It’s a sweltering Tuesday afternoon in the hepatology clinic. The air conditioning is struggling, and you wearily rub your temples, trying to shake off the fatigue from a brutal weekend on call. You review the chart for your next patient, Robert, a 58-year-old man with alcohol-associated chronic advanced liver disease. As he walks in, you smile. “How is that new rescue puppy treating you, Robert?” you ask.

He chuckles warmly and pulls out his phone. “She’s a handful, Doc. Look at this.” He shows you a photo on his screen: his puppy is sitting on the floor looking incredibly guilty, with the mangled remains of his favorite slipper scattered on the ground next to her. “Chewed them up yesterday, but she gets me out of the house.”