Kirk was right.  An update was required.  A long but funny tale…

Our team flew from Baghdad to Sulaymaniyah, Kurdistan, Iraq on Sunday afternoon.  I said goodbye to them there and flew on to Erbil, Kurdistan, Iraq.  I landed about 7 p.m.  My flight to Istanbul was not scheduled to leave until 4 a.m. and I could not check in until midnight.  Silly optimistic traveler that I am, I did not bring an electric converter to charge my phone and computer, and I did not have any Iraqi dinars (sent all that on with Kirk since he was staying and I was going), nor did I know the PIN to get cash from my credit card (since the ATM refused to give me cash on my bank card—tried that!).  As an anesthesiologist, I always hope for the best and plan for the worst and try to teach that mantra and philosophy.  I realize now maybe I should employ that philosophy as I travel!  Anyway, I was unconcerned. I had had food on the plane to Sulay.  I had been eating well all week.  There would be lots of food on the way home.  I was headed to airports with lounges and chargers.  It was actually nice to be “unplugged” in a largely empty but nice airport.  I had gotten behind on my yearly Bible reading schedule, so I had the whole book of Job to read.  Amazingly perfect timing of God, I realize as I reflect on the last 24 hours.  I had had an incredible week.  Not at all to the same degree, but like Job I went from the heights to the depths.  My last 24 hours was discouraging enough in the midst of it to never want to travel internationally again, especially to the Middle East (I actually did entertain that exact thought, at least once or more!).  A funny aside is that we watched the Bollywood movie “Three Idiots” (highly recommend it!) one night together as a team and there’s a cute little ditty and dance number in it called “All is Well.”  The trip to the Baghdad airport and the almost 4-hour check-in process caused us to coin the term “Fret Level:   High!”  but allowed us to keep repeating our new favorite phase “All is Well.”  Kirk texted that to me at one point during my adventure!

Job gives us insight into spiritual warfare, which I absolutely believe in.  Satan gets permission to torment Job.  Job suffers, not because he deserves it, but because God allows it.  It is one of the hardest to understand books in the Bible, but so good if you can let its lessons sink in.  I’m reading the John Macarthur study Bible and I love his extra teaching and insights.  This is his description of the Background and Setting of Job:  “The book begins with a scene in heaven that explains everything to the reader (1:6-2:10).  Job was suffering because God was contesting with Satan.  Job never knew that, nor did any of his friends, so the struggled to explain suffering from the perspective of their ignorance, until finally Job rested in nothing but faith in God’s goodness and the hope of His redemption.  That God vindicated his trust is the culminating message of the book.  When there are no rational or, even, theological explanations for disaster and pain, trust God.”  Job contains some of my favorite Bible verses:  “Though He slay me, I will hope in Him (13:15).”  I pray for such faith!  “As for me, I know that my Redeemer lives, and at the last He will take His stand on the earth.  Even after my skin is destroyed, yet from my flesh I shall see God; whom I myself shall behold, and whom my eyes will see and not another” (19:25-27).  Though He subject me to 24 hours of painful international travel, I will not dismay!  Ok, I’ll dismay, but I’ll realize as I recount it to Kirk and my mom how He saw me through it at every step…

It was clear when I landed Erbil in the evening. I was the happy optimistic traveler with time on her hands!  No need to sleep!  That’s what the long trip home on the plane is for!  Checked in at midnight, went through security, and found a comfortable chair in a café that took my last remaining American dollars for coffee, water, and some potato chips.  Watched most of the movie “Temple Grandin” (another highly recommended one—both movies mentioned in this update fabulous recommendations of Jeff and Allison Cabalka!)…until my computer battery died.  Noticed my phone was almost dead too.  Tried to get PIN from Kirk in case of need for money but he was already asleep and didn’t want to bug him.  I was unconcerned.  Headed West, remember?

Went to the gate and was so excited for the opportunity to fall asleep in my window seat when they announced the flight was delayed.  Uh oh!  Did some uncomfortable falling asleep in my seat until 5 a.m. when they said the plane should be landing at 5:30 a.m.  Submitted to sleep on the floor like most of my fellow passengers at that point and woke up around 6:30 a.m.  Problem noted!  Dust everywhere.  No visibility.  Ah, institute Plan B!  Quick call to Kirk with dying phone to get PIN.  He calls bank while I go to Duty Free to look for charger.  Duty Free guy suggests I beg Café lady for charger.  She has none, but she’ll let me plug into her Western power strip.  Enough juice on phone to receive PIN from Kirk.  Trip to ATM to get admission fee for lounge to continue search for charging options.  Lounge guy lets me in for free.  Nice Business Guy #1 sees me looking to charge, says I got no options, but, hey, use my portable charger!  Nice Business Guy #2 gives me the code for the Wi-fi.  I really like Nice Business Guy #2.  He’s in this story a lot…until I had to say goodbye to him.  Nice Business Guy #1’s portable charger is now dead too (thanks, American woman!) so I head back to nice Café lady.  I plug right in by her cash register and order juice and coffee with the lounge admission money I didn’t need.  Everything is almost fully charged when Nice Turkish Airlines Guy Who Speaks English comes to tell me flight is cancelled.  I like this guy too and wish he were in the story more also!  I am providentially positioned by my charging needs closest to the Turkish Airlines counter where he directs me ahead of the crushing crowd.

