Love In The Time Of Coronavirus

Love is sacrifice. There is no greater love than this, to lay down one's life for one's friends. All across the world, healthcare workers are sacrificing for their friends and for strangers alike. They are sacrificing for those who contracted COVID-19 from willful ignorance, from reckless disregard, and others innocently from some unsuspecting source. And yet medical workers treat them all the same, fight tirelessly for their healing. For this and so much more we all owe a great debt of gratitude and honor. 

But that is only a small part of what I want to say, and it is to those medical workers I write, I want you to be prepared. Your life is about to change forever, your sense of fairness, justice, and right and wrong may soon suffer so great an upheaval that it leaves you reeling in shock and existentially wounded. Please hear my words. I write them in love.

There is a term, many of you may know, a condition of the soul called moral injury. It is also a condition that many medical professionals already have from years of working in the healthcare industry. For anyone unfamiliar, “Moral injury refers to an injury to an individual's moral conscience resulting from an act of perceived moral transgression which produces profound emotional guilt and shame, and in some cases also a sense of betrayal, anger and profound 'moral disorientation’.” 1

“The concept of moral injury emphasizes the psychological, social, cultural, and spiritual aspects of trauma. Distinct from pathology, moral injury is a normal human response to an abnormal traumatic event.” 2

Moral injury refers to the “the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” 3

Said another way, moral injury is “A deep soul wound that pierces a person’s identity, sense of morality, and relationship to society”. 4 

There are critical distinctions that need to be made between moral injury, burnout, compassion fatigue, and post traumatic stress. Moral injury is primarily an existential crisis, and while it is often exacerbated and usually accompanied by the physical exhaustion of burnout, the ever narrowing emotional bandwidth of compassion fatigue, and the unconscious and very normal response of stress after trauma, it is more fiendish and perhaps more debilitating than all of the others combined.

Moral injury can be divided into two categories: individual responsibility, that is the perpetration of, or the failing to prevent, harm, and other responsibility where we witness the dereliction of sacred duty and/or betrayal by trusted others.

In this current crisis you are going to be asked to do more than you've ever done, with less than you've ever had, for more people than you could have possibly imagined. Resources will run out soon. At the time of this blog, New York has 5-6 days of critical medical supplies left. Already doctors and nurses are being asked to recycle disposable protective gear, or wear it long after it is safe to use. The decisions being made in boardrooms and political dens are affecting you and your patients in real time. And the stark reality of limited ventilators and other life saving devices is about to have a very real cost in human lives. This is battle field medicine, and no amount of training could psychologically prepare you for this.

Tomorrow, or maybe the next day you will have to choose which patient gets life saving resources. Tomorrow or the next day, another of your peers will fall ill, a victim of recycled masks, of compromised immune systems due to physical exhaustion from endless shifts. The blame may be easy to spot, the mistakes glaring and some even seemingly avoidable, but you will have no time to obsess on that, you will be in the fight of your life, perhaps the fight for your life.

The cumulative effect of all of this, the damage from this perfect storm of ignorance and unpreparedness, will leave your soul wounded. The unfairness, the tragedy, the inequality will fracture your heart, your mind, your spirit. Moral injury fills the vacuum where the illusion of human virtue once was. People will fail you, the system will fail you, your leaders will fail you, and you will be altered in ways unimaginable.

When this over, and it will end, you will be forced to deal with the moral injuries. Some will come from events where you failed, or perceive you did, the decision to give the ventilator to one patient over another. This will lead to toxic, negative, internally directed emotions and cognition like guilt, shame, and lack of self-forgiveness. Other events, those outside your control, administrative or political decisions or inaction that cost lives, will surface as toxic, negative, externally-directed emotions and cognition like anger, inability to trust, and lack of other-forgiveness.

Both types of events are associated with spiritual/existential issues, the loss of "faith", of questioning morality, and until resolved, these internal conflicts can in turn exacerbate social problems like isolation and aggression along with inducing mental health symptoms such as anxiety and depression leading to substance abuse and greatly heightened suicide risk. Doctors are already at one of the greatest risks for suicide, even in non-coronavirus times.

Limited life saving resources, the desire for personal safety over patient care, outright mistakes, administrative decisions with dire consequences, even co-workers playing God will all wound your soul, but the greatest existential crisis that you may face, will be why must the innocent suffer. This virus preys on the vulnerable, the weak, the defenseless. The ones who need us most. Where is the fairness, the justice in the universe? Where is God? If God exists, why doesn't He intervene?

