Besides those occasional visitors, and the two cashiers she works with at Safeway who happen to be of the same religion, Montoya never gave Jehovah's Witnesses much thought.
Montoya has a congenital heart defect, and is lying in the preop room of Seton Medical Center about to undergo an aortic valve replacement. Her husband and parents stand around her, silently praying as a nurse prepares Montoya for the open heart surgery that is an hour away. The Montoyas are Catholic, but when the doctor cracks open Cathy's chest, he will operate using surgical advancements developed for and perfected on Jehovah's Witnesses.
Montoya's heart surgery will be bloodless.
She didn't ask for a transfusion-free operation, but for decades, Jehovah's Witnesses have made that request. While the religion claims blood is sacred and the Bible forbids using it in any form, doctors -- propelled by the AIDS scare -- are finding ways to rely on blood less, and still save lives with surgery. "Blood transfusions are basically no good, and we are very aggressive in avoiding them for everybody," says Dr. Alex Zapolanski, director of cardiac surgery at the San Francisco Heart Institute and the surgeon doing Montoya's operation.
More than half of the nearly 900 heart surgeries at the institute last year did not involve blood transfusions, and only a fraction of the patients in those bloodless operations were Jehovah's Witnesses. The medical benefits going bloodless are clear: If the chances of HIV infection through transfusion are now remote, acquiring hepatitis through donated blood is not. And even the cleanest donor blood is still foreign, and can weaken a patient's immune system.
Zapolanski is not alone in his views on limiting blood transfusions. A study released in this week's New England Journal of Medicine shows that some critically ill patients actually have a better chance of survival when blood transfusions are limited, while younger and less ill patients are more likely to die when given more blood. As a new generation of doctors challenges blood's status as an all-purpose healer, fewer people are receiving blood than ever before: Ten percent fewer patients received transfusions in 1994 than in 1992, according to the latest statistics compiled by the Center for Blood Research in Boston.
"Indirectly, medical science is starting to see the wisdom of God's law," says James Pellechia, a spokesperson for the Jehovah's Witness church in New York. "While the Bible is not meant to be a book of science or medicine, we believe that when people follow its guidelines, it results in the best and healthiest way of life."
Zapolanski says the bloodless trend has nothing to do with what Jehovah's Witnesses read in the Bible, that it's only about the realization of good medicine. Still, the rise of bloodless surgery has created a rare happy circumstance: For a change, religious belief and medical science stand on common ground.
Cathy Montoya nervously runs her fingers through her dark, bobbed hair as she lies in the preop room. It is just past dawn and a trashy Jackie Collins novel sits open on the bedside table. The young mother of two toddlers laughs and jokes with her husband and elderly parents who have gathered by her. They all saw the movie Patch Adams days before her surgery.
"This family laughs a lot -- it's a coping mechanism," Montoya says. "It's my personality, but believe me, I'm stressed-out on the inside."
It's the first week of January; Montoya postponed the operation until after the holidays, even though her doctor suggested it be done sooner. Her faulty valve, which up until now produced nothing more ominous than a slight murmur, has begun to cause a back-flow of blood into the heart. This reverse flow is enlarging her heart toward the point where it could lose elasticity and fail.
"I started crying when they told me. I couldn't believe it," says Montoya, who is just 34 years old. "I thought, 'I'm too young to have heart surgery.' But I knew this is serious."
When the nurse ushers everyone out of the room for a few minutes, Montoya's husband, Rick, lets his joking smile fade. "I'm very nervous. They're going to operate on the organ that keeps her alive," he says, matter-of-factly. "One slip and she's gone."
Rick pauses, thinking about what he's said. His eyes begin to well. "I can't imagine life without her."
Though anxious about her chest being opened, Montoya is not worried about the bloodless approach. Because Montoya is not a Jehovah's Witness, Zapolanski had her donate a pint of her own B-positive blood prior to the surgery -- just in case. "I don't feel like a guinea pig in any way," she says. "Medicine has progressed and my surgeon is progressive, which is a good thing."
Three nurses dressed in blue scrubs arrive; one injects some Valium into the intravenous line protruding from Montoya's arm. "Better kiss her now before she falls asleep," the nurse says.
"I love you," Rick says, as Montoya struggles to keep her eyes open. "You'll be OK."
In the operating room, Montoya is surrounded by the heart/lung and anesthesia machines, various monitors, and a half-dozen stainless steel carts draped in blue coverings, which hold an array of sterile scalpels, scissors, and clamps.
The cell-saver machine also sits close by. Integral to bloodless surgery, the dishwasher-sized box is equipped with cylinders that spin collected blood, cleaning it before returning it to the body. A nurse follows each stroke of the surgeon's knife with the cell saver's hand-held suction gun. It is attached to a long, plastic tube, through which every stray drop of blood travels back to the machine for recycling.