I am joined in the crushing crowd by Nice Business Guy #2 who enlists the help of Nice Business Guy #3 to help me fight crushing largely male Middle Eastern crowd who are not that interested in lines or personal space.  Meet Nice Arab Iraqi Man Who Speaks English and His Wife who also helps me.  Turkish Airline (not so much English spoken here) plan is give them a cell phone number to call you on when they have a flight plan, go get your luggage, and go get on a bus to unnamed hotel.  I retreat to a quiet area to call United Airlines for different options.  Option #1 is a $5000 change to my itinerary leaving at 4 p.m.  Seems like an expensive option to me, especially with the air still thick with dust and me having no confidence any flights are flying today.  I resign myself to Turkish Airline plan.  I just want a shower and a nap!  Have I mentioned yet that in Baghdad we women needed to be much more “covered” (or “encapsulated” in some translations) than we actually need to be in Kurdistan?  I started this journey almost 24 hours prior.  There had been a lot of sweating.  I have on my best transition from covered to less covered outfit, but it’s still more clothes than I would like (can I tell you how much sympathy I have for those women with no options in this area!!!!) and my pants happen to be white.  See silly optimistic traveler comment above.  Have I also mentioned that since Kirk was staying and I was going that I had the extra bulky luggage?

I retrieve said luggage and find Nice Business Guy #2 outside.  Alas, his company is transporting him to a nice hotel.  He directs me to the Turkish Airlines bus and I notice Nice Arab Iraqi Man Who Speaks English and His Wife.  We are pretty much now in no English zone so I figure I’ll just follow people I recognize!  This is a secure staging bus, so we are transported outside the airport and dropped on a curb.  No other bus in sight.  Spot Nice Turkish Airlines Guy Who Speaks English (alas, for the last time!) and he asks “what are you doing here?!”  Good question!  He directs us back about a block or two to another bus.  Remember clothes, luggage, sand, heat?  We arrive at said bus.  Underneath luggage space is full.  Funny Iraqi guy says “I’ll help you.  This is Iraq, not Canada Air.”  One of the funniest lines of the day.  We pile on the bus, drive to who knows where, and get out at a not so lovely hotel.  There is no English signage, no Turkish Airlines representatives, and, once again, not a lot of English spoken.  They escort me to a room with Nice Arab Iraqi Man Who Speaks English and His Wife.  When I shake my head, they say “just for wait.”  Nothing to do but make conversation and I learn Nice Arab Iraqi Man Who Speaks English and His Wife are on their honeymoon!!!!  See, another’s situation could always be worse!  There is little on the bright side at this hotel, so I suggest to Nice Arab Iraqi Man Who Speaks English and His Wife that we go to a different hotel.  Their gift to me:  translation!  My gift to them:  a nice room on the first night of their honeymoon!  The new bride likes this idea.  Meanwhile, there have been lots of phone calls and texts between me and Kirk and Dr Hiwa in Sulay, utilizing their knowledge, help, and language translation.  They suggest some hotels.  They are too nice for Nice Arab Iraqi Man Who Speaks English and His Wife to accept so they beg me to come with them to a different “nice” hotel that they know.  I told them I didn’t want them to have to worry about me for translation all day and that I would prefer to find a hotel where English would be spoken and we said our goodbyes in the lobby.

By this point, Kirk and Hiwa have found a hotel for me and are sending a taxi driver who speaks English, so I make myself comfortable in the lobby for what turns out to be a good 90 minutes with five of my new Arab Iraqi friends who work at otherwise not so nice hotel.  One of them is actually a patron who is a petroleum engineer who speaks English.  He is very concerned for my welfare.  They all could not have been nicer.  Tried to get me numbers to Turkish Airlines.  Tried to get me a cab.  But I notice a very well dressed man sitting there patiently.  He gets escorted to a room.  He obviously has the same assessment as me and comes back shaking his head.  I notice his Kazakhstan passport and figure out he speaks Kurdish (and Turkish and Uzbek and German—failure from my German heritage!), but not English or Arabic.  Dr Hiwa speaks all three so I call him and have him tell my new friend my plan and ask if he wants to join me.  He could not have been happier.  Our five new friends put us in the cab that Kirk and Hiwa sent and we pantomime a lovely conversation all the way over to the Sheraton.  He, of course, pays for the cab and we part ways to our lovely rooms for much anticipated sleep!

I take off now yucky clothes, skip the shower, and fall dead asleep.  I wake to realizing I need to work on the next plan.  Turkish Airlines’ “we’ll call you” plan seems a little sketchy to me at this point.  The two contact cell phone numbers they had given me are turned off (they were sleeping too).  The local office was closed.  I called an international number and talked to an Indian friend who I could barely understand who told me that I was scheduled on a flight out on July 12!  I called my knight-in-shining armor husband Kirk and asked him to please call United again while I took a shower, got dressed, and went begging for a charger for the electronics that were dying again!  Praise the Lord, he got me on a flight out tomorrow through Frankfurt that requires an overnight and gets me home 48 hours late, but it gets me home and it did not cost $5000!  I’m in a clean, lovely, safe place, I ate my first meal in 24 hours, and my phone and computer are charged!  All is well!

