Kirk and I are en route home from Mongolia, where we conducted a pediatric cardiac catheterization mission with a team of seven: two cardiologists (Kirk and Dr. Mary Porisch), two anesthesiologists (me and Dr. Maria Garcia), a pediatric ICU doctor (Dr. Barbara Jo Achuff), and two pediatric ICU nurses (Katie Tankersely and Karene Proffitt).
In my yearly Bible reading this morning, I found myself at the end of Galatians and read again the verse “Let us not lose heart in doing good, for in due time, we will reap if we do not grow weary. So then, while we have opportunity, let us do good to all people…” (Gal 6:9-10). It was perfectly timed and I almost had to laugh out loud. I confess I had a hard time shaking weariness all week. I wondered and prayed about my seeming lack of stamina. I’ve been convicted and written about Gal 6:9 on previous trips. Why can I not seem to move on from this lesson?
This was my 17th trip to Mongolia since 2000 and something like Kirk’s 44th. Easily hundreds of people on our For Hearts and Souls teams have been a part of screening children, training doctors, performing heart catheterizations, and performing heart surgeries. This is the first September since 2005 where we have not done a pediatric cardiac surgical mission. It was scheduled and faithful team members were planning on joining us again. However, the dedicated surgeon, Dr. Tsgeenjav, with whom we’ve worked all these years retired and his replacement does not seem interested in pediatric heart care. This is a huge step back for the children of Mongolia, as now they have to leave the country again in order to have cardiac surgery, which is often prohibitively expensive. We still had a commitment to keep, however.
We usually do a cardiac catheterization mission simultaneous with our surgical mission. We perform diagnostic caths, determining if children’s conditions are operable. Sometimes if they have waited too long to have an operation, they are not. We also do interventional caths where we can open tight valves with balloon catheters and close holes with devices, preventing patients from having to have an operation. In 2012, Kirk had diagnosed a woman with a tight pulmonary valve on a screening trip in Gobi Altai and had promised her we would open the valve in the cath lab during our 2013 trip. She got pregnant, however, before we returned and the Mongolian physicians told her she should have an abortion. She sought the advice of our dear friend Mongolian pediatric cardiologist Dr. Ariunaa, who also consulted with Kirk, and they both reassured her she could safely continue her pregnancy and we would balloon her valve in 2014. Thus, despite not getting to do a surgical mission, we kept our promise of planning a cath mission. We were excited that we had secured the donation of the devices and balloon catheters we needed from a company we had not worked with before and planned on taking care of 20 children. While the rest of us traveled in, Mary (our cath doctor for this mission) and Katie screened over 50 children on Sunday and made a tentative schedule for the week. As Kirk and I arrived on Sunday afternoon, we learned that the company that had promised us the devices decided not to support the mission. We met and prayed as a team that evening, came up with an alternate schedule based on the supplies we had brought with us and left from previous trips, and sent out pleas for prayer. After a flurry of emails, the company promised they would provide them by the end of the week. They have yet to arrive.
When we arrived at the hospital on Monday, we hauled hundreds of pounds of supplies up to the fourth floor to new cath lab adjacent to the ICU where we had been assured we would work. We were told that instead we would have to use the first floor cath lab, which has less capability and honestly increases the risk to patients with long transports after general anesthesia and division of our team, supplies, communication, and ability to help one another in emergencies. But we hauled our supplies to the first floor, got organized, and were able to create a safe, workable clinical environment to take care of four patients. We did diagnostic transesophageal echocardiograms (TEEs) on two patients and determined one had a defect that had to be closed surgically and did not qualify for a device and that the other had a defect we could have closed with a device had it arrived. We told that second patient to stay in the hospital in case the device arrived by the end of the week. He now has to wait until we return another time with a proper device. Thanks be to God, we found appropriate sized devices in our storage closet of supplies from past trips and were able to close holes in two other patients without surgery. We were all encouraged by the Lord’s provision and our new plan for the week.
On Tuesday, we were told we actually could use the new cath lab later in the day and for the rest of the week. So we started on the first floor with a TEE on a patient who also turned out to have a defect that would require surgery and not a device. Then we packed up our supplies, hauled them up to the fourth floor, and reinvented the clinical setup wheel. We were able to do two diagnostic caths on two patients who had previously been declared inoperable because of the delay in their receiving heart surgery. We were able to tell the parents of both these children that the news was, in fact, good and their conditions were still operable. There is such joy in delivering this news and restoring these families’ hope. Now we pray for the provision of a place for them to have surgery.
When we arrived Wednesday, we were told we would have to go back to the first floor. We were a little out of patience at that point. We had met with the director of the hospital on Tuesday. He had apologized for our not being able to do surgery this year and he apologized for the confusion regarding the cath lab on Monday. He assured us we had the new cath lab for the rest of the week. So, after his intervention again, we were able to start late on Wednesday on the fourth floor. We were able to perform a procedure where we opened a narrowing in a child’s aorta with a balloon we found in our old supplies. She’ll have to have a surgery eventually but this will buy her some time. We were then able to open a narrowed aortic valve on another patient with a balloon we had on hand. We had hoped to do one more case on Wednesday but the hour was late because every step takes so much longer than we’re used to in the U.S. so we postponed it until Thursday.
