When a medical condition warrants a treatment — meaning the potential risks of the therapy are outweighed by the potential benefits — we say that treatment is indicated. Just because a treatment is indicated doesn’t guarantee a specific outcome, or that it will work at all. There are plenty of small and large instances where the gamble doesn’t pay off. All indicated means is that it’s worth going through the micro-experiment of trying. Whether it actually works, whether the benefits truly do outweigh the costs, is an assessment that can only be made after the treatment is completed.
Indication is the statement that this is the path forward. The actual process of the therapy determines the outcome.
I want to write about two stories that were indicated by my growing beliefs. The first is something small, because the small thing came first and it taught me something I needed before the large thing arrived.
Early in residency I made it a habit to offer to pray with my patients. Not all of them, and not every day, but usually at least once during the course of seeing someone. The offer was always the same: I believe that spiritual health is part of our whole health, and in that light, I like to offer to pray with my patients. Would it be okay if I prayed with you right now?
Almost no one said no. That’s not a claim about my particular charisma — the medical literature backs it up. The vast majority of patients believe that spiritual health contributes to their overall health, so when a physician offers to acknowledge that, most people welcome it. When someone agreed, I’d pray simply. For healing. That the medical team would be guided toward the right answers. Nothing theologically heavy or objectionable by most standards, except that I always prayed explicitly in the name of Jesus Christ.
One patient stands out, and he stands out precisely because he declined my offer.
He was older, mid-to-late sixties. He had been difficult since his admission — agitated with me, agitated with the nurses, always asking why this was done that way and that was done this way. Nobody moved fast enough. Nothing was ever quite right. We see a lot of patients like that, and most of the time you learn to absorb it without taking it personally. He wasn’t cruel (some are) and he certainly wasn’t dangerous (some are). He just wasn’t satisfied with anything we did.
I offered to pray anyway.
“Pray for me?” He looked at me like I’d suggested something absurd. “Why?”
I explained my reasoning again, calmly. He shook his head. “No. I don’t think I want that.”
“That’s no problem,” I said. “I just wanted to offer. I’ll be back to check on you tomorrow. Let us know if we can help with anything in the meantime.”
When I walked in the next morning, it was like he was a different man. His voice was softer. He had been kinder to the nurses. He was patient with me in a way he hadn’t been for the previous several days. He still declined any prayer — and he never did accept it — but whatever had hardened in him had softened, and he stayed that way for as long as he was in the hospital, and hopefully after.
I’ve thought about him a lot over the years. Nothing actually happened. I didn’t pray with him. No spiritual transaction occurred by any measure I could sense and certainly not that I could document in a chart. But something in the offer itself — the acknowledgment that he was a whole person and not just a diagnosis, that someone in that building considered his interior life worth attending to — did something that four days of competent clinical care hadn’t done.
The cost of that offer to me was minimal. A moment of professional vulnerability, the risk of an awkward interaction, the possibility of being told no. Which I was.
I didn’t know it at the time, but that was practice. Choosing the path my beliefs would indicate I take despite the potential costs.
The big story happened right after I graduated residency at the end of June 2020.
For most of that final year, my program had a policy that residents would not see COVID patients. The reasoning was practical rather than protective: every resident’s patient also had to be seen by a supervising attending, which meant two staff members exposed instead of one. So the attendings took those patients and the residents didn’t.
Outside of the hospital, Taylor and I had two children by this time and would soon be pregnant with our third. We had just bought a house. After a decade plus of student loans and running our family on a resident’s salary, an actual attending income was finally in front of us — and the things we had deferred during all those years of waiting were suddenly on the table.
A lot of residency graduates take time before starting their first job. Some travel. Some decompress. Some take a month or two just to study for their board certification. We needed income. So I graduated June 30th and started working July 1st.
As a freshly minted attending, I was immediately assigned the COVID patients I had been prohibited from seeing just a few weeks earlier. The clinical situation hadn’t changed. My position in the hierarchy had.
Then, in the winter of 2020, the first vaccines became available and my hospital moved quickly to institute an employee mandate.
At this point, I had opted out of vaccines for my children, as I described in the last chapter. I had not, however, fully opted out for myself. I had still gotten the flu vaccine that year. The COVID vaccine, though, this one felt different to me — I had and still have scientific concerns about delivery systems, ingredients, and production methods that I’m not going to litigate here, because that’s not what this chapter is about. What matters for this story is simply this: I didn’t want to take it, and I had reasons I could articulate and defend. Many of them were religious.
My hospital had a religious exemption process. I completed the required 1 page worksheet, then promptly attached my own two-page letter, with scriptural and research references supporting my position. It was strongly worded. It was clear about what I believed and why.
And then I didn’t submit it.
