people," technician Megan Phillips says.
"I thank God that we have that there," she adds, pointing at the cameras.
The staff tries to work with clients who have real problems paying, Stafford says. The doctors will pursue what they call "conservative care," performing the most essential tests or procedures while ensuring the pet is comfortable.
Coco, a poodle mix, was in congestive heart failure when her owner brought her into the hospital around midnight. The owner, who declined to talk to a reporter, couldn't afford the hundreds of dollars to save her life. So Engstrom put Coco on oxygen to make her comfortable.
Animals first
The hospital, one of two such clinics in the valley, opened in 2001, after a group of 35 local veterinarians pooled their money to offer emergency services, Stafford says. Veterinarians have a tradition of taking their own emergencies, but calls come at all hours of the night.
"It saved my life," longtime veterinarian Samuel Lynch says of the clinics. Before the hospital opened, Lynch, co-owner of the Desert Inn Animal Hospital, responded to about 25 emergencies a month.
"And that's not counting the phone calls at all hours of the night," he adds. Engstrom, however, thrives on the crazy hours and sometimes nonstop action, drawing her energy from adrenaline and a few caffeine-laced Rockstar energy drinks.
"It's so emotionally charged. I'm here to serve owners but animals come first," she says, before delivering Buttercup's diagnosis to Edwards.
She opens the exam room door and calls out in a singsong voice, "Hi, I have some good news."
Engstrom goes on to tell Edwards that Buttercup won't require surgery. She has no blockages but one thing is apparent on the X- rays.
"We have quite a bit of extra food in that belly. She's full. I'm afraid you may have a bit of a drama queen on your hands," Engstrom says.
Edwards smiles and shakes her head in disbelief, then thanks the doctor for her help.
But Engstrom is out the door, on to her next case. Things are picking up.
