Rogue Valley Veterinary Emergency is here when you need it most

By Midge Raymond

Last Friday, as the 4th of July parade in Ashland kicked off the holiday weekend, the Rogue Valley Veterinary Emergency (RVVE) hospital in Medford was embarking on a different type of holiday weekend. Having opened on December 6 of last year, “we’ve been increasingly busy,” says veterinarian and founder Sam Lewis. “Every weekend seems to be our new biggest weekend.”

The hospital aims to help fill the gap in emergency veterinary medicine in the valley. 

“The area has been in desperate need for more emergency care,” says Dr. Lewis. “In southern Oregon, you have an immediate population of about 220,000 and (previously) only one veterinary ER. There’s a very large radius of people who don’t have a choice as far as after-hours emergency.”

Currently open 24 hours a day from 7 a.m. on Friday until 7 a.m. on Monday, Dr. Lewis’s goal is to be open 24 hours a day all week.

But for now, it’s important to be open when most regular veterinary practices are closed. By midmorning on July 4, RVVE is staffed with three veterinarians and three vet techs, and already the open-floor hospital is filling with patients. Humans with their dogs and cats sit on cushioned benches, with dogs at their feet and cats in arms or carriers. Three mobile carts in the middle of the room are ready for exams, blood draws and other procedures. Past the carts is the lab, with diagnostic machines and workstations for the veterinarians and techs.

This open-space, transparent care model was pioneered by Veterinary Emergency Group (VEG), Dr. Lewis says, and with this model, human caregivers always have eyes on their animals. They can wait with them during intake and can hold them during procedures.

“I like it because when you’re dealing with an emergency, it is horrible,” Dr. Lewis says. “It’s typically the worst day of your life when you’re helping your family member, when you’re helping your animals, when you’re helping a loved one. And it’s scary. It’s confusing. One thing that’s also really important is I want people to see the value that they get when they come into this practice. When you go into a different type of emergency practice, where you’re tucked away in a little room, you don’t see how hard that team is working for you.”

In addition to the open area, which has a row of kennels along one wall, the hospital has a surgery suite, an ICU, a quiet room with acoustic paneling, rooms with extra kennels equipped for oxygen delivery and several isolation rooms for patients with intestinal or respiratory issues. One isolation room is specifically for parvo, a highly contagious virus with a mortality rate of up to 90%, and by design the room has a large window. Most parvo isolation units are in basements or in dark, windowless areas, Dr. Lewis says, and a bright room with natural light gives animals “a reminder of what to fight for.”

This morning, as two canine patients and one feline patient wait with their humans in the open area, Dr. Lewis knocks on the door to one of the private rooms, where Chester, a 10-year-old orange tabby, has been waiting with his human for test results. Dr. Lewis sits on the floor, at eye level with Chester, to discuss the results. 

Diagnostic testing — including PCV/TP, lactate, blood glucose, BUN strips and a FAST scan for effusion — is part of the $200 exam fee. “One thing that I find frustrating as a clinician is that when I’m working on a patient, there’s only so far your physical exam can go. The reason I include these tests is because people need to know this information. We want to make sure this patient leaves the hospital knowing they’re safe, knowing that patient is not about to destabilize at home. When you can diagnose disease, you can treat disease.” 

Dr. Lewis tells Chester’s person that the cat’s lactate is elevated, which signifies trouble getting oxygen to the body’s tissues. Chester has come in due to constipation, which has been an issue since an attack six months earlier by a larger animal in which Chester suffered injuries to his tail and back. His human has been treating him with laxatives off and on as needed. Dr. Lewis examines Chester’s abdomen and recommends a radiograph, which is an additional $200. “Constipation is usually secondary to something else,” he says.

He offers tips on how to keep Chester’s GI tract moving and suggests a consult with a specialist in internal medicine for Chester’s long-term care. As they talk, Chester gingerly walks around, examining the room and greeting Kai Reyes, the vet tech accompanying Dr. Lewis. Chester’s human agrees to the X-ray.

Back in the open area, the benches are filling up, and all of the doctors and techs are busy with patients, sitting or kneeling on the floor to examine them. It’s surprisingly quiet for an emergency room — no one is barking or yowling, and the humans speak softly. 

The sound of a door chime indicates a new patient has arrived — all patients have to be buzzed in, and most have called ahead. Dr. Lewis answers the door and does a quick triage: a woman with a puppy is worried about an ear injury but decides not to stay; the ear isn’t red or inflamed. 

Ten minutes later, the doorbell rings again. A couple brings in a dog who, after being stung by a bee, has been wheezing and vomiting. Dr. Lewis brings the dog to one of the carts and does an immediate ultrasound. “This is why it’s good to have diagnostics included,” he says. “I’m not wasting time in case it’s anaphylaxis.” 

In this case, it isn’t, and the two humans settle in with the dog to await further treatment.

A few minutes later, the bell chimes again — a woman has brought in a dog who is not eating and is having GI symptoms, including diarrhea. 

This is usually the most common complaint among ER patients, Dr. Lewis says. “I would say most the typical patient has vomiting and diarrhea. Good ol’ gastroenteritis.” 

