I often tell people that my faith in Jesus Christ is like a rope hanging across the Grand Canyon
that I would in all trust hang over that chasm on, knowing it would hold me. I grasp that rope
this past week. Brace yourselves for a long saga. I do this because so many of you bless us by
being genuinely interested, so I might as well tell the whole story once in detail. Good thing I
have an 11-hour flight to pull this synopsis off. If you tire of all the detail, you can skip to the
end for my spiritual conclusions.
Kirk, interventional cardiologist Mary Porisch, and I spent the week in Karbala, Iraq, once again
taking care of children with congenital heart disease, providing screening and treatment
evaluations and performing cardiac catheterizations. Iraqi friends had recommended our team
to this institution and Kirk had traveled there, at their invitation, in May to meet some of the
doctors and evaluate the facility, as he always does before we take a cardiac cath or surgical
team anywhere. The hope is to do a cardiac surgical mission there, but we decided to do a cath
mission first as a sort of dress rehearsal for getting to know and work with one another.
In unique ways, the three of us agree that it may have been the hardest trip we have ever done.
In saying that, it is vitally important for me to clarify at the outset I mean zero disrespect to our
hosts. We have had open communication about how the week went and I in no way want to
cause them offense. We learn and move forward. Please bear that in mind in any comments
you make on this post.
We have been doing pediatric cardiac procedural trips with For Hearts and Souls since 2005, in
Mongolia, Kosovo, Zambia, Nepal, and Kurdish and Arab Iraq. We have been doing such trips to
Iraq since 2010, in four other locations: Sulaymaniyah, Duhok, Fallujah, and Tikrit. We realize it
was all training for this last trip.
Romans 5:3 says we “exult in our tribulations, knowing that tribulation brings about
perseverance; and perseverance, proven character; and proven character, hope; and hope does
not disappoint, because the love of God has been poured out within our hearts through the
Holy Spirit who was given to us.”
Almost every For Hearts and Souls trip is a tribulation of a sort. There’s jet lag, long hours,
exhaustion, and the heavy responsibility of taking care of very vulnerable children in unfamiliar
systems with different and limited resources. Our teams have joked for years that our motto is
“Be exhausted, get sick, pay your own way…come back anyway!” I now realize that each trip
has been training for a subsequent trip, clinically, physically, emotionally, and spiritually.
We stepped up our training when we started going to “unsafe” places, like Iraq. We started in
Kurdish Iraq, however, when Americans were generally well-received and when conditions
were relatively stable. We used our confidence in this training to go to Arab Iraq, to Fallujah
and Tikrit, before ISIS…and then back to Kurdish Iraq, after ISIS and a change in stability and
perception of Americans. It is Arab culture, however, to protect one’s guests. We have always
been exceptionally well treated and protected by our hosts everywhere we have gone in Iraq.

We had no illusions about our physical safety and reception in Karbala, home of the third
holiest site in Shia Islam, other than confidence in the reception granted by our medical
colleagues and Kirk’s experience there in May. Our team was small, bluntly because the
destination does challenge one’s resolve and because we were assured the medical conditions
were such that we would not clinically need a bigger team. Obtaining our visas was our
prayerful test of God’s will and we received them on Monday, before we left on Thursday.