​

We spent the week in Fallujah, Iraq.  Preemptive Love Coalition and Living Light International built the relationships and laid the groundwork for a team to be invited there and we were the team blessed to be able to answer the call.  Kirk had been here to screen at the end of last year and was hopeful our team could return to help them open their cardiac catheterization laboratory, but it was taking a while to get all the details worked out.  Meanwhile, we planned a trip to Kurdistan, Iraq, to a place we had been before.  Then Kirk told us all that we were also going to Fallujah!  We have laughed this week about our stories in relation to this news.  There wasn’t really a moment for each of us to decide whether we were in or out.  We had already committed to the trip.  The trip had just changed…significantly in many of our minds and in the minds of our families.  I actually wrote this email to the team:

No surprise to all you who know and love him that my husband is full of faith and pretty absent of fear.  I wish I were more like him…and maybe the rest of you who have no fears, anxieties, or qualms about our upcoming trip. Things I know and believe:  God is good.  God is sovereign.  God is in control.  If I die, I go to heaven.  There is no safer place than inside the will of God.  Our days were numbered before there was yet one of them and there is nothing we can do to change that.  We are immortal until our work on earth is done.  This trip puts all those beliefs to the test for me.  But, I believe, so I go.  I had a lovely dinner with Minnette this week.  She was telling me she has absolute peace about this trip. That encourages me.  It also encourages me the simple prospect of spending a week with you fun, lovely, easygoing, faith-filled people, no matter where we are in the world and what we are doing!  I am working my way through the John MacArthur study Bible this year (it’s fabulous, by the way) and I just finished Chronicles and Ezra and am halfway through Nehemiah.  So like God to give me a timely study!  The amount of courage required by the “good” kings of Judah, Hezekiah and Josiah, to stand against their idol-loving cultures and truly stand on and follow the Word of God to the letter is inspiring, as was the courage required of Ezra and Nehemiah to use the favor they had in Babylon to leave comfortable posts and positions there to make a dangerous trip to Judah and restore the Temple and the Wall of Jerusalem.  

Ezra 7:6:  “This Ezra went up from Babylon, and he was a scribe skilled in the law of Moses, which the Lord God of Israel had given; and the king granted him all he requested because the hand of the Lord his God was upon him.”

Ezra 7:10:  “For Ezra had set his heart to study the law of the Lord and to practice it, and to teach His statutes and ordinances in Israel.”

Ezra 8:21-23:  “Then I proclaimed a fast there at the river of Ahava [before they left Babylon], that we might humble ourselves before our God to seek from Him a safe journey for us, for our little ones, and our possessions.  For I was ashamed to request from the king troops and horsemen to protect us from the enemy on the way, because we had said to the king, ‘The hand of our God is favorably disposed to all those who seek Him, but His power and His anger are against all those who forsake him.’  So we fasted and sought our God concerning the matter, and He listened to our entreaty.”

Their stories spoke to me.  We leave comfort, privilege, position.  We need to the Lord to go before, with, above, and behind us!  Kirk knows I hate fasting, but that convicted me too!  The Old Testament is full of repetitions of the following admonition:  “Have I not commanded you?  Be strong and courageous.  Do not tremble or be dismayed, for the Lord your God is with you wherever you go” (Joshua 1:9).

I admonish myself with this fact.  The outcome is the Lord’s.  In Daniel 3:17-18 Shadrach, Meshach, and Abed-nego declare “our God whom we serve is able to deliver us from the furnace of blazing fire.”  They declared their faith that “He will deliver us out of your hand, O king.”  But they accepted “even if He does not,” they were willing to die rather than bow in worship to anyone other than their God and Lord.  I will not bow to fear.  Our Lord is able to keep us safe…but even if He does not, I will be obedient to His call.  

I kid you not, as I was typing that last line, this song by Matt Redman (You Never Let Go) came on Pandora:

Even though I walk through the valley of the shadow of death 

Your perfect love is casting out fear 

And even when I’m caught in the middle of the storms of this life 

I won’t turn back 

I know You are near

And I will fear no evil

For my God is with me 

And if my God is with me 

Whom then shall I fear? 

Whom then shall I fear?

Chorus: 

Oh no, You never let go 

Through the calm and through the storm 

Oh no, You never let go 

In every high and every low 

Oh no, You never let go 

Lord, You never let go of me 

And I can see a light that is coming for the heart that holds on 

A glorious light beyond all compare 

And there will be an end to these troubles 

But until that day comes 

We’ll live to know You here on the earth 

Chorus: 

Yes, I can see a light that is coming for the heart that holds on 

And there will be an end to these troubles 

But until that day comes 

Still I will praise You, still I will praise You

​God is good!  See you soon!

