I was sitting in the surgeon’s lounge alone with Dr. Michael Bushuk, who at the time was our head of orthopedic surgery, when he asked me if I would be interested in helping out at the zoo. He said there was a gorilla who needed help and the zookeepers were looking for a surgeon.
He had had a zookeeper as a patient and they asked him to come up and amputate a gangrenous toe from a gorilla. He told me that they had done the procedure quite quickly and easily with the animal on some hay bales. When he was there they asked if he would come and look at another gorilla. He was taken to see Josephine.
Josephine was at the time the 45-year-old matriarch of the gorilla troop and they were concerned because she was not walking normally. Her mobility was greatly reduced due to a growth in her left groin. She was uncomfortable and her decrease in mobility was affecting her ability to look after herself. Dr. Bushuk said that he could not assist with this problem and that they needed a soft tissue surgeon. They asked him if he knew anyone, so he approached me. I told him I would be happy to help and he asked if he could put me in touch with the zoo.
I gave him the okay and went out about my business. When I went back to the office that day my secretary Cathy asked me if I was going to become a veterinarian. She had already received a call from the zoo before I could say anything to her.
I contacted the zookeepers involved and said that I would try my best to assist. They invited me up to have a look. A few days later I went and when I arrived I met the team and they told me about Josephine.
We went over to the rear entrance of the gorilla enclosure and there I was welcomed into the hallway between the cages that sits behind the public display. As soon as I walked in I was startled by a very large black figure that threw itself violently against the cage immediately to my right. The gorillas had immediately noticed the stranger and apparently this was their characteristic greeting for a newcomer.
After recovering my composure and taking note of the thickness of the bars, I was taken over to Josephine’s cage where she was sitting at the far end peacefully on her own. It was too far away to see the problem so she was lured over with gummy bears and she sat directly in front of me, just a few inches away. There was a small opening with an arm support through which I was told the gorillas pass their arms for blood pressure checks and withdrawing blood in return for treats. I was warned to keep my fingers to myself and we had a good look.
Josephine was sitting cross legged it on the other side of the bars and now I could see easily into her left groin. There was a large mass, approximately 14 x 15” and it was clearly obstructing the mobility of her left hip. When she had come over from the opposite end of the cage she looked uncomfortable. She looked directly into my eyes and gave me no hint of any expression that I could interpret. She seemed to be enjoying the gummy bears and it really did not seem to matter to her who else was there.
We went back to the conference room and talked further. I said I would be happy to help and we brainstormed about the various possibilities of Josephine’s problem. These included an inguinal hernia with or without intestine in it, or possibly a tumor. This could be benign or malignant. Regardless of the cause I felt that I was able to set up a scenario where we could at least make a clear diagnosis and help her if possible.
They next took me over to their veterinary facilities. The facilities at that time were quite old. The rooms were small, they were very dusty and much of the equipment was antiquated. They were in the midst of building a new facility, however, it was unlikely that this would be available for quite a number of months. We talked briefly about the possibility of doing her operation at the hospital but determined for practical and infectious reasons this would not be appropriate. So the decision was made that if we were going to do an operation it would have to be conducted in the hallway between the cages.
I asked the keepers why they approached me as a human surgeon as opposed to a veterinarian who could operate. I suspected that there would likely be veterinarians who could deal with this problem in Ontario. They said that to have anything like this taken care of would involve moving Josephine to Guelph, which is two hundred kilometers away, and that this would be quite stressful for her and for the entire troop. They were also hoping to save on cost, sheepishly admitting that they had absolutely no funds to offer me for my time. The money was not a concern to me as I wanted to help and this seemed like a marvelous adventure.
The zookeepers asked me if I was interested in having any tests done to try and assist with preoperative planning. A CT scan seemed too complicated but an ultrasound could be arranged, although it would require another anesthetic for her. I decided at that point that I would come as prepared as necessary and deal with anything that I found at the time of surgery.
I was also reassured by the zookeepers that if anything went wrong I would not be blamed, because if they could not get this problem fixed for her they were already talking about putting her down. This made me more determined than ever to do what I could.
After I left I started thinking about all the things that we would need in order to move forward. There were quite a number of people that would need to be involved. These included an anesthetist, a scrub nurse, an assistant and support staff. I considered the equipment that would be required. Given that this could be a hernia or a tumor with or without involvement of bowel, I needed to be able to resect intestine and/or repair with mesh.
Back at Scarborough General my first discussion was with Dr. Christopher Hawling. At the time he was one of our senior anesthetists, incredibly competent and completely unflappable. When I asked him if he would be willing to assist with Josephine’s operation he immediately perked up, as much as I had ever seen him perk up, and he replied in the affirmative.
I approached our supply department and asked if there were any stretchers that were broken or partially broken of which the hospital would otherwise dispose. When I explained that this was for a gorilla at the zoo that needed an operation a stretcher was immediately and happily procured and arrangements were made to get it to the zoo. The staff in the supply department also quickly put together a tray of old equipment and created a laparotomy set that was almost identical to what I would use for a major operation at the hospital. My friend and colleague Dr. Neil Orzech jumped at the chance to be my assistant at surgery, and nurse Sandra Ricketts also immediately volunteered her time without hesitation.
