Yesterday I had a new client walk in as I was on my way out the door. Psyched that I was finally going to make it to my spinning class at least one day this week, I (only briefly) thought of telling the receptionist to inform the gentleman that I had already absconded. Guilt stayed my hand on the keys in the ignition. And when I saw what this new client had in his purple plastic kitty carrier I was relieved to see I’d made the right decision.

The kitty-cat, a two-year-old tabby specimen, was recumbent, feverish, and painful. This was the third hospital he’d been to that afternoon. Lacking a regular vet (let’s leave that issue aside for the moment), he’d gone to the first large hospital he could find.

The first hospital quickly informed him of his cat’s condition. Kitty had a urinary obstruction. His bladder was huge and painful and, as a result, deadly toxins were building in his bloodstream that would certainly kill him if the bladder was not relieved. When an estimate for well over a thousand dollars was presented, the client (a young student from a family of recent immigrants with few resources) felt he had no choice but to take his pet to a less expensive hospital. They sent him to the animal ER down the street.

The animal ER, just opening its doors for the evening, echoed the estimate and referred him to me. The ER staff felt that if any regular vet could see him his bill would be manageable compared to an ER`s up-charge for convenience and emergency hours. And I was close by.

By the time I saw Kitty, the owner was frazzled, scared for his cat, and confused by the plethora of options that confronted him. Kitty, needless to say, was well on his way to that bright light at the end of the tunnel.

Before bothering with an estimate I unblocked the poor thing. He was so weak no anesthetic was required, just a sedating pain reliever. Passing a catheter through his tiny penis into the urethra and then the bladder, this action was quickly accomplished.

Now that the situation was somewhat under control I was able to talk to the poor shell-shocked client. I explained the condition and offered a wide variety of options. No surprise here: he chose the least expensive approach. For fewer than four hundred dollars I can’t practice medicine the way I’d like to but I can still save a blocked cat’s life.

Not everyone has the means to spend big bucks on a housecat when something goes terribly wrong. And perhaps that means they shouldn’t have one. But it’s not my job to judge. In this case my job was to unblock a blocked cat to save its life and come up with a workable financial solution for a struggling family—afterwards.

The sad truth of this story is that a pet owner that does not understand even the simple system of getting care for a pet in the US will fall through its cracks more easily. This cat might have died in another hour or two. What if the client had given up? He certainly had cause to be frustrated with the process.

Because this client expressed his money problems with the reception staff, as I was later informed, no vet ever examined the cat or talked to him directly. Receptionists and technicians at both preceding hospitals were charged with assessing his cat’s condition. Vets wrote up estimates without even looking at Kitty or talking to his owner.

Ultimately, hospital policy was as responsible for prolonging Kitty’s near-death experience as his owner’s failure to establish a relationship with a vet before the emergency. Which one is more forgivable?

Truth is, most vets don’t want to deal with new clients in emergency situations—especially clients who have expressed an inability to pay for services. This is a fact of doing business in any setting—no money is no good for business. While medicine should be different, that doesn’t change the common outcome: poor people don’t get proper healthcare for themselves, much less for their pets.

To a certain extent, all vets are guilty of making snap determinations that can unwittingly lead to a pet`s death. For example: the client has no money, I gotta get to the gym, whatever...

Working in an ER for many years hardened me to this reality: If you can’t pay we can’t treat. And working in a traditional hours setting has softened me to another: my lifestyle matters so that getting home to my child or to the gym is important, too.

Now that I have more control over how I practice (because I work in a hospital that gives me license to undertake less-than-standard-of-care protocols when needed) I enjoy my work more. But I still worry about all those pets who go without when we fall asleep—whether on the job or at night, snug in our beds.