Hostage Situation

It was a weeknight. I’m there for several hours seeing routine appointments when a STAT triage is called. The technicians rush the patient, Twinkles – a Chihuahua that has been hit by a car, into the treatment area. The dog has an elevated heart rate and respiratory rate and one of his eyes has some blood in it (hyphema). His jaw and teeth appear intact, his gums are nice and pink, and there are no obvious wounds.  Twinkles’ pupils are a bit small but equal in size and reactive to light.  An intravenous catheter is placed, a brief neurologic exam is performed, and an injection of pain medication is administered. I go to talk to the owner to obtain a history.

The owner is an older woman and a retired teacher.  She is obviously upset, but her demeanor doesn’t immediately scream: Beware, I’m insane.

Me: Hi, I’m Dr. Smith. Can you tell me what happened tonight?

Woman: What do you mean? I already told the girl who was in here before – my dog was obviously hit by a car.

Me: Yes, I understand that. Does your dog have any pre-existing medical conditions? Is he currently on any medications? Can you tell me how he got hit by the car? For example: Did it bump him or did it go over him completely?

Woman: I just watched my dog get hit by a car. You think I remember the details of that?! Shouldn’t you be helping him right now?!

Me: I understand, Mam. Your dog is stable. I am just trying to get some more information so that I might treat him better. I would like to take some radiographs (x-rays). After trauma, I recommend chest and abdominal views. I specifically want to make sure the diaphragm and the bladder appear intact. I would also like to perform a brief ultrasound to look for free fluid (FAST scan).

Woman: He was hit in the head. Is this all necessary?

Me (frustrated already – Insert emoji with the eye roll): Well, this is some of the pertinent information I was asking you about… He was hit in the head, you say.  Ok – so he was not run over?

Woman: I hardly see how that makes a difference.

Me: It actually makes a significant difference. I am going to go check on Twinkles, but my technician will be in with an estimate.

I leave the room. Twinkles is looking more comfortable.  A dose of mannitol is administered due to the head trauma and the mildly small pupils on initial exam.  I make an estimate for diagnostics and treatments, and I head into another appointment.  When I get out of the appointment, my technician has the signed estimate for Twinkles in her hand.  We take some radiographs, and there is concern for collapsed disc space between two cervical bodies but the radiographs are otherwise unremarkable. The patient was ambulatory (able to walk) at intake, and he had normal proprioception (meaning he knew where his feet were).

I go to talk to the owner and discuss the radiographs and offer a plan of overnight hospitalization with pain medication, intravenous fluids, and serial neurologic exams. I bring with me an updated estimate for the aforementioned plan.

Woman: This dog is my life. He has to be ok.

Me: I understand that. So far he is looking pretty lucky, but we will need to keep a close eye on him. I will likely recommend transfer to the specialty hospital in the morning for advanced imaging and consultation.

Woman: Twinkles can sing the alphabet. He is a very special dog.

Me (alarms are going off in my head – CAUTION: SHE IS NUTS):  Oh, that’s really neat. Here is the estimate for the plan I discussed with you.

Woman: Oh.  I don’t have any money.

Me (Not completely surprised but definitely not amused): Oh.  Umm… so you already signed the initial estimate, which we then performed. So at a minimum you owe us that amount of money.

Woman: Yeah, I needed you to start treating my dog. He was hit by a car.

Me (now notably pissed): Yeah, I understand that. Unfortunately, there are costs associated with treatment. And, as discussed upon presentation to the hospital, all services require payment tonight. Perhaps there is someone we can call for you. Children? Siblings? Friend?

Woman: My kids hate me! There is no one! Only Twinkles!

Me (Thinking: Oh, fuck. My boss is going to kill me!): OK. I’m so sorry, but Twinkles is going to have to go home with you tonight, and we will have to set up a payment plan for all services rendered so far.

Woman: Twinkles can’t go home with me – HE WAS HIT BY A CAR!