I approached the representative from Bard pharmaceutical if they would consider donating some mesh if it was necessary to repair a hernia and they generously agreed. The hospital also offered me the use of sutures and bowel staplers at no cost.
Over the next few weeks we prepared. Emails debating the optimum anesthetic whizzed through my account and there was vigorous debate around which drugs and doses would be appropriate. She weighed at the time about 270 pounds. I reviewed textbooks of gorilla anatomy provided by the zoo and I found there was not significant variation in the abdomen from humans.
We took the entire team up for a dry run. We considered the space, lights, power, cleaning items and quite importantly, and importantly hair clippers.
The zoo informed me that they had prepared two different statements for the press depending on the success or failure of the procedure and they reiterated that they greatly appreciated all of our efforts and they would understand if there were any problems.
We chose a date for the operation of August 2, 2016 and we prepared to move forward. We were told that the most dangerous time for the animal was the induction of anesthesia. Anesthesia would begin with an injection of a sedative in her arm and then we would have to wait outside her cage until she was asleep. During this period she could get hurt falling over by herself in the cage.
Fortunately, soon after the injection she slumped gently against the wall, coming to rest comfortably with her head tilted slightly to the left. Dr. Hawling and a zookeeper then entered her cage. and a tube with oxygen was placed in between her teeth.
The next task was to establish intravenous access. They shaved her arm and looked for a vein. This was difficult due to her dark skin, but eventually we were successful and we were able to give her the fluids and drugs that she needed. We brought in a large net and we carefully laid her down on top of it. Six of us then picked her up on the net and carried her out of the cage and onto the operating stretcher in the hallway. A few of the other gorillas were present but surprisingly they watched with interest without showing any signs of distress.
Once on the bed the next step was to establish an airway. In the operating room at the hospital this is done with a tool called a laryngoscope. For most patients the size that we use at the hospital is about 20cm long and 2.5cm wide. For Josephine the laryngoscope was twice as long and twice as wide. An industrial piece of tubing was used to secure her airway past the larynx.
We then took some buckets filled with soap and water and gave her a good scrub. I thought she would really stink but I found that her odour was not overwhelming. After a triple wash we started clipping the hair over her left groin.
At that point I could finally examine her and I was able to palpate the mass. It was about a foot and a half in diameter, soft and quite mobile. I thought it could still be a hernia, however, I thought it more likely to be some type of benign tumor.
It was time for the surgical scrub. Her skin was prepared with antiseptic and we scrubbed for surgery, donned our gowns and gloves and placed surgical drapes over the area.
We did a surgical timeout like we do with every patient at the hospital in the operating room. “This is Josephine, she is a gorilla, matriarch of the Toronto Zoo gorilla troop, she is here for an operation on her left groin, she has had her antibiotics.” Everyone agreed and Dr. Hawling said we were ready.
I made an incision directly on top of the mass. Her skin was considerably thicker than in a person. Using our cautery device we came through the skin into the subcutaneous tissue and then on top of the tumor.
On opening up the planes it quickly became evident that the growth was a gigantic lipoma. These are non cancerous growths of fatty tissue that are usually easily removed. This one shelled out like a big lychee nut. There were a few small blood vessels on the inferior side to tie off. The next thing I knew I was holding this large jiggly yellow mass from a gorilla’s groin in my hands up to the cameras.
We set about closing. Of course we made plans that we would never have to go back and remove any sutures. We closed in multiple layers with dissolvable stitches below the skin. Dr. Hawling removed her breathing tube as the anesthesia was reversed and we put Josephine back in her cage.
We watched her slowly wake up. She was groggy at first and a little unsteady but eventually she came around and then seemed to recognize her usual keepers. She did not seem agitated at all. After a couple forceful gorilla coughs she sat up and was able to enjoy a few gummy bears.
We never had to use the mesh, bowel staplers or any other specialized equipment that we had kept outside in one of the vehicles. After cleaning up we had a good lunch with all of the staff involved.
In the days and weeks to follow Josephine made a wonderful recovery. She did not seem to be in discomfort at all and she did not need any painkillers according to the zookeepers. She was quickly quite mobile and she never picked at or fussed with her wound in any way.
After a few days her mobility returned to normal to the delight of everybody involved. She made a full recovery and went on to live another 5 healthy years. I visited once to see her in her recuperated state, but she didn’t recognize me.
Performing Josephine’s surgery and organizing our team to take care of her was extraordinarily rewarding and I was fortunate to be involved. It was only in retrospect that I realized that this was the best advertising I could ever have done. I seem to be recognized quite widely as "the gorilla surgeon", and many patients state that they feel that the fact that I got involved shows that I have a kind heart.
Somewhat surprisingly I never received another call to be involved in any other zoological operations, and to be honest that was a little disappointing.
I was interviewed on the radio briefly after the operation as the gorilla surgeon and I was asked how it went. I said that it was so easy a monkey could have done it. The announcer didn't seem to notice my attempt at humour.
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