The emergency room (ER) at a veterinary hospital is a place of urgency, heartbreak, hope, and, sometimes , miracles. 

This past weekend, I found myself in the thick of it, working a shift that reminded me why veterinary medicine is both a privilege and a profound challenge.

It was a rare weekend. From the moment I arrived, the waiting room was full. The phone rang nonstop. My team and I were in constant motion, triaging pets in distress, fielding anxious calls from owners and making rapid, life-altering decisions. 

We saw more critically ill patients than usual—each with a complex story, each with a family hoping for the best.

One case stands out in my memory, a patient with severe skin disease. She waited nearly four hours to see me, her owner growing increasingly anxious. But the ER is a place where priorities shift in real-time. 

As I moved from one exam room to the next, CPRs—cardiopulmonary resuscitations—kept pulling me away. In an ER, every second counts, and sometimes, even the most urgent cases must wait as we fight to save lives.

In the midst of this chaos, two cats arrived within minutes of each other. Both were lethargic, with white gums—a classic sign of severe anemia. Anemia in cats is always serious, but these two were in worse shape than most. 

We quickly performed basic workups, including measuring their packed cell volume (PCV), a test that tells us how many red blood cells are present in the blood.

For context, the normal PCV for a cat is about 30–45%. These cats had PCVs of 9.5% and 8.5%. To put this in perspective, any mammal with a PCV below 10% is in critical condition. 

Blood is roughly half fluid and half red blood cells; cats can adapt to having about a third red blood cells, but below that, things get dangerous fast.

Both cats were lethargic, barely moving, uninterested in food. Their breathing was shallow. Their heart rates were up, trying to compensate for the lack of oxygen. One cat, with a PCV of 9.5, was breathing harder than the other. Oddly, the cat with even fewer red blood cells (PCV 8.5) seemed more stable. As a veterinarian, I could see across the room that both were very sick, but the cat with the higher PCV was actually more critical—a reminder that numbers only tell part of the story.

We placed the more critical cat on oxygen while waiting for lab results. It was clear that if we were going to save these cats, we had to act fast: figure out why they were anemic, treat the underlying cause, and provide blood transfusions.

The sicker cat had inclusions in its red blood cells that looked like hemobartonella—a blood parasite that destroys red cells. 

This can be treated, but this cat also had polycystic kidneys and free fluid in the abdomen, both extremely poor prognostic indicators. 

The owner, a young woman who clearly loved her one-year-old cat, was devastated. She asked what to do. 

I explained the risks, the costs, the chances. Ultimately, she chose euthanasia—a decision I supported. Even if we had transfused her cat, the odds of recovery were almost nonexistent. I told her I would have supported her if she wanted to try, but I agreed with her choice.

The other cat was being worked up at the same time. Any cat with a PCV under 10% should be considered critical, but this one wasn’t struggling to breathe. That told me something important: this cat’s body had adapted to the anemia over time. When red cell levels drop slowly, the body compensates by packing each cell with more hemoglobin, the molecule that carries oxygen. This process takes weeks to months. 

Owners often don’t notice the slow decline—cats sleep a bit more, play a bit less, but the changes are subtle. I often tell clients it’s like rolling down a hill: you don’t notice until you hit the edge of a cliff and fall. Sometimes we can catch them on a ledge, give them a little more time. Sometimes, if we fix the cause, they can return to a normal life.

In the ER, emotions run high, and sometimes owners, understandably overwhelmed, interrupt or question every step. 

While it can feel frustrating, I remind myself that their fear is driving their urgency. My job is to stay calm, keep explaining, and focus on the pet’s needs—even when it’s tough. 

There are moments when, despite my best efforts to provide clear information, an owner may feel unheard or dissatisfied—especially when the news is bad or the options are limited. I strive to balance compassion with honesty, knowing that my role is to advocate for the animal while supporting the family as best I can.

I tried to explain the chronic nature of anemia to the second cat’s owner, but she interrupted, insisting the symptoms had only been present for three days. I knew it felt sudden, but the science didn’t support that timeline. 

She interrupted again, asking if she should euthanize her cat. I said, gently but honestly, yes. Later, she told my staff I was rude. But in that moment, my job was to give her the truth, even if it was hard to hear. I believe rudeness is interrupting someone trying to save your pet, but I didn’t have time to dwell on it—there was another critical case waiting.

In that shift, we saw about 20 critically ill pets—each with complex problems, each requiring careful, compassionate attention. There were two or three “easy” cases, but mostly, it was a relentless stream of emergencies. And tomorrow, I’ll go back and do it all again.

Veterinary ER is not for the faint of heart. We are asked to make impossible decisions on little sleep, to balance empathy with efficiency, to manage the expectations of devastated owners while fighting for the lives of their beloved pets. Sometimes, we win. Sometimes, we don’t.

As a veterinarian, I am privileged to be part of these stories, even when the endings are sad. I see the best of people—their love for their animals, their willingness to fight for them, and their courage when it’s time to say goodbye. I also see the strain on my team: the techs, assistants, and receptionists who hold it all together.

This weekend was a reminder that every shift in the ER is a testament to the resilience of animals, the devotion of their owners, and the dedication of veterinary professionals. We do our best with what we have, one patient at a time.

The staff does it every evening, every weekend and every holiday. Tomorrow, I’ll do it all again.

MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566