When our 5-month-old kitten, Jasper, went into kidney failure a few years ago, letting him die wasn’t an option. We rushed him to our veterinarian, who drew his blood, X-rayed him, and cultured his urine. She told us he might have just a few days to live. So we drove him to an emergency clinic on the outskirts of Baltimore, where he saw an internist, then a nephrologist. He spent three days in the intensive care unit, hooked up to a catheter and intravenous antibiotics, while he underwent ultrasounds, urinalyses, and blood-chemistry profiles. Slowly, he began to recover. It took a while for our bank accounts to do the same. We had adopted Jasper for next to nothing from a shelter, but a few days of emergency veterinary care had cost us more than $3,000.

Twenty years ago, we couldn’t have spent that much money if we wanted to. The fancy machines, the complex diagnostics, even the veterinary specialists just weren’t available. Thanks to advances in veterinary medicine, our pets are living longer, healthier lives than ever before. But it has also become much harder to let them go. When our dogs and cats used to get very sick, we could justify putting them to sleep because it was the only option. Now, in an age of kidney transplants for cats and chemotherapy for dogs, euthanasia has begun to seem like a cruel way out.

Yet not everyone can afford to save their pets. And some go bankrupt trying.