​So, I would be absolutely lying if I said I was not nervous to come on this trip.  Everyone who reads these updates knows that I spend the week really seeking the Lord for what He is trying to teach me.  And often what I think the lesson is is very different from what I thought it was going to be.  By the time I arrived, I was actually excited for the honor and opportunity to step out in faith.  In my mind, this had never been required of me to this level, where I truly thought my personal security and safely could truly be at risk.  Here comes the part where I absolutely praise our hosts:  they have gone out of their way to protect us with constant armed guards, armored vehicles, etc.  I have never felt unsafe.  I realize that all of man’s defenses are ultimately penetrable but they did everything in man’s power to keep us safe.  They have been gracious, welcoming, generous, and concerned for our every need and comfort.  I could relax.  And, strange as it might seem, this confused me.  I was actually looking forward to a week of utter reliance on the Lord.  I realized how quickly I can revert to reliance on man.  The same is true in our care for the children.  We’ve done this a lot.  We’ve gotten good at making the best of maybe less than ideal circumstances.  Once again, I can begin to rely on my skills or supplies rather than on the Lord.  So if I wasn’t exercising utter reliance on the Lord for safety or for patient outcomes, was I at least being a good witness for the Lord in whom I believe (“they will know we are Christians by our love”).  Ah, such a familiar theme in these updates.  We can laugh as a team because we’ve been doing this together so long that we know each other’s idiosyncrasies, weaknesses, and hot buttons.  I’m sure mine are quite evident to my teammates.  After we finished our five days of twelve caths and all the children did well, we were treated to a trip to the province Governon’s late in the evening.  What an amazing caravan we were part of, absolutely hard to describe.  On the way home, I was reflecting on all these things.  I was disappointed in myself for not relying on the Lord like I wanted, for not praying without ceasing like I thought I should, and for failing to let His light shine through me.  Then one of my favorite verses came to mind:

But we have this treasure in earthen vessels, so that the surpassing greatness of the power will be of God and not from ourselves (2 Corinthians 4:7).

It brought tears to my eyes.  It’s not about me.  I am so earthen and I so fail.  But the power is God’s, not mine.  Thank God!

Early in the week, a doctor from here told us that “no one comes here, not even Iraqis…but you came!”  After our clinical work was over, we went to Tikrit (in another one of those amazing caravans) to visit their cath lab.  One of the pediatric cardiologists from there had worked with us in Fallujah during the week and was excited to host us.  We were the first foreign team that had visited there.  They were grateful…and asked us not to forget them.  Sometimes the simple act of showing up simply ministers:  “Like cold water to a weary soul, so is good news from a distant land” (Proverbs 25:25).  Once again I am astounded by the freedoms I enjoy.  No one chooses the country they are born in.  I have a choice.  I have been given the gift of privilege and position.  I can choose to be courageous and go and visit and hopefully help, serve, minister, and encourage those who find themselves in completely different circumstances, not of their choosing.  And the amazing part of God’s economy is that when I obey Him, I always receive so much more than I ever gave.  “Give and it will be given to you.  They will pour into your lap a good measure, pressed down, shaken together, and running over.” (Luke 6:38).  My cup runneth over…

I am on my way back from a trip to Mongolia and wanted to share something God showed me.  When I go to countries that have very little access to pediatric heart surgery, if any at all, I frequently see patients who are either too late for surgery or their surgical repair would be so complex that trying to find a way to get the child’s heart repaired seems impossible.  I really dread these situations and wish I would never have to make a mother cry again.  When I have to have these difficult discussions with families I always try to work into our conversation God’s comfort.  But even I as I say these words, they often seem trite.  Many of these families were not raised with a concept of a loving and compassionate God and, even if they were, in the midst of their pain no words ever seem to be appropriate or helpful.

I was having such a discussion with the mother of a two-year-old who has a large hole in her heart and lacks a blood vessel from her heart to her lungs.  The two-year-old was what I affectionately call a Smurf.  She was as blue as the cartoon character and just as animated.  Her smile brightened the room and her playfulness brought joy to all who watched her.  I started explaining to the mother the problem with her daughter’s heart.  After a couple of sentences the mother’s eyes filled with tears and they slowly rolled down her face.  With each following sentence I felt as if I was pouring salt into her wounds.  I explained the defects in detail, followed by how the heart would need to be repaired and that she would need multiple surgeries.  Finally, to top it all off, I went on to say that I was not even sure where she could be repaired as most humanitarian projects would not undertake so complex a repair and the family did not have the resources to go out of the country.  As the mother cried, the cute little blue girl cocked her head to the side and stared at her mother quizzically, probably wondering why her mother was crying.  She then asked me what would happen if we did nothing.  As I thought about my response, my thoughts turned to the mother and how much horrible news she could take in such a short period. As I explained that I did not know how long her daughter would live, I also told her that her child could also die from a simple cold.

What could I possible say to this mother?  Was there any way that I could help her find comfort in God?  I absolutely believe that God comforts the afflicted but how do I transition from “your child has a complex heart defect that will require multiple surgeries that you cannot get in your country and you are too poor to go elsewhere, and she might die before she gets treated” to “God loves you and will comfort you. Go in peace.”  Saying something like that would be ridiculous.  So again, I was asking, “What could I say?  Then God whispered the answer.  My thoughts went to her heavy burden, so I started’ “Everything I have told you is a very heavy burden for you to carry.  It is so heavy that you should not carry this burden alone.”  I then went on, “When I am at the airport, I often see two people sharing the load of carrying a duffle-bag with each person holding a handle.  I believe that Jesus wants to help you carry this burden and I encourage you to let Him take one of the handles of this burden you are carrying.”  As the translator finished I watched a glimmer of hope and relief enter into the mother’s eyes and she asked how could she ask Jesus to help carry the load.  I was relieved as well as I felt God had showed me a way to provide encouragement in a very difficult and seemingly hopeless situation.  I presume I will need to use what He taught many more times in the days to come.

