THE LAST MEOW.(pet medical care, pet owners, and the ethics of animal welfare)

She arrived in Manhattan looking ravaged and ravishing, like a queen of silent film with one last swoon left in her. Her sleek ermine coat was matted and worn, her long neck so weak that it drooped to her chest. For months she had managed to hide her condition, eating full meals yet still losing weight. Now she was days away from dying, but her pale-green eyes didn't show it.

Shawn Levering glanced down at his cat, Lady, then cast a bewildered look around the waiting room of the Animal Medical Center, on New York's Upper East Side. He had on scuffed bluejeans and a faded Wheels of Time T-shirt, silk-screened with a picture of a custom Cadillac. His face was freckled and ruddy, his forearms thickly cabled. Standing in the middle of the room, his feet spread wide, he had the specific gravity of a man who knows exactly where to reach for his tools. Back home, in Wilmington, Delaware, Levering liked to work on old cars, taking rusted wrecks and transforming them into street rods. But this cat and her problems, and the city to which he'd been compelled to take her, were beyond him. "This place is crazy," he said. "The taxi-drivers are like demolition experts. I just hope we can find our way out again."

Beside him, the veterinarian, Cathy Langston, nodded, her eyes on Lady. The cat was in the throes of chronic renal failure, she said. Her kidneys weren't filtering out the toxins in her blood anymore. "I think she would definitely benefit from dialysis. It won't make her kidneys better, but it will buy her time to see if she's a good candidate for a transplant." There were risks: clotting, internal bleeding, dangerous drops in blood pressure. More than a quarter of Lady's blood would be taken out of her body each time and filtered artificially. If the dialysis was done too quickly, it could cause seizures or even a coma, but the alternative was certain death. "I've got the whole team on standby," Langston said. "We can whisk her back, put in a catheter, and take a biopsy today. If she passes all the tests, we could have her ready for transplant by next week."

Like many of the center's eighty-five veterinarians, Langston is a specialist. "Everyone has to have a passion, and the kidneys are mine," she says. But such passions are relatively new in her field. Little more than twenty years ago, all vets were general practitioners, and neutering and spaying were among the most elaborate procedures they performed. Now the American Veterinary Medical Association has more than seven thousand specialists in thirty-nine fields, including cardiology, radiology, ophthalmology, and oncology. As the director of the center's quarter-million-dollar kidney unit, Langston usually has one or two patients in dialysis at any given time. Some owners have chartered planes for their animals, then stayed at nearby hotels during the treatment. But not all her clients are wealthy.

"We're looking at spending a thousand dollars in the next twenty-four hours and between three and four thousand in the next week," Langston told Levering. If the dialysis was successful, Lady would have to be transferred to the University of Pennsylvania, where her condition was first diagnosed. (The university's veterinary hospital didn't yet have a dialysis unit, but its vets were more experienced in performing transplants, and Lady was a high-risk patient.) The total cost would be more than fifteen thousand dollars.

Levering sighed and shook his head. Lady was already anemic, asthmatic, and congenitally blind. She had been born on the streets of Wilmington four years earlier, and dropped at a local animal clinic at the age of six months. Soon after Levering and his wife adopted her, she became allergic to her own tooth enamel. "That was a weird thing," Levering said. "Never heard of that before." But he had willingly paid four hundred dollars to have all her teeth pulled. In retrospect, it seemed like a bargain.

"I don't know. If it was up to me, I might not go through with it," he said. He was recovering from a bout of Lyme disease and from carpal tunnel syndrome, and he had recently had sinus surgery. His wife had been laid up for three years with back injuries, and was only now going back to work. If they were willing to go this far for a cat, it was partly out of a sense of shared misfortune. But mostly it was a matter of love. "My wife is totally wiped out about this," he said.