A.C.
First I'd like to play devil's advocate on one comment that I read: one person said surgery is not an emergency and can be planned for. That's not necessarily true. My mom went to the doctor's office for something "simple" and they wouldn't let her out at all; they transferred her straight to the hospital. I was called out of my highschool class and had to go home and get her gown and some bits---she was having surgery within the hour. That happens sometimes.
On the other hand, I was an in-home care provider and I never took paid vacations. We gave the parents several month's notice when we took family vacation (as soon as we knew the dates, ourselves) but I didn't think to charge for it because they'd have to pay someone else. However, I'd be more upset with the fact she left children with her husband or anyone else and told you AFTER the fact instead of clearing it with you beforehand. Do you know him? A doctor's appointment, she knew about ahead of time and could have made arrangements or asked if you were ok with the husband watching the children. Especially if he's just had surgery and may be too weak to do anything? That makes no sense. When my son had a pediatric appointment, I would get a "next appointment card" filled out for the parents, too.....so they had time to be ok with me taking him to the doctors with us, or to make arrangements that would be more suitable to them.
Not all in-home childcare is "bad" or a pain. I would say I was MUCH more flexible and worked with the parents more than daycare! But there are issues that come up, and that is one. I got very sick over the weekend once, had a 103 fever Monday morning, and was shaking incontrollably. My husband got a sitter for our own son, and I had to call the parents and tell them I couldn't watch children that day. I felt terrible about it, but I had to go to the doctor for shots and rest. If inhome childcare doesn't have a helper, it will probably happen eventually. But it only happened once with me, and I didn't charge since it was my fault not theirs. (I DID charge if was their choice not to come though).