“He saw a large crowd, and felt compassion for them and healed their sick” Matthew 14:14.

I just spent 12 days with Kirk in Kurdistan and Kosovo. Our plan was to go to Dohuk, Kurdistan, Iraq with our friends Dr May Porisch, pediatric cardiac interventionalist, and Dr Minette Son, pediatric intensivist, to do a week’s worth of pediatric cardiac catheterization procedures. Due to the brand new administration of the Minister of Health in Dohuk, the plan for us to do caths was cancelled the week before we left. Mary and Minette elected to stay behind, waiting for another time when we can do procedures. At my husband’s request, I went, even though I like to save my precious international travel time for times also when we can do procedures. We were already planning to go from Kurdistan to Kosovo, however, to meet our other friend Dr David Bush, pediatric electrophysiologist, to change two pacemaker batteries, so my services were going to be needed at some point on the trip. The moral of the story is always the same: I’m so glad I went! I’m always amazed at how much the Lord has to teach me by going to serve His children, anywhere in the world. Dave, Kirk, and I were discussing that in Kosovo, the different feelings we have when we get on the plane. There’s always a certain amount of trepidation, especially if we are doing procedures. We so desire to take care of these children well and pediatric cardiac care is not easy in the United States, let alone Third World countries! But every trip teaches us something and renews in us the privilege of the calling to go and serve.

 The theme song of these trips could be Chris Rice’s song which asks “How did I find myself in a better place?”. How did I find myself in a better place as a doctor? Having seen health care all over the world, I know I work in the best health care system in the world (not perfect, but the best!). I see how hard these Third World doctors work with limited supplies, limited resources, limited options for their patients, and limited pay…and I am humbled. The trips are worth it if only we can provide help and encouragement to these hard-working souls. Kirk and I arrived on Saturday in Kurdistan. We spent three days in Dohuk, working with Dr Serdar to evaluate about 60 of his patients with cardiac disease, and two days in Sulaymaniyeh, working with Dr Aso to evaluate about 50 of his patients. There are currently limited surgical options in Kurdistan, and there is currently not a way in Iraq to get an adequate diagnostic cardiac catheterization. A lot of these children have time-sensitive lesions, meaning if their hearts are not repaired within a particular period of time, they will become inoperable. Many of them need a cath just to determine if they are still operable. Each child becomes a puzzle of how best to find care for them, either in Kurdistan or out of the country. Child after child, I found myself shaking my head for the child, for the parents, and for Drs Serdar and Aso, and the many doctors like them. How frustrating to have knowledge to what could and/or should be done for a child, but often to have no way to get that accomplished. It made me so glad I went, to be reminded once again, and renewed my resolve to go back. If it is within our capability to help, how can we not?
We arrived in Kosovo on Sunday. On Monday, we spent a day with Dr Ramush, evaluating some of his many children with cardiac disease…and the theme was repeated. There were a number of children, in all three locations, for whom there was nothing we could do. Their stories would have been different, had they been born in the United States. As we sat there heart-brokenly explaining we had no surgical options, my prayer is that each and every child and parent was able to feel the love and compassion of Christ through us.
On Tuesday in Kosovo, we were able to change two pacemaker batteries (I did get to be an anesthesiologist on this trip, with the very capable help of a Kosovar anesthesiologist Dr Faim). The younger girl had hers placed years ago in Switzerland after a cardiac surgery left her without her own cardiac rhythm. She was entirely dependent on it. When the pacer stops, her heart stops. Kirk had been following these children with pacemakers and knew these two in particular were near the end of the lives of their batteries. Dr Dave Bush, through the generosity of Medtronic, was able to orchestrate bringing the appropriate supplies to get this accomplished. When we examined the young girl on Monday, we learned her pacemaker battery had less than a month of life left. The Lord had orchestrated for us to come just in time! Her battery change was risky because we needed a way to pace her heart while the battery was changed. Dr Bush was able to put in a temporary intracardiac pacemaker for this process and her procedure went successfully. The older boy we took care of had congenital heart block. He had more time left on his battery and his heart had an “escape rhythm” that allowed it to beat while the battery was out. His procedure was much less stressful, but necessary all the same. His father had been killed in the war with the Serbs right in front of his eyes. It blessed us to be able to give something back to this sweet orphan. May anesthetic work done, I returned to the States, leaving Kirk and Dave behind for two more days of lectures and seeing patients.

 These trips leave me so grateful. Grateful for the life I have been given, through no merit of my own. Grateful for the Lord’s safe keeping of us over miles traveled. Grateful for the Lord’s provision of supplies and whatever else we need to accomplish the medicine we perform. Grateful for the faithful doctors, nurses, and other health care workers who continue to dedicatedly serve in very difficult conditions in these countries. Grateful for all people in all the organizations that we meet who also are trying to help and serve in the name of Jesus. It is truly a blessing to cooperate together, as the body of Christ. Grateful that He brings us the crowds of the sick, His children, so we can get a glimpse of insight into the love and compassion He feels for them. May we continue to be His hands and feet!

