By Jane Snyder, Hospital Operations Coordinator
Acute respiratory distress syndrome. Poly-trauma. Acute kidney injury. These are the thorny cases that criticalists feast upon. For Ayla Preston, a board-certified emergency and critical care specialist and ER/ICU director at Four Seasons Veterinary Specialists, critical patients are her bailiwick. “I thoroughly enjoy critically thinking through complicated cases that are on numerous constant rate infusions, medications, monitoring modalities, and are dynamic in nature.”
But being a good veterinarian in Preston’s estimation means knowing the medicine like the back of her hand so she can step out of that scientific role to embrace the patient. “I want them to feel a sense of comfort when I care for them after a significant trauma or during a critical illness,” Preston explains. “I move with haste when it is indicated and when a life is at stake, but always find the time to give them love and show them affection.”
“I’ll never forget him,” says Preston. “His case was the one I learned the most from and I still carry that knowledge and experience with me.”
During her residency, Preston was faced with an especially difficult case, made worse by the fact that the client was one of her professors. The dog presented after being attacked and was non-responsive and barely alive. He recovered well and came back to life for several days, but ultimately succumbed to systemic inflammatory response syndrome, sepsis and multiple organ dysfunction syndrome. “I’ll never forget him,” says Preston. “His case was the one I learned the most from and I still carry that knowledge and experience with me today.”
Because patients who are critically ill or have suffered poly-trauma are never dealing with just one problem, an ECC specialist must dabble in multiple aspects of veterinary medicine. For Preston, the collaboration between the criticalist and other specialty and emergency clinicians in the hospital is one of her favorite parts of critical care. She and her team provide urgent and emergency medicine, critical care, and consult on cases in the hospital.
The ER is the “hub” of Four Seasons, and operates as a specialty within the hospital. One of Preston’s goals is for Four Seasons to become a VECCS Veterinary Trauma Center.
Four Seasons provides specialty medicine in surgery, radiology, cardiology, dentistry, oncology, critcal care and internal medicine along with a 24-hour emergency hospital. However, the ER is not a separate unit as it is in many other practices. According to Preston, the ER is the “hub” of Four Seasons, and operates as a specialty within the hospital. One of Preston’s goals is for Four Seasons to become a VECCS Veterinary Trauma Center within the next few years.
Dr. Ayla Preston and surgeon Dr. Jayce Lineberger, work together to repair lacerations on a dog who presented to the ER with severe dog bite wounds to his head, neck and torso.
Preston emphasizes a collaborative approach with clients and their family veterinarians, and strives to make a personal connection with them in stressful situations. During her consultations, Preston leaves time for questions, concerns and clarifications, explaining the situation so the client can understand. “I know I’ve done my best when I’ve worked collaboratively with my clients to help them through the difficult time with their sick family member. The worst part is the realization that we can’t save everyone, but also, that just because we can does not mean that we should.
Clear communication is fundamental to good medicine. Each client is called after discharge to see how things are going, according to Preston, and primary care veterinarians are updated daily on hospitalized patients. Offering consultation to family veterinarians with critically ill patients is a large component of Four Seasons’ practice as well. Specialty services are always available for consultation, even when the specialists are not in the hospital. For times when emergency radiology, surgery or endoscopy are required, a specialist is always on call.
While veterinary medicine is intrinsic to Preston’s everyday life, she does seek balance with outside interests. She’s married to Bret, whom she met during her senior year of veterinary school. They share their home with a golden retriever named Lola. For fun, Preston enjoys interior design and refurbishing old furniture. She seeks balance in her life through the closeness of family and friends. She loves to cook and garden, practice yoga and play tennis. She lives by the motto: Life is short. Be kind and humble.