Wednesday’s case was a bad one from the get-go. A 4:30 call from the specialty hospital across the street asked if we would take on a client with $32 to spend and a pup on its last legs.

Bring it on. Why not?

In part, I confess, I did so because we have an excellent relationship with the hospital across the street. My significant other works there. They provide care for my own pets at cost. And their large staff loves me well enough to recommend my services to their friends and family.

So when they’re in a bind I’ll always help out. Their very strict setup make a $32 case of potential Parvo an administrative nightmare a smaller hospital can more easily manage—though it’s true that our smaller income in many ways makes it harder to do so.

No matter. I was in a good mood, finally feeling like I’d recovered from my vacation. My cases had been non-challenging so far and I was due a little hassle. Some karma, too, right?

But this one was non-starter—and money was just the tip of the iceberg.

A Chihuahua-terrier mix. Emaciated. Recumbent. Pale. Shaking. Feverish. With vomiting and bloody diarrhea. And only four months old.

Euthanasia might have been a reasonable option for anyone. While the money issue would normally have made it a no-brainer in favor of an immediate end to her suffering, this owner wouldn’t consider it. (The presence of three little girls did nothing to support this alternative.)

The pup had been fine for a month until the owner had brought a new pup into the household. The new pup, an AmBull, was six months old and feeling just fine, but now this little baby had succumbed to something he’d presumably carried in.

She was clearly dying.

Though I couldn’t offer to keep an infectious pup in house without spending big money on diagnostics and other safety protocols (putting my paying patients at even a slightly increased risk seemed unbelievably unwise), I could certainly show this owner how to administer fluids and injectable medications at home.

The next day (yesterday) the little Chi-mix looked somewhat perkier but still on death’s doorstep. We added in some more meds and can only hope for the best at this point.

In light of yesterday’s post on the potential for veterinary malfeasance on the part of hospitals who would see pets euthanized when owners can’t pay, I’d simply like to point out that this scenario plays out daily in our hospitals. Right now we’ve got another one in-house who’s racked up $2,000 in supplies we’ll never be compensated for.

I don’t tell you this because I want you to think our profession is always generous and willing to work with the financially strapped. We’re not—not always. I’m jut trying to point out that these cases are always complex moral dilemmas we’re challenged to find solutions for—whether we choose to take them on or not.

Most people have no idea how stressful this can be. Sharing money cases with other hospitals helps. For example, the specialty hospital who punted this case over to me has also performed below-cost surgeries for several of my foster pets. They’ve also offered discounts and payment plans for my technicians. They play nicely.

That’s why it rankles to see that big news comes of situations where vets don’t give things away (or when they act badly), but nothing’s ever made of our frequent daily contributions. And that’s stressful, too.