The Travelling Vet

by Jonathan Cranston

  Diet: Aquatic vegetation, cropped grass, molluscs, small fish, frogs and worms.

  Incubation: 36 days. The female lays 4–10 eggs, which both sexes incubate.

  Wingspan: 208–238 cm.

  Weight: 225 grams at birth, reaching 8.5–11.8 kg as adults.

  Growth: Cygnets stay with their parents until 4–5 months, when they are able to fly and will join a large flock. Breeding won’t begin until 2 years.

  Body temperature: 39–40 °C.

  The ‘Royal connection’: Historically, swans were domesticated for food, and ownership was determined by a mark on their webs or beak, which were then registered with the Crown; any bird not marked automatically became Crown property. Today the British Monarch retains the technical right to ownership of all unmarked mute swans in open water, but the Queen only exercises her ownership over certain stretches of the Thames and its tributaries, which is shared with the Worshipful Company of Vintners and the Worshipful Company of Dyers, who together take part in an annual ‘swan-upping’, where all mute swans are rounded up, ringed and released.

  Predators: Adults are rarely preyed on because of their aggression in defence, but foxes, coyotes, lynxes and bears pose a potential threat.

  Conservation: Swans were nearly hunted to extinction between the thirteenth and nineteenth centuries, but protection measures led to a dramatic increase in numbers. Another peril arose during the 1960s–1980s because of lead poisoning from ingestion of fishing sinkers. Their numbers have since recovered, but they are still categorized as of ‘amber’ concern by the Royal Society for the Protection of Birds. There are currently around 6,400 breeding pairs in the UK, with 74,000 wintering here. There are about 500,000 birds worldwide, 350,000 of which are in the former Soviet Union. For more information on the mute swan, or to help support and protect them, visit www.rspb.org.uk.

  4

  SNOW LEOPARD

  ‘They call the snow leopard the ghost cat. Never lets itself be seen… Beautiful things don’t ask for attention.’

  Sean O’Connell, The Secret Life of Walter Mitty

  It had been a great weekend, celebrating my brother’s birthday, in the midst of the manic final few months of vet school – squeezing in the last few weeks of ‘seeing practice’, spending every spare moment reading through one of the twelve ring-bound files of notes accumulated over the last five years, or practising any one of a number of ‘Day One skills’ on the stuffed animals in the practical lab. Long days, late nights, and I was feeling the strain. So to have an opportunity for a brotherly get-together was just the thing to help me unwind. Beer and curry while watching Where Eagles Dare was our usual preference – invariably accompanied, much to my sister-in-law’s irritation, by our word-perfect chorus of almost every line. On this occasion, however, the unanimous decision was to watch an episode of David Attenborough’s Planet Earth series, the one that featured the first intimate images of a snow leopard ever filmed in the wild. We all sat mesmerized by the extraordinary footage of this beautiful and rare cat, hunting with such stealth and agility along the sheer cliff-faces of the Himalayas.

  Fast-forward a year, and I was working in a mixed practice in rural Devon, with the vast majority of my work taken up with TB testing, farm visits, small-animal consulting and routine operations. It was proving a steep learning curve, at once exhilarating and exhausting, but I loved it and rapidly found myself energized by the variety of patients I was fortunate to work with and help. The fact that one of our clients was a wildlife park, where I was occasionally asked to go and see a sea lion, lemur, capuchin monkey or raccoon was a real privilege.

  Over the course of the nine months since I had qualified, I had been to the wildlife park a handful of times, so I knew the layout fairly well, but somehow I had failed to clock that their collection of animals included two snow leopards. That was until my colleague, Dave, called me one morning from our other surgery.

  ‘What have you got on today? Can you come and help me at the wildlife park? I’ve got to operate on their fifteen-year-old snow leopard Amira. She’s got a wound in her front left armpit.’

  I was immediately transported back to that footage in the Himalayas, to the mystery and majesty of this beautiful animal. Of course, this was not the wild – a far cry from it – but to be presented with an opportunity to work with and care for such a beautiful creature was momentarily stunning.

  ‘. . . Absolutely,’ I replied eventually. ‘When do you need me?’

