She didn't speak any English and had a terrible temper after a recent probable stroke, so taking a blood sample was going to be particularly problematic. A longstanding needle phobia was one of the least serious issues. It was felt that the best policy would be to sedate her first, and we discussed this while she sat there grumbling. Her favourite drink was Coca-cola, although she rarely had it, so we placed a small amount of a benzodiazepine in a mugful. She spat out the first mouthful disdainfully, and the second. The needle phobia was now very apparent.
We were told that every two months she had an entire tub of Ben and Jerry's Chocolate Chip Cookie Dough ice cream—her absolute favourite, which surely wouldn't fail. We dutifully placed the sedative in a tub of the ice cream. She grabbed it and took what seemed like an enormous mouthful, shovelling it in with her left hand, as her right was weak. She spat it out again and looked absolutely furious. We stood well away before she could show her displeasure in more practical ways, but she calmly proceeded to scoop up some of her excrement that was on the floor, place it in the tub, and hand this back to us. The only option left was to shoot her with a tranquilliser dart.
Bella is a 42 year old chimpanzee at London Zoo, and, just like any other patient, she had her own particular way of telling us to “get lost.”
We have a collaboration with the Zoological Society of London so that, when they anaesthetise their non-human primates for reasons concerned only with the health of that animal, we take a small blood sample for research purposes. Chimpanzees are resistant to the effects of infection with the human immunodeficiency virus, a similar situation observed in a very small minority of the patients infected with HIV-1 whom we see. Unravelling the host factors involved, why some individuals become infected and do not develop disease, may lead to promising new treatments.
The collaboration works both ways: we get our blood samples, and the staff at London Zoo, who are always in need of medical equipment, get some of our redundant anaesthetic machines.
We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on http://submit.bmj.com Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.