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The ER is always an exciting place of unexpected events, interesting bodily fluids and fuzzy brown smells. Lives are saved aplenty, lives are also lost, and there is comedy of the high and low variety. I have seen the best and worst of humanity in the veterinary ER over the past 20-odd years.

But the ER usually has a somewhat predictable pace: Sundays are typically a steady stream of sick and injured pets walking, flying or gurneying in to see me and my ER accomplices all day long. Weekday evenings between 6 and 10 p.m. is the veterinary ER happy hour when the lion’s share of cases come in, so we usually staff accordingly.

There is one phenomenon that you can’t staff or really even prepare for: The Weekly Cluster. (In the ER, we often append a shortened version of “Firetruck” after the “Cluster,” but I’m sure you get the picture.)

Things may be ticking along smoothly with a dog giving birth in room 3, a cat vomiting in room 5, and the guy in a purple Speedo tripping out blissfully in room 6, but sure as shootin’ the Weekly Cluster is right around the corner. Or it might arrive on one of those full-moon-fever nights in high summer, where the guy in the purple Speedo is the one giving birth, all the rooms are full and the lobby is, too. The Cluster loves to stop by on those nights and make things just a little bit worse.

So, what the firetruck is the Weekly Cluster? Oh, it takes many forms, dear Reader.

It’s the unexpected in the land where the unexpected is the coin of the realm. It can also be an overlooked everyday detail that diverts your attention away from patient care to something else.

It‘s often not a giant medical case; those are what we’re there for. No, it’s usually something more mundane that snowballs to such an extent that it sucks all the oxygen out of the room and leaves you scrambling to make it go away. Strangely enough, it’s often a customer-service issue. The problem is the ER has a very short memory – we’re good at fixing the problem right in front of us, but last week’s issues are often lost to antiquity. As much as veterinary ERs really do want to keep pet owners happy, keeping animals alive is always job #1.

Here are a few that I can recall. (Names have been changed because I have forgotten them.)

• You saw (and saved) Princess last week after she had a dalliance with congestive heart failure (CHF). Somewhere along the way her very expensive allergy medication, which the owners brought in so it could be given to her while hospitalized, was misplaced. There are 48 drawers and 36 cabinets where it could be. The owners, while quite happy you saved Princess’s tiny bacon from the horrors of CHF, are incensed that the medication was lost. While all your staff hunt for the meds and the front desk fields their almost-hourly calls about it, the rooms are slowly filling and you have two lacerations to sew up and 11 charts to complete. You chuckle quietly to yourself and start to wonder if you should have listened to your parents when they suggested the exciting world of accounting as a career choice.

• The owners of Mary, a pug in renal failure, have travelled 3 hours at the urging of their veterinarian to see you at the university teaching hospital for kidney dialysis. There’s only one problem: your hospital does not offer kidney dialysis. Upon hearing this information, Mary’s owners are understandably upset and proceed to yell, cry and ask just how this could happen. You spend the next hour on the phone, looking for a facility that performs kidney dialysis. While you do this, the rooms are filling up and you have a dog waiting to go to surgery for a C-section, 15 charts to write up and four owners to call with lab work results. Your laughter turns to the bitter tears of exhaustion and hunger. You dry your eyes and nuke your 7-11 burrito. 
  
  
• Penny’s family made the hard decision to euthanize her for metastatic cancer last week. They requested a group cremation and did not want the ashes returned. They have now called back, 3 days later, saying they’ve changed their mind and would like Penny’s ashes back, and, by the way, do we have her collar and special blanket that she was brought in on? After learning from Princess’s lost-allergy-medicine debacle, you have selected a special drawer for lost patient items and look there first: no dice. You search the other 47 drawers and 36 cabinets, and are able to locate the collar and blanket. Luckily, you are able to call the crematory to make the requested changes before her remains are lost, and it only took 45 minutes on the phone. When you call to let the owners know that you’ve found the missing items, they ask you to please mail them. While you look for a suitable box and packing tape, the rooms are filling up, you have a broken toenail and two lacerations to fix, 17 charts to write up, six sets of lab work to call back and your 7-11 burrito (beef and bean) has been sitting in the microwave in the break room for 4 hours. You weep silently and wonder why you ever dropped out of trucking school.

You get the picture. You have now met The Weekly Cluster.

The Cluster usually abates once we've solved the issue at hand, but we know it'll always turn up again in some other form. Maybe we found the missing leash, CD-ROM of X-rays, or biopsy sample someone put in the fridge next to their Yoplait. But sure as Chekhov's gun will show up in the Third Act, the Cluster shall return. 

Now, where did I leave that burrito? Ah – there it is. Right on top of my application to barber school.