While Kat cleaned up the mess, I fed Callie.

I had assumed that Lyra would hear the food in the kitchen and appear shortly. When she didn’t, I went to check on her.

She was lying on her side. I rushed to her and stroked her head. I didn’t want to upset the girls. Lyra’s eyes were open, but she wasn’t focusing on anything. Her breathing was rapid and shallow. I buried my face in her ear, whispering her name and trying desperately to suppress my rising sense of panic. But as soon as I did, I could feel that her lips and nose were cold. Her gums were pale. I ran to get Kat.

“Something is seriously wrong with Lyra,” I told her. “We have to get her to the emergency room right now.”

While Kat got a towel to lift Lyra, I broke the news to Helen.

“Helen, Lyra is really sick.” Fighting back tears, I went on. “We have to take her to the vet right now.” Helen immediately sensed the seriousness of the situation.

“Can I come?” she said.

“Yes, of course.”

“Is she going to be okay?”

Tears started down my cheek. I hugged her.

“I don’t know.”

Kat and I rolled Lyra onto a beach towel and carried her to the minivan, where we carefully placed her in the back. Helen sat down next to her and stroked her head. It was all a bit much for Maddy, who asked to stay at home. Kat agreed to stay with Maddy while Helen and I sped off to the ER, only five minutes away.

It was an early Saturday evening and a crowd of people, cats, and dogs was filling the vet ER. An old man was trying to sign in a schnauzer. I ignored him and demanded immediate help.

“How much does your dog weigh?” asked the receptionist.

“Eighty pounds.”

“Two techs to the front desk for immediate assistance!” she barked into the PA system.

In less than a minute, two women appeared with a gurney, and we rushed to the parking lot. I opened the tailgate of the minivan. Helen was still sitting with Lyra. I could tell from the techs’ facial expressions that this was not good.

“How long has she been breathing that way?” one asked.

“Less than an hour,” I said.

They lifted Lyra onto the gurney and rushed her into the back of the hospital. Helen and I sat down in the waiting room. Numbly, I pulled her tight.

We didn’t have to wait long. Another young woman, with long blond hair and kind eyes, introduced herself.

“I’m Dr. Martin, the staff veterinarian tonight.”

I looked at her, fearing the worst.

“Lyra’s blood pressure is extremely low, and we can’t get an IV started in any of her paws,” she explained. “We need to make a cut in her neck and put the IV there to give her fluids. Is that okay?”

I said yes, and she rushed away.

The receptionist motioned me to the front desk to sign paperwork. Having been there before, I knew they wanted me to guarantee payment. Of course I would. The last form, though, I was not prepared for. Did we want CPR performed if Lyra’s heart stopped? If not, then she would be a DNR: do not resuscitate.

Even in humans, CPR offers a fifty-fifty chance at best. If Lyra’s heart stopped, that could mean chest compressions, defibrillation, intubation, even open cardiac massage.

I called Kat.

“They want to know if she should be DNR,” I said.

“What’s wrong with her?”

“She’s in shock, but they don’t know why,” I said. “They’re doing a neck cut-down to get fluids into her, but they need to know if we want them to do CPR if her heart stops.”

Kat was an ICU nurse. She knew what was down that road.

“I don’t want her intubated,” she said. “I don’t want her to suffer.”

I didn’t either. I checked the box for DNR and sat down with Helen. After fifteen minutes the vet came out and explained the situation. They had managed to get an IV into Lyra’s neck and she seemed to be responding to the fluids they were giving her. Her blood pressure, though, remained unstable. The lab work showed that the level of potassium in her blood was elevated. Everything else was normal.

“Does she have Addison’s disease?” the vet asked.

Addison’s disease, technically called adrenal insufficiency, is a somewhat rare disease in both humans and dogs in which the adrenal glands cease to function. The adrenal glands sit atop each kidney and produce several hormones that are necessary to maintain vital functions of the body. Adrenaline is produced there and helps maintain blood pressure and heart rate. The adrenal glands also produce hormones that allow the body to absorb sodium from food. Nobody knows what causes Addison’s disease. It often progresses so slowly, with only the vaguest of symptoms, that it is sometimes never diagnosed. Until the patient enters an Addisonian crisis. A crisis can be triggered by the slightest of stress—a viral illness or even a mild injury. Without the necessary hormones to rev up the body to fight the stress, the patient collapses into shock.

Nobody had ever suggested that Lyra might have Addison’s disease. It hadn’t occurred to me, Kat, or her regular vet. But the question made me wonder. Lyra had never been a high-energy dog. Could the “Sloth,” as we called her, simply have been fatigued and weak? Those would be classic symptoms. The intermittent vomiting could have been a sign too. I didn’t know.

Kat arrived and we all went back to see Lyra in the ICU.

She appeared to be sleeping. I was grateful that she didn’t appear to be in any pain. Several bags of different fluids were hung on an IV pole. Helen lay down beside her and stroked her head with the tenderest of touches. The vets were giving her steroids, presumptively assuming that she had Addison’s disease, but it was all guesswork. There wasn’t anything more we could do by staying at the hospital. Lyra appeared stabilized, and our presence could potentially excite her, which could send her into shock again.

I hugged her gently and whispered in her ear, “I love you, Lyra,” and wiped my tears on her fur. The vet promised she would call if anything changed.

The five-minute drive back to the house felt like it lasted an hour. None of us said anything.

The phone was ringing when we walked in the door. It was the vet. Right after we had left, Lyra vomited blood and started hemorrhaging from the other end too. If we didn’t do something right away, she was going to bleed to death into her digestive tract.

“She has DIC,” said the vet. I repeated that to Kat.

Disseminated intravascular coagulation, or DIC, occurs for unknown reasons following trauma or shock. The body goes haywire, clotting in places it shouldn’t be and using up the clotting factors in the process. The end result is uncontrolled bleeding, which is what was happening to Lyra. When it happens in people, only the most aggressive care can save the patient, and even then, the prognosis is poor. In the world of veterinary care, DIC is grimly referred to as “dead in cage.”

Kat started to cry.

The vet wanted to give her a transfusion of dog plasma, which would contain clotting factors to stop the bleeding.

“Do you think it will work?” I asked the vet.

“I don’t know,” she said. “Lyra’s condition is grave. If we can stop the bleeding, she has a chance.” I gave the okay.

“If anything changes, please call us right away.”

Nobody wanted to sleep that night. To distract ourselves, we stayed up and watched TV until midnight. Maddy wanted to be alone, and Helen slept with Kat and me. Callie curled up at the end of the bed, confused.

In the morning, I waited as long as I could before calling the hospital. The doctor on call for the day reported that Lyra’s lab values seemed stable. Her blood count had not dropped much, indicating that she hadn’t lost too much blood. But her clotting factors were still out of whack, and she was still bleeding out of her GI tract. The plan for the day was to try to keep her blood pressure stable.