-Kim

We closed nine atrial septal defects with devices, ballooned three pulmonary valves, one aortic valve, three diagnostic caths for patients with large VSDs (two were operable) did two diagnostic TEEs, and two diagnostic angiograms for a 4 y/o boy with a PDA and a 26 y/o young lady with pulmonary atresia.

Wonderful week! We give praise and thanks to God for his provision and earnestly pray that He was glorified by the work of our hands.

Solis Deo Gloria

“He saw a large crowd, and felt compassion for them and healed their sick” Matthew 14:14.

I just spent 12 days with Kirk in Kurdistan and Kosovo. Our plan was to go to Dohuk, Kurdistan, Iraq with our friends Dr May Porisch, pediatric cardiac interventionalist, and Dr Minette Son, pediatric intensivist, to do a week’s worth of pediatric cardiac catheterization procedures. Due to the brand new administration of the Minister of Health in Dohuk, the plan for us to do caths was cancelled the week before we left. Mary and Minette elected to stay behind, waiting for another time when we can do procedures. At my husband’s request, I went, even though I like to save my precious international travel time for times also when we can do procedures. We were already planning to go from Kurdistan to Kosovo, however, to meet our other friend Dr David Bush, pediatric electrophysiologist, to change two pacemaker batteries, so my services were going to be needed at some point on the trip. The moral of the story is always the same: I’m so glad I went! I’m always amazed at how much the Lord has to teach me by going to serve His children, anywhere in the world. Dave, Kirk, and I were discussing that in Kosovo, the different feelings we have when we get on the plane. There’s always a certain amount of trepidation, especially if we are doing procedures. We so desire to take care of these children well and pediatric cardiac care is not easy in the United States, let alone Third World countries! But every trip teaches us something and renews in us the privilege of the calling to go and serve.
The theme song of these trips could be Chris Rice’s song which asks “How did I find myself in a better place?”. How did I find myself in a better place as a doctor? Having seen health care all over the world, I know I work in the best health care system in the world (not perfect, but the best!). I see how hard these Third World doctors work with limited supplies, limited resources, limited options for their patients, and limited pay…and I am humbled. The trips are worth it if only we can provide help and encouragement to these hard-working souls. Kirk and I arrived on Saturday in Kurdistan. We spent three days in Dohuk, working with Dr Serdar to evaluate about 60 of his patients with cardiac disease, and two days in Sulaymaniyeh, working with Dr Aso to evaluate about 50 of his patients. There are currently limited surgical options in Kurdistan, and there is currently not a way in Iraq to get an adequate diagnostic cardiac catheterization. A lot of these children have time-sensitive lesions, meaning if their hearts are not repaired within a particular period of time, they will become inoperable. Many of them need a cath just to determine if they are still operable. Each child becomes a puzzle of how best to find care for them, either in Kurdistan or out of the country. Child after child, I found myself shaking my head for the child, for the parents, and for Drs Serdar and Aso, and the many doctors like them. How frustrating to have knowledge to what could and/or should be done for a child, but often to have no way to get that accomplished. It made me so glad I went, to be reminded once again, and renewed my resolve to go back. If it is within our capability to help, how can we not?
We arrived in Kosovo on Sunday. On Monday, we spent a day with Dr Ramush, evaluating some of his many children with cardiac disease…and the theme was repeated. There were a number of children, in all three locations, for whom there was nothing we could do. Their stories would have been different, had they been born in the United States. As we sat there heart-brokenly explaining we had no surgical options, my prayer is that each and every child and parent was able to feel the love and compassion of Christ through us.
On Tuesday in Kosovo, we were able to change two pacemaker batteries (I did get to be an anesthesiologist on this trip, with the very capable help of a Kosovar anesthesiologist Dr Faim). The younger girl had hers placed years ago in Switzerland after a cardiac surgery left her without her own cardiac rhythm. She was entirely dependent on it. When the pacer stops, her heart stops. Kirk had been following these children with pacemakers and knew these two in particular were near the end of the lives of their batteries. Dr Dave Bush, through the generosity of Medtronic, was able to orchestrate bringing the appropriate supplies to get this accomplished. When we examined the young girl on Monday, we learned her pacemaker battery had less than a month of life left. The Lord had orchestrated for us to come just in time! Her battery change was risky because we needed a way to pace her heart while the battery was changed. Dr Bush was able to put in a temporary intracardiac pacemaker for this process and her procedure went successfully. The older boy we took care of had congenital heart block. He had more time left on his battery and his heart had an “escape rhythm” that allowed it to beat while the battery was out. His procedure was much less stressful, but necessary all the same. His father had been killed in the war with the Serbs right in front of his eyes. It blessed us to be able to give something back to this sweet orphan. May anesthetic work done, I returned to the States, leaving Kirk and Dave behind for two more days of lectures and seeing patients.
These trips leave me so grateful. Grateful for the life I have been given, through no merit of my own. Grateful for the Lord’s safe keeping of us over miles traveled. Grateful for the Lord’s provision of supplies and whatever else we need to accomplish the medicine we perform. Grateful for the faithful doctors, nurses, and other health care workers who continue to dedicatedly serve in very difficult conditions in these countries. Grateful for all people in all the organizations that we meet who also are trying to help and serve in the name of Jesus. It is truly a blessing to cooperate together, as the body of Christ. Grateful that He brings us the crowds of the sick, His children, so we can get a glimpse of insight into the love and compassion He feels for them. May we continue to be His hands and feet!