That voice I had been learning to recognize and to follow — the one I had finally understood to be the Holy Spirit — told me to wait.
So I waited.
Simply saying, “I felt led to wait,” makes it sound like this was some serene season. It was not serene. I specifically remember taking my guitar out onto our front porch to sing one song during that time. One of the lines says, “This is life, to bid me, come and die.” I’d sing that song over and over, often with tears of fear welling up in my eyes.
Part of me was afraid to get an answer at all. What if it was denied? What if I was fired? How would I find another job when reports were circulating daily about people who had been terminated or resigned over mandates and then couldn’t get hired anywhere else because the next employer mandated the exact same thing? How would we make the mortgage payment on the house we had just bought? How would we take care of two children and a third on the way?
We had waited years for this income. There’s a specific weight to a decade of deferred financial life, of watching friends outside medicine buy homes and take vacations and build savings while you accumulate debt and work eighty-hour weeks toward a payoff that’s always two or three more years away. We had finally arrived, and now the whole thing was suspended over a two-page letter sitting on my desk.
I’ll admit something less noble too: some part of my delay wasn’t obedience. It was avoidance. As long as I didn’t submit, I didn’t have to receive an answer I was dreading. And there was a calculating part of my brain that wondered whether a flood of late submissions might slow the review process enough to buy me more time. I wanted my paperwork to be at the bottom of the pile.
The voice telling me to wait and my own fear telling me to wait weren’t the same voice. But I’d be lying if I said I could always tell them apart in the moment.
Two days before the deadline, I finally felt it was time, so I submitted the exemption.
The next day, a close friend texted me a news article: a class-action lawsuit had been filed against my hospital for denying religious exemptions.
The day after that, my exemption was approved.
I’ve turned those three days over in my mind more times than I can count.
I don’t know what would have happened if I’d submitted the letter in week one. I can’t prove the timing mattered. I can’t demonstrate causation, but I know how my story played out.
What I can tell you is what those weeks actually cost. While not a long time on the calendar, they felt very drawn out in a house with two small children and a third coming, a mortgage we had just signed and an income we had waited a decade to finally earn. Every morning I woke up and made the same decision again: wait. Every morning the fear made its case — submit it, get the answer, at least you’ll know. Waiting was both a comfort and a terror. Comfort because it postponed an answer I didn’t want. Terror because the question wasn’t going anywhere.
I waited anyway. And obedience, even when it’s mixed with fear, is still obedience.
The outcome was better than the one I had braced for. But the outcome isn’t the point.
The point is that an indication is not a guarantee. It never has been. It’s actually a decision to proceed without one — to look at the risks and the benefits, to weigh what can be weighed, and then to commit to a course, unknowns and all. I was given a choice to trust, and my family’s livelihood was on the table.
I chose to trust. That’s the whole thing.
The earlier prayer offer cost me nothing. This one could have cost me everything. The first was practice. This was the treatment.
There’s a question I get asked frequently once people learn how our family lives. They find out about the food, the filters, the supplements, the things we do and don’t do — and they’re genuinely puzzled, because it’s difficult to reconcile the systematic institutional buy-in required to survive medical training with a simultaneously held set of beliefs that appear to undercut the foundation that system is built on.
The question usually arrives as: How do you still work at a hospital?
It’s a fair question. I have several answers, but my favorite is this one:
If you were having a heart attack right now, would you rather I call the cardiologist and get you a stent — or sit down and have an hour-long conversation about what you ate this week and how much you exercised?
People still get sick. As long as that’s true, we need good doctors to take care of them when they do. Should healthcare be more oriented toward producing actual health rather than managing illness? Absolutely, without reservation. But until that train — loaded with institutional, financial, historical, and capital-S Science momentum — can be slowed and turned, we are going to need good conventional physicians as much as we need functional ones.
I am not opposed to the objectives of the system I work in. I am opposed to that system being the only thing anyone is permitted to consider.
Here’s what I understood by the end of that winter that I hadn’t understood before:
Conviction is cheap until it’s expensive. Anything I believed about stewardship, about questioning institutional consensus, about seeking truth over convention — all of that was theoretical as long as the only thing it cost me was a slightly awkward conversation in a hospital room or a different grocery list than my colleagues.
The mandate was the first time it cost something real. And that’s the actual test of an indication: not whether the treatment sounded reasonable when you consented to it, but whether the benefits held up once you were in the middle of the therapy and the side effects had arrived.
I was told this was the path forward. I couldn’t know whether it was the right one until I walked it.
What I didn’t know at the time was that this — the mortgage, the mandate, the exemption letter sitting on my desk for weeks — was not the hardest thing our family would face. It wasn’t even close.
That’s Chapter 5.