  ‘I’m consulting this morning till twelve, so the plan is to do it at about one. Can you bring the portable anaesthetic machine? Will it fit in your car? I can bring the rest of what we need.’

  The portable anaesthetic machine comprised a trolley carrying an oxygen cylinder with a set of pipes that fed the gas through a vaporizer to allow an anaesthetic combination to be delivered to the patient. It was quite a bulky and heavy piece of kit, but with a bit of rearranging of my car, it wouldn’t be a problem.

  ‘I’ve got a couple of visits this morning,’ I said, ‘but I’ll come back and pick it up before I head over to meet you.’

  ‘Perfect, thanks. See you at one. I’ll call if there’s any change.’

  My two morning visits were to a pet pig that needed stitching up after a disagreement with the barbed-wire fence she was trying to crawl under, and then to a bull whose hooves needed a trim. The pig required a couple of sutures; the bull required a dose of sedatives, the recruitment of all available manpower to rope him down, and an uncomfortable time lying at a very awkward angle in dung-soaked straw as I administered his strenuously unwanted manicure. By the time these two visits were done, it was midday, and I headed straight back to the practice, loaded the anaesthetic machine onto the back seat of my car, and drove to meet Dave at the wildlife park.

  We arrived at virtually the same time, and had a brief chat about our plan before heading to reception to find Tony, the head keeper, who told us Amira was suffering from a burst abscess in the armpit on her front left leg.

  ‘I’m not sure what’s caused it,’ he said, ‘but she’s quite lame with it.’

  ‘Could we take a look at her first,’ Dave asked, ‘and then decide whether we need to anaesthetize her for a closer examination? Where is she?’

  ‘She’s still in her outdoor enclosure. There’s a run from that into her house, with a cage we can trap her in. She’s trained to go through it, so we can administer any injections she might need.’

  ‘Great! So we shouldn’t need to dart her. That makes life a lot easier.’

  Following Tony through the staff room, and out the back of the main building, we found ourselves among the melee of punters who were just beginning their exploration of the park. In contrast to their meanderings, Tony was very purposeful in his direction. We passed the macaws and giant tortoises, wallabies and lemurs, through a beautiful oriental garden, and then reached a large chain-linked enclosure that was about 25 feet high. A 3-foot-high fence in front of it kept the public at a distance, and signs warned people against climbing them. A plaque mounted on the fence indicated the enclosure’s inhabitants: two snow leopards named Amira and Sasha. Looking into the enclosure, it was at first difficult to identify any occupants at all among the thick foliage, logs and boulders. Tony, however, spotted Sasha immediately, perched on a wooden platform 15 feet up, in the far corner. After a further few seconds he found Amira, who was hiding between two boulders in the other corner of the enclosure. As we stood there watching them, Jason, the keeper in charge of the snow leopards, came over.

  ‘Can you call Amira over?’ Tony said after making the introductions. ‘We just want to observe her first before we do anything.’

  The four of us climbed over the fence and Jason softly started calling Amira over. Alert to the sound of his voice, which was usually associated with food, Sasha silently and effortlessly jumped off her platform and headed straight over to us. Amira was more cautious, initially just focusing her attention in our direction, but after some gen
tle encouragement from Jason, she stood and gingerly walked over to us, clearly uncomfortable on her front left leg.

  ‘She’s pretty sore, isn’t she?’ Tony commented.

  ‘How long has she been lame?’ I asked Jason.

  ‘In hindsight probably two days. She’s not quite been herself, and she’s been spending most of her time in one spot, which is unusual for her, but it was most noticeable this morning.’

  As she came closer, we could see some streaks of dried blood that had run down the inside of her leg. Dave and I crouched down to get a better view of her underside, but her immensely dense, thick fur obstructed our view of the injury.

  ‘Looking at the colour of those bloody streaks down her leg,’ said Dave, ‘I agree it’s probably an abscess, but she’s clearly quite sore on it, so I think it’s best if we knock her out to look at it properly.’

  ‘I agree,’ said Jason. ‘I’d like to know what’s going on with her and I don’t want it to progress to something worse.’

