I (Kim) choked on a piece of meat at our Friday night team dinner thrown in our honor by our Mongolian colleagues celebrating the end of our week of pediatric cardiac catheterizations and surgeries in Ulaanbaatar.  Seriously.  Kirk had to do the Heimlich maneuver.  Afterward, we laughed.  Don’t’ get me wrong.  I thought it was possible I was going to die and I know Kirk saved me…but it seemed a fitting end to what seemed like an incredibly bizarre week.

We’ve been doing these procedural weeks in Mongolia since 2005.  Our friend Jim Courson, who more than ably served as our chaplain this year, asked me at the beginning of the week if I was excited about it.  I explained that “excited” is never the word I would use.  These weeks are indescribably rewarding…but they are also incredibly exhausting.  They challenge our skills, our energy, our patience, and our faith.  We need to do it but we joke every year we should make a team T-shirt that says “Mongolia:  Pay your own way.  Be exhausted.  Get sick.  Come back anyway.”   Kirk warned the team of twenty-eight of us, especially those who were with us for the first time, that the week would be hard.  He used the words spoken by Jesus, “If anyone would choose to follow me (following Jesus is choice, as deciding to serve in Mongolia is a choice), deny yourself, pick up your cross, and follow me.”  We come to serve.  We don’t come to be tourists or to shop or to necessarily get lots of sleep.  We come to serve, whatever that takes…and often that takes a lot, a lot of specifically denial of self.  We’re not purposefully trying to torture our team.  We don’t desire it to be hard.  We desire it to be smooth, well planned, and complication free.  Proverbs 19:21 says, “many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.”  Our plans for this year literally were re-ordered hour-by-hour, minute-by-minute, and second-by-second.

The first complication in our plans was the hospital starting renovating the floor on which we usually work.  In the end, it will be a blessing, with a new operating room, intensive care unit, and catheterization lab.  This was planned.  They knew we were coming.  They thought they would have it done.  They didn’t.  We’re used to the OR, ICU, team gathering area, and storage area all being right beside each other on the fourth floor.  The cath lab has always been on the first floor, so we’re at least used to that.  Two locations we can manage.  This year, still thankful to the hospital’s accommodation, we had an OR down the opposite hall from our usual fourth floor location.  The team gathering area was on the same floor but not near it.  The ICU was on the third floor in a completely opposite wing.  And the storage room that we’ve had for eight years, that we’ve shelved and organized and known what’s in it, had been dismantled, boxed up, and moved to a different building on the sixth floor.  Four locations.  The distances that needed to be covered to communicate, coordinate care, and move patients and supplies were long and confusing.  We might have all lost weight from the additional exercise!  We always have non-medical personnel on our team to help with logistics.  This year we had more than usual.  We’ve always trusted that the Lord knows who is supposed to be on our team.  There are certain roles that are non-negotiable and we make sure we fill.  There are additional roles that we trust the Lord to fill.  In terms of our “helpers” this year, once again, God knew our needs.

The second complication in our plans was a family tragedy for our beloved team member and pediatric ICU doctor Heather Chandler that prevented her from joining us at the very last minute.  Despite the fact that her capable ICU doc teammates Kristina Kypuros and Barbara Jo Achuff did not know they would be a team of two instead of three, God did.

The third complication is we usually have time on the weekend to unpack and organize our supplies at the hospital, so we can hit the ground running on Monday morning.  This did not happen this year.  Instead, however, we really had an incredible time of team bonding on Sunday that we usually do not have time for.  Once again, God knew.  We needed this time to really get to know each other and our reasons for being there…because the week provided endless reasons and circumstance to break our team unity.

