An excerpt from One Hundred Prayers: God’s answer to prayer in a COVID ICU.

(August 30, 2021)  Susan was 44 years old and previously healthy; an ardent anti-masker. When she caught delta COVID, she took ivermectin, zinc and vitamin C. She arrived at our ER about a week later, requiring immediate intubation. Mayfield started her on standard recommended therapy: dexamethasone and remdesivir* but Susan’s husband Connor called in and specifically forbid Susan’s nurse from administering the remdesivir*. None of us could ever remember a patient’s family restricting our use of an antimicrobial agent for any reason besides a history of an allergic reaction.

Within a few days of Susan’s admission, she was on 90 percent oxygen, proned and receiving a neuromuscular blocking agent to induce muscle paralysis to get her to stop fighting the ventilator. An echocardiogram showed that her heart was severely damaged – another known complication of COVID pneumonia.

[*Family intrusions into critical care management were symptomatic of an incredible erosion of trust. I don’t know who’s job is harder, mine or an airline pilot, but if my plane was crashing, I would stay out of the cockpit and trust my pilot to fly the plane the best they knew how.]

Prayer 231 (August 31, 2021)

Oh the depth of the riches and wisdom and knowledge of God!

How unsearchable are his judgements and how inscrutable

his ways – for from him, and through him, and to him are all things.

I pray to you Lord for a heart after your heart, not this cruel thing.

Grant me sober judgement – that I should not think of myself too highly, but according to the measure of faith you have assigned me. Whatever gifts you have given me, let me exercise them in your service. Let my love be genuine.

Give me the sense to recognize and reject evil and hold fast to what is good. Grant me patience in tribulation, constancy in prayer, generosity in spirit. Give me your forgiving and merciful heart.

Help me surrender my vengeful spirit and leave it all to your judgement Lord. Let me not be overcome by evil, but let your Holy Spirit in me overcome evil with good. [From Romans 11 and 12]

Susan was now on 100 percent oxygen and multiple pressor infusions to support her severely weakened heart. Her kidneys and liver were failing because her heart wasn’t delivering enough oxygen to them. I called Conner to let him know how bad things were going and to emotionally prepare him for Susan’s impending death. My first thought was how terrible it was to have to give news like this to him – Connor and Susan were married over 20 years and had two teenage boys. I asked Conner’s permission to be forthright, and apologized for being the bearer of bad news. As I laid out the grim tidings, Conner started laughing. I was momentarily stunned – was I really hearing what I thought I was hearing? Maybe he was actually crying. No. He was laughing!

I interrupted, “I’m sorry Conner, but I don’t understand how you could possibly be laughing at what I’m telling you.”

“Oh. Dr. Eckshar, I’m laughing because my wife and I both know that COVID is a hoax. I know you’re lying to me!”

It was amazing how stubbornly a person can cling to a failing belief system, despite incontrovertible first-hand evidence. But this surreality was becoming routine in our ICU. When that phone call was over, I asked our palliative care team to take responsibility for further communication. Conner later instructed them that “Susan would want everything humanly possible done to prolong her life for the next 100 days” – a request manifestly disjointed from the harsh reality we were facing: Susan wasn’t likely to live 100 hours, no matter what we did.

Prayer 232 (September 3, 2021)

Consider this statement carefully:

“We know that in all things God works for the good of those who love him, who have been called according to his purpose.”

We are those who love him, and have been called!

[From Romans 8:28-30]

I didn’t understand how the Delta scourge could be for the good of those that love God, but I believed somehow it must. I had given up trying to understand the purpose behind the pandemic anymore. Events would eventually unfold so as to provide some explanation. For now it was enough to trust God.

Prayer 233 (September 9, 2021)

God, you said “Let light shine out of darkness!”

Grant that we will not lose heart.

Because although our old bodies are falling apart, you make our spirits new daily. Don’t let hard times bring us down, because you use them to prepare us to spend eternity with you.

Help us look away from bad news, and focus on your work in the Holy Spirit. For the things of this world are transient,

but our promised home in your kingdom is eternal.

I speak of what I believe, now Lord may our thanksgiving overflow the glory of God. [An adaptation of 2 Corinthians 4:7-18]

That morning, Susan’s O2 sat fell to 15 percent when she was briefly supined for some nursing care. The nurses re-proned her immediately, barely preventing her from coding. Joyce was on call that evening, and she called Conner to tell him we had to abandon the pretense of full code status. CPR required turning Susan face-up, but her lungs couldn’t tolerate that anymore. DNR status was imposed the reality of the dire situation. This type of unilateral DNR decision-making, rarely employed pre-pandemic, had now become routine.

Susan died later that night of her twelfth hospital day from progressive hypoxemia. I heard that Conner and his sons came into the ICU briefly to be with her, apparently subdued and appreciative. I’m embarrassed to say that for the first time since he laughed at me, I felt sorry for Conner. I said a silent prayer for him and his now-motherless boys.

Robert Raschke is a critical care physician and author of One Hundred Prayers: God’s answer to prayer in a COVID ICU.