Ever get up in the middle of the night to the distinctive sound of Fido retching uncontrollably in a corner? Or to piles of bloody stool dappled across the bedroom floor? How about the invariably alarming midnight seizure? You’re not alone. It happens to us all at some point.

Next thing you know you’re driving, bleary-eyed and panicky, into the streets with sick pet in tow in search of your friendly neighborhood emergency hospital—which in too many cases is neither friendly nor remotely in your neighborhood.

If you’re lucky, perhaps your own vet keeps a beeper or an on site emergency service. With the advent of large-scale emergency hospitals and specialty clinics, however, this homier scenario has become progressively less likely. When you call your vet in 2006, chances are you’ll be redirected to the nearest 24-hour facility.

You’ll stumble in through its doors, carrying a meowling, bleeding Fluffy, only to be told by the surly woman working hard to keep her three jobs that the doctor is in surgery so you’ll have to wait 30 minutes. (I drove like a maniac for this? Who does surgery at three AM anyway?) If you’d only arrived earlier, you muse…but then you might have been the fourth in line for the doctor’s attention.

After twenty minutes you’re starting to think your time would have been better spent at the Dunkin Donuts purchasing a box of bribes. Finally…the doctor will see you now. Seemingly competent and surprisingly alert, the vet expertly sutures up Fluffy`s wound and returns her to you in exchange for six hundred dollars of your cash. You’re shocked, but then…who else was going to fix Fluffy at 4 AM?

A few hours later, at approximately 8 AM, you spy blood on your tile. A trail leads directly to Fluffy`s favorite sleeping spot where you notice her violently pulling at her stitches with her teeth. Now it’s time to load up again and drive to your regular vet who will doubtless feel slightly responsible for your having spent $600 on something he would have done for $150 had you waited four more hours.

Now take care—I’m not advocating you ever delay seeking medical attention in order to see your own vet, just know that, on average, you will pay 100 to 200% more at most emergency hospitals. Why else would anyone work those hours if not to be paid a premium for his or her services?

What inevitably happens at these facilities, however, is that explanation and option presentation takes a backseat to expediency and defensive medicine (especially at 3AM or on any given Sunday). This means that 1- the vet will typically offer only exactly what she thinks is best for your pet and 2-the best medicine is also the medicine that searches tirelessly for problems so as to ward of any lawyers that may ask: And why, Dr. X, did you not take an X-ray of Fluffy`s lacerated paw? Consequently, panels of bloodwork, X-rays, and plenty of medications are always administered (this is clearly a worthy subject for another post).

Pet owners are almost always provided an estimate before any service is rendered (beyond the basic exam). And most will gasp. But they won’t always grasp the inherent element of choice in declining any of the products or procedures on the itemized list. They just want Fluffy fixed. If they have the money it will usually get spent.

For the record, should the estimate appear unusually high, there are four possibilities: 1-your pet is very sick and needs lots of care, 2-you have no earthly idea what things are supposed to cost, 3-the hospital is running up the bill (because the vet wants to or because the vet is under pressure to do so) or 4-because they’re being expedient and/or defensive (see above).

Nonetheless, every client has the right to ask to speak to the vet about the costs and to attempt to ascertain whether certain tests and procedures are absolutely necessary. That may be impossible without extensive knowledge, and I wouldn’t expect most clients to be that savvy, but it helps to let the staff and the vet know that while you respect them, and you still want everything possible done for your pet, money is indeed an issue. My advice? Kill `em with sugar but stay firm and you’re doing the best you can for your charge in these trying situations. I know it’s hard.

The stressful part of all this for me, the general practitioner, is that I know Fluffy. I know that she needed X when she received Y. I know that she didn’t need those two extra tests. Furthermore, I have a vested interest in being judicious about spending your money.

It irks me, too, to see you pay so much—not just because were it not after hours that income would have been mine, and not just because now you have nothing left over to spend on resuturing her (when they should have sent you home with an e-collar), but mostly because I know you and I feel frustrated on your behalf.

Moreover, whenever I send you elsewhere, that elsewhere is a reflection of me and the quality of my recommendations. It sucks when they f--- up or charge you four times more for what may turn out to be a lower quality of service. (Truthfully, I can say that—in my area—this happens about 25% of the time—maybe you`re luckier.)

But that’s the breaks guys. Unless I suit up and head out with my bagged dinner at 7 PM, I’m in not a great position to complain. I do anyway, but only when the damage is egregious. That’s why I still give out my cell phone number. I won’t usually get out of bed, but I will call to make sure Fluffy isn’t X-rayed for her superficial laceration.