This new client was taking no prisoners on this particular morning. She was angry and frustrated at the emergency hospital across the street. She’d arrived there with a serious emergency and the estimate had topped $5,000. When she subsequently showed up on my doorstep she was still seeking satisfaction for the pressing problem of her dog’s impending death.

And this dog was trying to die with a vengeance. Buster, a ten year-old Lab mix, was lying on his side with a death-grimace engraved on his face. He was panting hard. His abdomen was impressively distended over his otherwise lean frame. His pulses were downright crappy (that’s a medical term). And the vivid pink his gums once were was now muted down to a muddy shade of gray.

Buster’s owner was mad. She was tearful. And she was scared. She wanted something done NOW for her close-to-death dog. She couldn’t lay down a credit card for a deposit on the e-service estimate so she’d come to the closest hospital for help (now that it was 8 AM and we ordinary vets were seeing patients again).

I’ll be honest. I wasn’t pleased to see her in the condition she arrived—less still her dog’s. It certainly wasn’t the other hospital’s fault that its services are priced to match their specialist-driven level of care. So I did my best to send her back across the street—for her dog’s benefit. But money was an issue and specialists were not an option.

A few X-rays later and it was clear her dog’s case was not the gastric bloat I’d been expecting but something potentially more sinister: an apparent splenic torsion. This is when the spleen (not the stomach, as in bloat) twists on its ligaments and strangles itself. The spleen often is not completely twisted—so blood gets in but can’t get out and it ends up getting dramatically engorged with blood. It’s as bad an emergency as any bloat—except that you can always take out a spleen and a stomach needs to survive the ordeal.

The question always remains, however: what caused the spleen to twist? Sometimes it’s obvious: a mass on the spleen, a foreign body in the GI tract, a traditional bloat (the most common cause). But sometimes it’s not. In these nebulous cases we usually affix the stomach to the body wall after removing the spleen—just in case the stomach was the initial cause (and to prevent it from doing the twirl all by itself at some future date).

So I offered to do my best—all the while explaining that 1) I expected a splenic torsion but I didn’t know what else I would find once inside Buster’s abdomen, 2) he would likely die regardless of my ministrations, and 3) the surgeon across the street would do a much better job for $5,000 than what I was planning to attempt for less than $2,000.

She agreed to let me do my thing (a procedure I perform maybe four times a year, no more) and I subsequently cancelled the next two hours of appointments. Because I didn’t know this woman from Eve, I asked for a $500 deposit and proceeded to surgery.

What I found was more than just a simple twist of spleen. While it was indeed rotated, hugely engorged and very unhappy-looking, it was the liver that emerged as the true offender. It was also big—so big that it was cracking and bleeding all over its surface. Buster’s belly, already sloshing blood, was filling up faster now that I was messing around in there. Not good. So I cut a snippet off the liver’s bleeding edge, passed it to a tech and asked her to make an impromptu impression smear so I could look at its cells under the microscope.

I scrubbed out at this point. There was no sense going any further without informing the owner of this new development. Especially now that the slide under the microscope confirmed the presence of the cancer I’d expected: lymphoma.

Thankfully, the owner agreed to my recommendation: euthanasia. Problem was, she’d needed to drive home and would now have to brave full-on, Miami rush-hour traffic to get back—all while Buster remained alive and under anesthesia so she could be there when he died.

You might think this is a crazy thing to want but it’s a common practice. At this point we sew our patients back up and sometimes go to great lengths to keep them alive for their owners—only to euthanize them in short order once they arrive.

Buster had lost so much blood that he needed an emergency transfusion at this point. While I had a donor at the ready, I wasn’t about to tap this precious resource for an unsavable pet. Crude as this may sound, I wouldn’t have consented to a transfusion at this point even if she’d had all the money in the world to spend—not once she’d elected to euthanize him. So keeping him alive was a trying proposition.

Almost a full hour later she arrived—in time, thankfully. She obviously loved this dog very much and was completely heartbroken to see him go. In the end, he went peacefully.

These are the cases I remember from my days as an emergency vet. Sometimes I miss them, in spite of the drama and money issues that seem to drive their resolution. Still, I far prefer my generalist role. There’s nothing like knowing your patients and their people when it comes to rendering a satisfying service.