Grace.  Unmerited favor.  Kirk and I are on the plane home from Mongolia.  During our annual Searching for the Broken Hearts week, Kirk and a team of about 22 Americans and 16 Mongolians screened 2,184 children for congenital heart disease in the southwest portion of the Gobi desert near the China border and they found around 50 children with cardiac defects.  During the subsequent Mending the Broken Hearts week, our team of about 30 Americans worked with a Mongolian medical staff to perform 10 open heart surgeries and 19 heart catheterizations.  The Mending week is an utterly exhausting week.  It’s easily the most exhausting of my year.  I always mentally process during our mission trips what the Lord is teaching me and what I want to share in these updates.  I confess this year I had no such mental energy.  Six of us left Mongolia at 10 p.m. on Saturday night and flew to Beijing, where we had a 12-hour layover.  Kirk smartly made a hotel reservation for us.  We stayed in a beautiful hotel, where we got a good night’s sleep, a wonderful shower, and a good breakfast.  It was when I was closing up my suitcase that I remarked to Kirk “I haven’t even thought about my update!” which I usually write on the plane home.  I told him “God is going to have to tell me what to say (He usually does!) because right now I have no idea other than statistics and chronology!”  It was when we were standing in line to board the plane and we got the call for a free upgrade to business class that it hit me like a ton of bricks.  Grace.  Unmerited favor.

I struggle to rejoice in our good fortune because members of our team didn’t have such good fortune.  People’s flights got delayed and canceled.  They got stuck in Mongolia, Korea, and China.  Some wanted upgrades and didn’t get them.  Some wanted to sit together and couldn’t.  What a lesson for life.  Why me?  No life is perfect and into each a little rain must fall, but my life blows me away.  I did nothing to deserve being born in the U.S. to the wonderful, loving, stable, supportive family I was born into; nothing to deserve the amazing educational opportunities available to me; nothing to deserve the phenomenal man I am married to; and nothing to deserve the front row seat of God at work.

Kirk started going to Mongolia in 2000.  He started the Searching weeks in 2003.  We’ve been doing Mending weeks since 2005.  I have seen more miracles on my trips to Mongolia than I can even recount.  The first was in 2005 when our container of medical supplies did not arrive and we did a week of surgeries (including the first pediatric heart surgery ever done in that country with cardiac bypass) with whatever they had in Mongolia (which was not a lot back then) and what we brought in our suitcases.  There’s a story in the Bible (in 1 Kings 17) about the widow’s oil that she uses to make bread never runs out during a drought…until it is no longer needed when the drought is over.  That week the supplies were just like the widow’s oil.  We would find things we didn’t know we had…and when the last case was done, they were gone.  This year, circumstances changed in our supply line.  But, for better or worse, I lived through that week in 2005.  It’s good in that I know we can do a lot with a little.  It’s bad in that sometimes I wonder if I plan well enough for what we’ll need.  But we left a room full of supplies last year.  That room is usually full of what we left behind when we walk in on Saturday to unpack our container of supplies that Samaritan’s Purse ships for us.  This year, that room was the emptiest I had seen it since 2005.  Things I had planned in my mind to be there were not.  I must admit I panicked…and started praying!  As we unpacked, things just started showing up.  We have a lot of wonderful friends who gather supplies and donate things to us.  Those boxes were full of supply gold!  You know who you are and we thank you!!!  The week just went that way.  Every supply, equipment, or medicine hole that I thought was there was filled…and sometimes just at the very moment that we needed it.  I told the team on the last day that one of my favorite verses in the Bible is Mark 9:24 “I do believe.  Help my unbelief.”  I don’t know how many miracles I need to witness before I stop doubting.

We went to church on Sunday as usual.  Boggi’s mom was there, as usual.  I’ve written before that her daughter died under our care in 2007 (one of two we’ve lost in over 100 international surgeries, Undermaa in 2006 and Boggi in 2007).  Our team’s most fervent prayer every year is not to have to go through that again.  God was again gracious this year.  Boggi’s mom moves us to tears and wonder every single year as she tells us September is her favorite month because she knows children will be helped and she prays for us with a fervor I cannot describe but that makes me cry every time.  The church we go to was planted by our dear friends Dr. Rita Browning, a pediatrician, and Margie Stone, an occupational therapist, who are long time missionaries to Mongolia.  The church has an orphanage.  This year we had the privilege to perform surgery on one of their orphans, Ganbayar.  The Lord makes it clear in the Bible with verse after verse, like “pure and undefiled religion in the sight of our God and Father is this:  to visit orphans and widows in their distress” (James 1:27), that He absolutely reveres orphans.  As such, probably the softest part in my husband’s heart is for the orphan.  These sweet orphans on Sunday prayed for us and danced for us and recited verses for us.  What an honor to be so honored by God’s treasured orphans.  What a gift to all of us, but especially to Kirk.

