A Pomeranian sat in its owner's arms violently trembling and panting. "He's been shaking like this for 30 minutes. ... I got in as quick as I could," said Scott Nelson.

Dr. Louise Beyea asked a series of questions, as a team jumped into action. One woman held the dog, Louie, securely as another shaved his arm to insert an IV catheter.

Beyea didn't think it was a seizure; his symptoms were classic for dogs who have been in a compost bin. Louie was given a small dose of Methocarbamol.

"He's panting because he's really hot. He would have gone into heatstroke, and he wouldn't have made it," she said.

Eventually, Louie's breathing adjusted. The shaking relaxed. "It's hard when your kid is sick. ... That's my little boy," Nelson said, his hands in his pockets.

Seeing a dog in Louie's condition may appear striking to the untrained eye, but Beyea has been a veterinarian for 30 years. She recently worked her last shift as a rotation regular at BluePearl Veterinary Partners (formerly Affiliated Emergency Veterinary Service), where she's worked for more than 10.

Cases in the ER clinic are all over the board, from an animal with a broken toenail to one that's been hit by a car. Panicking doesn't assist the animal or the client, she said, so remaining calm is paramount no matter what comes through the door.

Beyea has always been level-headed in a crisis, a trait she attributes to growing up on a ranch in Nebraska. At an early age, she worked in the hay fields, fed livestock, and later administered medications to the family's cattle and horses.

She was also exposed to death as a child. There was a story about a lost-then-found kitten, a dog that ran into a mower, animals that were struck by lightning. These experiences, and even her own childbirth and physical traumas (13 broken bones) come in handy at the clinic.

Beyea knows what it's like to be sick, to feel pain, to have a personal cancer scare, and pet owners are feeling the same feelings for their pets, she said.

Injuries can also be a part of the job as a veterinarian. If they can't run, they're going to do anything to protect themselves, she said. In her work with big and small animals: "I've been kicked, bitten, stepped on, smashed against a wall, scratched."

During a recent visit to the West Duluth clinic, Beyea was pragmatic, calm and direct. Among her clients were Morpheus, a black bulldog mix from Moose Lake who ate a pan of flan; and Bella, a goldendoodle cross breed with a squinty eye.

In the exam room, Bella kicked and whipped her head.

"When she struggles, I'll give you a tip, don't tell her it's OK," Beyea said. "It's not OK to struggle. You're trying to reassure her and tell her life is fine, but she doesn't get that. What she hears is 'What I'm doing is OK.'"

After a series of questions, Beyea applied numbing drops and an orange dye, which illuminated a small ulcer. After demonstrating how to apply the medicine, the tiny dog hopped around the exam room, quick to lie on her back for belly rubs. I've scratched my eye before, it's really painful, said Beyea before exiting the room.

Working in a veterinary emergency room has its challenges. There isn't an established relationship with the client, and circumstances are often highly emotional.

"We're not giving booster shots to healthy puppies. We're dealing with a guy who's been drinking and cleaning his gun and accidentally shoots his dog. Or people are walking with their dog, and he goes off to chase a rabbit and gets hit by a train," Beyea said.

Another source of stress can be the cost of care, which runs at least $100. Several hundred more can come with blood work, X-rays, certain medications - and most costs are out of pocket, she said. And distraught clients are asked to make life-or-death decisions.

On a metal table, a fluffy gray cat lay on a black blanket with cartoonish ghosts. Veterinary technician Jen Tasky swapped it out for a lavender cover with a floral design.

With syringes in one hand, Beyea lifted the immobile feline. "Alright, pretty kitty, we're going to make it so it doesn't hurt anymore," she said, walking into the exam room, where its owners waited.

It's not unusual to see one euthanasia each shift, Beyea said, and the most she's seen in one night is 11. The cause is the severity of injuries or the cost of emergency care. "Sometimes, that means the dog doesn't live, even though a broken leg is fixable."

Because each case is an animal that is sick, injured or traumatized, it can affect all involved.

The emergency veterinarian is treating the animal, issuing the life or death options and carrying out that directive. ("I'm the one injecting that drug," she said.) During a terminal diagnosis in human medicine, there's support in social workers, hospice care, clergy. Doctors are removed from that death, but not in veterinary medicine, Beyea said.

The work has taken a physical toll - not bouncing back from the chaos of a night shift - but the hardest part is the emotional labor, she said. That's why it's important to take care of yourself in a workplace that can be traumatic to the heart and soul.

Her solutions are to find healthy ways to process, talk to coworkers or a therapist. She journals, reads poetry, gardens, hikes, bikes. And while there's pain, Beyea said the joy of the job is immense, as is the camaraderie.

"It's definitely not a one-person show," she said.

Many of the staff have been working together for so many years, they know what each person is going to do, said lead veterinary technician Emily Regier. "We don't even need to speak ... we have a well-oiled machine."

Of Beyea, Regier said she is someone who is passionate about her profession; she ensures her colleagues are appreciated, and that leaves an impression. "One thing that she's taught me is to not sell myself short ... and to be proud of what I've accomplished in my job," Regier said.

In the field, many doctors aren't trusting of their team, but Beyea trusts her technicians and values their input, said veterinary technician Desiree Lillo.

Lillo recently had a gerbil pass away, and Beyea's suggestions helped extend its life a couple of months. "I know she's never going to be fully retired. She's always going to be working or having her hands in some sort of animal adventure."

What drew Beyea to the work, her favorite parts, are performing surgery, figuring out the puzzle of an animal ailment, and witnessing healing.

The morning after Louie was admitted, he went home smiling and wagging his tail, she said. "It's extremely gratifying."

During that shift, Beyea also saw Clara Bow, an extremely lethargic Shih-Tzu. Kathy Sowl of Duluth said her husband was worried their rescue dog was dead when he came home that afternoon. After examining the cloudiness in Clara's eyes, Beyea determined she was likely around 10 years old.

To Sowl's surprise and concern, Beyea offered this: "We're never going to have one dog in our life. We get to enjoy all these personalities. Multiple opportunities to fall in love."