Kirk and I had to leave the team on Thursday morning due to a previous family commitment, but we have heard the praise report that they we were able to keep our 2012 promise. There is a mom with a healthy one-year-old baby who finally had her tight pulmonary valve successfully treated. They were also able to open another tight pulmonary valve and close an ASD, all this once again from supplies left in our beloved storage closet. We are praying about what they will be able to accomplish on Friday as we have been told the hospital is celebrating its anniversary and it is being declared a work holiday.
None of the things that caused me to be weary this week should have surprised me. We work with limited supplies in relatively austere conditions. We’re jet lagged. We work long hours. It’s clinically stressful. The Lord’s plans are often very different than our plans so He uses all kinds of circumstances to constantly change our schedule. But probably very true confession: I’m sure I thought that after all these years and trips to Mongolia, it just shouldn’t be that hard any more. Before the trip, I had a very hard time motivating to go to our storage unit in San Antonio to organize and select medical supplies to take with me to Mongolia. I thought surely after all this time and progress they will have appropriate supplies? I felt somewhat silly after I filled one bag and then two, wondering if it was going to be worth the extra baggage fees and effort to haul all that stuff to Mongolia. It turned out that I was glad to have every single thing I packed in those two bags, as was everybody else who threw extra things in their suitcases. I was profoundly discouraged this week that it seems that after all these years of investment, care is not progressing, and maybe even going backward. I was disappointed by the lack of integrity we kept encountering. And I no longer seemed to have the stamina for all the logistical and clinical frustration.
But then perspective enters. When we got to Mongolia, we were picked up at the airport by the father of a child we were going to take care of who then treated us to dinner. That same father got up early to take us to the airport this morning and will make sure all of our other team members make their flights as well. Other fathers provided rides to and from the hospital. These are not expressions of bribery or looking for favors. These are expressions of gratitude by men who are incredibly thankful that we would come to take care of their children. The father who took us to and from the airport is highly educated and his work involves exposure of government corruption. His salary is not great, so he does not have the means to take his child out of the country. But he’s a desperate father who loves his daughter and wants her to be taken care of well. We had incredibly honest discussions with him about the state of health care in his country. Mongolia is very rich in mining resources and many are getting rich. I am amazed by the addition of fancy hotels and restaurants and stores such as Louis Vuitton. But the majority of the population is still incredibly poor. And the riches pouring into the country are not pouring into the government health care system. There are renovations and improvements, but they are not commensurate with the amount of money we know was supposed to be spent, meaning pockets were lined and patients did not benefit. And like a lot of places in the world, they spend a lot of money on fancy machines, but not on simple supplies such as alcohol pads, IV supplies, and reagents for laboratory equipment. I come visit, work, and am incredibly frustrated by this system for one week. For people like this man and his daughter and the many Mongolian health care professionals with dedication and integrity, this is their daily life. And our coming to help them gives them hope.
“He has told you, O man, what is good; and what does the Lord require of you but to do justice, to love kindness, and to walk humbly with your God?” (Micah 6:8). It is so very easy for me to get wrapped up in concerns about my comfort, my rest, my safety, and my resources. Because of the circumstances of our life, I hadn’t been on an international medical mission trip this year, when I usually do six a year. I liken it to an athlete failing to practice and getting flabby. I had gotten flabby and comfortable and selfish. The Lord needed to send me out once again to remind me of the lesson He keeps having to teach me over and over again. I am indescribably blessed and have plenty to give out of the abundance He has given me. It’s not about me. It’s about Him and what He asks me to do for His children in His name. Keep praying!
We didn’t go to Fallujah, Iraq this week. We were supposed to. This would have been Kirk’s fifth trip, my (Kim’s) fourth, and our team’s fourth to do cardiac caths there. Our team this time was made up of Kirk, me, pediatric cardiac interventionalist Allison Cabalka, and pediatric intensive care nurse Katie Tankersley. This would have been Allison and Katie’s first trip there. We had planned this date a year ago.
I’ve written before of my coming to terms with the fact that it was possible that I was putting my life at risk by traveling to this particular place on the globe and that making me truly question whether I believe what I say I believe: that Jesus died for my sins and that because of my faith and trust in Him that if I die I will go to heaven. Coming to terms with this, I had been willing (but admittedly scared) to go to Fallujah the first time. Once I did that, saw the need, and made the friends we had there, it was easy to go back the next two times. I confess that, for me, this time was different. If you’ve been following the news, it has gotten increasingly volatile in Iraq. I understand anyone who wants to do me harm can do so at any place, any time, but I did feel safe in the hospital complex in Fallujah. It was the transit there and back by road from the Bagdad airport that I dreaded. Kirk and Allison were fearless and willing. Katie asked me at one point a few months ago if it was ok if she was nervous. I replied, “I hope so, because I am!” We termed ourselves the obedient members of the group. If the door opened, we would go. We simply prayed for the Lord’s will to be done.