There are no easy answers. There may be none you find satisfactory. But for your own well being, for the care of your soul wounds, let me offer what I believe is the only true inoculation against, and the only cure for moral injury: hope.

If you are reading this as a Christian, than you will perhaps appreciate what I am about to say, but in the event you do not believe in God, or the Christian God, please consider the thoughts to follow objectively. Every code seems nonsense without the key, a jumble of words and phrases with no meaning. If your universe seems dissonant, confusing, and indecipherable, (or when it does after this is all over) let me humbly offer the Key.

First you must realize you are not alone in this, hundreds of thousands of medical professionals are going through or will go through the same things. Secondly, I believe in a God who suffered in every way, bore every burden any human would ever suffer, and understands intimately your moral crisis, your soul wound. Feeling alone in this is an inescapable prison, but knowing you are not alone, that others, most importantly that God understands, is the beginning of comfort, the first glimmer of that hope.

The Christian bible says “Not only that, but we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope,” Romans 5:3,4

Scripture makes many promises, and perhaps none as seemingly unfathomable as this: “suffering produces hope”. The promise that for the believer, good will come from our afflictions. 

As I've written about before, I spent 16 weeks at a field hospital near Mosul, Iraq. There I saw the worst humanity can do to the most innocent among us. Children targeted by drone strikes, hunted by snipers. One night I carried five children to the morgue. It leaves you breathless, concussed. It shakes your faith. No easy answers come in those moments, no words of comfort for others come easy either. And yet something in us holds fast. Words form on our tongue that are not our own…

"…rejoice in your sufferings, know that suffering will produce endurance, and endurance character, and character will produce hope."

This passage is saying that when Christians suffer, they have a strength that is not their own, in their weakness they find God's grace, His great power, holds. When they would run in fear or in despair, when they would curse sacrifice and live for themselves instead, His nature in them holds. When in the midst of their worst physical, mental, even existential crisis, He never leaves them, hope is produced and that hope holds. For the Christian hope is not an abstraction, it is a person, His name is Jesus Christ.


Christianity is much more than a path to follow, a philosophy to obey, it is the transformation of our very nature by God Himself living in us. The power and the intimacy this affords us becomes such great confidence in the darkest hour. For the Light of the world is in us and even death could not extinguish Him. 

My prayer for you is this: Fall to your knees as you fight this wretched demon COVID-19, or perhaps it has already knocked you to your knees, and cry out for God of the universe to give you the hope of Jesus. He promises to work all things together for the good of those who love Him. He is infinitely able, and His love for you both unfathomable and unstoppable. 

Love is sacrifice. There is no greater love than this, to lay down one's life for one's friends. Jesus calls you friend, He laid down His life for you. So that you could live this life with the same power that raised Him from the dead and destroyed the sting of death, the power of the grave forever.

Let His perfect love casts out all fear. Let Him start to heal those soul wounds. Let Him be your peace in this storm, your shelter from more moral injury, from fear itself. 

Keep your chin up and wash your hands. Love you all. Xoxo




1. Litz, Brett T.; Stein, Nathan; Delaney, Eileen; Lebowitz, Leslie; Nash, William P.; Silva, Caroline; Maguen, Shira (December 2009). "Moral injury and moral repair in war veterans: A preliminary model and intervention strategy". Clinical Psychology Review. 29 (8): 695–706.

2. Molendjk, Tine (2018). "Toward an Interdisciplinary Conceptualization of Moral Injury: From Unequivocal Guilt and Anger to Moral Conflict and Disorientation". New Ideas in Psychology. 51: 1–8

3. Litz, et al. 2009, p. 697

4. Silver, D. (2011). Beyond PTSD: Soldiers have injured souls. Truthout.org (9/3/11). Retrieved from http://www.truth-out.org/news/item/beyond-ptsd-soldiers-have-injured-souls

Behind Those Blast Walls

My first day at the emergency field hospital just east of Mosul, Iraq was very much like my last day. Mortar strikes on civilians, children bloody and broken, black bags to hold the dead. The slow, solemn walk, cradling a ten year old in my arms, counting the steps to the morgue. Laying someone's son down on cold gravel, reading his name one last time on the death certificate taped to the body bag.

