"Well now, Rosicky, if you know more about it than I do, what did you come to me for? It's your heart that makes you short of breath, I tell you. You're sixty-five years old, and you've always worked hard, and your heart's tired. You've got to be careful from nowon, and you can't do heavy work any more. You've got five boys at home to do it for you." 

Symbolically, the fact that Doctor Burleigh diagnoses Rosicky with a "bad heart" may strike readers as strange; Rosicky's defining trait is his abundant and selfless love for others. However, Burleigh's remark that Rosicky's heart is "tired" offers a different way of thinking about the diagnosis. In a figurative sense, Rosicky has perhaps given so much of himself that it has worn him out.

"Sometimes the Doctor heard the gossipers in the drug-store wondering why Rosicky didn't get on faster. He was industrious, and so were his boys, but they were rather free and easy, weren't pushers, and they didn't always show good judgment. They were comfortable, they were out of debt, but they didn't get much ahead. Maybe, Doctor Burleigh reflected, people as generous and warm-hearted and affectionate as the Rosickys never got ahead much; maybe you couldn't enjoy your life and put it in the bank too." 

The tension between a profitable life and a worthwhile one is central to "Neighbour Rosicky." To a certain extent, Cather suggests the two are incompatible, not only because financial success so often comes at other people's expense, but also because it often involves self-deprivation. "Getting on," in other words, requires a person to compromise both his sense of morality and his sense of pleasure and beauty. Cather explores the relationship between these senses in more detail as the story goes on, but it is significant that she first raises the topic through Doctor Burleigh. Because he is the only major character not a part of the Rosicky family, “Doctor Ed" functions as something of an objective observer, and a stand-in for the reader; his conclusions about what has held the Rosickys back over the years therefore nudge readers towards a similar understanding.