About a week before we left, our visa to enter Iraq had not come through. In consultation with our partner ministry Preemptive Love Coalition (PLC), we decided to change our itinerary to go to Kurdish Iraq since that did not require a visa. We have ministered there numerous times since 2009 and always appreciate the opportunity to return. We knew there was plenty to do there while we waited to see if our visas to go into southern Iraq would come through. We arrived in Sulaimani on Saturday, November 9 in the wee hours of the morning. We slept a few hours and then went to the hospital for a day of screening cardiac kids with our dear friend pediatric cardiologist Dr Aso. (Saturday is the traditional first day of their workweek, as they take Fridays off and work a six-day week.) On Sunday morning, the four of us were able to do a comprehensive lecture on intensive care of cardiac patients with a room full of eager physicians, nurses, and clinicians. They anticipate opening a pediatric cardiac center within the next year in Sulaimani and these were the initial named staff. It was so motivating to us to see their eagerness, hear their thoughtful questions, and witness their desire to learn and take care of patients well. We might have found our reason for detouring into Kurdistan in that room that morning as Katie felt inspired to return and help them with training their pediatric ICU nurses as they open their center!! I confess we stoked this inspiration for the rest of the week and, Lord willing, feel very confident it will come to pass.
After the lecture, we did an additional day of screening on Sunday and awaited word on our visas. We were told they were likely to come through on Monday, so Jeremy Courtney, the director of PLC, spent lots of time on the phone with our friends in Fallujah trying to figure out how we were going to get there (by car or by air) and when. Dr Aso had a planned day in the cath lab on Monday, so we had a wonderful day spent supporting him as he did he four pediatric cases. We loved being able to reunite with the cath lab staff, with whom we had done several previous cath weeks. The director of the cardiac center came to visit us that day and asked us if we could return the next day and do another series of nursing lectures. We explained we were willing if our visas did not come through. We got word that afternoon that they had not. We arrived in Iraq to a torrent of rain. Evidently the rain had affected the hours that the visa office was open. The visas did finally come through on Wednesday, but by then we had elected to stay in Sulaimani. We would have had to travel on Thursday, Friday would have been a non-work day, and we had to leave the country on Saturday.
We spent some time teaching in the ICU on Tuesday morning and then screened more patients in the afternoon. Katie did a wonderful nursing lecture on Wednesday morning and we were once again inspired by the eagerness and desire of these nurses to learn. We actually had to complete the lecture in three different lecture halls because we had planned the event at the last minute and kept getting moved on from one lecture hall to another due to advanced scheduling. The nurses kept making the move with us, even when it required a move to another building. We realized they could have bowed out at any time, but kept with us until lunchtime, asking many good questions. We screened again that afternoon.
On Thursday, we got to fulfill a long held desire on our part to screen in Halabja. Halabja underwent a chemical weapons attack by Saddam Hussein in March 1988 where thousands died and many more were injured. Our friend Sarko, who serves with Samaritan’s Purse (SP) in this town, lost his parents and his legs on that day. Ever since our first visit to Kurdistan, we had wanted to visit but had been unable to. Sarko was able to pull together a screening of some forty patients on short notice. We were provided a wonderful greeting and amazing hospitality. With that and the number of news cameras on hand, it was evident that our visit was very meaningful to those we visited.
On the morning that we were to go to Halabja, Kirk read an email sent by our dear friend Nawzad, who also works for SP, in Sulaimani, the night before:
Hi Dr Kirk. I hope you all had a good day today. I just saw news saying the mayor of Fallujah has been killed today while he was visiting one of the projects in Fallujah! It is sad to hear all this bad news about southern Iraq but I am glad you didn’t go there at this time.
Dr Aso also told us he was glad we did not go to the “scary movie” part of Iraq. We hear this a lot. Not even Iraqis are willing to travel to the parts of Iraq that we are. The fact that we are willing to inspires a lot of conversation. 1 Peter 3:15 says “if someone asks you about your Christian hope, always be ready to explain it.” We pray these conversations allow us to do just that.
Interestingly, I just read an article on the plane about America’s greatest generation. There was an excerpt from a speech that Ronald Reagan gave in Normandy (a place Kirk and I were blessed to visit earlier this year) on June 6, 1984 to veterans of D-day and their families forty years after that day:
You risked everything here. Why? Why did you do it? What impelled you to put aside the instinct for self-preservation and risk your lives to take these cliffs? What inspired all the men of the armies that met here? We look at you, and somehow we know the answer: It was faith and belief; it was loyalty and love.
Now please understand that we don’t even come close to be comparable to these heroes! But the quote resonated with me. When Jeremy first asked Kirk to go to Fallujah, he said he knew he would do it out of love. That is a high honor. As the song says, “they will know we are Christians by our love.” We do have hope. And we do have faith that our God is good and in control. We are willing to submit our lives to His will to share His love.
