Our Dog Is Vomiting and Has Diarrhea
"Our dog is throwing up and has diarrhea."
"He suddenly stopped eating. Why won't he eat?"
"He's vomiting and having diarrhea, and he's shaking all over. He can barely even stand. Doctor… what's wrong with our dog?"
Yoo Mu-hwan, who handled the internal medicine cases, heard questions like these several times a day.
It could be nothing more than overeating. Spoiled food could do it too. In cases that weren't serious, the symptoms often resolved on their own in a day or three. But there were also the ones that could not wait: pancreatitis, viral enteritis, colitis. A swallowed foreign body. Poisoning. A tumor taking root in an internal organ. Kidneys quietly giving out. Animals vomited, had diarrhea, and turned their faces from the food bowl for more reasons than anyone could count—and the only way to find out which reason was to run the tests. All the more so when the patient was fourteen years old, like Teun-teun-i.
Yoo Mu-hwan stood in front of the blood chemistry analyzer and waited for Teun-teun-i's results.
The truth was, a diagnosis had already risen in his mind the moment he saw the dog. Fourteen years old. Poor appetite. Weight loss. Vomiting. Diarrhea. And a Schnauzer. The name that surfaced, sharp and unwelcome, was chronic kidney disease.
He tried, hard, to push that name back down. No. It might not be that. It could be indigestion, just like the guardian said. But that was only a hope. A wish.
The results did not stray from what he had expected.
"BUN at eighty—normal is eight to twenty-six. Creatinine at 2.7, against a range of 0.5 to 1.3. And, well…"
The liver enzymes were all high too. BUN and creatinine were the markers of kidney function, which meant both Teun-teun-i's liver and his kidneys were in poor shape. The phosphorus was considerably elevated as well.
"Hah. No wonder he has no appetite."
Yoo Mu-hwan let out a long breath over the printout. Behind his eyes stood the dog who, only minutes ago, had looked up at him so pitifully. The moment he opened that door, Teun-teun-i would look at him the same way again.
He sighed once more, the air stuck in his chest. Kidney failure was expensive to treat—and even the word treat was a stretch. You did not cure chronic kidney disease. You slowed it. You bought time with supplements and fluids and special diets, a little more time, and you paid for that time until the very end of the animal's life.
And the guardian waiting in the exam room—the one holding that quiet, sweet-faced little dog—would not, if Yoo Mu-hwan's read of her was right, be in any position to bear those costs.
So what would become of Teun-teun-i then?
At times like this, it really was…
"God. This is going to drive me crazy."
Some people would say it, of course. How can you spin all that from a single blood test? The numbers might have just spiked. Give it a few days and they'll come back down. You're overreacting.
He hoped, truly, that they were right.
But Yoo Mu-hwan knew better than anyone that they were not. The pallor in Teun-teun-i's eyes. The heavy, sour stink of his breath. The fine trembling that never quite stopped. Every one of those signs was the disease speaking its name.
He heaved another sigh, then another, and finally stood. Sighing was not going to change a thing. He would go in and try to persuade the guardian. Who knows? Maybe I read it wrong. Someone like her might have more means than she looks like she does.
He left the lab with that thought in his pocket and opened the door to the exam room where Teun-teun-i and his guardian were waiting.
"Ah, Doctor. He's all right, isn't he? It's just an upset stomach, right?"
The right? trembled in her mouth. The hands holding Teun-teun-i trembled too, a faint shiver she could not quite hide, and the look she turned on Yoo Mu-hwan was already full of dread. She had guessed, he thought, that this was no small thing. Of course she had. Yoo Mu-hwan had met Teun-teun-i today. She had lived beside him for years. She would know her own dog's condition better than anyone—even if she did not know the name of the disease, she would know whether it was grave or light.
Yoo Mu-hwan sat, drew a deep breath, and opened his mouth.
"Ma'am. Teun-teun-i is sick."
Her pupils jerked, a hard little shake from side to side. She had heard, in that word sick, that he did not mean a stomachache. The hand stroking Teun-teun-i's back tightened. She petted him harder than before, as if a firmer touch could hold him in place.
"…He must have a really bad case of indigestion, then. He doesn't get sick often, our Teun-teun-i, but when he does, he does it properly."
Yoo Mu-hwan answered the denial with silence.
"Haha. I probably shouldn't have given him sweet potato. I got indigestion from sweet potato myself once, and this little guy…"
"Ma'am."
"Yes, Doctor."
"His kidneys… you mean his actual kidneys?"
"Yes. His kidneys. Their function has dropped a great deal."
She sat blank for a moment, then found her voice again.
"So—so it's that thing. The one we know about. Where people go for dialysis, that…"
"Yes. That's the disease."
"Hah…"
She said nothing more. She did not look at Teun-teun-i either. She turned her face aside and stared at the white wall.
"Then… no. All he's done is skip a few meals and throw up. That doesn't make any sense. Our Teun-teun-i couldn't have a disease like that. Could you be mistaken, Doctor?"
Yoo Mu-hwan shook his head, slowly, and turned his eyes to the monitor, where the results still glowed.
"If you'll look here…"
He had only begun when she cut him off, her voice gone flat and firm.
"No. Just give him a shot. Once the indigestion clears, he'll be fine."
He had expected that answer. He swallowed a sigh and offered the one he had prepared.
"Let's give him a shot, and a bag of fluids as well, before you go. He's been vomiting and having diarrhea for days. He's dehydrated, and that at least we need to correct."
