A meeting of hearts if not minds

Christina Blouvan-Cervantes had been battling aggressive leukemia when her blood count plummeted and she landed in the emergency room in Fresno. Her doctors told her a blood transfusion was her only hope. But her faith wouldn’t allow her to receive one.

So she turned to one of the only doctors who could possibly keep her alive: a committed atheist who views her belief system as wholly irrational.

Dr. Michael Lill, head of the blood and marrow transplant program at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute, is a last recourse for Jehovah’s Witnesses with advanced leukemia.

PHOTOS: Doctor treats Jehovah’s Witnesses

They arrive at Lill’s door out of desperation and a desire to live. Many specialists decline to treat them because of their biblically centered refusal to accept blood transfusions, a mainstay of conventional care for the cancer.

Lill thinks their refusal is risky and illogical but nevertheless has devised a way to treat them that accommodates their religious convictions.

Despite his belief that God doesn’t exist, he has become a hero to many devout believers.

“We don’t care if he believes in God or not,” said David Goldfarb, chairman of the Los Angeles-area Hospital Liaison Committee for the Jehovah’s Witnesses. “What we really believe in is, ‘Are you a skilled and great doctor … and can you respect our belief system?’”

Lill, a 52-year-old Australian native, said ideological differences between doctor and patient are beside the point.

“Just because someone makes a decision which I would view as the wrong decision … doesn’t mean at that point in time I say, ‘No, I am not going to look after you anymore,’ ” he said. “I try and treat people’s religious beliefs with respect.”

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Leukemia, a disease of the blood and bone marrow, produces cancerous blood cells. Treatment involves chemotherapy to destroy the cancerous cells, sometimes followed by transplants of stem cells that develop into healthy blood cells.

Blood transfusions are usually required, because both the cancer and the treatment suppresses the body’s production of blood cells. Without transfusions, the risk of death from anemia or bleeding is significantly higher.

Jehovah’s Witnesses draw their beliefs about blood from a literal interpretation of the Bible, which repeatedly warns against its consumption. Among the passages often cited by adherents: “You must not eat the blood; pour it out on the ground like water.”

It is a violation of God’s command for a Jehovah’s Witness to accept whole blood, red or white blood cells, platelets or plasma, Goldfarb said. It is left to patients to decide individually whether they are comfortable accepting stem cells.

Lill, who received his medical training in Australia, came to the United States in 1989 to work in the bone marrow transplant program at UCLA Medical Center. He accepted a position at Cedars-Sinai in 1997. He and his wife, a stem cell researcher, have two children.

He stumbled into the niche of treating Jehovah’s Witnesses with leukemia after getting his first referral about 15 years ago. He saw both a professional challenge and an unmet need. Since then, about 50 Witnesses from around the world have come to his team for help, including 35 who have received stem cell transplants.

“People have the right to make their own decisions,” he said. Before treating the patients, Lill has a candid discussion about religion and medicine, freely using words like “death” and “dying.”

About four years ago, Lill himself was treated for cancer of the appendix. The experience, he said, helped him better understand his patients’ fears.

To avoid transfusions, Lill first builds up patients’ blood counts with medications. Then he limits blood loss during a regimen of chemotherapy and stem cell transplants.

When he draws blood from patients to check their cell counts and organ function during treatment, he uses tiny pediatric tubes. He gives women a drug to suppress their periods and prescribes a hormone to boost red blood cells.

He has trained his staff in how to treat Jehovah’s Witnesses, and “No Blood” signs are posted in their hospital rooms.

Other hematologists and oncologists consider Lill’s bloodless treatment experimental and risky.

“There is a certain nobility in trying to help these patients,” said Dr. Stephen Forman, chairman of hematology and cell transplantation at City of Hope cancer center in Duarte. “But it is of questionable good safety.... You might get yourself in a situation where your patient could die.”

One of Lill’s Jehovah’s Witness leukemia patients died recently after suffering a brain hemorrhage. Lill said the death might have been prevented if the patient had received a transfusion.