We met Mary in Istanbul on Saturday night and, after 48 total hours of travel, arrived in Najaf,
Iraq at 7:30 a.m. on Sunday morning. It took five hours in the airport to process our visas. It
took another hour to get out of the airport, because we had to make a claim for our luggage
that did not arrive from Istanbul and we had to convince a cadre of customs officers that we
should be able to bring our medical equipment into the country. We were supposed to go to
the hospital to conduct screening for the week’s procedures but given that we arrived at the
hospital at 3:30 p.m., the screening was called off. We were graciously given a “sack lunch” and
driven to our guest house to rest. The plan was to meet our medical hosts for dinner that
When we arrived at the guest house that had only an attendant outside, I noted no cell phone
or Wi-Fi signals. We were so exhausted we collapsed into a three-hour nap and woke to a text
alerting us to a change in circumstances. The good news was there was a cell phone signal! The
bad news was the friend of the surgeon hosting us had died suddenly so he was appropriately
going to Baghdad to mourn with his family and friends. The pediatric cardiologists were unable
to meet us for dinner. We were in a guest house in a neighborhood with no restaurants or
stores close by that we could walk to, not that we really thought it safe to walk anywhere
anyway. They arranged to have dinner brought to us. I found Wi-Fi hardware, so we summoned
the attendant, who gave us access codes. It is no small thing to have cheap, reliable
communication with our family and friends so far away in the world. We discovered we had no
hot water but decided not to summon the attendant back at that late hour. We were thankful
to find a large selection of tea and a warming kettle (I don’t think I’m going too far in saying
caffeine is an utter necessity on these trips!). We were told a driver would take us to the
hospital in the morning and we would start with a breakfast meeting and then the delayed
Our home church, Calvary Chapel South Maui, participates in something called the NEST while
we are gone on these trips. Participants submit at least one e-mail prayer over the duration of
the trip, so that we receive one prayer per day per NEST team. We had three NEST teams this
time, so three prayers per day. In turn, we keep them updated and send them prayer requests.
Having people interceding for us in this way has palpably transformed our trips. We walk in
greater confidence. I cannot overstate how much I have come to believe in the power of prayer
through our experiences with the NEST. Being able to communicate with the NEST was one of
the primary reasons for wanting Wi-Fi. And as soon as we had it, I alerted the NEST to our
circumstances. They kept us buoyed and supported in prayer the rest of the trip, as I kept them
abreast of all that went on. They are just as much a part of our team as those of us who go.
Knowing they were praying, we went to sleep in peace.

We got up to still no hot water so no showers, but hot tea! And our friend Lori Tezak, who took
us to the airport, had felt prompted by the Holy Spirit to give us wipes as we left. Thank you,
Lori, for the lemon bodily refreshment!!
Kirk and Mary had received Viber messages overnight requesting us to take care of a two-day
old emergency patient first thing in the morning for a very challenging procedure. That’s a
whole mental change from breakfast and screening. We had not met or worked together. We
had no idea of their equipment, supplies, or capabilities. And this would be an incredibly
challenging and risky patient to take care of well. We do not like taking unnecessary risks and
jumping into this so quickly seemed to be doing just that.
The driver got us to the hospital late. We texted when we were arrived, and they responded by
asking if they could take the 2-day old to the cath lab! We were whisked to the pediatric
cardiologist’s office, where Dr. Ammar was actively screening patients and asked us to jump in.
We asked if we could have breakfast, in part to slow the train and have a chance to talk to one
another and plan. He took us to the cafeteria, put food in front of us, and told us he’d be back
in ten minutes. Then back to screening we went. Dr. Mohammad arrived and the same pressure
to start with the 2-day old ensued. Kirk and Mary did an ultrasound of little Karam’s heart and
were not sure he would benefit from the procedure or they could do what they were
proposing. We also learned that the anesthesiologist/ICU doctor who we thought would be
there to help me that week had taken vacation. They heard our concerns to do things
methodically and well…and to test the system by starting with an older, less risky patient. We
finished with the screening and planning for the week. We went to the drivers’ office to get our
medical supplies and found a driver had never gone for our bag that had arrived 24 hours late
from Istanbul. A driver was dispatched and got into a car accident. It was hours before we
learned he was ok. We did do a diagnostic cath on Monday afternoon and we were able to give
good news to our first patient, 23-year old Jenam, that she was still operable. Dr. Mohammad
did offer us dinner but we elected to take our exhausted selves back to the guest house to bed.
We still had no hot water or luggage, the Wi-Fi had quit working, and there was no cell signal
On Tuesday morning, the driver picked us up very late and then just dropped us off outside a
locked hospital door. Someone let us in, but we didn’t have a hospital Wi-Fi code to
communicate that we were there. We went to find breakfast at the cafeteria, but they were
done serving it. Dr. Mohammad found us and we communicated we were more than a little put
out. We soon had food and hospital Wi-Fi codes, the Wi-Fi and hot water were fixed at the
guest house, and our luggage was retrieved by the end of the day.