Allison and Kirk were disappointed that we did not go to Fallujah. Jeremy and Matt, also from PLC, were profoundly disappointed. Katie is brave enough to admit with me that we were relieved! These are the emotions for which I feel guilty. Kirk prayed that the reason we did not go to Fallujah would become apparent. I don’t know if there was any one thing. Katie’s inspiration to return to Kurdistan would be worth it. All the divine appointments and reunions with friends we minister with in Kurdistan were worth it.
Getting to see a Syrian refugee baby and to hear from those who are ministering to that suffering community and to be sobered by that reality was worth it. The opportunity to go to Halabja was worth it. We love the verse James 1:27 which says that “pure and undefiled religion in the sight of our God and Father is this: to visit orphans and widows in their distress, and to keep oneself unstained by the world.” We pray that we did have that opportunity to visit orphans and widows in their distress…and somehow share with them the love of Christ.
When I heard about the mayor of Fallujah, I wondered if the Lord had protected us from something. The ways of God are so far above me. Sometimes His will is accomplished by the sparing of His people and sometimes it is accomplished by the death of His people. I am grateful for His mercy to me and our team.
Prior to leaving Sulaimani this morning, we got this message from our friend Dr Firas in Fallujah: “Hello my friends .. i hope u r doing well.. i am so sorry for this mission .. i had more than 50 patients waiting for u since 6 months & i did all the preparations .. i hope to see u in near future … God bless u .. thanks.” That brings tears to my eyes. I think as long as I am on this earth, I will not be free from this wrestling. It is amazing to me how the Lord designed us with such an instinct for self-preservation. It is the wacky paradox of the Christian: we believe in and long for heaven…but God sure made us to want to remain on this earth. Every trip is so good for me though. I live such a good life. I am so blessed. I need, on a very regular basis, to see how the majority of people on this earth live. And I need to be willing to sacrifice my resources, my comfort, and my very life to serve God’s people. As the apostle Paul said, “the love of Christ compels [me]” (2 Cor 5:14).
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.
During a recent screening in the Kurdish area of Iraq I had an interaction with a family that made me reflect on my faith in Providence.
A small team of us went to the Fountain of Love in Shoresh, Kurdistan Iraq to screen children for heart defects. Shoresh is village that was developed to be the new home for the widows and orphans that came to be as a result of the ethnic war against the Kurds. Fountain of Love is a community center that was the vision of Sami Dagher and opened in 2010. We were there to screen children in 2010 and returned this year at the request of local officials. During the 5 day screening we screened children with known heart defects as well as those that the parents had concerned because of the chemical weapons used against their family members.
There were many children with known heart defects to be screened to determine if they were eligible for surgical repair. As I was busy echoing a grandmother holding a bundled infant caught my eye. She was crying. I asked one of the nurses working with us to go and ask what was the problem. The grandmother just stated it had been a very long and trying day. It took almost fours to get the infant. Only then did I find out that this baby was only 21 days old. He was the first child of this young couple and the grandmother had come along to help. Today had been a very difficult day. Just this morning they were informed that their son had a very serious heart condition and were sent to us from Kirkuk for a more definitive diagnosis. As I was asking the family about the newborn, tears streamed down their faces. After examining the child and performing an echo, it was clear that the child had transposition of the great vessels which means the blue blood coming back from the body goes back to the body and the pink blood coming back from the lungs go right back to the lungs. Therefore, the body does not get the oxygen it needs. The infant seemed stable but there were a couple of things the family stated that had concerned me. The baby was not feeding as well as he had been a couple of days before and had vomited a couple of times; however, from everything I could see the cardiac circulation should be adequate for this child to be blue but stable. I explained that we would do everything we could to get their baby treated as soon as possible and I asked them to follow-up with the pediatric cardiologist in Kirkuk. Before they left, I asked if I could pray for their entire family. They eagerly agreed and we prayed. We all cried during that prayer.
Shortly after they left we were notified that a visiting team was in a hospital in Southern Iraq and that they were willing to evaluate the infant for possible surgical repair. We were all excited about the potential surgery for this little one. In my heart I was rejoicing as I thought about the witness of a prayer being so quickly answered for this family and what it might mean for eternity. In my mind, I was concerned about the surgery and the health of this child. We usually operate on these children during the first two weeks of life and he had been acting a little sick and I so much wanted this to be a victorious story.
The following day the family made the long journey to Southern Iraq. The distance is not so long but with numerous check-points the trip becomes very arduous. The family left early in the morning and the team at the hospital was waiting for the infant. I thought the infant would probably be operated on in the next day or two.
