In my day to day life as a veterinarian, there is something that I dread doing. This particular thing makes me squirm, twitch, drool and retch. I try to avoid it at all costs, and I consider myself to be blessed if I have technicians willing to do it for me. Want to guess what it is?

Expressing anal glands? (Nope. I secretly think it is rewarding to do this)

Doing a dental on a pus filled, rotting mouth? (Fun times!)

Sifting through dog puke to make sure it threw up all the rat poison? (Love it, even though I am a sympathy puker)

Draining a 4 day old, putrid, maggot infested cat bite abscess? (No, although dealing with maggot wounds sometimes makes me reconsider my career choices.)

As gross and vomit inducing as all of the above may be, the thing I hate doing the most as a veterinarian is talking to clients about money.

That may surprise those of you non-veterinarians out there, but if you were to take a poll I have a feeling you would find many vets feel the same way. We came into this career to do the best we possibly can for each patient, and when finances intervene it gets tricky and heart wrenching. We find ourselves having to consider and weigh the best interests of the patient, the finances of the client, and the demands of our business. I love and want to help animals, and yet I have to make a living. These sometimes competing interests can put us in a horrible dilemma, where no matter which way we turn someone gets hurt.

After vet school I practiced for about 3 years in the desert of Southern California. If you are nuts enough to stay with me on this blog you will realize how much I learned out there. Anyways, in that area were a lot of backyard Chihuahua breeders.

Chihuahuas are cute little dogs. Sometimes they can be little bitty land sharks, but regardless of their nature the females often have a teeny pelvis and have to give birth to puppies with larger than normal skulls. As a result, it is a breed in which pregnant females often need to undergo a Caesarian section.

One day, a man I will call Mr. Smith came running into the clinic with his pregnant Chihuahua, “Precious.” Precious weighed all of 5 pounds, and had been in unproductive labor for 2 days. By this point she was cold, weak and in tremendous pain. Her puppies were dead, and lodged in her pelvic canal.

I quickly did an exam on her, and started her on emergency treatments….warming her, giving her IV fluids and a dose of pain medication. I told Mr. Smith that the only hope for saving Precious was to do an emergency C-section. She would need to be on intravenous fluids, pain medication and antibiotics. The total cost for treatment was going to be 600-800 dollars.

Mr. Smith scoffed, and told me that the only money he had was the forty dollars he had in his pocket…not even enough for the initial exam. He didn’t own any credit cards, and insisted there were no relatives he could call, or items he could pawn. I had a sweet, shivering, dying dog whose owner could not possibly afford the treatment needed to save her life.

I went and begged and pleaded with my boss, who kindly but reluctantly allowed me to cut Mr. Smith a break. I would give Precious the treatment she needed, we would spay her so she could no longer have puppies, and we would only charge Mr. Smith $100.00, which would need to be paid within 5 days. Mr. Smith appeared to be grateful, and left Precious in my care.

The surgery went extremely well, and 2 days later Precious was bright, happy, and munching on the daily chicken I would bring her. Mr. Smith thanked us, and took Precious home.

Guess what? He never paid us a cent.

About 2 months later, Mr. Smith returned to the clinic with “Angel,” another pregnant Chihuahua with the exact same problem as Precious. Dead puppies. Unproductive labor, this time for 3 days. Cold. In tremendous pain. Dying.

Now, the veterinarian in me wanted to rush Angel back and get to work saving her. However, this would have meant doing another 600-800 dollar procedure at no cost. I spoke to my boss, who as gently as he could told me we could not afford to extend more charity to this man who had yet to pay us ANYTHING for the first C-section. He told me I could offer to have Mr. Smith sign ownership of Angel to us, or I could offer to put Angel to sleep at no charge, which would at least end her suffering.

I went back into the exam room and explained this all to Mr. Smith. He was very angry. He told me there was no way he was going to let me “steal or murder” his dog. He kept begging me to save her. He cried. He pleaded. He told me that his mother had just recently died and Angel was the only friend he had left in the world. He asked me how I could be so cold and heartless. Didn’t I see she was suffering?

It was an awful situation. In the end, Mr. Smith yelled that I was a cold hearted witch that only cared about money. He took Angel home, where I am sure she died a horrible, painful death. That case still haunts me.

Now I know some of you may be agreeing with Mr. Smith…that I was cold, that I should have just done the surgery and saved Angel. I could have let him make payments, or taken a post-dated check, or just gone ahead and done the surgery at no cost. The kind, compassionate veterinarian in me agrees with you. After all, it wasn’t Angel’s fault that her owner could not afford the surgery, right?

Here’s the thing though….when would it end? What if in another few months Mr. Smith came into the clinic with no money, with another sick dog that needed help? What about the clients that sacrificed and stretched to pay for their animal’s treatment? If I continued to give my services away for free, I would either bankrupt the hospital or find myself without a job and a mountain of student debt, a car payment, insurance payment, rent, etc.

It is expensive to operate a veterinary hospital. For your average clinic, by the time you factor in the daily cost of employee salaries, supplies such as medications, electricity, water, waste disposal, taxes, etc. it costs at least $2800 per day.

This is why I hate discussing money with owners. I feel guilty, because there is a part of me that feels bad for charging people for what I do. In a perfect world, I could give each pet the best care every time. Money would be no object AND I would make enough to pay my bills and save a bit.

However, that dream world doesn’t exist. I used to think human doctors had it so easy because insurance paid for everything. Hmm. It seems like they aren’t even close to figuring that one out. How do you provide good quality health care to everyone when good quality health care is REALLY expensive? Like I said, it is a dilemma.

We veterinarians are not rich. We don’t go into this profession to make a gazillion dollars. Many of us are happy if we have enough left over to put into savings. We want to practice good medicine, and we want to use our knowledge and expertise to save lives. It breaks our heart when this isn’t possible, and it crushes our souls when we get accused of loving money more than the well-being of our patients.

There are, of course, a few dishonest veterinarians out there that try to milk clients for everything that they are worth…who pad the bill with unnecessary tests, or the most expensive medications. Trust me…they are few and far between. Our profession abhors them.

If you own a pet, please consider that veterinary care is often quite expensive. Plan for it, and consider having a savings account, or looking into pet insurance. Take your dog or cat into the vet for annual exams so that potential problems can be addressed early on. Remember that when we present you with a treatment estimate we are not trying to scam you. We care about your pet, and we need to get paid for what we do so we can continue on caring for pets for many years to come.

If you are a vet that has found yourself in the same dilemma, my next blog entry will be for you. (Compassion fatigue). In the meantime, be kind to yourself and remember that you can only do what you can, with what you have, given the situation in front of you. Take care.