We were able to do a diagnostic cath on 19-year old Shahd, but sadly had to tell her she was
inoperable. We then undertook a relatively “simple” procedure (closure of a patent ductus
arteriosus or PDA, for those in the medical know) on 6-month old Mostafa. During this
procedure, a catheter punctured his heart, the sac around his heart filled with blood, and his
heart stopped. After CPR and a needle procedure to remove this blood and put in a drain, we
had many more hours of intensive care to stabilize him, make sure the bleeding had stopped,
and take him to the ICU. We cancelled the two other planned causes. We got Mostafa to the
ICU after 7 p.m. and then went to dinner with the director of the hospital (and the entire
medical staff!) and got in bed after 11 p.m. We closed the day with the same negotiation about
now 3-day old Karam and explained we had not had a good dress rehearsal to undertake that
case with confidence.
We had asked for the driver to come earlier on Wednesday so we could get there in time for
breakfast. We actually waited outside our guest house for 45 minutes. When we arrived, Dr.
Mohammed said he had been waiting at the door for 30 minutes and the driver told him he had
waited for us for 30 minutes outside our guest house. He believed us when we explained that
couldn’t be the case because we were standing outside.
We were able to take out Mostafa’s breathing tube that morning, which is a huge praise that
his CPR had gone well, and he was neurologically intact. He still needs healing and prayer. That
was no small thing he went through. We were about to bring our first already sedated patient
into the cath lab, when an adult was whisked into the lab without warning. It was not an
emergency and we protested. The adult was whisked out and we then did a successful PDA
closure on 20-month old Abass, who was the size of a 9-month old because of the cardiac
failure caused by his PDA. He had a cold and an abnormal airway and abnormal respiratory
mechanics, so, as I expected and planned for, he was not easy to take care of as he emerged
from anesthesia. We usually have nurses with us to take care of the patients post-operatively,
but the plan had been to recover these patients in the ICU with their very competent nurses.
When it was time to take Abass to the ICU, we were told there were no beds. We took the
patient to adult cath lab recovery and Kirk and I watched him while they did the adult cath case
we had prevented earlier. Abass still needed oxygen and to be monitored closely and we
thought we had someone responsible for that, so I went to set up for the next case. I came back
to find him blue, off oxygen, and not monitored. More vigorous conversations ensued. We were
starting to feel like things were spirally out of control, we were earning the disdain of the
medical staff and patients’ families, and, most importantly, we weren’t taking care of these
patients safely. We thought of stopping, but we had made promises to these families. Kirk and I
found ourselves alone in the cath lab, prayed, and carried on.
Nine-month old Miriam was next, and her PDA closure and recovery went very well. We then
did a diagnostic cath on nearly 3-year old Alaa. He is the victim of poor diagnosis and surgical
misadventure, which is unfortunately not an uncommon finding for us internationally, and will
need another surgery. His mother took this news especially hard.
We now had a full day of three cases that had gone well enough to give us the confidence to
take care of Karam. They asked us to do so at the end of the day but listened to our desire to
undertake this case first thing in the morning, when everyone was fresh and rested. By bedtime
that night, Kirk was very ill, and I was very worried. I alerted the NEST again and they started
praying. Two hours later, he was asleep but I could tell his fever had broken and our prayers
were being answered. I was able to go to sleep and he was well enough to carry on with
When we arrived Thursday morning, they told us they had five cases for us. We knew about
Karam and 3-year old Mesk. The other three were a surprise. We told them we’d take it one
case at a time and do what we could.
