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Dr. Christopher DeWald examines Tracy Pickett in her first appointment after scoliosis surgery in Chicago, Illinois.
CHICAGO TRIBUNE (MCT)
CHICAGO--As a Jehovah's Witness, Tracy Pickett has enjoyed knocking on doors and introducing strangers to the tenets of her faith. But by the time she reached her mid-40s, scoliosis made every step excruciating and her spiritual mission impossible.
Walking again would require surgery that often involves tremendous blood loss and a transfusion. But transfusions to replenish the blood supply are forbidden by her church.
"Even though I love life and I don't want to die, I want good medical care without blood," said Pickett, 49. "If it got to that point, I would rather lose my life than disobey my creator and take a blood transfusion."
Dr. Christopher Dewald, Pickett's orthopedic surgeon at Rush University Medical Center, nervously agreed to find alternatives and perform the surgery. Dewald said he couldn't fathom letting a patient die on his operating table, but because he respected Pickett's convictions, he invested time to explore the options.
"I explained to her that I would have a hard time letting her pass away right in front of me and that I might have a problem not giving her blood," said Dewald, a Roman Catholic. "But I was going to do everything in my power to honor her wishes."
For years, many doctors have resisted accommodating religious tenets that they believe endanger their patients. But more physicians, including Dewald, are practicing within the confines of religious restrictions.
Although alternatives to transfusions have been around for years, more physicians are weighing patients' spiritual well-being and peace of mind as part of their treatment.
"In the rational realm, it doesn't necessarily make sense," said Dr. Valluvan Jeevanandam, an expert in high-risk cardiac surgery at the University of Chicago Medical Center. "But if what they believe makes them peaceful and content, I'm not going to take that away from them."
Jehovah's Witnesses cite Acts 15 in their own New World translation of the Holy Scriptures to explain their objection to blood transfusions. "Therefore my judgment is that we should not trouble those of the Gentiles who turn to God, but should write to them to abstain from the things polluted by idols, and from sexual immorality, and from what has been strangled, and from blood."
Most Christians believe that verse denounces pagan rituals such as eating and drinking blood. But Jehovah's Witnesses interpret it as a prohibition on accepting blood that has been removed and stored. They also point to four verses in Leviticus and three verses in the Book of Deuteronomy to demonstrate that any blood spilled and not eaten (referring to animal blood) should not be reused, but given back to God.
Because it can be difficult to find doctors who respect the rule, the church appoints hospital liaisons to manage a database of local physicians and make referrals.
"Each major city of the world has a hospital liaison committee to bridge the gap between the Jehovah's Witness community and medical community," said T.J. Bullock, the church's liaison in Chicago.
Jeevanandam has accepted many of Bullock's referrals. He said he warns every patient that the mortality rate is higher for anyone who declines blood transfusions.
"We don't have a 100 percent success rate. We do lose people," he said.
Dr. Hieu Ton-That, a trauma surgeon at Loyola University Medical Center, has worked to overcome the widespread misperception that Jehovah's Witnesses wholly reject medical care.
An atheist working at a Catholic hospital, Ton-That has discovered he also must overcome a clash of values.
"Obviously, there are some values that we should share as a society: preservation of life if possible, autonomy," Ton-That said. "My job is understanding where people come from and giving them access to care that's appropriate to their value system."
Ton-That has launched a hotline for patients who want to avoid blood: 708/327-0RBC (0722), which stands for "Zero Red Blood Cells."
While Dewald agreed to do Pickett's surgery, he also referred her to a hematologist to increase her blood count in advance. Once in the operating room, he used a cell salvage machine that suctions, washes and filters blood so it can be recirculated instead of thrown away. Jehovah's Witnesses believe such machines act as an extension of the circulatory system, so blood doesn't leave the body.
To control any blood loss, he divided the complex procedure into two separate operations. By the time he walked into the operating room, he felt confident that both surgeries would be a success.
Pickett's convictions have prompted him to contemplate his own Catholic beliefs.
"Could I let someone die?" he said. "I would've had a hard time walking out of the operating room. A plan was not in place. I'm not sure what I would do. I never completed that sentence."