The fluids would put out the immediate fire. If he could bring the blood values down even a little, Teun-teun-i would hurt less at home, for a few days at least, and rest a little easier.
"What…? Just give him the shot, please."
"…All right."
He could not look at the woman from whom he had just taken even that last hope. No—he did not want to look. And he hated himself for having no other answer to give.
Every time it came to this, the same questions rose in him.
Why did I become a veterinarian?
Why is there nothing I can do for these kids in pain?
But he could not live on that lament. From morning until evening—sometimes late into the night, into the small hours—he met sick animals, and situations like Teun-teun-i's were not rare. They were the work. Which meant that even now, the only thing left was to do his best.
"All right."
From the injections that would quiet the symptoms, Yoo Mu-hwan chose the best ones, the expensive ones, and gave them to Teun-teun-i. Then he spoke to the dog.
"Teun-teun-i. You'll feel a little stronger once you get home. And I'll see you again."
He wanted the guardian to bring him back. He wanted another chance to give this dog the treatment he could give. So the moment she carried Teun-teun-i out of the hospital, Yoo Mu-hwan went to the reception desk.
"If Teun-teun-i comes in, you tell me. I don't care if it's my day off. You tell me."
And his wish was granted.
Three days after the shot, the guardian appeared with Teun-teun-i in her arms. He looked far weaker than before. She stepped into the exam room holding him and said,
"Doctor, after the injection he ate his breakfast yesterday just fine. I thought he was getting better. But now he won't eat a thing. And he has no strength at all."
Yoo Mu-hwan was grateful, in a thin way, that the shot had bought him two days of eating. What worried him was how much worse the disease would have grown in the meantime.
"He was still drinking water, but from yesterday evening he stopped that too. Completely. And he keeps throwing up… From last night he's vomited six times already. And he hasn't even eaten anything…"
Urgency tightened Yoo Mu-hwan's voice.
"Ma'am. I told you last time—a shot by itself can only take the edge off the symptoms. Teun-teun-i needs to be hospitalized. He needs treatment to bring his numbers down."
She nodded, slowly.
"Hah. I did bring some money, but…"
She drew two hundred thousand won from her pocket and set it on the exam table.
"This is honestly all I have. I looked into it a little, and I heard hospitalization is terribly expensive…"
It was not even enough to cover the exam fees. Yoo Mu-hwan nodded anyway.
"Let's get him admitted first."
"Th-thank you, Doctor."
Relief loosened her shoulders. She stroked Teun-teun-i's forehead, the dog still clutched tight against her lap.
"Teun-teun-i. You listen to the doctor, okay? You'll be all better in a few days. Our Teun-teun-i is brave, so you can do this, right?"
The forehead under her hand was glossy. So was the fur along his back. The rest of his coat was unkempt, but those two places shone. Looking at them, Yoo Mu-hwan thought, She's been holding him and stroking him all day, hasn't she.
The heart of a guardian who wanted to do something and could not must have been heavier than he could imagine. To a person like that, the only thing he could offer was this.
"I'll take the very best care of Teun-teun-i."
"Please look after him."
"I will."
He asked her to come every day and cheer Teun-teun-i on, and then he sent her home. He gathered the dog into his arms and went to find Lee Jun.
Knock, knock.
"Come in."
At Lee Jun's voice, Yoo Mu-hwan entered with the Schnauzer in his arms.
"Is this Teun-teun-i?"
Lee Jun had already heard the report, and he had already sided with Yoo Mu-hwan's judgment.
"Yes. The guardian says she wants him admitted. But this is all she has… I'll settle the rest myself."
Yoo Mu-hwan took the money from his coat pocket and held it out.
"Don't be ridiculous. Don't worry about that—give Teun-teun-i everything we can do for him. Run the full workup. Ah, I have about thirty minutes, so let's look at the x-rays and the ultrasound together."
Even healthy animals hated being examined. Teun-teun-i was sick, and weak, and still throwing up. Lee Jun wanted to spare him even a little of that distress. When Lee Jun did the imaging, the animals were not only calm—they were fast. Yoo Mu-hwan knew that well, and he bowed his head.
"Thank you, Director."
"Let's go."
Before they began, Lee Jun explained to Teun-teun-i why the tests were needed. The dog seemed a little startled at first, but as he listened, he settled, and he went through the exams quietly, without a struggle.
The numbers had climbed even higher than they had three days ago.
"BUN at 112. Creatinine at 3.2. Higher than the first day's labs. Let's get him on fluids and bring the azotemia down first."
Azotemia — also called Uremia
A condition in which toxic waste that should have left the body in urine instead accumulates in the bloodstream.
"Yes, understood. And Director—I'll take the night shift tonight."
There was a steely resolve in Yoo Mu-hwan's eyes. Tonight's duty belonged to Go Gi-jin. But looking at that face, Lee Jun knew there would be no talking him out of it. Even if I sent him home, he'd stay and watch over this little guy. In that case, it was better to just switch the shift.
"I'll talk to Dr. Go."
"Thank you."
"Don't thank me. I'm the one who should be thanking you."
Lee Jun looked steadily at Yoo Mu-hwan, who took on an animal's care as willingly as if it were his own, then turned his gaze to Teun-teun-i.
"Teun-teun-i. It looks like you'll be staying here with us for a few days. We'll get you strong and sturdy again—and then you can go home."
"Woof."
Teun-teun-i nodded, the motion faint and weary.