The NEST was on full alert and praying when we started 2.5 kg (about 5 ½ pounds), 5-day old
Karam. His case went well. We couldn’t do the procedure they proposed, but we did do a
procedure that helped him. (I have to stop and fill in the details for the medical people. He had
pulmonary atresia, tricuspid stenosis, and a restrictive atrial septum. We were able to do a
Rashkind but not a PDA stent. His PDA was actually too big for the stents the family were able
to acquire for us, as the hospital did not have any nor did we have any with us.) He has very
unstable physiology and doing the cath and the procedure did make him more unstable for
quite some time. This was not a surprise to us. We were in the cath lab for several hours after
the case just to get him stable enough for transport. When we told them to have the ICU staff
ready for receiving him, we were told he couldn’t go to the ICU, as we had been promised
before we agreed to do the case. The reason was there was no attending ICU doctor…because
he was on vacation. We explained that we were three doctors and we would take care of him,
all night if we had to. He went to the ICU. Their nurses were very capable and impressed us very
much. He was very stable by day’s end.

At 5 p.m. on that last day, we took care of 3-year old Mesk, the last case we had agreed to do at
the outset of the week (we cancelled the other three surprise cases). She is also the victim of a
surgical misadventure, will need another surgery, and her mother also took this very hard.
Please pray for all these patients and their families!
I was feeling discouraged at the end of the day Thursday. I felt like we had had so many fights
and I was concerned about all our relationships there. It just felt like the whole week had been
a battle. I haven’t even addressed in this long story how hard it is to be a female physician in
that culture, something I felt more acutely than ever. I don’t believe most American women
know how good they have it, which is a subject postponed for further musings. The week was
hard to wrap up in a neat little bow. We’ve endured challenges before with travel, illness,
luggage, supplies, equipment, exhaustion, personalities, cultural differences, car accidents,
choking (me, with Kirk having to do the Heimlech maneuver at our wrap-up team dinner), and
even patient deaths. Maybe it’s memories fading over time, but it’s seemed before we had
more clarity of purpose, what God was up to, and the victories that we could rejoice in despite
the pain. But then God started encouraging me.
We had warm and encouraging goodbyes with Drs. Mohammad and Ammar, many of the staff,
and many of the patients’ families. Mary and I even received handshakes, hugs, and kisses,
which I consider miraculous and tremendously respectful. Karam’s grandparents followed us
out to the parking lot to thank us as we were leaving.

You can imagine we were a little concerned about a driver getting us to the airport on time on
Friday morning. We were also concerned about getting our medical supplies out of the country.
This has never been easy and our airport experience earlier in the week gave us no confidence.
Dr. Mohammad communicated our concerns to our driver before he left us to go home to his
family in Baghdad Thursday night. The driver told us “Inshallah” which means “If God wills.”
That was a funny interaction when Kirk told him we needed an “OK” not an “Inshallah.” We
asked for his phone number. The NEST was praying. Our Kurdish doctor friend Fitoon was on
telephone standby to call the driver (or an alternate driver) and talk to airport personnel. Dr.
Mohammad had also written us a letter. The driver arrived early and proudly. Getting our
medical supplies out has never gone easier. The battle was over.
As we waited for our plane, the verses in James that I posted previously and the verses that I
opened with in Romans came to my mind. Mary, Kirk, and I all agreed that we could have in no
way endured with perseverance what we went through this week had we not been through
what we’ve been through before. We all see the hand of God training us to go deeper and
deeper in our faith with Him. And we have learned the absolute power of prayer enabling and
upholding us.
I chose to read Eric Metaxas’ biography of German pastor and martyr Dietrich Bonhoeffer on
this trip. What a great and timely choice. I cannot recommend it highly enough. I also watched
the movie “On Wings of Eagles” about Olympic runner Eric Liddell’s service and death as a
missionary in China. Just as I believe most Americans need to serve outside the U.S. to have
their eyes opened to how fortunate we are and all we take for granted, I believe we need to
read these challenging and inspiring stories of incredible people of faith. When I do, I learn the
sacrifices I have made are very small, as are the challenges I’ve endured.
Think on these reflections from Bonhoeffer, who was involved in the plot to assassinate Hitler
and paid with his life. Metaxas explains Bonhoeffer’s realization “that the idea that one could
go back to a time before troubles and death was false to begin with. The war was only showing
them a deeper reality that always existed.”
