With an emphatic indeed, Paul goes on to bear witness to the severe nature of the illness and then to the wideness of God's mercy—both to Epaphroditus and to himself. We have no way of knowing the nature of the illness; what Paul underscores is how serious it was, enough to bring Epaphroditus to death's door. The repetition of this motif in verse 30 further indicates its great seriousness.
But the other side of reality, which the Philippians would now be experiencing with Epaphroditus's arrival, is that God had mercy on him—a clause probably read much too nonchalantly by those of us who have the benefits of modern medical science. How God had mercy on him we do not know (perhaps by "gift of healing"?); the phrase probably does not mean simply that in God's good mercy Epaphroditus got better, but that God had a direct hand in it. Paul's emphasis in any case rests altogether on the mercy of God evidenced by Epaphroditus's recovery, which stresses not so much generosity toward the undeserving—although that is always true as well—but the experience of mercy itself. This is indicated by the final addendum, not on him only but also on me, to spare me sorrow upon sorrow, a phrase that once again presupposes Paul's close relationship with this community. They know well his affection for them; the concluding plaintive note simply underscores it.
But what is the first level of sorrow on which additional sorrow would have been piled? Probably it alludes to the recurring motif of suffering, of Paul's continually being poured out as a drink offering (v. 17), especially in his present imprisonment. This little phrase should also be kept in mind when in this letter we repeatedly hear Paul speak of rejoicing. Joy does not mean the absence of sorrow but the capacity to rejoice in the midst of it. Paul's gratitude in the present case is for mercy, that he has not had sorrow of this kind—the loss of a longtime and dear brother in the Lord—added to the sorrow he already knows.
As usual, therefore, Paul can hardly speak without reflecting on everything from a theological perspective. The God he serves is full of mercy, both in healing the sick and in sparing the heavy-laden from further sorrow. Note too that Paul simply would not understand the denial of grief that some express today when they rejoice over the death of a loved one. No, death is still an enemy—ours and God's (1 Cor 15:25-26)—and grief is the normal response; but it is sorrow expressed in the context of hope (1 Thess 4:13).
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