Bloodless lung transplant.

Oh, for Pete’s sake

Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.

She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.

The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

Literally, her position is: “My beliefs are insufficient to save me, but obviously medicine can so I need it.  But I want medicine to comply with my beliefs anyway.”

Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?

Easy answer: no.  Absolutely not.  There are plenty of people eager to avail themselves of the wonders of modern medicine without demanding that doctors take more time to do a transplant with their hands effectively tied.  You want medicine?  Then get the medicine.  You don’t?  Try prayer.

By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.

By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.

Nobody is denying someone care.  In fact, if anybody is denying a lung transplant to Ms. Tomczak, it’s her.  People like Ms. Tomczak are free to go get a lung transplant.  They are not free to dictate the status of the medical discipline to doctors.  Imagine if a patient was saying they wouldn’t take pain killers unless it was morphine.  It’s clearly the patient denying himself medicine, not the doctor.  Ditto for Tomczak.

“At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”

Which is why hospitals prescribe homeopathy.  Wait, no they don’t, because that makes absolutely no sense given our understanding of medicine.  You go to a doctor because you don’t know enough to fix the problem yourself.  That’s the whole point of hiring an expert.  If the expert in the room is you, then you don’t need the doctor.  If it’s the doctor, you need to listen to what she’s telling you.

The article expresses optimism that this type of treatment could become the standard.

Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.

Tomczak is the 11th person to have a bloodless transplant attempted.  However, she had specific instructions for the doctor.

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

You know what the backstop is?  Using a fucking blood transfusion like everybody else.  You know why?  To keep people from fucking dying.  That’s why blood transfusion is the standard and this is highly, needlessly risky bullshit.  That’s why using blood transfusions during transplants will remain the standard.

Religion of humility, but you’re going to need all of medicine to bend to your ancient beliefs.  Gag me.

(Thanks to Amy for the link)

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