I have to imagine that a skewer in the squishy parts could result in a wide range of potential injuries. Maybe the specific injury here was just an “x-ray and pliers” kind of job as you suggest, but suppose this particular skewer skewered one or more organs, or resulted in some kind of awful hemorrhage or something. I could just as easily imagine the sort of injury that would require intricate surgeries and a lengthy hospital recovery, implying the round-the-clock attention of a number of specialized humans with mouths to feed and other career prospects (including patching up human animals instead!).
Euthanasia might be the only humane option in an x-ray-and-pliers outfit not staffed and equipped to perform such an heroic sort of intervention in the timeframe it would take to succeed.
One thing that does stand out to me is the extreme shortage of people willing to become veterinarians, even at these prices. It seems like regardless of the pricing on the retail end, capable young people considering modern veterinary life are sizing up the entire financial, emotional, educational, and lifestyle bargain and not finding the payoff to be worth it.
That said, I am sympathetic to the idea that modern veterinary practice has strayed too far from the way it’s done in lesser-resourced settings. Maybe it is more appropriate to set aside advanced and expensive medical techniques in favor of more cheaply-educated practitioners, more conventional business hours, simpler tools and supplies, more frequent recourse to euthanasia, and so on.
The blessing and the curse of modern medicine, no? It’s bad enough to have to face death when it feels inevitable, when “all that can be done to save them” is relatively simple and well-understood. Knowing that the same situation might be survivable under different circumstances—with more money, or in a place with the right practitioner, or if we’d just had this particular exotic antivenom in stock, or if the line had been shorter that night, or if we could hire some bioengineers and a lab to custom-tailor a treatment to puppy’s genes… the same death then comes with a lingering feeling of guilt over the possibility that more could have been done.