The psalm begins with a beatitude: blessed is the one who considers the poor, for the Lord will deliver him in the day of trouble. God will protect him, keep him alive, let him be called blessed in the land and not give him up to the will of his enemies; he will sustain him on his sickbed and restore him from his illness.
Then David prays from his own illness: Lord, be gracious to me, heal my soul, for I have sinned against you. His enemies speak evil of him and ask when he will die and his name perish. When one comes to visit, he utters empty words; his heart gathers mischief, and when he goes out he tells it. All who hate him whisper together against him and imagine the worst for him, saying that a deadly thing has fastened on him and that, now he lies down, he will not rise again.
The most painful part is the betrayal: even his close friend, in whom he trusted, who ate his bread, has lifted his heel against him. David asks the Lord to be gracious to him and raise him up, and he knows God delights in him because his enemy does not shout in triumph. In his integrity God upholds him and sets him in his presence forever. The psalm ends with praise: blessed be the Lord, the God of Israel, from everlasting to everlasting. Amen and Amen.