During Lill’s rounds one recent morning at Cedars-Sinai, he washed his hands and went into the room of Kyle Hester, a 21-year-old Jehovah’s Witness from Fresno who was waiting for a stem cell transplant. Hester lay in his bed, hooked to an IV and an oxygen tube. His face was pale and his arms swollen. A book of Scripture lay open beside him.

Lill had bad news. Hester’s stem cell transplant would have to be postponed. His hemoglobin levels were too low, and he had pneumonia and a possible infection.

“I don’t know if we are going to have enough time to get everything about you perfect again before we move on to the next step,” Lill told him.

Hester bit his lip and nodded. His brother, Eric Hester, said they don’t believe in miracles. But they do believe in prayer. They pray for God to guide Lill.

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Wanda Smith, a Jehovah’s Witness from Texas, sat on an examination table in Cedars-Sinai’s outpatient cancer center. Her husband, Will, clasped a blue bag filled with medications.

Lill greeted the couple and launched into routine questions about her recovery from her stem cell transplant: Any coughing or shortness of breath? Nausea or vomiting? How is your appetite?

Smith, 65, announced in a Southern accent that she had gained six pounds in a week. Lill teased her about a Jehovah’s Witness tenet: “And you aren’t supposed to be celebrating Christmas or anything else.”

“No, I didn’t,” she laughed. “I just got my appetite back.”

Smith’s journey to Cedars-Sinai started a year ago with an excruciating pain in her knee. When she was diagnosed with acute leukemia, she thought: “Is this a death sentence?”

When she told a Dallas doctor she wouldn’t accept blood transfusions, he advised her to get her affairs in order. She tried a different doctor, then heard about Lill. When she arrived at Cedars in July, Lill was compassionate but direct: He promised to follow her wishes but not that she would live.

Smith’s belief in resurrection bolstered her for the fight ahead. “We are like everybody else. We want the best medical service we can get,” she said. “But of course, we have our limits.”

After chemotherapy at Cedars-Sinai, Smith received a transplant of stem cells from her brother.

This was a weekly follow-up visit. Her blood counts and her liver and kidney function looked good. “I think you are doing great,” Lill said. “In another three weeks or so, I will let you go back home to Texas.”

She smiled and clasped Lill’s hand. “You know you can do no wrong, right?”

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Blouvan-Cervantes, 27, was diagnosed with severe leukemia in 2009 after back pain landed her in the hospital near her home in Fresno.

“I was so terrified of dying,” she said. “As long as it is not going to go against what I believe, I’ll do anything.”

She heard about Lill through her church, and soon she was undergoing chemotherapy at Cedars-Sinai. After returning home, she ended up in the emergency room with a high fever. As she moaned and struggled to breathe, doctors and nurses pleaded with her to accept a blood transfusion. Barely able to speak, she scribbled a note: “Please don’t give me blood.”

She survived the night and returned to Cedars-Sinai. She said she feels safe there. No one questions her faith or her decision to decline transfusions.

In October, Blouvan-Cervantes received a stem cell transplant. Beforehand, she noted that the bag of stem cells looked like blood. Lill assured her it contained nothing deemed improper by her religion.

Blouvan-Cervantes won’t be considered cured until her cancer has been in remission for five years. A number of Lill’s patients have reached that milestone.

At a recent appointment, she and Lill discussed whether she might be able to go home in a few more weeks. But she was still nauseated and tired and had body aches. A blood test showed her white blood cell count was low, making it harder to fight infection.

Blouvan-Cervantes dabbed her eyes with a tissue. She said she just wanted to feel normal again.

Patricia Van Strien, a transplant coordinator who has worked with Lill for 14 years, tried to console her, praising her bravery in sticking to her religious convictions.

“You had a diagnosis and Dr. Lill had an approach that we could try and fix this,” she said. “Many doctors say there is nothing we can do.”

Blouvan-Cervantes is grateful Lill is not one of them. “He is my lifesaver,” she said.

anna.gorman@latimes.com