Time of death 18:17.

Patient #855.

I'll never forget the sounds of his dying. The rattling and the gurgling. I'll never forget the songs we sung over him, the prayers strangled by grief and sorrow. The tear stained cheeks and our righteous anger. I'll never forget the faraway look on his precious face. I'll never forget his face. What was left of it.

Many of us were strangers a week before, two days before. Strangers taking care of other strangers. One set from the west, a land of peace and prosperity, one set from northern Iraq, a region ravaged by terrorism and war. And now here we all were, doctors, nurses, pharmacists, translators, construction workers, administrators, and HR reps.  One and all hearts turned inside out and taking care of the dying while other new friends fight for the living in mobile operating theaters a few hundred feet away.

That last night may have been the worst. The toddler with ribs exposed from mortar wounds. 9 children in one day. But there were other days, other nights when I thought my heart might die. The toddlers with their feet shot off. The whole families targeted by drone strikes. The burnt and blackened restaurant patrons, victims of a suicide bomber. One night in particular I carried five children to the morgue. It leaves you breathless, concussed. The mortar of sorrow, a direct shot to the soul.

I'm processing, I'm free bleeding my heart and thoughts here so I don't explode and because I don't have the luxury of denial. I cannot separate my belief in a good and sovereign God and the suffering of innocence. If there is no reconciling the two than I am lost. We all are. Especially Christians, fools to be pitied of all men.

But what we found there, behind those blast walls, with the ceaseless drums of artillery fire, the strangled song of the whine and wail of one ambulance after another, was that hope is not a thing you wish for, it is the only thing afloat in a raging sea of chaos. It is what you hold on to, what holds on to you so you do not go under the relentless waves of grief. And we found that you hold on to each other. And you pray like gasping for your last breath. And you plead with heaven, even when heaven is silent. And you raise your broken hearts together in a pitiful little petition, more whimpers than words, and you beg, unified in grief, "Jesus please....."

The Bible says that suffering produces hope. A comical, sadist thought when the belly is full and the sun of our futures never sets, always shines on our glorious destinies. But when the night never ends, when the morgue is full, when evil seems to be laughing in every shadow, on those nights you somehow see it. Suffering produces hope in this way: when terrorism and hate and the cancer of evil spreads over all that is good with a blight of darkness, the light still does not go out. There is a flame in the hearts of those who have known the love of God. There is a song of praise that is not stalled on their lips, is not silenced. There is a light in the inner places of those who have heard the Word of Life and believed. This is the flower of hope that grows in the garden of souls by heaven's Holy seed. This is the hope that springs eternal, because it has always existed, always will exist apart from the human stain, in the Holy heart of God.

Suffering produces hope in the same way bomb blasts produce the broken bodies of children. It is the inevitability, the cause and the effect of universal laws. But only one will remain. Hope will swallow grief one day because Love will conquer all. But Hope is inevitable in us only when we trust, against our own instincts, in the goodness of God and allow ourselves to be taken deep into our own human frailty, far past vulnerability to the point of despair. And in that wasteland of our utter uselessness, in that wilderness of our unraveling, God is there, He is faithful, He alone, as He has always been, is holding the universe together and simultaneously holds us in the palm of His hand.

That is the only hope: that God holds His own in the palm of His hands while they yet suffer. And that the insatiable hunger of the mouth of Hell cannot devour the ragtag, broken band of believers called the church.

In the picture above I hold in my hand a 50 caliber bullet taken from the body of a pre-teen boy. An ISIS sniper shot him because their's is an ideology of fear. They target the weak, not just because the weak are a low-hanging fruit, but because most of us are weak. Most of us are trying to live our simple lives in peace. ISIS needs capitulation. They need submission. A sniper bullet in the side of a child reminds us the world is not at peace and things are not simple. It reminds us that suffering isn't a concept, that no abstraction paralyzed this young man. It reminds us that we are fragile and vulnerable. It reminds us that to walk the way of love our hearts will be obliterated by suffering.

And so against all hope we hope, that Love will one day conquer all. But not human love. Only God's selfless love, for with it carries His perfect all-powerful justice and the promise and ability to make all things new. Godspeed that day. Especially for the precious children of Mosul.

Grace and a Sheet of Glass.

