Sally emerged last month from her white room at the Denver Zoo into a maze of logs and rope, leaning on her fists, both of them closed loosely as if they cradled buzzing flies.
The 44-year-old Sumatran orangutan ate some oatmeal and peanut butter in the exhibit, studied people on the other side of the glass, and slipped her long fingers into a concrete barrel full of bubble-bath. She scooped up drifts of foam and ate it, giving her a white beard and mustache, and mugged like Lucille Ball for her audience.
She was back to her old self, said Cindy Cossaboon, Sally's principal zookeeper, back to being a "very strong, stubborn woman" who finds loud noises rude and who likes to comb the long, coppery hair that shrouds her body and
Were it not for a zoo veterinarian and a team of physicians from two Denver hospitals, however, Sally would have died last summer.
Her saga compelled high-profile surgeons to rush to a bare-bones, old-fashioned operating room, and launch into a lengthy, complex operation that likely would have ended badly — death — had they made a single error.
The doctors had never worked together before as a team. None had operated on an orangutan before, nor were they especially familiar with the great apes' anatomy. The surgery they performed may have been the first of its kind.
But they were not deterred.
"This was a patient in need, and just like any other patient, there was something wrong and we weren't sure what it was and we knew it needed to be addressed quickly," said Ruben Alvero, a reproductive endocrinology and fertility specialist at the University of Colorado School of Medicine. Alvero flew back early from a conference in Florida to attend the surgery, driving straight from the airport to the operating room. "We felt strongly we had an obligation to the patient."
"Something was wrong"
Sally, the eldest of the Denver
Like most orangutans, Sally is solitary, preferring time alone. She fills her days eating the vegetables and fruits that comprise most of her diet — all of it weighed in precise amounts because orangutans in captivity are prone to obesity. She cycles between different environments: smaller, quiet rooms shielded from the public; the indoor space, with the ropes and the meandering climbing structure where Sally makes paint out of chalk and water to draw on the walls; and the sprawling outdoor area, where the 130-pound ape often climbs a cottonwood tree and watches traffic on East 23rd Avenue.
Until last winter Sally was good-natured, with "a lot of personality and a lot of rules," said Cossaboon, who has worked with the Denver Zoo orangutans for nearly 10 years. When Sally would see other orangutans getting attention from zoo employees, she would demand at least equal time.
But a little more than a year ago sour moods began replacing Sally's normally upbeat, spirited approach to life.
"She wasn't interested in food, in playing," said Cossaboon. "We knew something was wrong."
At the same time, her menstrual flow had become erratic. At first zoo doctors weren't too alarmed — she was an elderly orangutan after all. Most orangutans don't live much longer than 50 years in captivity (it's shorter in the wild). But by January of last year, the volume of discharge began to disturb zoo veterinarian Diana Boon. The ape started showing signs of anemia.
In March, Boon called Preston Stubbs with the Animal Hospital Specialty Center in Highlands Ranch, a veterinary clinic known for its surgical staff. When she reported Sally's problem, Stubbs offered his CT scan imaging equipment, free of charge.
The machine revealed a large mass in the abdomen, which they guessed was a fibroid, a benign tumor associated with
The strategy failed. And in June, Sally stopped going to the bathroom.
"It was an emergency," said Boon.
Surgery particularly high-risk
During the spring Boon had formed what she called "Team Sally," a group of five surgeons who work out of University Hospital and two anesthesiologists from Children's Hospital. Should Sally need surgery, Boon wanted physicians who had prepared for it.
She began getting in touch with other zoos, to amass enough orangutan blood for the operating room. If Sally's condition forced surgeons to cut open Sally's belly and remove the growth, which had swelled into something the size of a soccer ball, having blood on hand would be important. It was major surgery.
But when Sally lost the ability to go to the bathroom, Boon understood she had only days to live if the obstruction wasn't removed. So on a Friday afternoon she fired off e-mails to the team, telling them the surgery had to be done by Sunday. And they wouldn't have blood.
"It had to be a bloodless surgery," Boon said. "It was either this would work, or this wouldn't work and it would be fatal for Sally."
And then, the group got a break. Covidien, a Boulder company that makes a device called LigaSure that helps limit blood-loss during surgery, donated the use of a machine for Sally's sake.
Another snag loomed. The procedure demanded quite a bit of rummaging around in Sally's abdomen. If a wayward blade nicked her distended bowel, she would die; Sally would not understand how to use a colostomy bag.
Six nerve-wracking hours
Boon selected Dr. Monique Spillman, a gynecologic oncologist, to lead the team, and Spillman began searching for information about orangutan anatomy immediately. Unfortunately, she didn't find much — where human anatomy is mapped in great detail, orangutans remain relatively uncharted.
Still, orangutan anatomy at least parallels that of humans. So once Team Sally's far-flung members all finally stood in the zoo's pale-blue operating room, and Spillman cut into the ape, things seemed familiar.
"What we first encountered was the infected part," said Spillman. "It's like somebody took a bowl of spaghetti and poured Super Glue all over it."
The huge fibroid contained an abscess, a zone of infection, which explained why it was growing so rapidly. Sticky adhesions on the fibroid attached it to other things in the abdomen, like the bladder, the bowels and the abdominal wall.
Methodically, patiently, the team picked its way through the cavity, liberating organs from the fibroid one scrap of flesh at a time.
The mood was intense and "collegial," said Julia Embry, a senior gynecologic oncology fellow.
"Everyone was peeking in, no one made a decision without discussing it with everybody else," said Embry, who grew up around animal surgeries — both of her parents are veterinarians. "It just warmed your heart. I felt honored and privileged. To look back at your life one day and say, 'I was able to help this endangered species.' "
When they felt confident the organs were safe again, the team turned over the procedure to Alvero, who best understood female reproductive organs. Should the uterus be removed? Alvero decided it should stay put — pulling it from the abdomen would have added three more hours to the surgery, and could have caused more harm than leaving it alone.
"It still gives me chills," said Boon of the "nerve-wracking, inspiring" six-hours of toil.
Cossaboon, the orangutan keeper, canceled a vacation to be with Sally during the procedure. She couldn't watch from within the operating room, though. Fear and anxiety overwhelmed her, and she paced outside the room while the doctors worked.
Weeks later, Sally had recovered enough that Cossaboon, who knows her better than anybody else, could not tell she had just gone through such an ordeal.
Team Sally and their families returned to the zoo within the month, to see how she was doing.
"She was getting all pretty for us when we showed up," Embry said. "When the zookeepers tried to get her to show us the incision, she just combed her hair. She was primping for us."
Alvero said the reunion formed an even deeper connection between the team and Sally.
"You kind of saw there was some sort of understanding," he said. "Dare I say it? She seemed grateful."
Doug Brown: 303-954-1395 or djbrown@denverpost
Team of doctors
A team of five surgeons working out of University Hospital and two anesthesiologists from Children's Hospital Colorado saved the life of Sally, a 44-year-old orangutan living at the Denver Zoo.
Dr. Monique Spillman, gynecologic oncologist
Dr. Kian Behbakht, gynecologic oncologist
Dr. Henry Galan, maternal and fetal specialist
Dr. Ruben Alvero, reproductive endocrinology and infertility specialist
Dr. Julia Embry, gynecologic oncology fellow
Dr. Geoffrey Lane, anesthesiologist
Dr. Mark Thompson, anesthesiologist