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Kinder cuts draw faithful fans

In hundreds of surgeries a year, doctors take ‘bloodless’ route Jehovah’s Witnesses, secular patients flock to Legacy program

By Peter Korn

The Portland Tribune, Nov 11, 2005, Updated Oct 30, 2009

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John Hanna remembers what it was like for Jehovah’s Witnesses in Portland before 1991. Good medical care was hard to find.

Understand, Hanna knows there are plenty of fine physicians in Portland. But Witnesses have a long history of conflict with the medical community because their religion forbids the transfusion of blood.

A few local doctors treated Witnesses, Hanna says, but major surgery was almost impossible to get. Unable to find local doctors willing to perform surgery within its guidelines, the Witness community would send members out of state for surgery. Even worse, Hanna says, were trauma patients, victims of accidents. “There were cases where people would just bleed out,” he says.

Hanna and other leaders of the Witness community started talking to local physicians. Which led them to David Rosencrantz, a sympathetic urologist at what is now Legacy Good Samaritan Hospital & Medical Center. What Witnesses wanted was surgery aimed at minimizing blood loss, and surgeons willing to respect their beliefs, even if it meant letting them die by not giving them transfusions.

What they got, thanks to co-director Rosencrantz, was Legacy Health System’s Bloodless Surgery and Medicine Program, the only one in Oregon and among the first in the country. And Rosencrantz? Well, he’s a bit of a hero to some in the Witness community. As a result, he’s pushed for changes in surgery that affect everyone.

“We found a doctor willing to carry the banner and help people better understand our needs,” Hanna says. “He’s been a champion of our position.”

Bloodless surgery Ñ on the face of it, the phrase doesn’t make sense. Surgery almost always involves blood, often lots of it. But what Rosencrantz and colleagues try to do is limit bleeding as much as possible so that Witness patients do not need transfusions.

Consider the program’s first case, back in 1991. A Witness at a hospital outside Portland had suffered a miscarriage and was bleeding profusely. Emergency doctors said she needed a transfusion, but she refused. Her sister-in-law, who had heard about the new program at Good Samaritan, phoned Rosencrantz from the hospital emergency department.

“She was bleeding to death,” Rosencrantz says. “They didn’t know what to do.”

What they did was transport the woman to Good Samaritan, where Rosencrantz called in a gynecologist and an anesthesiologist to try to stop the bleeding. The surgeons, using a piece of equipment called an argon beam coagulator Ñ which uses gas and electrical current to help stem bleeding Ñ succeeded. So why was the originating hospital, which had its own coagulator, unable to care for the woman? Rosencrantz thinks the answer lies in attitude.

“They were stymied by the fact that she bled and bled, and they couldn’t give her blood,” he says.

Saying no to the safety net

Bloodless surgery actually begins well before a patient has seen an operating room. Medications are used to boost the blood’s red cell count weeks before surgery, and to improve the blood’s ability to clot. Surgeons can use high-tech scalpels to limit the cuts that cause bleeding, and cauterize vessels so they stop bleeding. Blood salvaging also is part of the program. Using machines called cell savers, surgeons can capture lost blood and return it to the patient.

But often the answer to Witnesses’ prayers is not so much technique as patience Ñ surgeons taking extra time to make sure they don’t nick or scratch with their instruments, because the safety net Ñ transfusing to replace lost blood Ñ is unavailable.

“If you’re going to truly do bloodless surgery you’re pushing the envelope,” Rosencrantz says, “using all the techniques you can to not lose blood.”

Blood is complicated stuff. It can carry disease, it can sustain life, and it deteriorates. Blood is expensive, about $500 a pint. Before World War I, when blood typing and transfusion techniques were refined, losing blood was a death sentence.

But transfusions are not an exact science. For instance, there is disagreement among physicians as to when they are necessary.

Anesthesiologist David Farris, the bloodless surgery program’s co-director, says if a surgical patient’s hemoglobin count, a measure of red blood cells, falls below 10, most anesthesiologists will call for a transfusion. But it’s better to set the limit at a blood count of seven, Farris says. According to Farris, transfusions lead to higher fatality rates among surgical patients. Doctors haven’t yet figured out why, but blood-borne infections are suspected as at least one cause, Farris says. Whatever the reason, transfusions increasingly are being avoided in all patients unless necessary.