The paper, folded, sweat bleached and poorly printed read:

Funerailles de Mr. Andre Eliphate

Ne le mai 1961

Decede le 22 Septembre 2012 a l'age de 51 ans

At least that's what it appeared to read, the legacy of a man already fading for want of ink. And then underneath there was a picture, in decorated uniform, blurred beyond recognition, and an epitaph:

"Tout vit, tout naitre, tout perisse"

"Everything lives, everything born, all perish." But what have we learned. Only what we already know. The order of service on the back does not tell us how to live life, or better yet avoid death, to be unborn. It proffers the names of choral groups and the arrangements they will sing. Pays honor to the speakers, speaking to honor the deceased, who will themselves die one day. The snake with its tail in its mouth. Oh, this pitiful little piece of ephemera, maybe it will survive, longer than the man. Pressed between pages in an album celebrating his life only to be shelved and shrouded in dust.  

But this is not the man, this paper. Anymore than the script on it's back is the funeral. He lived and loved and raised 7 children. He protected his community from violence until gang members shot him for stopping their thieving in broad daylight of a woman selling mangoes in the market. He was the father of my friend Alfedo, who speaks 7 languages and works tirelessly without complaining at every task put before him. He will be missed like all good men by his family and friends. Such is the nature of these things. 

But my God the funeral. 

A thousand mourners packed and then overflowing out of a flesh coloured concrete church with one small humble cement cross at its peak. I stood at the door, straining to see Alfedo, straining to comprehend the Creole songs and eulogy. But nothing said or sung was of any importance. Grief was the only language spoken today, and of a sort I have never heard nor seen. As I stood there concussed by the screams all my words for what I was hearing failed me. A banshee's wail, an ambulance siren. I would welcome either in the casket black night over what I heard today. Tortured anguish, hopeless desperation, convulsive sorrow....words cannot touch what I saw. Women in white dresses flailing, flung down to the dirt floor by grief. Rolled and shook and throttled by grief. Seizurred and spun and batted about by so great a grief that those who tried to restrain them could barely do so. Woman after woman carried out of the little church, white dresses ripped and stained and faces soaked with sweat and tears, their screams unabated their arms and legs lurching in every direction, bent at impossible angles.

The bible talks about groanings words cannot utter. I have heard these things today. And even the occasional comprehendable "Why! Why!" was so strangled by grief as to be beyond language. Nothing ever spoken could touch the despair and gravity of those groanings. I wanted to cover the ears of the children, to cover the ears of those women. No one should ever make these noises, have to hear these noises. 

I stood outside in the Haitian sun. Reeling, trying to make sense of such sorrow. The women who had been carried out now whimpered in the courtyard of the church. They sat sprawled on the ground, shivering with exhaustion. Across the street a bar was opening. Patrons laughing, drinking beer and rum not 50 feet from the mourners. One group drinking away their own grief and the other having drunk to the dregs of sorrow's sourest cup. Next door to the bar a little shop called "Le Sange de Jezi Cosmetiques". The Blood of Jesus Cosmetics. Only in Haiti. The irony as the recession of the corpse commences. A white casket cradled in uniformed arms. Inside a Father, a friend, a brother and son, a fellow officer- the mortician's art, the embalming perfume, the make-up. And the blood of Jesus, the covering of the Christian, a soul snow white forever. Le Sange de Jezi Cosmetiques.

Alfedo approaches. Vacant-eyed and asleep on his feet. I embrace him, pray for him as tears soak our shirts. And then he too recedes. Into the throng of mourners. I catch my reflection in a glass surface; hair sun bleached and wind-whipped, face gaunt with sadness, eyes red and weary and wasted looking. And I realize I am seeing my reflection in the window of the hearse. Grace and a sheet of glass....

The national radio programs called for manifestations around Port-au-Prince today. Nothing new. This time it's Aristide holdovers protesting President Martelly. These things rarely go well. Lots of stuff gets set on fire and people get busted up real bad. There was no sign of any of it though, just a few spray can scrawls on crumbling walls that proclaimed Aristide president for life. They would have seemed silly today, small and insignificant against the backdrop of such intense suffering and pain. We drove back to Titenyan in silence. Everyone of us, alone with our thoughts, thinking of loved ones lost and those we would be crushed to lose. I hope everyone of the guys went home and hugged their kids, their wives. Called up their closest friends. I am thinking of my son and also of my beautiful muse. They both seem a million miles away. Oh what I would give for their hugs right now.