There’s nothing worse than waking up in the middle of the night with a premonition that one of your patients is waiting for you—dead in his cage. I had one of those last night. So I got up, got myself dressed, and arrived just in time to see him take a few last gasps. At least I got the chance to call the owner and give her a chance to elect for resuscitation.

I didn’t really need to. She and I had already discussed euthanasia. In fact, that’s why this geriatric dog was in our hospital instead of the 24-hour facility. We were trying to give him one last chance to improve with warm fluids and pain relievers after suffering some sort of unspecified brain injury, but we didn’t exactly have great expectations for recovery—hence the cash-kind option of an unmonitored evening at our place.

Still, I hate keeping critical cases overnight in the hospital—regardless of the circumstances. There’s no one there to watch them. And while it’s true that most cases will get better (or not) once they receive the basics (fluids, antibiotics, warmth, pain relief), there’s a significant percentage that benefit greatly from round-the-clock care.

If the pet is sick enough to benefit from hourly care—and even when they’re not—I let my clients know that I won’t be there overnight. (There’s always the option of crossing the street for constant care at the e-clinic.) I do promise to check on them and I always keep my word to pop in at night (thankfully, I live five minutes from work), but I can’t pledge to remain present when I have a family to go home to—and not while there’s a reasonable alternative so nearby.

Somehow, however, pet owners are willing to take the risk of less attention in favor of the convenience (?), lower cost (?), blind faith (?) of keeping their pets hospitalized in our “care” overnight. To be sure, most pets won’t benefit significantly from being directly observed—not to the tune of an extra few hundred bucks for the attention of someone the owner doesn’t know (and might even distrust). So I can easily understand why they often prefer to keep their pet with us.

Unfortunately, every time a client takes this tack with a critical case (over my reservations and recommendations) it puts a lot of stress on me—and not just in my waking life. It inevitably barges in on my sleep and sometimes gives me the urge to get out of bed and put my fears to rest with a middle-of-the-night visit.

You should know this condition is not so healthy for a vet. Too many of us engage in this less-than-rewarding kind of masochistic behavior. In my case, I just can’t say, “No. You need to take Fluffy across the street—no matter what.” Instead, I cave to the, “It’s OK as long as you understand we can’t be here at night.” And then I stress out at all hours and sometimes end up taking a pet home to watch them more closely.

And, lets be honest, most owners aren’t typically willing or able to compensate me for that kind of stress. Keeping a vet up at all hours for your pet just because you have a trust issue with the folks across the street—or a cash issue? That’ll be $100?, $500?, $1,000? What is one night’s sleep worth these days?

It’s not that I expect to be reimbursed for my every raw nerve, but I do need to get a grip on the reality of how each case will tax me personally—and charge accordingly for the real time I put in when cases won’t be cared for like I believe they should be. Or just learn to let it go. Hmmm. A conundrum indeed. What’s a vet to do?