A Physician Reflects on Faith, Science, and Working in the COVID ICU
Physician John Trinder shares with us his journey into medicine and some of the challenges he faced and moments of hope working in the ICU during the COVID pandemic.
Dr. John Trinder is a critical care physician who worked in a hospital ICU in Ireland during the COVID pandemic. He shares with us about his journey into medicine and some of the challenges he faced and moments of hope amidst the recent pandemic.
Can you tell us a little bit about your Christian testimony and journey into medicine?
I was raised in a Christian household in the evangelical Anglican tradition. I came to Christ around the age of 7 and ratified my commitment as an adult by public profession of faith. My spiritual life and faith have developed over the years through prayer and Bible study, and in fellowship with other Christians, especially within a community of faith.
From a young age I was taught a healthy respect for science, and for learning in general. At school I had a driving sense of curiosity and particularly enjoyed the sciences. This culminated in a desire to study Medicine by age 16. There was, of course, a desire personally to make a difference for patients who are sick.
Did you ever experience conflict between your faith and the science you were studying? How did you find peace?
Not much, I have to confess, and certainly none due to my upbringing or the church I grew up in. I was raised to trust the scientific method and encouraged to pursue scientific knowledge, so I never believed in a young earth, given the multiple different scientific methodologies demonstrating an ancient universe and very old earth. I saw early Genesis as having nothing to say on the age of the earth. Even at a young age it seemed a no-brainer to me that the “days” of creation needn’t be 24 hour days, especially when 2 Peter affirms that to God a thousand years is as a single day.
At school around the age of 14 or 15 years old I did have a somewhat embarrassing experience of being awarded a prize in Religious Education. This was for an essay I wrote on the topic of “If you have to choose between belief in the Bible or science, which would you pick?” I was later told that the reason I won the (very uncool at the time) prize was because every other pupil chose one or the other, and I argued that there was no conflict and no need to choose.
I think in this life doubt is the natural dance partner of faith. If we have certainty, it doesn’t seem to leave much room for faith (or for humility!). I find it intriguing that the more we learn about the universe, and of the Bible, it seems we find more layers of the onion to peel.
As a young teenager I had read and been influenced by Walter J Beasley’s book “Creation’s Amazing Architect,” and I quoted quite a few of the arguments presented in that book. In later years I came to recognize this book as seriously flawed, being heavily concordist and possibly rather Deistic. Nevertheless, it was a key reason why at the age of 14 I saw no conflict between faith and science, and in fact a harmony between the two. By the time I left school, I had already embraced evolution as the means by which God created humankind. In both churches where I have been an active member, that has not been a problem.
When I started undergraduate study in medicine, one of the first things I did was join the university Christian Union (CU). At one of the undergraduate medical lectures, our Biochemistry lecturer asked us to raise our hands if we didn’t “believe in” evolution. (It turned out that he had a bit of a bee in his bonnet about Christians) I was horrified to see the vast majority of my Christian friends from the CU raise their hands in response to his prompt. I began to realize that other Christians had different views than I had. Nonetheless, a scientific career trains one to be skeptical, so naturally I have had doubts along the way on the validity of my faith.
Where possible, science encourages simple solutions over unnecessarily complex ones. So it is reasonable to ask in a modern world where much is understood mechanistically whether there is anything beyond the material. Ultimately at various times I have been very conscious of God at work in my life, and in the lives of those around me. As has been said before by others, I think in this life doubt is the natural dance partner of faith. If we have certainty, it doesn’t seem to leave much room for faith (or for humility!). I find it intriguing that the more we learn about the universe, and of the Bible, it seems we find more layers of the onion to peel. While there is evidence for faith in Christ, despite learning more, we don’t seem to get closer to proving objectively either the Theist’s or the Atheist’s position. I find that quite compelling, and I don’t think it’s accidental.
Similarly, I think if we’re prepared to wrestle with Scripture, rather than dismiss it on a superficial or lazy reading, it keeps stepping up to the mark and delivering a remarkable coherence across 66 books compiled over a protracted period in the ancient world.
You’ve followed BioLogos for a while now and have shared it as a resource over the years with others. What in particular drew you to BioLogos? What about us is worth sharing with others?
I really enjoyed reading “The Language of God” by Francis Collins when it was first published. It further solidified my understanding of Christian thinking and evolution. It was also written in an accessible way for non-scientists, so I’ve found myself readily recommending it to others who were struggling with evolution from a faith perspective.