The next day was another full day of screening and as I was echoing another child,Nawzad, our trusted friend and translator handed me a phone and said it was the grandmother of the infant who we had seen the day before and that she was crying. As I said hello, the only word I heard through the crying was, “gone”. Between the accent and the crying I couldn’t understand anything else. I handed the phone back to Nawzad who has the bedside manner of a saint. As soon as he was on the phone it disconnected. Nawzad called back the family and was able to understand that the child had died 15 minutes after arriving at the hospital. He didn’t even have a chance to be fully evaluated. My heart sank, this was not the ending I had been hoping and praying for. This was not how I wanted to see victory. This was not the first time that I had had different ideas about how Providence should handle a situation. In the moment, trusting in Providence can be very difficult, especially when a child has just died. The bible says, “God’s ways are not man’s ways.” I find this to be incredibly true. In my mind I am able to come up with a game plan by which physical health is restored which leads to spiritual restoration and through all of this, God is glorified. That is what my plan for this family was. We just happened to be in a city very close to this family on a day their child had been diagnosed. We prayed and an answer seemed to come almost immediately that we had found an avenue to get care for this baby. The baby had made it to the hospital. Then the baby died and I find myself once again needing to find comfort in the way of Providence and not my way. I have watched Providence do miraculous work after the death of other children. But each time I wish there were another way. Or at least I wish I could have the end of the book to read. I would like to be able to reassure myself that eternity was secured for the family for a heavenly reunion with the infant who is now safely in the arms of God. Yet, if I had the end of the story it would not be faith. Therefore, I find myself trusting in a few simple truths. God is good. God’s ways are not my ways and He loves that family more than I do. As I recollect these simple truths I find comfort as I trust in Providence once again.
Providence: God conceived as the power sustaining and guiding human destiny.
A team of five of us (me (Kim Milhoan), Kirk Milhoan, Mary Porisch, Minnette Son, and Molly King) just left Iraq. Excluding trips to Kurdistan, Iraq, which I refer to as “Iraq for beginners,” this was our third team trip to “Iraq Proper” to perform pediatric heart catheterizations. Teaming up with our partner organizations Preemptive Love Coalition and Living Light International, we went to Fallujah the first time in July 2012. We returned to Fallujah in January 2013.
I’ve already confessed I didn’t want to go to Iraq the first time, was happy it went well and I survived it, and was hoping I wouldn’t be called to go again. Knowing whom I’m married to, I should have known that would not be the case. I actually don’t think I’ve known Kirk to say no to any request for pediatric heart help. I went back obediently the second time, warning Kirk that my available time for trips was limited and he would need to look for another anesthesiologist if he wanted to make frequent trips to Iraq. On that second trip, Nadwa, from Living Light International, asked us where else we travel to in the world for pediatric heart care. She challenged us to actually stop going to those places, to free up our time and resources, because other people were willing to go there, but no one is willing to go to Iraq. She’s not far from wrong. As they told us on our first trip to Fallujah, it had gained such a reputation during the war that Iraqis don’t even like to go there. It’s not overly dramatic to say our risk of death is much higher on these trips than others. I had to come to terms with that on my first trip and ask myself if I really believe what I say I do. Do I believe I serve a great, loving, sovereign God who sent His Son to die for me so that I will live eternally with Him? I do, so even though I love the life the Lord has blessed me with on this earth, I do believe heaven, whenever I get there, will be a great reward and I’m willing to stake my life on that hope in order to serve His children. As I had already come to terms with that, Nadwa’s challenge convicted me. I came to the conclusion on our second trip that the need was so great, that since I was one of the few willing to go, I would continue to go. I went on this trip willingly and, Lord willing, will continue to do so.
What was different about this trip, however, was that we went to Tikrit first, for three-and-a-half days of caths, and then we went to Fallujah, for three more. Every new location is incredibly stressful. This is no small feat what we do, taking care of children with heart disease well in international environments. We had visited Tikrit ever so briefly on our first trip because they were hopeful we would do a trip there some day. They told us then that we were the first international team that had ever visited their hospital and literally asked us not to forget them. We kept our promise to return, but I knew from that first tour that the conditions were going to be austere. In anticipation of this, I brought more supplies on the plane than I ever have. We could not have done what we did without them.
We flew into Baghdad on Friday, were met by our hosts from Fallujah, and actually driven to the hospital complex in Fallujah where we have stayed before. We had arrived in the afternoon, the time at the many required check points is unpredictable (we easily spent hours at check points on this trip), and it is unsafe to travel after dark, so our hosts felt it was safer to take us to Fallujah. We left Fallujah at 6 a.m. on Saturday and arrived in Tikrit around 10 a.m. We ate a quick breakfast and got to work, taking care of four patients that day and finishing around midnight. I found the first case so challenging from a conditions standpoint, I was ready to quit. I prayed for the will, stamina, and ability to continue and the next three cases went better. We had planned to do four cases on Sunday, but our first two were incredibly challenging and took longer than we expected, one child had eaten when they shouldn’t have, and the last child was small and therefore more challenging, so we elected to stop, regroup, and start again the next day. We ended up screening more patients that night until midnight. Sometime after 10 p.m., Kirk said he would see the thirteen families waiting at that time and no more (after word spreads that the American doctors are screening, the flow of patients seems to never stop). After those thirteen families, a baby was brought in that was not on the 10 p.m. list. That baby had fluid around his heart that would probably have killed him within days. We took that fluid from around his heart as our first case the next morning and I realized if we had come for only him, it had been worth it. We did two more cases that Monday that went well, but our work and screening still took us to our third midnight in a row. We finished with an incredibly stressful last case on Tuesday morning. We praise God that we took care of eleven children well, but it was exhausting and harrowing. We so desire to take care of children well, and not to hurt them, that it felt a little bit like doing a high wire act without a net. Our hosts were so good to us. They were welcoming and made sure we had good food to eat and a good place to sleep. The cath lab staff was helpful, hard working, and eager to learn. They were so appreciative that we were there. But we found ourselves, hilariously to us, longing to get “home” to Fallujah.