  ‘Where’s the run with the cage?’ asked Dave. ‘Will you be able to get her in without Sasha?’

  ‘It’s just over there.’ Jason pointed to the left front corner. We could see a wire-mesh cuboid, 2 by 2 by 15 feet in size, connecting to a small whitewashed building on the other side of the enclosure. ‘It shouldn’t be too much of a problem.’

  ‘Great. Well, Jon and I need to get our equipment, so if you could coax Amira into the cage, we’ll go and get what we need.’

  As we turned to head back to the car we realized a crowd was gathering, obviously aware that something unusual was happening. Accustomed to such a scenario, Tony was quick to address them as we slipped away.

  ‘One of the snow leopards has got a problem with her leg, so the vets are here to examine her, but I’m afraid I need to ask you all to move away so we don’t unduly stress her.’

  Disappointed but understanding murmurs followed his announcement. Since it was in the animal’s best interest, they would be happy to oblige. A few parents simplified the explanation to their inquisitive and disappointed children as they slowly moved away.

  ‘What’s the plan?’ I asked Dave as we headed back to the car.

  ‘We’ll inject her with Ketamine and Medetomidine in the cage, and then get her to walk into the house before they take effect and she goes to sleep. That way we’ll be away from Sasha and out of view. We’ll intubate her and then you can do the anaesthetic while I have a thorough look at her leg. We’ll take some blood, too, while we’ve got the chance, so we can check her general health status.’

  ‘Sure.’ I said. Then, ‘Do I just treat her as I would a big cat?’

  ‘Yeah. Jaw-tone, eye-position to gauge how asleep she is, just like you would any other cat.’

  Dave had pre-packed a box with everything he thought we’d need. Opening it now, and rechecking the items, we talked through the procedure step by step, happy we hadn’t forgotten anything. I then lugged out the anaesthetic machine from the back seat, and we headed back to the snow leopard enclosure.

  We had been gone maybe ten minutes. In that time, Tony had cordoned off the area from the public and Jason was just coaxing a protesting Amira down the walkway into the built-in trap. We carried the equipment round the corner of the enclosure to the door of the housed enclosure, which Tony now confirmed would be where we’d be carrying out the procedure. Dave then drew up the drug combination, after estimating her weight. We walked over to the trap where Amira was now caged. Threatened by our presence, she growled, hissed and swiped at us from her confinement with an intimidating ferocity.

  ‘Are you ready to inject her?’ Jason asked Dave.

  ‘Yeah, all set.’

  ‘Can you help me pull these handles, Jon? That way, we can pin her against the side of the cage for Dave to safely inject her.’

  There were two handles, one at the front of the cage and one at the back, and these were connected to a sheet of wire mesh. Pulling on them temporarily constricted the area where Amira was contained, allowing Dave enough time to safely inject into her rump before she could deploy her immense strength against us.

  As soon as the injection was done, we released the handles, and Jason then opened the front shutter of the cage, allowing Amira access to her indoor pen. A combination of displeasure and fear made her rapidly vanish down the run and into her house, where Jason then shut her in. The first phase of the procedure had been successfully achieved. We now had to let the drugs take effect, trusting that Dave’s calculations had been correct.

  ‘How long should it take for her to go to sleep, Dave?’ Tony whispered, conscious of the need for quiet.

  ‘About five to ten minutes.’

  A small window ran along the top wall of the building. It was fairly opaque with dust, but through it we were just able to make out Amira within her barred pen. Initially she prowled around the enclosure, growling as she went, but gradually as the drugs took effect, she lay down, head swaying from side to side. Eight minutes after the injection she slumped onto her side, completely unconscious. We sprang into action, opening the door into the housed area and carrying in our equipment.

  Before opening Amira’s cage, Jason gently prodded her with a stick to confirm she was asleep. She didn’t flinch. The cage door swung inwards and so it gently pushed Amira out of the way – another good test of how asleep she was. Loading her onto the stretcher, we then carried her into the alleyway, her head towards the door. Dave gently opened her mouth to check her jaw-tone: the action stimulated her tongue to unfurl and then curl up, a normal reflex, but no less intimidating. Her inch-long canines gleamed at us.

