A reader sent us a letter in which she described how her own dog had had life-saving surgery on two occasions.

She remarked that the expense of two surgeries was considerable, but said she could not live with herself if she had to put her dog to sleep over money.

She wondered how veterinarians cope with having to face that possibility on a regular basis, as their clients balance financial concerns with the needs of their pets.

This is a difficult issue for all veterinarians. When the idea of becoming a vet takes root within the mind of a child, money is not a consideration.

As I (Dr. Henry Bianucci) read James Herriot’s “All Creatures Great and Small,” I envied the simplicity of that time and place and the purity of the veterinary profession.

James’ dedication was to his client and the well-being of his patient.

The money was almost an afterthought and had no influence upon the course of treatment. That literature largely shaped the public image and perception of what being a veterinarian is like.

I never thought of veterinarians as wealthy, and I didn’t particularly care.

It was not until I was in veterinary school that one of my professors, Dr. Gordon Baker, who was from England, told me that he was a personal friend of James Herriot, and that his name was in fact Alf Wight.

I remember telling a childhood friend’s father that I was going to become a veterinarian, and the first thing he said was, “Well, you’ll never get rich.” I told him I didn’t care, that at least I’d be doing what I loved every day.

But the closer I got to graduation, the more I began to consider the economic realities of life as a veterinarian. I still had no desire for wealth, but the holders of my student loans, landlords, power companies, etc. apparently had not read James Herriot. They wanted their money.

When I started my own practice, the realization was complete; the veterinary profession is a business. If a veterinarian disregards that fact completely, they will not be around long enough to do much good for anyone, including themselves.

Likewise, most veterinarians cannot completely embrace a pure business model either. The stress of not helping would destroy their job satisfaction and morale. This is a business with more heart and compassion than any other I have seen, and therein lies the conflict that tortures many a veterinarian.

Most vets are still that kid at heart who became a veterinarian for the purest of reasons. But that same veterinarian has a family, employees, Uncle Sam, bankers and vendors with their own needs and demands. So, what happens when they are faced with a client and their companion in need of a surgical or medical procedure but of limited means?

The most important consideration is the prognosis with, and without, surgery. If someone is in a precarious financial situation and their pet has an advanced malignancy (Cancer) or other disease process with a poor prognosis, is it worth putting financial strain on their family to treat it?

Furthermore, is it even right for the patient, even if they had all the money in the world? Some of these cases may not ever leave the hospital or may have short survival times after the procedure.

The old saying “where there’s a will, there’s a way” informs the next step in this delicate navigation. Basically, when a case can be helped and the owner is willing to work with us, speaking for our hospital, it will be helped.

A great illustration of this is an 8-year-old Dachshund, named Mike. He had eaten a toy, and it was obstructing his intestine.

Without surgery, he would die. With surgery, he would be completely cured and his longevity would be unencumbered. The problem was that although the owners were able to pay, they were not able to pay the full cost right away.

They were devastated and were about to put Mike to sleep, believing this was their only option to end his suffering. When we were called about this case, the answer was clear.

These owners wanted to make this work. They told us what they could do, and we took it from there. End result: Max is home for Christmas, the owners are so happy, and I got a beautiful, custom-made thank you card.

Owning a pet carries many responsibilities. Financial responsibility is an important one, but maybe even more so is the responsibility to make the right choices about whether and what medical care is appropriate.

A veterinarian’s job is to guide a client to the best answer for them and for their pet. That guidance may end in a sad and painful place.

As vets, we know our job will be happy, sad, stressful and painful, all on the same day. That’s life as a vet.

We cope by knowing that we have done our best to counsel the right decision for our patient and our client.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.