The second anaesthetic was not much better than the first, unfortunately. Once again the darts did not discharge properly. (Adrian later realised that the syringe that was being used to pressurise the darts was carefully washed by the vet technician and contained a small amount of water. This was then getting into the pressure chamber of the darts, causing premature loss of pressure and therefore only partial drug delivery). When Ninio was eventually down, I was able to work on his less problematic right tusk – it only had a crack in it. I was able to amputate the tusk, do a partial pulpectomy and seal the tusk again with a polyethylene filling. For the left tusk we decided to just open up the pulp canal in order to create drainage. For this I needed and extension on the hole saw that I had brought. The local technicians did a brilliant job at extending this for me and it worked well.

We left Poland disappointed but promised to return to remove Ninio’s tusk. Over the next 5 months we worked hard to make sure that when we went again we would succeed. I was fortunate enough to make contact with SOMTA tools in Pietmaritzburg who produce all kinds of cutting tools. I described my predicament to them, explaining that I needed equipment that does not exist. To my astonishment they decided to take on this challenge as a project and the development began.

In Pretoria another company, HentIQ, owned by Louis la Grange (husband of Valme and father to Francois – both vets) was very keen to improve and enlarge my elevators. The largest I had were only 50 cm long. I needed to extend them to 70 cm and do a few other modifications. Louis was also able to design and make some other pieces of equipment for me.

With all of our new equipment and a multitude of plans we returned to Poznan in early May 2013, determined to relieve Ninio of his problematic tusk. This time we flew directly into Poznan, arriving on the Sunday and immediately unpacking and getting everything ready for the big operation scheduled for Monday morning. Last-minute adjustments were made, such as purchasing of a new drill as both drills they had were too weak to drive my new purpose-made cutters.

Adrian had, by then, realised what the problem with the darts was and sorted this out. The anaesthetic was thus as smooth as we are used to, to our great relief. Ninio went down by sitting first (no splayed legs) and we were able to push him over onto his right-hand side in order that the left tusk (the one to be removed) was uppermost. All the equipment worked well and I was initially making good time.

After 2 hours the tusk fragments I had cut were already starting to move – I was so optimistic! But by 3 hours into the procedure I was getting a bit dejected. We had said to one another that 3 hours was what we knew we could safely keep Ninio under anaesthetic for (even though he was under for about 4.5 hours the last time we worked on him, we knew that was far from ideal), and things were progressing too slowly. At this point I opted for plan C.

I have once before extracted a tooth with a winch and this was what I decided was needed in this case. The hand winch was brought in and it was attached to the most movable piece of tusk. After only about 3 minutes of applying traction to this piece of tusk it moved. Removing a tusk is like removing a pipe – what gives it strength is the intactness of this pipe. As soon as that first piece moved the structure of the tusk was weakened and I was able to manipulate what was left in the alveolus. The last piece I removed (with the winch) was enormous and once everything was out I wasn’t sure how I had got it out in the pieces I did! For long periods of time all I had done was focus on the immediate task at hand and silently prayed. There was a lot of praying!

With the tusk removed all that remained was to empty the alveolus of the pulp. If left, this diseased pulp would continue to be infected and form abnormal ivory. This task took another 20 minutes of blood, sweat and tears. At one stage (while my arm was literally up the alveolus to my armpit) I overheard Adrian say to one of the 23 people in the enclosure I could have gone into obstetrics!

After 3 hours and 45 minutes Ninio was standing. Adrian and I had discussed pain relief for Ninio in depth and it was very pleasing to see that after all that this elephant had gone through the combination used by my very able anaesthetist was working very well. He started eating that same day. Within the next 2 days he was interacting with the other elephants, allowing close inspection of the alveolus and eating as if nothing happened.

We left Poznan on the Thursday, humbled as the zoo community there overwhelmed us with gratitude for what we had done for Ninio. (This time we could actually see the emotion on their faces).

As I sat at Frankfurt airport (after my plane was delayed for 12 hours) I thought of all the people who had made my dream to work with elephants possible.

As always, my family have been willing to be without a father and husband for frequent periods of time (sadly this is the fate of many spouses and children of veterinarians). Then there are my staff members who make sure all the equipment is ready and packed, as well as the various companies who have been instrumental in equipping me to be able to perform the surgery. Lufthansa was willing to give me a 23kg extra weight for free – the 4 new elevators alone weighted 10kg. (My thanks to Heidi for convincing them). The list grows to include the 23 willing helping hands in the enclosure on the day of the surgery. All of this proves that veterinary science is truly a team sport.

A special word of thanks goes to the National Zoological Gardens for allowing Adrian to accompany me on this venture. It is always a pleasure working with him.