Since BioLogos was founded, it has produced many high quality and helpful resources. I think they can be of use to Christians and non-Christians, helping challenge or dispel misconceptions, assumptions, and rash judgments on the interaction between science and faith. I do think those who have not studied the sciences can find the area intimidating, and sometimes hostile. But BioLogos has made an enormous contribution in pushing back against fear of the unfamiliar for such people, provided they are prepared to engage. Others who have already embraced scientific understanding will find much to enrich their insights further.
You’ve worked as a Physician in the critical care unit during the COVID pandemic. What has that been like?
Hugely challenging. Nothing in my 35 year medical career has come close to the difficulties it has presented, but I am privileged to work in a well equipped and staffed university hospital. I can’t imagine what it must have been like for those in less well equipped and staffed healthcare systems elsewhere in the world. At the start, a key problem was trying to predict the scale of what was going to happen, and prepare for a range of scenarios. I had been involved some years earlier in national planning for the then expected flu pandemic. However in the end, that didn’t come close to the scale of the demand that we experienced with COVID-19.
For the first time we were having to anticipate a scenario in which the national ICU capacity would be severely overwhelmed. Intensivists are accustomed to stressful situations and tend not to panic or be alarmist. Respected intensivist colleagues in Italy were using terminology like “a tsunami of cases.” Despite trying to source extra ventilators internationally, we knew that equipment isn’t of much value if you don’t have the trained staff to look after patients attached to life support devices. It is part of our usual job to recognize when some patients are not responding to therapy and cease aggressive attempts to prolong life. This is because in such circumstances we can add to the burden of suffering by continuing life-supportive treatments which only serve to prolong a patient’s death, and in ways which can be injurious to dying patients. However, we are normally resourced to deliver intensive therapy to every patient who stands a reasonable prospect of benefiting, until the point where it is clear that he or she is no longer benefiting.
In the early days of COVID-19, we were looking at the very real possibility that, despite sourcing extra equipment, redeploying relatively untrained staff into ICUs to support the trained staff, and compromising nurse:patient ratios beyond safe levels, we would not be able to admit everyone to the ICU who might benefit and that many would die as a result. A further, even less palatable, possibility was where we may have to terminate life support in some patients earlier than we normally would, with their resultant death, in order to give new patients with a perceived better chance of survival, the support they needed. This is a practice known as reverse triage, but clinicians feel extremely uncomfortable about it. Obviously, it raises lots of ethical issues, and there are controversies around who should make these decisions, treating doctors or non-treating administrators. I’m glad to say in our region that we didn’t ever get to the point where that was something we had to do.
Another very real issue was the risk to us as healthcare personnel. There were reports of doctors, nurses and first responders dying after contracting COVID-19 from patients they were caring for. Since it is primarily a respiratory disease, many of us in disciplines working on, or in close proximity to patients’ airways were going to work every day wondering if we’d die from exposure to the high viral load we were likely being exposed to. Some did. There wasn’t always a reliable supply of personal protective equipment in the first wave and, when available, it made almost every task in critical care more difficult.
Since (COVID) is primarily a respiratory disease, many of us in disciplines working on, or in close proximity to patients’ airways were going to work every day wondering if we’d die from exposure to the high viral load we were likely being exposed to.
There was also the risk of patients in the hospital with other conditions becoming cross-infected from those harboring the virus, despite the infection control measures in place. The necessary infection control measures, together with the need to redeploy staff from other areas meant that investigations and treatments for other things had to be delayed.
What about the misinformation that was circulating during the pandemic? How did that impact your job as a Physician?
The difficult situation in the hospital was made much worse by what was going on outside, with all the misinformation that was being circulated, especially on social media. False allegations that doctors were part of a major conspiracy, were being paid to falsify diagnoses on death certificates, and were spreading lies, were particularly hard to take when you knew the truth. Staff were putting their own lives at risk for the benefit of others. We desperately wanted to stem the tide of patients presenting to the hospital with severe disease, but it was so disheartening to hear people challenge world authorities like the CDC, Dr. Fauci, and the WHO, who were doing their best to collect and analyze available data and develop public health guidance.
In my discipline, we are used to patients and relatives sometimes having unrealistic expectations of what can be achieved with critical care. It was disturbing to see many in wider society have unrealistic expectations of what could be said scientifically with confidence. Many seemed to expect scientists to have robust facts from the outset when science requires a period of data collection and examination of evidence. And so we had the denigration of the efforts of Dr. Fauci and the CDC over advice on the efficacy of masks. Many folks don’t appreciate that sometimes the answer changes depending on how the question is being asked (e.g., whether masks protect the wearer individually, or others collectively).
