I have a friend whose brother is a cardiac surgeon. At one point he was telling his brother about the patients who end up on his operating table. Most are overweight or elderly, he explained. But every once in awhile he finds himself operating on a different kind of patient.

"I'll get a young guy in," he said. "Maybe in his 30s or early 40s who looks perfectly healthy: trim, muscular—but he needs a quadruple bypass."

It was an ominous reminder that heart disease advances silently, invisibly. Often the first symptom is a heart attack. That means that even young, thin people can look vibrant and healthy yet be perilously close to death. In such cases, appearances deceive. Outwardly, everything looks fine. Inwardly, they're in trouble.

The same thing happens spiritually. And I'm convinced leaders are particularly susceptible. We preach, teach, and counsel. We pray in public. Outwardly, we look great. But inwardly, we might be in trouble.

Each time a leader falls there's a chorus of shocked ...