Blood-Free Transplants for Jehovah's Witnesses Dr. Michael Lill of Cedars-Sinai Medical Center has developed an unusual program. His technique enable patients who are Jehovah's Witnesses to receive bone marrow transplant without the blood transfusions their religion prohibits.
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Blood-Free Transplants for Jehovah's Witnesses

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Blood-Free Transplants for Jehovah's Witnesses

Blood-Free Transplants for Jehovah's Witnesses

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ALEX CHADWICK, host:

This is DAY TO DAY. I'm Alex Chadwick.

MADELEINE BRAND, host:

I'm Madeleine Brand.

On Saturdays at Cedars-Sinai Medical Center here in Los Angeles, the elevators stop at every floor so that observant Jewish patients don't have to push the buttons on the Sabbath. The hospital helps devout patients of all faiths, even Jehovah's Witnesses who reject certain treatments. That's where Dr. Michael Lill comes in. He's a blood cancer specialist who treats Jehovah's Witnesses despite a lot of complications.

CHADWICK: And here is something else about Dr. Lill.

Dr. MICHAEL LILL (Blood Cancer Specialist): I'm on the atheist side of the agnostic fence.

CHADWICK: So what moves a non-believer to serve the deeply religious? Here is the first of a series of profiles on health care workers. NPR's Patty Neighmond spent a day with Dr. Lill.

PATTY NEIGHMOND: The beginning of the day, like Michael Lill himself, is low-key but intense.

(Soundbite of boxing)

NEIGHMOND: With boxing gloves and a piercing stare, Lill circles his opponent as they spar. He's good at it; he's rugged and seems to thrive on the potential danger. As a young man Lill played Australian rules football, which is like a wild combination of rugby and U.S. football without the padding.

Dr. LILL: I've always enjoyed a strong physical contact. And now that I'm approaching 50, there's also a certain middle aged male desire to be able to compete with younger men in their 20s and 30s. But that's, you know, that clearly wasn't the case when I was actually 30.

NEIGHMOND: It's also the kind of physical and mental training that helps Lill stay focused through his day. An house later, as he walks into Cedars-Sinai Cancer Institute, Dr. Michael Lill grabs a cup of coffee. He never gets to actually drink it, but cup in hand he moves quickly through a maze of halls, takes an elevator, and ends up in a patient unit where Jay Winger(ph) lies on a bed face down.

Dr. LILL: Okay, just try and relax a little bit there if you can. You're all sort of tensed up on the bed. So take - I know, that's tough. Take a couple of breaths in through your nose; blow them out through your mouth.

NEIGHMOND: Lill inserts a needle deep into the hip bone and turns it almost like a corkscrew to draw up a vial of bone marrow. A half hour later the patient is sweaty and exhausted.

Dr. LILL: I think this is probably about as much as we can manage just with local anesthetic.

NEIGHMOND: Lill washes his hands, something he'll do dozens of times throughout this day, and heads down the hall, this time taking the stairs.

Dr. LILL: The difficulty today is that I'll need to see 15 patients in the hospital and then have a clinic with 15 patients in the clinic, and that'll mean in order to see the patients up here I'll have to come back after I finish my clinic and continue ward rounds at 7:00 o'clock tonight.

NEIGHMOND: But first there are rounds with residents to discuss the patients who are here for bone marrow transplants.

Unidentified Man: This is Saul Miller(ph) presenting patient Ruth Medina. She is a 25-year-old female Jehovah's Witness here for a autologous stem cell transplant for a Jehovah's Witness protocol.

NEIGHMOND: Ruth Medina is unusual because her religion forbids any medical treatment that uses blood or blood products.

Ms. RUTH MEDINA (Jehovah's Witness): For me it's the sanctity of blood. Blood is the life of a person.

NEIGHMOND: That mean Medina will refuse a blood transfusion. But she's here for a bone marrow transplant to treat Hodgkin's lymphoma. And transfusions are typically given to boost patients' strength and help them survive the transplant.

Dr. LILL: How are you doing today?

Ms. MEDINA: I feel good. I feel really tired, but...