This trip was all a lesson in perspective. The first time I went to Kurdistan, Iraq, I was afraid and thought it was a big deal. Then the first time I went to Iraq proper, I was so relieved to get to the safety of Kurdistan. After going to Tikrit, I was so relieved to get to Fallujah.
I read the book “Unbroken” on the way home from our recent pacemaker/screening trip to Kosovo. It is the true story of Louis Zamperini, who was an Olympic runner in the 1936 Berlin Olympics. He became a bombardier in World War II, flying out of Hawaii. His plane went down on a search mission in the Pacific and he and two others survived in a life raft longer than anyone ever has. Their third companion eventually died on the raft, but the other two floated into Japanese territory and were held as POWs for over two years. The story is harrowing and compelling. It is absolutely unbelievable to me that these men survived the conditions on the raft or the conditions in the POW camp. Timely perspective. Reading how absolutely much they suffered and yet endured gave me a longer yardstick to measure suffering, and endurance. It gave me more endurance for tiredness, hunger, and imperfect food, bathroom, and sleeping conditions. I have felt before that these families we serve didn’t choose where they were born. For the most part, they didn’t choose the conditions they live under. But they are God’s children and I can enter into their conditions and endure fatigue and hunger, if necessary, to serve them.
The conditions in Fallujah are quite nice. We stay in a dorm on the hospital complex that we now consider “home.” They feed us wonderful food. Our hosts are gracious. It was our third mission there, so we have achieved a rhythm with the local staff in terms of supplies and work flow that allows us to work much more efficiently. We took care of 11 patients in three-and-a-half days in Tikrit. We took care of 16 in three days in Fallujah. All along the way, there were many firsts: first international team to Tikrit, first pediatric heart cath in Tikrit, first PDA device placed in Tikrit, first ballooning of a narrowed pulmonary valve in Tikrit, first ballooning of an aortic narrowing in Fallujah, the first time we’ve done six cath cases in one day anywhere internationally. Our productivity would have been amazing for home. It was really amazing in Iraq.
All week I was marveling at the new perspective I gained. I had an endurance attitude in Tikrit and my only true complaints were about making sure we were taking care of the children well. I marveled that I was excited to get to Fallujah. The trip from Tikrit to Fallujah involved one incredibly long checkpoint that lasted well over two hours and involved us being taken by Iraqi Army escort to an Army base while we waiting for the appropriately high up approval to allow us to enter Anbar Province. I marveled that my normally anxious self did not feel anxious.
I’d get a chance to check the news on the internet most nights before I went to bed. Largely, it is not encouraging. There are so many hot spots and places of unrest in the world that it is hard to keep up. The Bible talks of the End Times and that only the Father knows the day or the hour, but that we can know its season (Mark 13). That’s the dichotomy for the Christian: live like your life could go on and on until a ripe old age or that it could end at any minute. I guess that’s the dichotomy for all of us. I found myself agreeing with the Ephesians 5:16-17: “mak[e] the most of your time, because the days are evil.” The evil in the world gives me more motivation to be about my Father’s work, taking care of His children. I said to one of my teammates “with all that is going on in the world, I may as well be in Iraq.”
Obviously Mary was feeling similarly. Her devotional on our last day of procedures in Fallujah was based on the book of Esther. There is a Persian plot to kill the Jews. Esther, the Queen of Persia, happens to be Jewish, unbeknownst to her husband. Her cousin Mordecai pleads with her to go to the King to expose and defeat this plot. Esther explained that no one, not even the Queen, can go before the King unsummoned and the punishment for doing so is death. Mordecai reminds her “who knows whether you have not attained royalty for such a time as this (Esther 4:14)?” So Esther answers “Go, assemble all the Jews who are found in Susa, and fast for me; do not eat or drink for three days, night or day. I and my maidens also will fast in the same way. And thus I will go in to the king, which is not according to the law; and if I perish, I perish (Esther 4:16).” None of us on our team have a death wish and we love our lives and our families and would love the Lord’s grace to continue to enjoy them, but we have come to that peace where we can say “if I perish, I perish.” We were also struck by Esther’s request: please fast and pray. Those of you who are concerned for our safety, this story tells you what to do: fast and pray. We appreciate every prayer said on our behalf and we know they are many and effective.
