Early in his medical career, Dr. Wes Ely worked as a phlebotomist at a nursing home where one of his patients was an unresponsive elderly woman with dementia who never spoke or indicated she was even aware of her surroundings. During his regular visits, he would simply put a tourniquet on her arm and draw blood without saying a word or acknowledging her in any way.
One day, Dr. Ely noticed that the sun was shining through this woman’s window, directly into her eyes, so he closed the curtain. He was shocked when she then turned to him and said, “Doctor, everything that is light is Jesus Christ.”
That incident had a profound impact on the Catholic doctor’s career and the way he has chosen to practice medicine in a way that looks at his patients not just as a collection of symptoms, but as three-dimensional human beings whose emotional and spiritual needs are also a vital aspect of healing. Dr. Ely shares his views – as well as the life-saving work he has done improving practices in hospital intensive care units – in his Christopher Award-winning book “Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU.” We discussed it recently on “Christopher Closeup” (podcasts below).
For some Christopher Award winners, being notified about their win is the first they hear of The Christophers’ motto, “It’s better to light one candle than to curse the darkness.” But that was not the case with Dr. Ely. Unbeknownst to us, he has lived by that motto since childhood because his mother used to receive the local Catholic newspaper which carried the columns of Father John Catoir, The Christophers’ Director at the time.
The idea of lighting a candle in the darkness was especially important to Dr. Ely during his childhood because his father left their family to pursue a different life. That choice wounded the young Ely, who says he felt “defective” after the abandonment. His mother, however, countered this idea with one of her own. She wrote on a bookmark, “Wes, Jesus loves you. May you know this and love and serve Him all the days of your life.”
Dr. Ely’s mother may have put those words on paper, but eventually they came to be written on his heart.
Another impactful experience for Dr. Ely was his work as a farmhand during his high school years. He recalled, “I was in charge of the pickers, and the pickers were usually migrant workers. They worked for an hourly wage, and their whole life was in these fields. They didn’t have a safety net, and I saw that…These pickers, they would get a cut, that would become an abscess. They would get a toothache, that would become a gap in their smile. I realized that they were, in a sense, silenced in their own life. I viewed this as a testimonial injustice.”
Around this time, Dr. Ely read Maya Angelou’s memoir “I Know Why the Caged Bird Sings,” about growing up in Stamps, Arkansas. The book addresses the trauma Dr. Angelou experienced and how she was silenced as well. That, said Dr. Ely, “made me dive even deeper into this notion that people all around me were suffering and getting hurt – and could it be that maybe there was something I could do from a vocational perspective to help give them a voice and help them find a way forward. That’s really what led me into medicine.”
Despite his noble intentions of serving the sick, Dr. Ely admits that he often lost sight of his patients’ humanity during the early parts of his career and needed reminders, like the aforementioned encounter with the woman with dementia. This was especially true when he became a critical care doctor working in the Intensive Care Unit (ICU). He explained, “I was creating harm…[by] distancing myself from the actual person…I overinflated, egotistically, my power, my ability to heal.”
For instance, it was common practice for many years to intubate ICU patients and put them under deep sedation for days or even weeks at a time, believing this would help them recover from whatever malady they were suffering from.
In the early 90s, Dr. Ely began noticing that while his patients who underwent this treatment were often cured of their original problems, they wound up developing new ones. He said, “In five to 10 days, they acquire a problem called Post Intensive Care Syndrome – or PICS, which was only defined in 2012. It’s basically acquired dementia, acquired PTSD and depression, and then neck down, a problem of muscle and nerve disease.”
In his follow ups with patients, Dr. Ely learned these were not temporary issues, but rather debilitating ones that led to loss of employment and even suicide in some cases. Despite pushback, he embarked on a mission to prove that ICU practices were the cause. After many studies which included tens of thousands of patients, he discovered he was right. Then came time to develop a solution. “We created a safety checklist called the A, B, C, D, E, F bundle – six letters, which I abbreviate the A2F bundle,” said Dr. Ely.
In essence, that means if a patient needs to be put on a ventilator, he or she will only be sedated enough to stay comfortable. Then the next day, doctors will assess if the patient can stay awake to consciously interact with family or staff. Dr. Ely explained, “We’re going to try and get you out of the bed. We’re going to walk you, even on the ventilator. We’re going to try and give you just enough sedation and pain meds so that you’re not suffering in pain. You’re not anxious…But meanwhile, your brain is being engaged, and so are your legs and arms and chest wall so that you’re not losing all this muscle and the neurons aren’t dying. The old way was just to leave you unconscious in a bed for many days on end, where neurons are getting killed, the sedatives are worsening your brain and your muscles and nerves are getting damaged and dying. So that by the time we’d get you off of all that 10 days later, you had this new problem. Well, no, we’re not going to let that happen to you because when you get out of the ICU, we want you to have the life you had before.”
Dr. Ely is the founder and co-director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University Medical Center in Nashville, which spearheads much of this work and research. You can find them online at ICUdelirium.org.
Through all these scientific advancements, Dr. Ely came to a revelation that gave him a better approach to his career: “Medicine is a tool by which to serve God and family and friends. St. Ignatius’s principle and foundation is, why are we here? We’re here to praise, reverence, and serve God, and in so doing, to save our soul. The way that I want to do that now is to look into the eyes of every single patient and say, ‘This is an entire person’…and find out what is important to this person and how can I serve them better?”