Given these complications, we planned a lighter schedule for the week and especially for Monday.  We always start the week with a planned schedule.  It ALWAYS changes, due to kids getting sick, families not showing up or deciding they don’t want procedures, lack of supplies, unforeseen complications, or just things taking longer than we expect.  We have a tremendous amount of trust in each other as a team.  If any physician on the team thinks it is not safe to proceed with something, we don’t.  Kirk and Mongolian pediatric cardiologist Ariunaa ultimately interact with the patients and families and communicate with the rest of us what we are doing next.  They said they had never experienced anything like it this year with patients eating when they shouldn’t, not showing up, or getting sick, or families changing their minds.  We felt like the schedule changed so much we had whiplash!  On top of this, everything just seemed harder, probably because we had done it one way in primarily one location since 2005.   We had hit somewhat of a stride in past years and now everything seemed new again.  Despite all this, by Wednesday night, we had managed to accomplish three successful surgeries and ten successful caths.

Wednesday night was probably the climax in terms of emotion and mood.  When Kirk and interventional cardiologist Mary Porisch were in Mongolia for a cath week in July, they had met an infant who had a critical narrowing of the valve leading to his lungs, severely limiting the blood flow to his lungs, making him very blue, and was significantly at risk of dying.  They simply did not have the resources to take care of him well, so prayed that he would live so that we could take care of him this week.  Kirk and Mary have seen another child in this position internationally who didn’t survive long enough to see the team return.  They were ecstatic to see him when they returned this week.  The family was a poor nomadic family from the western part of Mongolia and they had never left the capital.  They had just stayed, waiting for the team’s return.  Unfortunately, this child had a very significant respiratory infection this week, which markedly increases the child’s risk for general anesthesia.  Kirk told me about the baby at the airport when I arrived 24 hours after him, assuming that we just wouldn’t be able to take care of him this week.  Knowing the baby would likely die if we didn’t, I came up with a plan in my mind for taking care of him that night and told Kirk and Mary in the morning that I thought we could do it.  By the grace of God, we did, successfully, on Wednesday night.  There are cases where we know we are significantly impacting a child’s life and then there are cases where we know we are part of truly saving a child’s life.  This was one of those cases.  We were so euphorically thankful to see him turn from blue and sickly to pink and healthy!!  It was so wonderful to see the reaction of his parents and his whole extended family.

On Thursday morning, we were able to do another miraculous case in the OR for a 22-year-old young woman who should have, because of her cardiac defect, been inoperable after two years of age.  We also did a cath on another 22-year-old woman that helped us determine a surgical plan for her and we were planning to take her to the OR that afternoon.  However, after that, everything changed.  We took care of an infant in the cath lab that, to use golf terminology, should have been a chip shot.  Her case should have been fast, easy, and uneventful.  Thus began our graduate level lesson in the will of God.  Absolutely everything that could have gone wrong with her case did.  I am still marveling.  I have absolutely never seen anything like it in my entire career and in all our international trips where we’ve taken care of hundreds of kids.  She was being taken care of by another anesthesiologist in the cath lab.  Just trying to get the case started, there was difficulty getting her asleep, with her airway, and getting an IV.  IVs that went in came out.  The line that was being used to do her cath just quit working.  They had to get another line in her neck emergently.  The device that went in that should closed her cardiac defect went to the wrong place.  They struggled for a very long time to retrieve it.  Over the course of that time, she got progressively ill and unstable.  They decided it was better to just remove the device in the OR, so they called me since I would be the one to take her there.  We got her stable enough to transfer and moved her to the OR.  There were surgical complications.  After they were done with the surgery and we undraped her, the line in her neck started to come out, so we had to replace it.  The line in her leg that we were using to measure her blood pressure was cutting off the blood supply to her leg, so we had to replace that. After the lines were appropriately in, it was time to turn to making sure she was stable enough to wake up and that she woke up well.  I was very worried about the effect of everything she had been through on her brain.  And I never like to try to transfer an unstable patient to the ICU…especially since we had so far to take her.  This was probably around 8 p.m.  She had probably gone into the cath lab around 10 a.m.  A core group of us stayed and we sent the rest of the team home.

