Five of us (Kirk, me, pediatric interventional cardiologist Mary Porisch, pediatric intensivist Minnette Son, and pediatric nurse practitioner Nelia Soares) are en route home from Fallujah, Iraq.  Kirk, Mary, Minnette, pediatric nurse practitioner Molly King, and pediatric intensive care nurse Shannon Kyle made this trip in July 2012.  Our international trips are always a lesson in perspective, but it seems these trips to Fallujah are even more so.

I’ve already confessed I didn’t much want to go to Fallujah in July, truly because of fear.  But that trip went extremely well.  Our trips are always rewarding.  I felt like I had stepped up to the plate, checked the box, and was free of further obligation.  However, usually once we’re in a country and we make relationships and we love the work and those we work with, it’s inevitable that we start talking about when we’ll return.  Things don’t seem incredibly stable in Iraq.  The Kurdish Prime Minister Talabani, who seemed like a stabilizing force, has recently suffered a stroke.  There is high suspicion of heavy Iranian involvement in the government.  It appears there is increased al Qeada presence.  The citizenry is getting increasingly dissatisfied with the government and their perceptions of its corruption and is increasingly staging protests.  I’ll confess again that I thought maybe we shouldn’t go back.  This never crosses my husband Kirk’s mind.  Then I simply requested maybe we not be so public with exactly where we were going as we were last time.  It turned out to be incredibly hard for us to get visas this time.  I don’t think I would have been disappointed if we hadn’t.  I’m truly embarrassed to admit that now and am glad there are people like Kirk and my teammates and our ministry partners (Preemptive Love Coalition and Living Light International) who are more faithful than me.

Since the last trip was so historic (the first American volunteer medical team in Fallujah after the war), it was much higher profile.  There were ceremonies and press conferences and therefore no way to keep our presence a secret.  As such, the security was incredibly heightened.  We were always under armed guard and rode in armored vehicles when we traveled anywhere.  Since the first trip had been so successful and had gone so well, this one was much lower profile and gone were the armed guards and the armored vehicles.  We were driven from the Baghdad airport to the Fallujah Hospital compound when we arrived; we never left the compound (since we stayed in a dorm adjacent to the main hospital building) until we returned to the Baghdad airport; and there were armed guards for the compound.  But the contrast from the last trip was striking.  Was that level of security unnecessary?  Or were we more at risk this time?  I can’t answer that question.  I only know that both times we were safe…and well insulated from what was going on in the rest of the country.  We did notice an increased number of long security checkpoints between Baghdad and Fallujah.  On Friday, Muslim day of worship and a non-working day, we understood there were possibly more than a million people blocking the highway outside of Fallujah that leads to Syria protesting the government.  This was maybe a mile or so from us…and other than hearing it was going on, we would have had no idea.  On Wednesday, the Iraqi security forces raided a terrorist warehouse outside Fallujah that had 4 cars fully outfitted with car bombs and 2 more being outfitted.  We met some nurses that serve in the emergency room and I asked one how often she saw trauma from car bombs or IEDs and she said “every day.”

The strange thing for me in all this was I felt like I could be anywhere.  The only time I was outside during the whole week was for the fifty-yard walk to the hospital in the morning and the fifty-yard walk back in the evening.  Last time we were instructed not to even really look out our windows, but this time we were much freer to.  It’s an incredibly disorienting phenomenon.  So we asked a lot of questions, of our ministry partners and of the doctors and staff that we worked with.  When the news was on, we’d ask them to interpret it for us.  This was all part of our team’s lessons in perspective.  I’m glad for the ride to and from the airport when I got to look out the windows and imagine how people live in this country of concrete, barbed wire, check points, and car bomb threats.  I was happy to work with the local pediatric cardiologist Dr. Firas who is so smart and competent and caring for his patients…and see how he deals with limited resources and limited opportunities for his patients that he so clearly loves.  It’s good for me to see this wonderful man not be able to go to a medical conference in the U.S. because he holds an Iraqi passport and cannot get a U.S. visa.  I was humbled to meet nurses from India who serve one-year contracts and live that disorienting dorm life where the only time they go outside is to go to and from the hospital or to go to the store once or twice a month in full hajab dress for an hour at a time under armed guard…all so they can better the education and circumstances for their families back home.  I endure different food, bedding, and plumbing for a week…and, by the grace of God, I’m free to go back home.

Those of you in ministry know there are enough disappointments, discouragements, setbacks, betrayals, and inconveniences that, at least for someone like me, it is easy to be tempted to quit.  This is truly how I have been feeling lately.  As God’s timing would have it, Guest Pastor Rich Atchley preached an incredibly convicting message at our home church Oak Hills in San Antonio the weekend before we left for Iraq.  He advised us to beware of the “default mission”.  My default mission is I’m a full-time pediatric cardiac anesthesiologist in San Antonio.  I have call commitments, partners I would like to keep happy by not abandoning them to more work in my absence, a mortgage and bills to pay, and a house and animals to take care of.  I need to stay home more!!  He then reminded us that the default mission will always avoid the cross.  The cross involves suffering.  I don’t like suffering.  I’m a big fan of avoiding that.  The cost, however, is missing the true mission, that which God has called and equipped you for.  I was so glad to be heading to Iraq after I heard his incredibly convicting message.  On the flight over, I read a column in my favorite World magazine by Janie B. Cheaney talking about the parable in Luke 19:11-27 where the nobleman goes to a distant country to receive his kingdom and leaves his servants to invest his money while he is gone.  They decide they don’t want this man to rule over them and they don’t want to be about his business.  How that is so like us.  We don’t want Jesus and His expectations and His rules and His call and His cramping of our style, but we want to be about our own business.  But what does the Bible and this parable say we are to be about in Jesus’ absence?  His business.  Thus, I arrived in Iraq incredibly convicted that I was supposed to be there.  The beautiful thing about Jesus, though, is He is a rewarder of obedience.

As a team we took turns giving our morning devotionals this week.  Mary shared on the morning of our second clinical day her conviction to pray about everything, which also convicted me.  She also shared what she had learned in the Bible about the threshing floor, where wheat is separated from the chaff.  We always call our difficult clinical cases the “threshing floor.”  Sometimes we feel like we are getting threshed incessantly all week long!  The most famous threshing floor in the Bible is the one King David purchased in order to build the temple.  That was revolutionary to me:  we build altars on threshing floors.  My clinically difficult and exhausting international weeks are actually a form of worship!  That second day was a day that I was dreading because we were going to do two incredibly challenging cases: one a diagnostic cath on a baby with Tetralogy of Fallot who would be at risk of having what is called a “tet spell” and dying and one an interventional cath on a baby with a very tight pulmonary valve that put her at risk of sudden death who was so small that she was just much more complicated to take care of in a safe fashion with the limits of international care.  I went into that day with a much more prayerful and worshipful attitude.  Both cases went very well.  We actually learned that the small baby had been turned down for care elsewhere in the country so if we hadn’t taken care of her she likely would have died.  I ended up realizing I truly sacrifice so little and I get rewarded by being part of literally saving a life.  Yes, God is that good.

We took care of sixteen patients this week.  Last time we made history just by showing up.  This time we made history by doing first time ever procedures in that part of the country.  We kept calling it “walking on the moon.”  We walked on the moon several times.  We likely saved lives, extended lives, or, at least, made a difference in lives.  We pray that through it all God was glorified and the patients, the families, and those we worked with somehow saw the Jesus that loves them in us.  Will I go back?  Lord willing, yes.  How could I not?