I have recently had the pleasure of participating again in priesthood blessings, an LDS ritual based on New Testament precedent in which believers place olive oil and then their hands on a person’s head before pronouncing a prayerful blessing on the recipient. As I indicated a few years ago, these blessings are a sacred part of my attachment to the LDS Church. These recent experiences, blessings of support in the midst of complex and challenging life circumstances, returned to my mind an episode some years ago in my practice as an ICU physician.
There is a stage in shock (life-threatening impairment of circulation, often related to overwhelming infection) where an individual is dying before your very eyes. Blood pressure is perilously low, heart rate is exceedingly high, the patient is comatose, and every beat of the heart (we call them systoles in our medic-speak, three syllables with the accent on the first) threatens to be the last. These are challenging situations that stretch your capacity as a physician, often late in the night, requiring responses every few minutes if not more frequently. This young man had arrived with a combination of a severe, “double” pneumonia and an accidental aspirin overdose (having heard that tylenol can be fatal in accidental overdose, he had treated his fever and aches with the ancient pain reliever the chemists called acetylsalicylic acid when they bullied it from willow bark and modified it slightly). Every organ system stood in profound disarray, his blood pressure too low to support life despite enormous doses of adrenalin and related compounds that our nurses pushed into his IV catheters. I immediately set to work initiating his life support systems, the sterile plastic tubes that transform the dying individual into a semi-cyborg in the precincts of death. The anatomy of his veins was unusual, so the process took some creativity, while we adjusted the adrenalin infusions on a minute-to-minute basis. As I finished the initiation process, the young man’s wife and parents arrived. I informed them that perhaps 1 in 10 patients survive this degree of illness but that I was fully committed to his possibility of survival. They asked whether they could administer an LDS priesthood blessing to him, and I reflexively told them that I thought theirs was a perfect idea, my mind immersed in juggling the support of the failing organs of this profoundly critically ill patient.
I stepped out of the room, checking laboratory results and arranging for dialysis to begin the process of eliminating acid from his blood (for the cognoscenti, his blood pH was 6.72 when he arrived). As the family left the room, tears in their eyes, I resumed my place at this young man’s side, coordinating with his skilled nurses the administration of the various life support therapies. To my surprise, though he remained profoundly critically ill, his blood pressure had finally reached a level that suggested he just might survive (for the cognoscenti, his mean arterial blood pressure had finally risen from 30mm Hg to 55mm Hg).
I asked his nurse what had happened to change his status, and, among all the other interventions, the nurse told me that she had suddenly suspected that one of the adrenalin infusions (dopamine) had been having an effect on the heart opposite to its intended effect, so she had stopped the infusion. She is no particular friend of Mormonism or religion in general–she finds religious types silly and stifling. And she is a highly skilled critical care nurse with years of experience. As I inspected the ultrasound of this young man’s heart, I could see that the nurse had been right, that under the influence of that particular agent, combined with the fluid loss that occurs in the most severely infected patients, the heart was having difficulty expelling blood smoothly. This nurse’s careful attention (her inspiration?) I believed had made a crucial difference. Of course, we all continued at his bedside from midnight to 5am regardless, slowly making ground as the life support therapies allowed his body to begin to stabilize itself.
Over the course of the next 15 days, this young man slowly awakened and was liberated from life support therapies. Eight days after this liberation, he made it home to his wife and family to finish his convalescence. He returned to work several months later.
I wonder how best to interpret this experience. For his family, a beloved husband/son had returned from the dismal antechambers of premature death after a priesthood blessing. For me, this case was a reminder that having an experienced critical care nurse at your side is a priceless blessing, that sometimes we do not see everything ourselves, that less is sometimes more, that in rare cases the adrenalin infusions we administer to save lives can work against us. I also remember that as desperately as we want to know, we cannot reliably predict the future. Our entemporalment limits our views; the fact that we experience time linearly is a necessary element of our mortality.
In the interests of time and space, I will not belabor the point, but I am interested in how people propose we should navigate the often uncertain realms of divine Providence, the answers to prayers, the miraculous efficacy of priesthood blessings, and the complex tapestry of our relationships to God and to each other. If we can explain a mechanism, is an event no longer miraculous? Is miraculousness a reflection of the perspective of the observer, and if so, does that matter? Can such a perspective further a relationship with God, independent of whether God is perceived to deliver what is requested through prayer or blessing? Though the insightful nurse at the bedside would laugh (goodnaturedly) at the thought that her work had come as a result of a priesthood blessing, I am inclined to let that reading stand, to see in her commitment to a life-saving discipline, in her desire to excel, in her well-honed instincts, the marks of God’s hands.
Happy March Fast Day
 As always, I have anonymized the episode to protect patient confidentiality. The fundamental observation that a non-religious nurse made an important change in therapy immediately after a priesthood blessing is true.
 I use “adrenalin” to refer to what physicians call “vasoactive medications,” or “vasopressors” and “inotropes” for simplicity. This young man was receiving norepinephrine, dopamine, phenylephrine, and vasopressin when he arrived in my ICU.