The Jehovah's Witness Protection Program

http://jwpp.bandcamp.com/

My first clue that 'something was up' lay in the fact that it was 7 am in the Intensive Care Unit and getting to my patient was a challenge for all of his visitors in his room.

My second clue that 'something was up' lay in the fact that my patient was African-American and all of his visitors were white.

Now before we get all racially sensitive, I am very aware that many families are blended in many ways and many of us are close friends with people of all races. As well it should be. However, in the hospital where I work, it is an uncommon sight to see a room full of white people at the bedside of a black man at seven in the morning. Just sayin'.

My patient was a Jehovah's Witness and was losing a great deal of blood. He chose not to receive a blood transfusion. Fair enough. I respect his decision. But I had work to do, so I asked that only two visitors remain in the room. Three men remained.

The oldest of the three, a diminutive man dressed in a white shirt, beige trench coat and glasses with 'flip-up' sunglass lenses stood staidly at my patient's bedside and without introduction said, "I would like to speak to the doctor". I asked my patient if it would be OK for the man to speak with the doctor on his behalf. He consented.

When the doctor arrived, the little guy in the trench coat said "We want EPO and Iron only. No blood products. Fingerstick blood samples only".

The plot thickened. I suspect that these men were from the "Jehovah's Witness Hospital Liaison Committee". or what I referred to as the "Jehovah's Witness Protection Program". Although they never did introduce themselves or state their relationship to my patient it was clear that they were at his bedside to advocate for his choice not to receive blood.

My problem was not with my patient's choice.

My problem was with the fact that the JWPP guys came off all self-righteous and pushy. No "please's" or "thank you's". It was clear that they considered us, the health care team, to be the enemy. At one point, another JWPP rep abrasively questioned, "Why is it taking so long to give the EPO and Iron? Didn't the doctor order it?" Sucking it up, I chose not to say "It's been 15 minutes."EPO" and Iron are not going to save this guy." But instead, I gently informed them that "these medicines would be given in a timely manner, but that they were not considered 'emergent' at this time."

My JWPP team seemed sadly misinformed.

Explaining that "fingersticks" are a great alternative to classic blood draws if you haven't already lost 3/4 of your circulating blood supply was received with incredulity. I had to show them my patient's white, almost translucent fingertips in order to prove the point. I still don't think they believed me.

"EPO" (as they referred to it) is actually "Erythropoetin" a building block of red blood cells that is normally manufactured in our bone marrow. My patient had no difficulty in manufacturing red blood cells. He was just losing them at a rapid rate. "EPO" may not hurt - but in the immediate treatment of profound blood loss, it was not going to help.

Iron is a component of our blood that helps carry hemoglobin (oxygenated blood). Again, without an adequate supply of blood, giving Iron is somewhat moot.

An incredibly courageous choice. My patient knew that receiving blood would save his life and that we were ready to give it to him but he chose not to receive it. Was it his strong faith? Was it his fear of being shunned? Was it the fact that he was not strong enough to change his mind? I will never know.

I do know that his decision was respected by all members of his health care team. I also know that the JWPP could have chosen to sit with him and hold his hand throughout the night while he lay dying in a hospital bed, but instead he was left alone, holding the hand of a health care worker, a nurse he had just met a few hours earlier.