Have you ever held a baby orangutan in your arms? Twenty-eight nurses volunteered to do that and more, round the clock, for 82 days before the sickly primate passed away in July.
Sandar was born to Miri, an 18-year-old orangutan at Zoo Atlanta, which has the largest population (10) of the endangered species in the United States, on March 30. Baby orangutans normally weigh more than 1.5 kilos at birth, but Sandar weighed barely a kilo and wasn’t nursing. After three days, zoo curators intervened to try to save the infant.
Because orangutan babies cling to their mothers for the first three or four years of their lives, zoo officials knew it would take 24-hour holding and feeding.
“Given the size and condition of the infant, zoo veterinarian Dr. Faye Evans thought our neonatal intensive care unit would be a good resource,” said Chrys Fields, RNC, BSN, NICU, a staff nurse at Children’s Healthcare of Atlanta. “They wanted to know what size feeding tube to use, and how many calories to give so that he would gain weight appropriately.
“They also were desperate for volunteer help, as the assistant primate curator and animal program director had been taking care of the infant for eight days, and they were exhausted. I knew I just couldn’t sit still and let this opportunity go by. I volunteered that day.”
Fields was excited by the rare chance to use her nursing skills to care for an endangered animal, and she also knew it would please her son, Brendon (12).
“He has some special challenges of his own — being on the autistic spectrum — but he loves animals and watching ‘Animal Kingdom,’ ” she said. “I was able to talk to him about Sandar every day, and took him to visit once.
“He was able to watch him from a distance and got to talk one-on-one with the assistant curator and learn about orangutans. I’m so grateful he had that experience.”
Fields trained with Laura Mayo, Zoo Atlanta’s assistant curator of primates, to learn about the special needs of orangutan infants. The nurse spent 29 hours that first week at the zoo, in addition to her 32-hour job at Children’s Healthcare of Atlanta.
“Orangutan infants bond strongly with their mothers, and Laura encouraged us as surrogate mothers to form that same bond,” Fields said. “We definitely bonded. He’d sit upright on our chests, with his long arms wrapped around our necks and his hands entwined in our hair.
“He had special places he’d like to nestle, and he recognized the voices and smells of those who cared for him often. When I’d speak from across the room, he’d respond by vocalizing or ceasing to vocalize. There was eye contact, too.”
As word about Sandar spread, other nurses volunteered to work shifts with Fields, using a spreadsheet to coordinate the schedule. Eventually, 28 nurses (26 from Children’s) helped care for Sandar, along with three doctors, including Dr. Usama Kanaan, a pediatric cardiologist at Children’s Healthcare of Atlanta’s Sibley Heart Center.
Doctors discovered a hole in Sandar’s heart, which might have healed on its own normally, but he developed complications, hernias, pneumonia and respiratory problems.
The nurses set up a nursery as they would in the NICU, with a changing station, feeding tubes and medications. They also tried to mimic Sandar’s natural environment by holding him and making animal sounds. On his good days, nurses stimulated him with small toys and colored lights and encouraged him to climb and suckle using a pacifier.
“It took a lot of brain power and collaboration,” Fields said. “Every day, things changed and we were challenged as to what to do next. We’d give reports to each other at shift changes. ‘How is he?’ ‘What’s going on?’ ‘What’s the plan?’ we’d ask.
“We took what we knew, changed it up a little bit and adapted. That’s what nurses do — we flex.”
What amazed Melissa Goodbread was “how similar Sandar was to a human infant.” Goodbread, RN, BSN, is a nurse in Children’s NICU.
“He shared the same condition as some human preemies, and the hernias and breathing problems we’d seen in other patients,” she said. “The trainers taught us his cues for wanting to eat, climb or play, but they were so similar to human patients that it was like I knew them by instinct.”
Goodbread could tell when Sandar was stressed and when he was at ease.
“The greatest challenge was trying different medications to see how he’d react, and getting to know what worked for him,” she said. “Every baby is different, and nursing this one more different than anything I’ve ever done. It was challenging, but comforting to know that holding him was the best thing we could do for him.”
Goodbread worked her regular job at night and cared for Sandar during the day, sometimes dozing as she held him. “We slept together,” she said.
The nurses’ goal was to get Sandar back to his mother, the same as for their human patients.
“When his condition worsened and it became apparent that he wasn’t progressing... that he would need feeding tubes and oxygen to live... well, that just doesn’t work in the primate world,” Fields said. “The zoo veterinarians had to look at his increased suffering and make the decision that was realistic and best for Sandar.”
The zoo staff euthanized him on July 1.
A nurse called Fields to come see him on his last day.
“I cherished that last bit of time with him,” said Fields, who still chokes up at the thought. “I wanted to make sure someone was holding him at the end. Someone did and others were holding his hands.
“They tell us as nurses to be compassionate, but that we shouldn’t cry. That just doesn’t make sense.”
Brendon was there for his mother when she came home the day Sandar died.
“They say that children on the autistic spectrum don’t show empathy, but he knew I was upset and [he] tried to console me,” she said. “That was eye-opening. My son might have his challenges, but he also has a lot of strength.”
Many of the nurses who cared for Sandar have talked to each other about the experience. All have been saddened by his loss.
“We’ve all said the same things — how hard it was to watch him suffer, but how uplifting it was to help. We knew we did everything possible and that it was some of the best nursing we’ve ever done,” Fields said. “Funny that it was caring for an animal that brought us back to the basics of nursing and reminded us of why we do what we do.
“We talk about losing a buddy and a friend, because that’s what he had become to us. I don’t know if he ever knew how good he made us feel.”