Though Dr. Ely’s Catholic faith serves as the foundation of his life, his medical philosophy embraces people of all faiths and none. He explained, “I was in India, in Kolkata, at Mother Theresa’s Home for the Destitute and Dying, and one of the things that she always said when they asked her, ‘How do you do it? How do you pick up these people? They’re covered in vomit and maggots and flies?’ And she said, ‘I just look in their eyes, and I say to myself, ‘This is Jesus Christ.’ …For a non-Christian, the same thing can happen. You can look in the person’s eyes – whether you’re Muslim, Hindu, atheist, agnostic – and say…’I am here to serve this entire person.’…I take a spiritual history of my patients and put them in charge. Not me. I do not believe in proselytization. I do not believe that I am there to push my religion on anybody else. Never would I do that, and the church does not embrace that. So instead, what I do is, I put them in charge and I say, ‘Do you have any spiritual values that you want me to know?'”
In “Every Deep-Drawn Breath,” Dr. Ely shares the story of a dying patient who was an atheist and didn’t believe in an afterlife. Instead of a religious ritual, the doctor accommodated her request to have her family members gather around her bed and ask them each, “Do you love me?”
They responded, “Yes,” then gave her a hug and a kiss. She repeated this ritual two more times, asking them again “Do you love me?” followed by a yes, a hug and a kiss.
Dr. Ely recalled, “The emotion was raw. Each family member, open and exposed. They seemed to move beyond quick answers, to thinking about the depth of their love, what it meant to them, to her. She had asked not to be knocked out with morphine, wanting to be present for her loved ones. In completing her ritual, she turned to her other doctor and me and said, ‘You are part of my inner circle now,’ and reached out to grant us the same enduring gift. We were stunned by her generosity and felt unworthy…It was such an amazing thing to witness, this intense interaction that this dying woman had with her family members, knowing that she didn’t believe in God or afterlife, and yet, this extremely selfless act of exchanging love between one another. To me, it was so dignified and it so transcended the moment of her physical illness, that this is why I feel so fortunate to be at the bedside with people and have them let me into their inner circle.”
There was one patient for whom Dr. Ely’s Catholic faith did play a role. His name was Gian, and he was a doctor whose wife is one of Dr. Ely’s colleagues at Vanderbilt. Gian had contracted COVID before vaccinations were available, so he was struggling to stay alive. During one visit, Dr. Ely asked Gian, “What matters to you?”
Gian responded, “The Eucharist.”
Since Dr. Ely is a Eucharistic Minister, he was able to bring Gian Holy Communion the next day. He actually had to calm Gian down because he got so excited at the prospect of receiving it that his oxygen saturation declined. But once he stabilized, Dr. Ely read from Scripture, offered prayers, and gave Gian the Eucharist.
Gian began crying afterwards, saying, “You have no idea how much this means to me. This is the most important thing I could ever want.”
Dr. Ely said, “As physicians, Gian and I incorporate science into faith, acknowledging that when we ingest the Eucharist, it enters the workings of the cells of our entire body. My faith affirms that consuming the Eucharist helps me become a better servant of God and others, and I readily admit that I need all the help I can get. I believe that how we handle ourselves on earth will echo into eternity, and the Eucharist is both our shield and protection during life and our Viaticum, food for the journey in dying. For Gian, the knowledge that this might be the last time he received the Eucharist – and it was – transformed the moment for him, transforming him beyond the sterile walls of the ICU, to a place where he felt safe, loved, and in an eternal relationship with God. It was a very humbling experience for me to do that, [one] I never take for granted, whether it’s me being able to witness my atheist patient’s end of life plans…or getting something as explicit as providing the Eucharist to a patient. All of these experiences, I think, are gifts that allow me to understand the fullness of healing and to be a healer.”
Dr. Ely hopes that people who read “Every Deep-Drawn Breath” find it helpful and enriching on multiple levels. He said, “I hope that the reader will…[see] each of these people in the book…and say, alongside suffering can be joy and love…That’s my first and foremost hope. The second hope is that people will feel empowered to be the voices in their own narrative and that they won’t be silenced. There’s a lot of social justice in ‘Every Deep Drawn Breath.’ There’s stories about how we used to segregate blood for blacks and whites. There’s stories about how the first lung transplant was done on a prisoner, and that Medgar Evers died feet away from that first lung transplant patient…So all of these things are in the book and we’re all part of that story. So I hope the reader can see that all of us have to dive into this mission of humanism. Humanism is the way forward, regardless of our spirituality. It is not about religion, it’s about being part of the human race and we can do this if we will draw on the right sort of tools, which I hope that they will find inside the pages of ‘Every Deep Drawn Breath.'”
To bring things full circle, Dr. Ely also reflected on the ways he lights a metaphorical candle when he endures times of darkness in his life. He concluded, “There’s been a lot of heartache in my family and…with my patients, when I hope that one of them will survive and they don’t. When I hit those moments of darkness, I try to remind myself that my job is to take what comes and find the beauty and the love alongside that sadness and heartache. And to say to myself, I’m here to praise, reverence, and serve God. I was never promised an absence of suffering. All I was promised was that I would be accompanied by my heavenly Father…I have a motto that I keep in the forefront of my mind: V = v. I got this from Maximilian Kolbe. He used to teach the seminarians that the capital V, Voluntas, God’s will, must become my little v, voluntas . In other words, my will is subordinate to the will of God in my life…That’s the way I go forward.”
(To listen to my full interview with Dr. Wes Ely, click on the podcast links):