NEIGHMOND: Ruth Medina's bald from recent chemotherapy, but she sits upright in her bed looking strong and beautiful in her bluish gown. She says she's completely comfortable with her decision to say no to a blood transfusion, even to save her life.

Ms. MEDINA: We actually don't ever even sit around and cry about it. We're always so optimistic about it. We know that it's something that I can get over. I have a lot of strength.

NEIGHMOND: Medina came to Cedars because Dr. Lill decided to buck the system and give Jehovah's Witness patients a chance against cancer by performing bone marrow transplants.

Dr. LILL: Many of my colleagues think that I'm slightly crazy to be doing this and they're more than happy to refer their Jehovah's Witness patients to me.

NEIGHMOND: Other doctors won't risk it because they worry patients might die without a transfusion. But when Dr. Lill examined the actual statistics, he found most patients didn't really need them. He decided to conserve patients' blood and make the need for transfusion even less likely.

Dr. LILL: What we do for our Jehovah's Witness patients is that the blood tests go into pediatric tubes so we don't use as much blood. We don't draw the blood from central lines so we don't throw away that first tablespoon. We don't do as many blood tests.

NEIGHMOND: Since the program began six years ago, Cedars has performed so-called bloodless transplants for 21 Jehovah's Witnesses.

Dr. LILL: In my capacity as a healer I am not a technician. We are supposed to be treating the whole human being. And that involves an understanding of their spiritual aspects as well as the mechanical, technical aspects of deciding what dose of chemotherapy I give for what particular indication.

NEIGHMOND: Lill's decision to treat these patients is motivated not only by respect for their beliefs, but also by Lill's own philosophical commitment.

Dr. LILL: I think amongst a most important set of core values in the United States are the philosophy that comes out of the Enlightenment and a key part of that came out of so many people killing each other in such horrible ways for so many hundreds of years in the middle of Europe over religious issues.

NEIGHMOND: So for Lill it simply comes down to this.

Dr. LILL: Individuals get the right to make their own choices, even if they're bad choices.

NEIGHMOND: It's dark outside, around 6:30. Dr. Lill has one last patient to see; a 35-year-old mother of two who's worked the past year and a half, even though she has leukemia.

Dr. LILL: She's a very strong vigorous lady and she used to get herself discharged from hospital as early, as fast she could so she could go back and continue to do her house cleaning stuff so she could get the money to support her children. And it's not at all clear what's gonna happen with that entire family dynamic now.

NEIGHMOND: As Lill turns to walk into her room, his eyes look worn; he shakes his head. The patient has had a severe stroke and Lill knows she will die soon.

Dr. LILL: It's a very sad end to the day.

NEIGHMOND: Lill hunches, walks slowly down the hall to his car and then home. It's always painful, he says, when patients die, and it should be. Lill says doctors shouldn't ever get to the point where they no longer connect to their patients. And for him that empathy grew even stronger a few months ago when he was diagnosed with cancer.

Cancer of the appendix is rare, not a lot is known. In the best case, after surgery and chemotherapy, Lill says he's looking at a nearly 90 percent chance of survival. But just talking chances, he says, has been sad for everyone.

Dr. LILL: My daughter, before - just before she went to bed, sort of burst into tears, so I had to - she's almost 17 now so she doesn't do this very often. So I had to hold her and that was really one of the more difficult moments, was holding her while she wept for about 20 minutes. And putting her to bed and then kind of went outside and wept for myself for about half an hour.

NEIGHMOND: But forcing himself to talk frankly, openly, with both his daughter and son, has somehow made coping easier.

Dr. LILL: It hasn't changed their behavior all that much, but I think that - it's not like they suddenly start tidying up their bedroom or - but I think that it's demystified for them and therefore also removed a lot of the emotional power of the unknown and the danger of everything when you don't know what's going on. So I think that's been a very helpful thing for myself. And I think it's probably something that people could do more often than they do.

NEIGHMOND: Dr. Michael Lill runs the bone marrow transplant program at Cedars-Sinai Medical Center in Los Angeles.

I'm Patty Neighmond, NPR News.

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