After feeling excruciating pain in her side one day, Glenease Stinson, 75, learned she had a malignant kidney tumor and that the kidney needed to be removed. All surgeries carry risks, but she had a big one: As a Jehovah's Witness, she could not have a blood transfusion.
Witnesses cite Acts 15:28-29 and other passages in the Bible to support their belief that taking blood into the body through mouth or veins violates God's laws. Believers will not accept blood even to save their lives.
But Adventist Bolingbrook Hospital urologist Dr. Avtar Dhindsa had an ace in the hole for Stinson. He gathered a team that included Dr. Michael Tuchek, an expert in juggling medical necessity and religious tenets.
"I was put on the Jehovah's Witness list, for lack of a better term," said Tuchek, a cardiothoracic and vascular surgeon, referring to the list that the church keeps of doctors who are experienced in surgery without transfusion.
Tuchek estimates he does one every month or so on Witnesses.
"Bleeding is a real, real problem," said Tuchek, a senior partner at Cardiac Surgery Associates in Downers Grove.
"Thirty to 50 percent of heart [surgery] patients need blood transfusions." Tuchek said he started treating Witnesses when he was a resident in the 1980s and a Witness came in with burns on 70 percent of his body.
"I got drawn in, but once I got there, I saw a need," Tuchek said. "A lot of [doctors] don't want to touch Jehovah's Witness patients because [they fear] they'll get sued. I saw that these patients are sincere. They have a right to decide. I think they should be treated with the same respect" as anyone else making a medical choice.
Stinson, of Bolingbrook, understood the risks of kidney surgery but declined a transfusion.
"I knew I'd rather die than break one of God's laws," she said.
While Stinson did not waver, some Witnesses who need a doctor seek the help of the Jehovah's Witness Hospital Liaison Committee, a group whose main functions are to educate and bring patients together with doctors who are comfortable working on them, said T.J. Bullock, the committee's chairman.
"We firmly believe this needs to be [the patient's] decision," he said.
The group is made up of church elders with medical backgrounds or medical aptitude. Usually, Bullock said, they help facilitate what the patient has already decided.
"Is there a medication this doctor's not thinking of? A different approach they're not using? Another doctor who might be more helpful?" he said.
New techniques have been developed, including alcohol ablation -- a catheter-based method used on Stinson by Dr. Luke Sewall, an interventional radiologist -- to minimize blood loss. Before, surgery without transfusion meant Witnesses died at a much higher rate, Tuchek said, although no available data confirm the death rate.
"Six or seven years ago on Christmas Eve, a young woman in her 30s had a massive heart attack, and they tried to transfer her to several hospitals, but they wouldn't take her because she was a Jehovah's Witness," Tuchek said. "I ended up [taking] her and, at the end of the day, her hemoglobin was so low she died on the table. Techniques since that time improve the odds."
Techniques before and during surgery include using medications to boost the bone marrow production of red blood cells, which increases hemoglobin levels; thinning a patient's blood; and drawing a patient's blood into a heart-lung machine to conserve healthy blood to reintroduce when surgery is completed. After surgery, he said he may use artificial products that promote blood clots, and bone marrow-boosting medications.
Tuchek - who works with Witness patients at hospitals throughout the Chicago area, Iowa, and northwest Indiana -- said he respects a patient's beliefs but does not always agree.
"They know I don't agree," he said, "but I try to make sure that they're convincing me that they're doing it for the right reasons. As long as they intellectually understand the situation and in their heart believe that, 'My religion counts and ... I don't want blood,' I have no moral dilemma whatsoever operating on Jehovah's Witnesses."
In the cases of Witness patients who are younger than 18, Bullock said parents almost never consent to a blood transfusion.
"If they're under 18, the hospitals have the right to take custody and transfuse a child, and we understand that," Bullock said. "What the [committee] recommends is that we locate a pediatric doctor who has a good record of cooperation to maximize our position. ... What we're looking for is someone who is willing to push the envelope and do everything they can [to avoid a transfusion]. We try to make sure the court understands it's not a negligent parent, it's just a blood issue."
Most of the hospitals he has worked with have been very cooperative, he said.
"By and large, they work very hard to work with Jehovah's Witnesses," Bullock said.
Methods used on Witness patients can create potentially harmful side effects, Tuchek said.
"Make the blood too thick, it can clot and cause a heart attack or stroke," he said. "On the flip side, if you don't give [Witnesses] the bone marrow boosting, they're anemic and have low hemoglobin. They're pale, they can't breathe well, can't exercise, they're short of breath."
Doctors and scientists are trying to come up with new alternatives to blood transfusions, he said.
"In a war zone in Iraq, they're looking for artificial blood that would carry oxygen and nutrients without having it come from a human being. ... As it stands now, we don't have that ability, but people have been working on it for 20 years now, and they're getting closer."
As for Stinson, she is fully recovered, grateful for her doctor's care and firm in her beliefs.
"I believe that if it was Jehovah's will, I would live; if it was not, then I wouldn't," she said.