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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That Old School Bell’s Gonna Ring Loud and Long…

The other day I ran into an old friend.  We were in school together from the 6th grade until high school graduation and started to reminisce.  I teased him about a pretty unpopular teacher that we shared for 7th grade English who unfortunately followed us to the high school.  We had her again for 9th grade English.  Some poor folks even had her three years in a row.

She berated him constantly–whether he was doing anything bad or not, and I can still hear her calling him out in class,  “Mark Burke, you so mannish!”  My husband suffered a similar fate in her classes:  “Tommy Burns, you are grinning and that means you are up to no good!”

At any rate, I asked my friend who his favorite teacher was.  His answer came as a complete surprise to me.  I had in mind all of the great teachers we had in high school, whether physics or chemistry or 12th grade English lit.  But he shocked me by again reaching back into the 7th grade at old Ford School in Watts Mill and saying, “Well, Jackie, I guess it was your daddy.”

Another shared teacher, my daddy Jack Holmes taught us 7th grade science. I had almost forgotten that.

Surprised and humbled, the best I could do was blurt out “Why?”

“See, it’s funny what I can remember about school and what I can’t,” he said, “but I can remember specific questions on tests he gave us.”

Yeah, right, I thought.  “Name one.”

But he did.  “True or False.  Astronauts cannot eat in space because they can’t swallow.”

I had to think for a second, because it seemed so obvious that it sounded like a trick question.  My friend went on to explain the answer, that yes, they swallow because the muscles do the work of pushing ingesta down into the stomach.  The question made him think and made an impression on him, so I began to think of teachers who had made an impression on me.

My favorite teacher was 10th grade English teacher Mrs. Anna T. Mims, an exquisite lady who somehow took Silas Marner and inspired in me a love of literature that shapes who I am today.  I also adored the almost bashful and halting delivery of algebra-trig and physics teacher Mr. Ben Miller, the precise and demanding Chemistry teacher Mr. Harold Ligon, the irascible U.S. History teacher Mr. Tommy “Sub” Sublett,  strict government teacher Mrs. Rosemary Johnson and Mrs. Keith Oakes, who prepared us well for college with senior English lit.

I spent so many years in school, from Ford to the high school to Wofford College to the University of Georgia.  It would never have occurred to me that anybody could remember specific questions on specific tests.  Later on, I searched  my brain to see if I could recall any test questions.

They were all in college or vet school.  There was the infamous social ethics test at WoCo given by Professor Walt Hudgens, who passed out blue books and then said, “There is no test.  But I want you all to sit here and write in your blue book for at least an hour.  You can doodle, draw, write love letters, whatever…just pretend that you are taking a test.”  The class was flummoxed.  I chewed on the end of my pen for a few minutes staring off into space, then furiously started to write.

Of course it was a test, and on one of the ethical dilemmas we had studied.  Not as good of a test as the previous year when he came in the room, threw a rubber chicken on the desk and said, “Prove that this isn’t God,” but a test nonetheless.  He graded our blue books. I made an A+.

Another Wofford test I remembered was in the second day of class in Dr. H. Donald Dobbs’ freshman zoology.  Each fall he’d start with about 150 would-be doctors filling the lecture hall and rather quickly weed out those who weren’t cut out for medicine By the end of the four years, roughly a 12 to 14 of us actually made it into medical, dental or veterinary school.

Dobbs did it starting on the second day of class with a pop quiz on Latin and Greek prefixes, suffixes and root words.  Most of us, myself included, bombed the quiz.  Why would we think to study our dead languages for zoology class?  In fact, we probably represented the first generation of students who didn’t have the opportunity to take Latin in high school.  Tenacious, I hung in there and made it to the end.  In fact, on the biology class senior comprehensive exit exam, I scored  #1 of 19 graduating bio majors, edging out top rivals who went on to become orthopedic surgeons and gynecologists and dentists.

Another test that sticks in my mind was in vet school’s Public Health class, Dr. Brown’s infamous Caribou Test.  Most of my eighty-odd classmates bombed this test, which could have been on something important like tuberculosis in cow’s milk affecting everyday milk consumers.  Instead, 100% of the test was on the obscure cycle of brucellosis in caribou, wolves and native peoples in Alaska.  I aced the test, mainly because I enjoyed thinking about going up to the last frontier and hunting some of those pretty little caribou with my deer rifle.

I barely remember dragging myself out of bed, driving to the vet school and taking Dr. Clay Calvert’s cardiology final.  I had the flu so I called him and he would not let me out of taking the test.  I was out of my head with fever, but did about as well on the test as anybody else, as none of us could fathom Dr. Calvert or what he wanted from us come test time.

Small Animal Anatomy’s final lab practical was a doozy.  Dr. Peter Purinton took dogs and cats that we had dissected in the traditional longitudinal fashion and sawed them in cross-section, sticking pins in nerves and muscles and veins that we had never seen from that angle.

But the most interesting single test question I recall is from the practical exam in large animal anatomy.   Our only classroom blurb in poultry anatomy had come on the last day of class, “Chicken Day.”  On Chicken Day, Professor “Arvle the Marvel” Marshall divided us into groups and each group was assigned an organ system.  We had to make up a skit about our organ system and it was a big joke.  Nobody gave a rip about a chicken unless it was barbecued at a fraternity party.

The question was posted at the base of an articulated chicken skeleton.  “What gender is this bird?”  Hurt yourself thinking if you wish.  I got it right, but then I was the only student who could identify the bacculum of a raccoon when a dairy farmer hosting us for herd health lay it on the table and asked us what it was.

Next week, school starts again.  For better or worse, teachers are leaders who shape our lives even as they struggle to get through their workdays and their own lives.   Their classroom time is only part of their job.  There is lesson prep and there are forms to be filled out, bus duty and other hoops to be jumped through for the school system.  There are tests to be graded.  They give to their schools with pride, show up for ball games and open houses, encourage and inspire.  I feel that a single simple act of kindness and caring from a teacher may make the difference in a child’s life.

As Jack Holmes would teasingly say to us before the first day of school every year, “That old school bell’s gonna ring loud and long in the morning.”  I still run into people he inspired, from 6th grade at Enoree School to Laurens Primary to Ford or Sanders or Gray Court to the ball fields or boy scout camp.

What an amazing gift.

 

 

 

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