It continued to be an exercise in “this is unbelievable!!”  Soon after they left, we lost our oxygen to the OR (this is actually not uncommon in Mongolia, so I took this is stride).  After the oxygen came back on, she still wasn’t ready to have her breathing tube removed, so I gave her a small dose of medicine to sedate her.  She had a lung reaction to this medicine.  While I was breathing for her by hand (thank God I was), the power went out.  We started having Mary write down all the complications because we found it so amazing.  After the power came back on, it seemed her lungs were finally starting to recover …until I noticed all the sudden we were no longer successfully breathing for her.  I tried to suction out her breathing tube without success.  The oxygen levels in her blood got scarily low, so I just pulled her breathing tube out and it had a huge plug of material in it.  I was able to breathe for her by hand.  I got her breathing on her own but in that whole incident I had turned the anesthetic gas back on to manage her and her lungs reacted to that.  I gave her medicine for that which, as a predictable side effect, affected her heart rate and blood pressure.  I finally got all this stabilized and everything that was keeping her asleep out of her system and our worst fears were realized.  She wasn’t waking up.  Her brain had been injured.  Those of us in the OR with her cried and prayed.  We got her stable enough and finally took her to the ICU about one in the morning.

We try so hard to not take unnecessary risks.  This was not a risky procedure.  Everything we do in medicine has inherent risks involved, but I never would have imagined this scenario in my wildest dreams.  You can imagine we’ve talked about it and analyzed it.  Every step made sense.  No one really did anything wrong.  Everything we do in medicine has a potential complication. The more procedures you do, the more patients you take care of, you are going to see them.  To see them clustered like this in one patient is still unbelievable to me.  So, here we are, a group of incredibly well intentioned people who only want to do right by our patients and who are incredibly conservative in taking risk and we find ourselves living a nightmare.  Most importantly, we have a family devastated by this outcome.  See what I mean about graduate level education in faith?

I still shrug as I write this.  I don’t have a lot of answers.  God knew the week we were going to have though.  Jim talked to us on Sunday about Psalm 119:68, the fact that “You [God] are good and do only good.”  He challenged us to rest in that fact no matter what the week held.  I’m so thankful we started the week with this verse. It comes down to a question of do you believe this?  There are three possible outcomes with Emujin:  God will perform a miracle and she will be healed, she will live neurologically devastated, or she will die.  Since 2005, we have lived through three painful deaths:  Undermaa in 2006, Boogi in 2007, and Ireedui last year.  We hate these outcomes with a passion.  We pray against them.  Kirk works really hard in his patient selection to make sure we are not taking unnecessary risk.  And then we have this outcome on a simple case?  God has been gracious many times with miracles.  I believe in miracles.  I was so praying for the miracle.  It could still happen.  But it hasn’t.  And what will I believe if it doesn’t?

One of our team members, through tears, was trying to process it with me.  She wondered what this family would think of the American team.  I told her the story of Ariunaa bringing a patient to the U.S. many years ago for heart surgery and the baby dying.  She had called Kirk and asked what to say to the mother.  Kirk told her he had no words, but told Ariunaa just to abide with her in her pain.  The mother stayed in the U.S. for six weeks and ultimately became a Christian because of the love and compassion she was shown in that horrible circumstance.  Do we believe God is good?  Do we believe God is in control?  Do we believe in heaven?  I believe in the grace and mercy of God that if Emujin dies, she will go to heaven.  Isaiah 57:1 offers a perspective that when the righteous perish, it is actually merciful because they are “taken away from evil” and “enter into peace.”  In the Bible story of the Israelites passing into Israel after wandering in the desert for forty years after their escape from Egypt, God tells them to set up memorial stones so they could remember the goodness of God (Joshua 4:7).  I love His goodness.  I love His miracles.  But do I love Him and trust Him when I don’t get the miracle?  Am I like Job who can say, “Though he slay me, yet will I trust him” (Job 13:15)?  All the goodness of God, all the times I have read the Bible, all the beautiful songs I have listened to serve as memorial stones for me in the darkness.  God is good.  God is control.  God only does good…even when I don’t see it.  Early in the week, Jim brought up the Ecclesiastes 5:2:  “Do not be rash with your mouth, And let not your heart utter anything hastily before God.  For God is in heaven, and you on earth; Therefore let your words be few.”  There is a worship song based on that verse that rang in my ears all week:  “You are God in Heaven.  And here I am on earth.  So I’ll let my words be few.  Jesus I am so in love with you.”  I kept singing it over and over in my head.  My words are definitely few on this one, but am I like a little child who only loves Daddy when I get my way?  Or do I love Jesus even when I don’t?