It was so disheartening to see scientific recommendations obstructed by party political affiliations, and fringe views paraded as if they were legitimate alternatives to overwhelming scientific consensus. Worst of all was to witness so many who considered themselves committed evangelical Christians undermine public health messaging by indulging in ill-informed speculation and promotion of conspiracy theories. It revealed a deep distrust of science generally in evangelical circles, a distrust whose origins may be traceable back to unnecessary conflict over evolution and biblical interpretation.
However, this wasn’t merely an intellectual/theological debate, countless lives were at stake. Of course there was more than this involved. Many Christians argued for their individual and collective “rights”, arguably at the expense of others more vulnerable. Much seemed to be related to distrust of governmental authority. All of that made treating critically ill patients more difficult as you couldn’t help feeling that some people in society simply didn’t care that they were sending more patients for you to deal with than you might be able to cope with, and that many could die as a result of their actions.
I wouldn’t say that my faith felt challenged in the sense that it wavered (during the pandemic). If anything, my sense of dependence on God was more heightened.
There was also the bizarre contradiction among those who wouldn’t accept the medical science to keep them out of hospital (e.g., vaccination), but once in the hospital demanded that you throw everything at them that medical science has to offer (and some things it didn’t). And, among those who didn’t survive, we had families demanding that we falsify death certificates by not including COVID-19, when that was the condition we had been treating and from which the patient had sadly died.
Were you able to do anything to combat misinformation yourself?
When not at work, I put quite a bit of effort into countering misinformation on social media. I used real data on ICU capacity and overload to explain why the situation was dire and required public health measures that were unprecedented in living memory. Overall, these posts seemed to be well received, but unsurprisingly I was attacked by anti-vaxxers and those claiming I wasn’t being truthful. One asserted “There’s a special place in hell for people like you.” I admit I found that difficult to process for a while.
I’m privileged to work in a great multidisciplinary team. One of the challenges has been sustaining that team through both the stresses of the pandemic, staff illness, and depleted numbers due to infected staff having to isolate. Some staff simply haven’t been able to take the strain, and some talented and highly skilled members of the team will never practice again. That too has been hard to watch.
Were there moments your faith felt challenged?
I wouldn’t say that my faith felt challenged in the sense that it wavered. If anything, my sense of dependence on God was more heightened. In the developed world, society has gotten rather used to medicine and technology being its “savior.” When the pandemic first hit, I think it rocked that confidence. I was certainly drawn to pray much more vigorously and earnestly than I had before. There were also reports that many in society who didn’t normally do so turned to prayer.
Were there moments of hope?
I can think of several. This disease proved to be quite difficult to predict in terms of the clinical course it would take in individual patients. We were having to admit many patients to the ICU who wouldn’t normally end up there with viral pneumonia. Sometimes it was younger patients who died, or those with little or no underlying disease. Often it was older patients, but we had surprises on both sides.
There is little to match the feeling when patients who looked almost certain to die, whose lungs were literally falling apart, leaking air and requiring multiple drains, who developed clots in their lungs, and who you could barely get enough oxygen into on a ventilator, start to improve after several weeks.
Many of us prayed hard early for the development of a successful vaccine…I think God answered that prayer with not one but a whole array of effective vaccines.
A relatively young and previously healthy patient came back to visit us in the ICU recently to say thanks. At several stages during his lengthy ICU stay he looked almost certain to die. Yesterday he walked out of hospital after 120 days. His wife gave me a huge spontaneous hug, temporarily breaching infection control guidance, but that’s hard to prevent! Experiences like this help give me hope for future patients.
There has been amazing progress in a short time with research identifying therapies that improve outcomes in COVID-19 and, equally important, ones that do not. The degree of collaboration across institutions and the speed with which it occurred to achieve this progress has been magnificent, while ongoing.
Many of us prayed hard early for the development of a successful vaccine. Without taking away credit from the talent and hard work involved in doing so, I think God answered that prayer with not one but a whole array of effective vaccines. The vaccines aren’t perfect, and will likely be superseded by better ones, but they have saved countless lives. As Christians, we must always choose hope. But we mustn’t misplace our hope — it should be hope in the God who provides. Remarkably, he invites us to help partner with him in his plan to make the world a better place, and equips us to do so. That’s an abundant reason for hope.
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