As we were driving out of Fallujah to go to the airport in Baghdad, I was staring out the window as I usually do on all our drives, taking in the conditions. I saw a dusty little sparrow. I like to joke that even the animals in Iraq must ask themselves “how did I get here, instead of someplace beautiful and lovely like Hawaii?” And if the animals, how much more the people? I remembered that even a sparrow cannot fall to the ground without the Father knowing it and we are so much more than sparrows (Matthew 10:29-31). The Father knows every person in each poorly constructed house in that war-torn country and loves them the same as you and me. Everything in Iraq is so dusty that even the palm trees are covered in dust. The phrase “dry and weary land” kept coming to me, so I looked it up in my Bible and found Psalm 63, written by King David:
O God, you are my God; I shall seek you earnestly;
My soul thirsts for You, my flesh yearns for You,
In a dry and weary land where there is no water.
Thus I have seen You in the sanctuary,
To see your power and Your glory.
Because your lovingkindness is better than life,
My lips will praise You.
So I will bless You as long as I live;
I will lift up my hands in Your name.
My soul is satisfied as with marrow and fatness,
And my mouth offers praises with joyful lips.
When I remember You on my bed,
I meditate on You in the night watches,
For You have been my help,
And in the shadow of Your wings I sing for joy.
My soul clings to You; Your right hand upholds me.
But those who seek my life to destroy it,
Will go into the depths of the earth.
The will be delivered over to the power of the sword;
They will be a prey for foxes.
But the king will rejoice in God;
Everyone who swears by Him will glory,
For the mouths of those who speak lies will be stopped.
The times, justice, my life…they are all in the Lord’s hands. My soul is so satisfied with the beautiful life the Lord has given me. I know His right hand upholds me and He hides me in the shadow of His wing. His lovingkindness is truly better than life. I am willing to trust Him with mine so I can be in the position He has called me to, to serve His children, “for such a time as this.”
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?
“Woe to him who builds his house without righteousness And his upper rooms without justice, Who uses his neighbor’s services without pay And does not give him his wages. Who says, ‘I will build myself a roomy house With spacious upper rooms, And cut out its windows, Paneling it with cedar and painting it bright red. Do you become a king because you are competing in cedar? Did not your father eat and drink And do justice and righteousness? Then it was well with him. He pled the cause of the afflicted and needy; Then it was well. Is not that what it means to know Me?” Declares the Lord. Jeremiah 22:13-16
I’m flying home from an incredible nine days in Nepal; Kirk is with me after spending fifteen days. I read the above verse on the way home and it struck me. Every time we leave our comfortable lives with our material ease, reflections and conversations occur among team members about whether our lives are right or whether we should feel guilty for what we have. In theses verses in Jeremiah, the Lord is reprimanding the King of Israel for his selfishness. What struck me is He never tells him it is wrong to have these things. He basically tells him his father had them too…BUT he cared about justice and righteousness and the cause of the afflicted and the needy. And He asks the question, “Is not that what it means to know Me?” I love this. Knowing the Lord changes us…and changes what we do.
We basically went to Nepal to love…and pray they would know we were Christians by our love. Dr Kirk and Dr Minnette Son, our dedicated pediatric intensive care doctor who has served on our pediatric heart teams all over the world, joined a group of six from Calvary Chapel Maui (David and Robin Courson, Larry Boydstun, Dean Kellio, and Joey and Jess Markoya) to trek into the Himalayas and show love in whatever way possible, including delivering simple medical care. I and nurse practitioners Cathy Woodward and Lisa Matosovsky, also dedicated team members all over the world, joined them late on this trek. What an adventure the three of us had!!
We flew into Kathmandu on Saturday morning. At the airport, we immediately met our driver Sachin, whose job it was to drive us the many hours to the trailhead. We picked up our guide “Everest” (so nicknamed by us because this mountaineering guide with 20 years experience has, in fact, guided Mount Everest; we were a little beneath him, but he never showed it. He took such good care of us!). We also picked up our two porters along the way; it was their jobs to carry our overnight backpacks while we carried our daypacks. We drove from 9 a.m. to 6 p.m. over one of the most incredible roads in the world. One segment is in fact called “the most dangerous road” in the world. We ended up at a guest house in Syabru Besi in the Langtang National Park. This is where the road ends. So the only way to visit the towns and villages to the east is to walk. We walked about 8 hours Sunday and stayed in another guest house. We walked about 6 hours Monday. Kirk actually walked down and met us and walked us back up to where we held a clinic that afternoon. Their team had gone higher and farther and had had a medical clinic farther up the valley the afternoon before. Some of their team had even climbed to a high camp at 16,000 feet. We arrived in Langtang, at about 13,500 feet, about 2 p.m. and started our clinic about 3 p.m. What an incredible experience to be in this beautiful valley at the top of the world, staring up at the majestic, snow-covered Himalayas and taking care of the villagers in this Tibetan village. In order to have had this experience of going that high and far and getting to participate in the medical clinic, we had to walk down in one day what we had covered coming up in two. We figure we easily walked forty to fifty miles in three days, covering an elevation change of almost 9,000 feet. Physically expensive…but priceless!
