Shrill, agonal screams echoed through the tiny exam room.

Startled, I stumbled backwards into the concrete wall, hitting my head hard, and the screams stopped. I realized they had been my screams. I screamed louder, more desperately, and rammed my shoulder into the wall over and over until the wall crumbled around me, engulfing me in rubble and knocking me to the ground.

I sat bloodied and beaten, defeated and done, my voice now hoarse...all but gone, my shoulder dislocated, or worse. It was difficult to tell. I felt numb.

I struggled to my feet and returned to reality. I stood across the table from her, both of us bowing our heads over the body of her sweet dog.

Out loud I whispered, "I am so sorry for your loss."

Her voice too was hoarse...all but gone.

"Thank you," she whispered back.