As we were closing up shop after a busy clinic day in Oakridge, we got a call from the Roatan Zoo—one of the new keepers had been badly mauled by one of the monkeys while cleaning the enclosure.  Oh man…after a late night working on the computer and a CRAZY day in clinic I was looking forward to lying down for a while, but when the call comes for help, you have to help–so we grabbed our minor surgery bag and some antibiotics and headed over.

Apparently, the victim had been employed there about two months, and was working (as usual) with the main keeper, who had been with the zoo

for 5 years.  They had been in the cages together many times before, and had no problems, but this time the head keeper stepped out to grab some additional cleaning supplies and one of the monkeys decided to challenge the new guy.

While with the head keeper, he had been safe—the head keeper’s place in the monkey society was well established (as boss), so the new keeper got a free pass.  But when he was left on his own, one of the males just went for him.  He was knocked to the ground and savaged, bitten and clawed all over his legs and his arms and hands; the monkey actually went for his face—all the wounds on his arms and hands are classic defensive wounds.  Fortunately the head keeper heard the commotion, ran back and pulled the monkey off (the monkey immediately submitted to the head keeper).

The male in question had been horribly abused in its previous home; it had come to the zoo nearly dead…now it is in fine form; I guess it feels strong enough to challenge newcomers in its little kingdom.  Everyone always looks at monkeys and goes ‘Awwww….how cute.”  And it is true, with their little human faces and adorable antics, they are pretty fun—but they are also wild animals with motivations all their own, and with lots of strength, agility, speed and teeth and claws!

When we got there, the poor guy was a little shocky, covered in blood, dried monkey saliva, and dirt and debris from the bottom of the monkey enclosure.  He was so filthy and crusted that we couldn’t even see where the wounds were.  Pretty bad scenario from an infection point of view; monkeys have fangs that can bite pretty deep and inoculate your tissues with their raw sewage-like saliva (pretty similar to human saliva, probably).

I immediately gave him an injection of ceftriaxone and an injection for pain.  We used a garden hose (the water at this resort/zoo is filtered and potable) to soak off the filth and dried blood as it would have taken more gauze than we had with us, and been more painful.  The hose helped gently soak open the dirty scabs over the wounds, and let them bleed out a little to help clean them.  Finally we could see the wounds—lots of them, probably around 40 bites and claw marks.  If he hadn’t been wearing jeans, I think he would have lost half the skin on his legs, and if he hadn’t had his arms up in front of his face things would have been a whole lot worse.

After disinfecting and irrigating all the wounds, we salved them with antibiotic ointment, dressed them, and gave him oral antibiotics and painkillers, and fresh bandages for his family to change for him if he got wet.  We also started him on acyclovir, an antiviral given as prophylaxis for monkey bites. The next day, all his wounds were clean and dry except for his right hand and left forearm, which were very swollen (and pus was expressed from the hand).  We added a second, stronger antibiotic and got him to start bathing his wounds in hot soapy water a few times a day.

It worked—his swelling went down and his wounds are healing nicely.  Never a dull moment practicing medicine in the tropics, but most of all I liked that we were able to bring care to his home.  The house call is still my favorite consult.

When I was a kid I watched my dad do house calls in Los Angeles…practicing Alaskan small-town doctor medicine in a big city.  In my folks’ house, as long as I can remember, there is an old print of a painting of a doctor, circa 1830ish, on horseback with a lantern and black medical bag in the dead of night, riding slowly through a driving rainstorm.  There’s no adrenaline rush about the figure; the doctor is not flying down the road, coat trailing behind and sparks flashing from the horse’s shoes on the cobbles.

Instead, the doctor looks cold and wet—can barely see his face behind his upturned collar, peering head through the dimly lit night.  He has the air of one doing a job that he is doing because he has no choice, because it is who he is.  It would never occur to him that someone else should be the one to go out in the night and go help a sick patient.  He goes, and gets cold and wet and more tired (he must be a critical care doctor), because to him, that is what a doctor does.  It isn’t even a sacrifice, just a part of his core being.  I always felt like that picture captured some of the essence of what being a doctor means to me.

All photos of patients are depicted with consent of the patients.