On the plane out of Mongolia into Korea, Kirk and I played dueling iPhones, sharing with each other songs that encouraged us in this circumstance.  There are many.  Have you heard the words to “Held” by Natalie Grant?  “Two months is too little.  They let him go.  They had no sudden healing.  To think that Providence would take a child from his mother while she prays is appalling.  Who told us we’d be rescued?  What has changed and why should be saved from nightmares?  We’re asking why this happens to us who have died to live.  It’s unfair.  This is what it means to be held, how it feels when the sacred is torn from your life and you survive.  This is what it is to be loved and to know that the promise was when everything fell, we’d be held.  This hand is bitterness.  We want to taste it, let the hatred melt our sorrows.  The wise hand opens slowly to lilies of the valley and tomorrow.  This is what is means to be held….”  What about “Praise You in this Storm’ by Mercy Me?  “I was sure by now that You would have reached down and wiped our tears away, stepped in and saved the day.  And once again, I say amen and it’s still raining.  But as the thunder rolls, I barely hear you whisper through the rain ‘I’m with you’.  And as Your mercy falls, I raise my hands and praise the God who gives and takes away.  And I’ll praise you in this storm and I will lift my hands.  You are who You are, no matter where I am.  Every tear I’ve cried, You hold in Your hand.  You never left my side and though my heart is torn, I’ll praise you in this storm.”  Or “Bring the Rain” by Casting Crowns?  “I can count a million times people asking me why I praise you with all that I’ve gone through.  The question just amazes me.  Could circumstances possibly change who I forever am in You?  Maybe since my life was changed long before these rainy days, it’s never really ever crossed my mind to turn my back on you, oh Lord, my only shelter from the storm, but instead I draw closer through this time.  So I pray:  bring me joy, bring me peace, bring a chance to be free, bring me anything that brings You glory.  And I know there’ll be days when this life brings me pain, but if that’s what it takes to praise you, Jesus bring the rain.”

Kirk has wondered if the Lord has been challenging his faith, if he’s been too afraid to take on riskier cases internationally because he was afraid of the outcome.  He felt like the Lord taught Him this week that the Lord controls the outcome, even when we take on simple cases.

After my choking episode, I couldn’t sleep.  I kept replaying the week, Emujin, and that episode in my mind, asking God what I was supposed to learn from it all.  At dinner, Barbara Jo was sitting next to me and I had grabbed her arm.  She had seen the universal sign of panic on my face, asked me if I was okay and if I could speak.  When I shook my head, she called out to Kirk, who was two seats away.  He jumped up and came over.  I had this peace that I knew he would do everything he could to save me.  I actually thought it might not work, but I knew he would try everything.  I wasn’t terrified, which is still shocking to me.  I kept playing over and over what that felt like to know how much I trusted Kirk…and I realized that is how much I trust God.  I felt like God told me “see how I sent Kirk to save you?  I’ll always save you.  That is why I sent Jesus.”  This sweet realization made me cry so hard I had to get out of bed because I thought I would wake Kirk.  Saving me doesn’t mean I get my way.  It doesn’t mean Emujin necessarily gets a miracle.  It means that I know with every fiber of my being, in every circumstance, that God is good, that God is in control, that heaven is for real, and that Jesus is the way there.  I don’t know what God is up to with Emujin.  I don’t have to know.  I do know God’s grace is sufficient to comfort us and a grieving family.  May we praise Him in this storm.


Afterword:  We just received word that Emujin has died.  “The Lord gave and the Lord has taken away.  Blessed be the name of the Lord (Job 1:21).”  May the God of all comfort comfort her family as only He can.