After church, we had a luncheon for the patients and their families, a tradition that Kirk began in 2006 and that has been graciously supported by Samaritan’s Purse Children’s Heart Project for the last few years.  There were three young men there (Uugnaa, Otga, and Choijko), all of whom came to San Antonio with Children’s Heart Project for their heart surgeries, performed by our surgeon Dr. John Kupferschmid.  They traveled with Kirk and the team on the Searching trip and enthusiastically shared the Gospel with the children and their families.  At the luncheon, they shared their stories of their surgeries and their coming to faith in Christ.  At the end of the luncheon when the children and families were prayed for, I was sitting at a table with these three young men and one of them was absolutely overcome, sobbing.  I realized how absolutely personal it was for him and how he could pray in a way I never could for the healing of these children’s hearts and souls.

We did ten surgeries this week, two a day over five days.  Only one of them was “easy.”  It is heart surgery in Mongolia, so no surgery is ever “easy,” but only one went perfectly smoothly from beginning to end.  Our desire is to teach and work ourselves out of a job in Mongolia, so we have increased the complexity of the cases year after year.  This year, we did some hard cases.  And the hours were long.  There were complications and delays that added up and added up and we never got the second patient to the ICU before 9 p.m. all week.  That is unusual.  And exhausting.  For everyone.  We always have a team chaplain with us.  This year, Lloyd Folsom joined us and had some big shoes that are impossible to fill from our former beloved chaplain (who continued to pray for us all by name all week, even though he couldn’t be with us).  Lloyd created his own big shoes right alongside the former ones:  different, but equally good.  His devotional on Thursday morning was about the story in Luke 8 where Jesus tells the disciples to get into a boat to go to the “other side” of the Sea of Galilee.  During the trip, a storm comes up and the boat is nearly sinking before they call on the Lord for help.  He talked about our tendency to focus on the goal (the “other side” or, for us, the end of the week) and to wait to call on the Lord, even though He is right there with us, until we are nearly perishing.  The easiest case was on Thursday morning (I kept saying longingly after that, during every difficulty, “remember that first case on Thursday morning?!”).  One of the hardest was on Wednesday afternoon. Eegii really could have died…and he didn’t.  He really could have had a bad neurological outcome…and he didn’t.  Praise God!  He showed up with another miracle and was gracious to answer our most fervent prayer.  I realized after Lloyd’s devotional that that is what had happened.  It is so soothing when things are going badly in the operating room to lock eyes with my team members and know they are praying.  And to know that word is spreading to the rest of the team not in the O.R. and they are praying.  We cried “Lord, we are perishing!” and He was mighty to save.

The sweet orphan Ganbayar’s surgery was supposed to be Friday and we moved it to Tuesday.  He had the most post-operative complications.  Another miracle.  The Lord knew we needed to take care of him on Tuesday so we would be there to take care of him through these complications.  He was so miserable a lot of the time.  On Thursday, two people came into the O.R. to tell me, with tears in their eyes, that Boggi’s mom was sitting with him, in the same bed her daughter died in, all day long comforting him.  Words fail.  Another single mom helped us this week too, as one of our drivers (her profession).  We took care of her only child, her daughter, in 2008.  She died suddenly this past year likely of an abnormal heart rhythm.  She shared with Kirk that she remembered and appreciated the love and care of our team and she also was willing to re-enter a scene that I’m positive brings her sadness in order to serve us because we had served her.  We pray that all those around us would see Christ in us.  These two moms are some of the amazing proof that, miraculously and inconceivably, people do.

Kirk was trying to encourage the church members on Sunday that we had the same goal as them, to share the Gospel and the love of Christ, but that we just have a unique way of doing it, through pediatric heart care.  It’s the perfect metaphor for the Gospel.  We have a heart broken by sin and we need a free gift, the sacrifice of Jesus Christ, to heal it.  These children have physically broken hearts and they need the gift of our heart care to heal it.  The only step required is to accept the free gift.  We have had children whose families, for whatever reason, have refused the gift…and the children have died.  Our purpose is not only to fix physical hearts but to heal broken souls.  “For what will it profit a man if he gains the whole world and forfeits his soul (Matthew 16:26) ?”  If we heal physical hearts but these children and their families are lost for eternity, we’ve done nothing except make ourselves feel better.  On Saturday, I helped Kirk and Dr. Mary Porisch, our dear and dedicated pediatric cardiologist friend, screen about 25 children.  Many were children who have been taken care of by us in the past coming for follow-up checks (one family traveled for over a day for their quick time with us!).  The number of crosses I saw around necks for a country that is only 3% Christian was amazing to me.  More miracles.

I said at the outset I did nothing to deserve this front row seat on miracles.  The only thing I did was accept the free gift.  As Lloyd pointed out this week “I am not the person I should be, but by God’s grace I’m definitely not the person I was.”  And when Kirk and I were at a hospital in Kenya for a month in 2001 observing children dying of cardiac disease, I prayed that if the Lord opened the door for me to be a pediatric cardiac anesthesiologist to take care of His children internationally, I would do it.  It’s a funny thing to me that it took eleven years for me to fully realize the absolute privilege of answering the Lord’s call on my life.  He lets me see Him work in powerful and miraculous ways, in healing children and in changing the lives of our patients, their families, and the people who travel with us.  Grace.  Unmerited favor.  Thank you, Lord.