From my lungs to his…

…Breathing life into an Eastern diamondback rattlesnake

Crotalus adamanteus

Big Chief, male Eastern diamondback rattlesnake and king of the forest. Photo by Alex Bentley

Handling venomous snakes under anesthesia is never straightforward.  At any moment, an anesthetized snake–particularly during induction of anesthesia or during awakening from anesthesia–can experience enough arousal to snag you with his fangs.

It is my third Eastern diamondback rattlesnake this year, a vigorous 6.5 pounds male sporting a 9 inch circumference and at 66 inches total length, much longer than I am tall.  An impressive individual and a member of the largest species of venomous snake in North America, he is nonetheless fairly easy to handle.    His radio transmitter, thermal recording device and identifying pit tag are already sutured up tight inside his lower abdomen.  Biologist and field coordinator Mike Martin places the sleeping serpent back into his box and three biologists, a veterinary technician and I all walk around muttering, allowing the tension of having handled him before and during surgery to diffuse.

prepping the diamondback

Tension is evident in the faces of biologist Mike Martin and Kathi S. Craft, LVT.  These procedures always carry some risk to the handlers.

After a few minutes, we wander back to the snake’s box and observe him.  He is not waking up, not even a little bit.  This is not unusual; they can wake quickly or slowly.  But we all stare at him with his crazy pattern of diamonds long enough to decide he either isn’t breathing or at least isn’t breathing enough to be conducive to his well-being.

The three biologists rightly become nervous.  They’ve actually seen, assisted in or done many more of these procedures than I, a mere mortal veterinarian, have.  But it is my O.R., a sacred place where I command the bridge and seldom perform my job with an audience.  It is usually just me and one or two technicians.  But their concerns are buzzing in my ears like a swarm of bees.  And I am the one who has to make the call as to what must happen next.

applying glue to incision

The procedure is done, I have removed the drape, cleaned the patient of blood and I am applying a cyanoacrylate tissue adhesive to the incision.  Photo by Charles Smith

I go on autopilot, a place where I am directed by years and years of training and my emotions are checked at the door.  Come, go along with me.

Me:  Do you want me to entubate him?

Them:  It might be a good idea to give him a breath or two

Me:  OK, get him up on the table, head on this end.

Them:  Do you have a red rubber catheter? (a tube used to pass into the glottis of snakes)

Me:  I have a trach tube that will fit him.

Me, to my LVT:  Kathi, I need a tongue depressor.

Kathi, instantly at my side, is bearing a handful of tongue blades:  Right here, doctor.

rattlesnake mouth

Opening the mouth, it’s a tricky thing, whether you are doing it to tube feed the individual, as team leader Ab Abercrombie and I are doing with this one, or whether you are entubating it to assist breathing, as I did with “Chief” and Mike Martin.

Mike silently and carefully considers what he is about to do and then holds the snake’s head up off the table for me.  Then it is happening.  Holding it flat with my right hand, I insert the tongue depressor laterally between the patient’s mandible and maxilla and I turn the blade 90 degrees to open the mouth.  The fangs unhinge and drop down and I hear biologist-intern Alex in the background remarking on how big they might be.

I am not looking at the deadly fangs at all.  My focus is on the glottis–the tracheal opening–in the floor of the mouth just behind the front teeth.  Automatically, I use my left hand to insert the tip of the endotracheal tube and advance it slightly.  It is a snug fit, and I don’t need to put it far.  During this procedure, both of my hands are within two inches of the fangs.

Then it happens.  I lean forward, put my lips on the adapter end of the trach tube and generate a breath from my lungs into his, my face mere inches from his truly impressive fangs.  But I am not looking at the mouth or the fangs or the glottis.  I am looking beyond to watch my own breath expand his glorious body.

At the apex of the breath, I pause.  Air is neither leaving my lungs to go into his, nor is it leaving his lung to come back into mine.  For a second or two, we are one.

I release my lips and take the trach tube out of his glottis and observe a fractional spasm.

Then, perhaps a bit too bitchily, I say:  I think this is unnecessary.  He is getting body tone back.