Me (Insert emoji with the red face and steam coming from his nostrils): I understand that. Unfortunately, Twinkles can’t stay here without payment of at least the low end of the estimate.

Woman (walks out of the exam room into the lobby): I need to leave!  I watched my dog get hit by a car tonight, and I just need to go rest.

Side note: The doors at this facility lock after 8pm for the safety of the staff in the hospital. All the employees are equipped with keys to let people in and out of the building, but, technically, the clients can’t leave on their own volition.

Me: Mam, that door is locked to keep strangers from entering the building. And I’m afraid you can’t leave until we resolve a treatment plan for your dog. Also, I would like you to join me in the exam room where we can discuss things privately.

Pan out to the lobby where people are clutching their pets closely, sensing the crazy radiating off this woman. I try to assure people with my facial expression that I have things under control. Likely my face reads more like: RUN! ALL OF YOU! SAVE YOURSELVES!

Woman: ALL YOU CARE ABOUT IS MONEY! You thoroughly explained the treatment plan. Twinkles needs to stay! HE WAS HIT BY A CAR!

At this point, I gesture to my technician to please escort the guests in the lobby to various exam rooms. I also quietly ask her to call the hospital manager.

Scenes from a lecture in veterinary school about how to deal with clients begin to run through my head. I squat on the back of my heals to try to make myself small and non-threatening.

Me: Mam, I am so sorry this happened to you and Twinkles tonight. I am sorry that you are not in a place financially where you can offer Twinkles the kind of care he unexpectedly needs this evening. However, I can’t let you leave without paying or without taking your dog with you.

Woman: OPEN THESE DOORS! I CAN’T DO THIS RIGHT NOW!

Me: Mam, please calm down. As I said, I am so sorry …

Woman: I NEED TO LEAVE!

Me: Mam, please listen to me …

The woman charges the reception desk and reaches over the counter.  She promptly picks up the phone.

Woman: I’m assuming I need to dial 9 to get out.

Without waiting for an answer, she dials 9-911.  I hear the operator answer.

Woman: I am being held hostage at the animal ER!

I can’t help it. I audibly laugh.

Me: I am actually glad you did this, Mam. We clearly need a moderator.

She provides the location of the hospital and hangs up.  She then casually makes a cup of coffee and sits in the lobby quietly while we wait for the cops to arrive.  It’s as if she has gotten a little bit of crazy energy out and now feels some momentary relief.  In the meantime, she doesn’t even think to ask for an update on her dog or ask to see him.

This hospital is in a small, safe town, so it takes the cops less than 5 minutes to arrive. I leave a technician in the lobby to babysit her, while I go speak with the other clients.  

I leave an exam room and enter the lobby just as the cops arrive. The woman begins with a rundown of her evening and the events that lead us to this moment. I explain to the officer that the pet is stable and needs to go home with the woman at this time.

Cop (to the crazy lady): Mam, try to think about it this way. If you parked your car illegally and it got towed, then you would have to pay in order to get it back.

I think: Solid scenario, kind officer, but there is no way this lady is going to appreciate this analogy.

Woman: DID YOU JUST EQUATE MY DOG TO A CAR?! TWINKLES KNOWS THE ALPHABET! TWINKLES CAN SING!

The officer and I lock eyes, and I can see that he now appreciates what I have been dealing with for the past 2 hours.

Perfect timing – my manager shows up. Brief introductions are made. Crazy lady meet hospital manager. Hospital manager meet crazy lady and the clever officer with the worthless analogies.

Cop: OK, Mam. Everyone here is sorry for what happened to your dog this evening.  With that said, you can’t act this way.  (He then looks at me). Unfortunately, you can’t hold her here.

Manager: Mam, we will treat your dog with compassionate care and we will monitor him overnight.  Please be here in the morning to get your dog.

Woman (glaring at me): That wasn’t so hard was it?!

Me: I give up.

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