  ‘We need to intubate her, but I’ve brought a gag to use. If she inadvertently closes her mouth, those teeth will crush through a human hand effortlessly,’ Dave warned me. It was an alarming thought. ‘Can you see the gag in the box with the endotracheal tubes?’

  I located a small block of wood covered in Vetrap, then found an endotracheal (ET) tube and the laryngoscope. Tying a strip of the bandage material around her upper jaw, Dave held up her head and opened her mouth. I gently placed the gag between her upper and lower molars until it caught, and then, happy I wouldn’t lose any fingers if she clamped down, pulled out her tongue and used the laryngoscope to visualize the vocal folds, between which I gently inserted the ET tube. Removing the laryngoscope, we used the Vetrap to secure the ET tube to Amira’s upper jaw, before, with an airway now secured, connecting up the anaesthetic machine. While Dave and Jason then positioned Amira on her back so they could examine her wound, I used my stethoscope to assess her heart rate (108), then her respiratory rate (26). The values felt right for her size, but it was the pattern that was important. Dave had packed an anaesthetic chart, which I started filling in, monitoring her parameters every five minutes. If everything stayed roughly the same, then all was good; any sudden changes and I would need to respond. Next, I put some lubricating gel on her eyes to keep them moist, thus compensating for the lack of tear production during her anaesthesia.

  ‘How does she seem?’ Dave said, turning to me.

  I gave him the figures. ‘She seems pretty stable.’

  ‘Good. What flow rate have you got her on?’ The flow rate is the concentration of vaporized anaesthetic agent that is added to the oxygen and delivered to the patient.

  ‘Two and a half per cent.’

  ‘Fine. Well, just keep a close eye on her, particularly when I start examining her wound. It’s a bit cramped in here, so if she suddenly wakes up, we’re in trouble.’

  With four of us in the alleyway, plus Amira and all the equipment, there was indeed very little room to move. Furthermore, the door only opened inwards and the anaesthetic machine and I were blocking that escape route. As I looked at her curled lips, and those large gleaming canines, and her dinner-plate-sized paws with inch-long claws, I suddenly felt very exposed and vulnerable. She certainly seemed to be asleep, but any sudden pain stimulus and she might react. Nervously I checked her jaw-tone and
blink-reflex, and decided to turn the vaporizer flow rate up to 3 per cent.

  ‘Are you happy with her, Jon? I’m going to start examining this wound. I’m not sure how painful this could be, so be prepared.’

  ‘She seems very stable,’ I confirmed.

  Dave abducted her left front leg away from her body, revealing a mat of bloody dried fur surrounding a large puncture wound. The wound was still weeping and the exposed flesh was purulent and inflamed.

  ‘It’s pretty nasty. I wonder how she did it. Let’s clip and clean it, and go from there.’ He started clipping away at the dense matted fur around the wound. Amira didn’t flinch. I rechecked her parameters: heart rate 120, respiration 24. She was reacting slightly to the stimulation, but there was still no blink-reflex or jaw-tone. I was happy with that. Dave continued slowly and methodically around the area, then took a litre bag of sterile saline, inserted a needle, and then used this to flush and clean the wound. As he continued his work, I found myself mesmerized by the beauty of the creature before me. I took in the soft, thick, dense, smoky-grey and straw-yellow fur of her coat, dotted with the black open rosettes across her body and the smaller black spots across her face and legs. Her velvety smooth tail, as long as her body, the large supple paws with their springy pads that allowed for such silent movement yet contained such deadly razor sharp claws. Her small ears that minimized heat loss, but nonetheless allowed for such acute hearing; the thirty-two teeth that could crush through bone, or tear through flesh, with such effortless ease; and the usually alert, attentive eyes that now lay concealed, behind her third eyelids.

  Dave had by now finished flushing the wound; Amira remained motionless, save for her rhythmical breathing. Removing the purulent material had revealed healthy granulation tissue underneath, but Dave’s attention was now drawn to what appeared to be a track in the wound. Using a pair of 15-cm crocodile forceps, he gently probed the wound, inserting them down the track which seemed to lead to the front of her shoulder. To our shock, the forceps disappeared up to their handle.