Originally from Oregon, Dr. Lewis has moved around for much of his life, “but my family have constantly found their way back to Medford.” His background includes animal science and technology, but it was in Los Angeles, where he worked at an emergency practice, that he learned how much he enjoyed emergency medicine. “Following that, I went to vet school, came back out and went straight into ER, and I haven’t turned back.”

By late morning, the doorbell chimes more consistently, and six of the seven benches are occupied. On one of the carts, Dr. Ann Schlipf is checking the vitals of Pyewacket, a Siamese Manx who came in with diarrhea and a poor appetite, and a tech draws Pye’s blood. Dr. Schlipf knows the cat and her humans from her former practice; she joined RVVE after being in a day practice for eight years, which followed 30 years of working full time in emergency medicine. She currently does one shift a month, and today she’s here from 10 a.m. until 10 p.m. “I missed ER,” she says. “I like ER. It’s nice setting up routine relationships with clients, but I like the unpredictability, the uncertainly.” 

Another cat patient arrives, and, ten minutes later, a dog. Meanwhile, Reyes and Amanda McPhetridge, a vet tech who is also part of the RVVE management team, take Chester for his radiograph. Chester’s person accompanies Reyes and McPhetridge to the X-ray room, standing behind a window, a safe distance from the machine but where he can still see Chester.

Out on the floor, the door chimes again: a dog has been hit by a car. By now, the open floor is humming; there’s still little noise from the animals, but with more patients, the doctors and techs are busy doing intakes, talking with clients and consulting about diagnostics and treatment. 

“My staff care very, very much about what they do here,” Dr. Lewis says. “I think that a lot of us have experience in corporate medicine, and that has caused us to wish there was a different way of doing it. I do think it can be done better, and I am trying to put my money where my mouth is.” 

At noon, when additional staff arrive, Dr. Lewis calls for a huddle, and the staff gathers in the open lab area. “Hi, guys, happy 4th of July,” Dr. Lewis greets them. “First,” he says, because the hospital is already nearing capacity, “let people know there is a 2- to 4-hour wait time.” He instructs them to get vitals first, but for efficiency, “if a patient is difficult, move on to an easier one” and ask for help. Most important is getting an accurate weight, he says, so they can properly dose medications. If a patient’s case is straightforward, get them treated and on their way. 

“Second,” he says, “I have stocked the fridge.” 

The staff breakroom’s refrigerator is stuffed with iced teas and sodas, veggies, cheese, nuts, crackers and yogurt, with staff lunchboxes squeezed in; containers of single-serving chips and goldfish crackers are on top of the fridge, with boxes of pastries on an adjacent table.

“I’m looking forward to a healthy 4th of July,” Dr. Lewis says, closing the meeting. “Let’s help some people.” 

The doorbell chimes again: a dog with a foreign body in the mouth. Despite being busy, the hospital’s atmosphere is calm as patients are triaged, registered and treated. 

Dr. Lewis examines Chester’s X-ray results, which reveal an enlarged colon. “When we start getting megacolon, we get into more dangerous territory,” he says.

Back in the private room, Dr. Lewis shows Chester’s human an X-ray of a normal colon to compare to Chester’s, then outlines treatment options and long-term care. Chester receives subcutaneous fluids and a prescription to increase his laxatives from one laxative twice a day to two laxatives three times a day. 

“He’ll go home with that and then will make the long-term decision,” Dr. Lewis says. “The laxatives may work, but if not, then it’ll be a harder conversation.”

And this is a conversation that will be with Chester’s regular veterinarian; with RVVE doing emergency care only, the staff does not always see patient outcomes. “It can be frustrating for clients,” Dr. Lewis says, “who often like their ER doctors.” 

The doorbell continues to ring: a lost dog, a dog with facial wounds. Meanwhile, some of the morning’s patients are getting ready to be discharged. With his tech background, Dr. Lewis has created a prompt that uses AI to build patients’ charts, to summarize records and to prepare discharge reports. “It makes everything more streamlined and efficient.” 

Veterinarian Kim Keeling, who works 12-hour shifts that often stretch even longer, appreciates the efficiency of AI. “It makes everything go faster,” she says. “Then we can see more patients.”

It’s early afternoon, and the main area is full, with several animals being treated in adjacent rooms. The dog stung by a bee is stable, as is the dog who was hit by a car. The dog with GI issues had a normal ultrasound and is awaiting bloodwork. Chester is on his way home, and for Pye, the Siamese Manx, Dr. Schlipf has recommended a 24-hour hospitalization so staff can keep her hydrated, give her anti-nausea meds and repeat her bloodwork.

“When I’m working with patients,” Dr. Lewis says, “and they’re in a crisis, being able to come through and say, ‘Hey, yeah, let’s get this under control, let’s figure this out, let’s try and get you back to your primary vet and get you healthy’ — I really like the ability to say we’re here when you need it most.”

The doorbell chimes again. 

Ashland resident Midge Raymond is co-founder of Ashland Creek Press and author of the novels “Floreana” and “My Last Continent” and co-author of “Devils Island.” Email suggestions and questions for Catty Corner to her at [email protected].