There’s something about the first day back after a holiday or long weekend that brings out the crazies in people. While their pets are legitimately sick and in need of medical attention, they have a way of over-dramatizing their need to see the vet—immediately. It’s especially annoying to us since they’ve sat with their sick pet all weekend avoiding the e-clinic like the plague and saving it all up for us—with attitude.

Don’t get me wrong—I’ll take all the patients I can get and I appreciate the clients’ trust in us. What’s more, I understand their reluctance to endure the emergency alternative. But when your cat can’t urinate or gets poisoned with supermarket flea medication and your regular vet is not in…please see the emergency vet!! And don’t cop an attitude with the bleary-eyed, post-holiday weary doctors and staff. We’re not immune to your stress.

My first patient of the morning is a cat that rightfully deserved her place in hospital all weekend. She’s dying—in short, inexorable increments of progressive, immune-mediated anemia. I gave her a blood transfusion last week but her owner refused to leave her under our care or seek out the internist’s opinion.

The elderly owner, convalescing at home herself, always sends in her neighbor, a doddering elderly woman herself, with whom she shares cat-keeping duties. Between the two of them I swear they must have forty cats. The two of them have become increasingly frustrated with the lack of a clear diagnosis.

“We know she has an immune-mediated hemolytic anemia (otherwise known as IMHA) but we don’t know what’s causing it.” This is a frustratingly horrific disease of the immune system where red blood cells are consumed at an alarming rate by the body’s over-active defense cells. The body is, in short, committing hari-kiri.

“We have a better chance to find out what’s causing this, or at least devise better treatments if you would consent to see the internist.” No dice. Yet every day I get three or four calls suggesting a new potential diagnosis: from hemobartonella to fleas and hookworms. They’ve been online non-stop since last week. Shark cartilage, vitamin B12, milk thistle…the list of suggestions goes on and on.

If your vet told you she was currently unable to do more than what she’d already done and you were still even slightly concerned, assuming you had the money you’d see the specialist. Right? Not these gals. They even go out of their way to try and kill their cat with home-care. Against my express instructions they’ve begun to ply this four-pound cat with a red blood cell percentage of 8 (normal is 25-35%) with large volumes of subcutaneous fluids. At this rate she’ll be dead by morning.

Remember last week’s case of “oh-my-God-my-dog-can’t-breathe”? The dog died later that night after the owner refused the life-saving surgery offered by the specialist, convinced that the dog had heart failure and not a whopping pneumothorax from a tear in its lung. This anemia kitty’s case is going in much the same direction. The only difference is that this cat’s probably going to die anyway—regardless of anything we might do. Cold comfort.

Then there’s the poisoned cat: new clients sent over by the specialty hospital (they only see cases by referral unless they’re in dire straits). This small cat received a dog-sized dose of a dog-only supermarket flea medication (which I don’t even recommend for dogs). This was last night.

After spending all night salivating and obtunded with pupils the size of saucers they decided she should be seen by a vet. But they didn’t want me to do anything for her. Fluids, bloodwork, hospitalization?—nothing. A bath to remove the residual chemical was their only concession to treatment. Oh well. At least the fleas are gone.

And the blocked cat with toxins up to its ears and near-deadly levels of unpurged electrolytes? Apparently the wait-and-see attitude was a successful alternative to that nasty emergency hospital. We were able to save it—only just. No matter that kitty spent a whole night yowling in pain and vomiting profusely.

Finally, there’s the most dramatic case of all. The golden retriever with the stomach as full of gas as is possible for a canid without spontaneous rupture—twisted, no less. This is called GDV (gastric dilatation-volvulus) or “bloat.” Anyone who’s heard of this disease knows how uniformly deadly it is when left untreated. Miraculaously, this dog did not die. Somehow he made it through after a whole night of painful retching and pacing. Surgery was curative—and needn’t have waited ‘till morning.

Know the worst part? These are all excellent clients usually willing to do anything we might suggest. They just happen to have suffered terrible experiences at the emergency clinics. So they stay far away from them if possible, preferring to wait it out at home unless their pet looks like it’s going to die. And the reality is that many pets with a variety of medical conditions don’t look like they’re going to die…until they do.

So that was my morning. Need I even begin to recount my stories from the afternoon?