I might add that I slept like a baby that night.

endotracheal tube

A 3 mm endotracheal tube is designed for cats, kittens and tiny dogs. It fit our patient perfectly, though the majority of snakes need much smaller and more specialized tube.  In a pinch, a red rubber catheter may be used in place of a designated tracheal tube.

 The patient began breathing well on his own right after my gift of breath.  He was rattling and tongue flicking in short order.  Because snakes have only one elongated lung and lack a diaphragm, sometimes they need a little help to jump start their respiration after a surgical procedure.

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Editing the Bucket List

Nolan at Disney's Animal Kingdom Park, 2011

I worked on my bucket list a little bit this morning.  Its changes over the past six or so years reflect little accomplishment and a lot of mellowing out.  The thing about a list, you see, is that it is ever changing.

  • See my son graduate; live long enough to be a grandmother
  • Go trekking in the Himalayas Mongolia!!!!  Sleep in a yurt, ride those little horses and drink fermented mare’s milk
  • Remember my father every single day of my life and appreciate my mother every single day.
  • Ride a horse across some Godforsaken Western landscape…alone Teach my son to ride a horse; he can fish, shoot, hunt and play guitar.  Learning to ride is the only essential life-skill I think he should have that he has yet to master.
  • Raft the Snake River in Idaho Finish rafting the rest of the Chattooga after almost drowning there last year.
  • Fly over Alaska in a tiny little plane and then set it down somewhere to hunt moose  I’d settle for killing a really big whitetail
  • See a black bear in the wild  (in South Carolina)
  • Bungee jump—Well I did a bungee tower, not quite as high as a bungee jump, but close
  • Take my son and husband to the Outer Banks.
  • Read all the classic (again) from Beowulf to Jayne Eyre to Silas Marner to The Sun Also Rises to The World According to Garp
  • Run a marathon Not so important anymore.  I do want to do more triathlons, maybe up to Olympic Distance.
  • See Hamlet in an off-off Broadway play or college theater group; See Godspell again
  • Learn to scuba dive What was I thinking!?!
  • Go to a cooking school
  • Catch a rattlesnake Accomplished May 2009.  Pin and pick up a venomous snake with my hands Accomplished May 2010.  Catch an alligator (again)
  • Visit New Orleans during Mardi Gras; have coffee and beignets at the Café du Monde
  • Hang my clothes on a clothesline again, on  a regular basis.
  • Work a humanitarian mission, mission trip or field research project in a Third World nation
  • Deliver a calf again
  • Go to a tent revival and really get in the Spirit
  • Go to the Super Bowl!
  • Nude beach?  No, private beach, nude
  • Remember hearing my grandmother giggle
  • Have a really great garden again ; freeze and can things for winter
  • Finally see an Ivory-billed woodpecker  Should I can this?  I’ve made two attempts already that did not go well!!??
  • Take my son to Disney World Accomplished April 2011
  • Go to an Irish Pub and close the thing down, singing too loud
  • Learn to do basic carpentry, and minor to moderate home repair—or learn to sew, which is basically carpentry with cloth
  • Attend La Tomitina, that tomato-throwing festival in Spain
  • Run the Peachtree Road Race again  Set to do this a week from tomorrow.  Pray that I finish!
  • Walk through a street market in a Third World Country and not worry about what (or who) I am eating
  • See a Jimmy Buffett concert again with friends and family
  • Go to the Kentucky Derby  wear an outrageous hat and drink mint juleps
  • Finally get one of my book manuscripts published; I have  five languishing in drawers
  • Spend a month in Mexico, immersion-learning the language
  • Tour Switzerland with my mother (her ancestors came from there) Not looking too likely; her health is not great
  • Take my family on a tour of the American West—Rushmore, Devil’s Tower, Yellowstone.   I hear the Grand Canyon is nice.
  • A day at work where EVERYTHING goes right
  • Watch or re-watch all the movies that won Best Picture at the Academy Awards; Well, maybe not all of them; gotta figure some are boring.
  • And my ultimate:  hitch-hike, take a train, walk, ride a horse, sail, etc, etc, from here to Tierra del Fuego Paddle my kayak across the Okefenokee Swamp and ride my bicycle back (accomplishing my first “Century” on the bike and so much more!)

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