James is a seventy-two-year-old man with end-stage dementia who was transferred from another hospital. At the time of transfer James had sepsis from two multidrug-resistant organisms, respiratory failure requiring ventilatory support, renal insufficiency, pancytopenia, and hypotension requiring vasopressors. He has severe contractures and foot drop, has a feeding tube, and has been nonverbal for several months. His son, Paul, is requesting full code and treatment focused on recovery despite James’s extremely poor prognosis.Paul is James’s only child, and James’s wife is deceased. Paul says he has the “gift of prophecy” and knows for certain when God is speaking to him. “God,” he says, “doesn’t lie.” He says that he and his father spent years preaching together and have witnessed many healings. He believes that they are being “rebuked” because at a time when his father was too tired to travel much, they held fewer revivals and did not save enough souls.

James’s condition has worsened slowly. He has almost no urine output and does not breathe over the ventilator. He is extremely volume overloaded; his toenails have bloodied and popped off. By hospital-day twenty-one, he had only corneal reflexes. The medical team is troubled; if James is to stay on the ventilator, he will need a tracheostomy, but this would only further prolong what has already been an agonizingly prolonged dying process.

Paul continues to pray for his father to get up.