Just as time-lapse photography makes visible, in an ever more compressed and
penetrating form, movements that would otherwise not be thus grasped by our
vision, so the war makes manifest in particularly drastic and unshrouded form
that which for years has become ever more dreadfully clear to us as the essence
of the “world.” It is not war that first brings death, not war that first invents the
pains and torments of human bodies and souls, not war that first unleashes lies,
injustice, and violence. It is not war that first makes our existence so utterly
precarious and renders human beings powerless, forcing them to watch their
desires and plans being thwarted and destroyed by more “exalted powers.” But
war makes all of this, which existed already apart from it and before it, vast and
unavoidable to us who would gladly prefer to overlook it all.
Metaxas summarizes that “because of war, they could see things as they truly are. The
promise of Christ is therefore all the more real and desired.”

As the war did for Bonhoeffer, these trips help me “see things as they truly are.” Our illusion of
safety and security in the U.S. is just an illusion. And it’s an illusion that doesn’t help us. It
makes us selfish and self-protective. As I repeat so often, life is hard, but God is good. “For God
so loved the world that He sent His only begotten Son that whoever believes in Him should not
perish but have everlasting life” (John 3:16). Every one of us on this planet is a sinner in need of
a Savior. Jesus Christ is that Savior. Our belief in Him guarantees us an eternal life of the
security that we desire but will never attain on earth. And how will the world know unless we
are sent to tell them (Romans 10:14)?
More from Bonhoeffer, long but worth it:

We know, of course, that God and the devil are engaged in battle in the
world and that the devil also has a say in death. In the face of death we cannot
simply speak in some fatalistic way, “God wills it”; but we must juxtapose it with
the other reality, “God does not will it.” Death reveals that the world is not as it
should be but that it stands in need of redemption. Christ alone is the
conquering of death. Here the sharp antithesis between “God wills it” and “God
does not will it” comes to a head and also finds it resolution. God accedes to that
which God does not will, and from now on death itself must therefore serve God.
From now on, the “God wills it” encompasses even the “God does not will it.”
God wills the conquering of death through the death of Jesus Christ. Only in the
cross and resurrection of Jesus Christ has death been drawn into God’s power,
and it must now serve God’s own aims. It is not some fatalistic surrender but
rather a living faith in Jesus Christ, who died and rose for us, that is able to cope
profoundly with death.
In life with Jesus Christ, death as a general fate approaching us from
without is confronted by the death from within, one’s own death, the free death
of daily dying with Jesus Christ. Those who live with Christ die daily to their own
will. Christ in us gives us over to death so that he can live within us. Thus our
inner dying grows to meet that death from without. Christians receive their own
death in this way, and in this way our physical death very truly becomes not the
end but rather the fulfillment of our life with Jesus Christ. Here we enter into
community with the One who at his own death was able to say, “It is finished.”
As Metaxas says, “this was how Bonhoeffer saw what he was doing. He had theologically
redefined the Christian life as something active, not reactive. It had nothing to do with avoiding
sin or merely talking or teaching or believing theological notions or principles or rules or tenets.
It had everything to do with living one’s whole life in obedience to God’s call through action. It
did not merely require a mind, but a body too. It was God’s call to be fully human, to live as
human beings obedient to the one who had made us, which was the fulfillment of our destiny.
It was not a cramped, compromised, circumspect life, but a life lived in a kind of wild, joyful,
full-throated freedom—that was what it was to obey God.”

Amen. I could say it no better.
Do I believe it? I realize that rope over the Grand Canyon that represents my faith in Jesus
Christ is a zip line. And it turns out I’d ride it to the other side to share Him with others. It’s
God’s grace to give us joy in the journey. “Consider it all joy, my brethren, when you encounter
various trials, knowing that the testing of your faith produces endurance. And let endurance
have its perfect result, so that you may be perfect and complete, lacking in nothing” (James 1:2-
All praise, honor, and glory go to Him.