I loved encountering the larger team and seeing the palpable difference they were making in the lives of those around them. Our little team of three had been pretty much under the radar, respecting the fact that we were three women traveling with three men and not making much of our medical experience. By the time we reached the larger team, everyone in the valley knew there was medical help around and they asked liberally. Nepali culture is also very much based on the caste system. Guides have higher status than porters. Both keep a certain polite distance from their clients. The larger team had successfully broken down these walls. It was so fun seeing them all interact and joke with and walk with and eat with and hug these members of our team. And it was fun to merge our teams so we had so much more freedom to do so with the three dedicated men who were taking care of us. The trek in itself is indescribably beautiful. I spent a day driving and two days walking, not really ministering and wondering why the Lord had me there. I felt like He told me it was a simple gift for me, just to admire His beauty. I was so thankful to the health and ability and opportunity to just do that. But I loved joining up with the larger team and seeing the impact just simply loving people was having in their lives. We all (teams, guides, porters) drove together, in a bus this time, down that same incredible road back to Kathmandu on Wednesday. I can’t describe how much I enjoyed the beauty of the scenery and the beauty of interactions on that bus. Dear Lord, we pray they met You simply because they met us.
We all got to have dinner together on Thursday night at the Rum Doodle in Kathmandu. It’s an historic restaurant with lots of trekking and climbing history. Since members of our team got to a high base camp, the whole team got to sign a big Yeti foot that will be displayed, amongst thousands of others, in the restaurant. Since our team verse was “how lovely on the mountains are the feet of them who bring good news (Isaiah 52:7),” we called our team “Beautiful Feet.” What a fun honor.
On Friday, Kirk, Minnette, Cathy, Lisa, and I joined our perfusionist friend Bart Hensler, who had arrived from San Antonio, and a team of friends from Mayo (peds cardiologist Allison Cabalka and her husband Jeff, peds ICU doctor Sheri Crow and her husband David and daughter Lydia, heart surgeon Lile Joyce and his wife Tina, heart surgeon David Joyce and his infectious disease doctor wife Joyce) to focus on heart care in Kathmandu. Allsion and Sheri have been leading this effort for the past five years and the rest of us have been honored to join them. We presented a symposium on Tetralogy of Fallot on Friday morning at the Cardiac Society of Nepal, with hundreds in attendance. The president of Nepal actually came to “open” the meeting that evening and we were all privately introduced to him. The meeting continued on Saturday and Bart and Sheri presented a symposium on ECMO (extracorporeal membrane oxygenation, basically long term cardiac or lung bypass for emergency situations) that afternoon. We all spent time at the hospital on Sunday morning observing surgeries and post-operative critical care. Cathy and Lisa presented an historic nursing conference on Sunday afternoon. Bart and members of the Mayo team will continue to observe, help, and consult at the hospital during the rest of the week.
On Saturday morning, we got to attend church at Sundar Dhoka, a ministry to lepers and disabled in Kathmandu. We had met the family who runs this ministry last year but hadn’t gotten to go to church because of our cardiac work. I’m so thankful we got to go this time! The pastor, who had been a member of a high caste family, had been paralyzed by falling out of a tree soon after he had gotten married and while his wife was pregnant with their son. They were rejected by their families and the pregnant wife had to harvest her own rice simply to keep them fed. He was taken care of in a mission hospital, where he became a Christian, and this incredible ministry was born. I love worshipping internationally because it reminds me of the universal truth of the gospel, despite language and despite culture. There was such unbridled joy amongst the “outcast” in this church that it moved me to tears numerous times.
A unique week. Three very different ministries and experiences. All, however, about doing justice and righteousness and pleading the cause of the needy and the afflicted. Is that not what it means to know Him?
I (Kim) always write these updates on the way home from our trips. I didn’t want to write the one I wrote coming home from Fallujah, Iraq (our last trip). I don’t want to write this one either. That’s because, for me, this trip was not wrapped up in a tidy little easy to explain package. It’s not Spirituality 101. It’s an advanced course in the Lord that I love. But here’s what I know: He is good and He is in control.
I always seek the Lord for the lesson of the week. This year, I selfishly sought Him for the miracle/lesson that I specifically wanted. I’m not saying that the Lord is not gracious in answering prayer. He is so very gracious and He answered so many of our prayers this week. But He is not a vending machine. His ways are not our ways (Isaiah 55:8).
There is criticism and opposition to what we do and how we do it in Mongolia. Kirk and our Mongolian pediatric cardiologist friend Dr Ariunaa have taken the brunt of this. It has been indescribably wounding. I know the hearts of these two people that I love and their desire to improve the pediatric cardiac care in Mongolia and I know the battles and consequences they have faced to do it. What I wanted for the week was miraculous reconciliation. This is rough territory. That’s why I hesitate to write about it. We desire to do what the Lord has asked us to do with humility and pure motivation. We fully confess mistakes and imperfections. We’re not perfect, but our hearts are in the right place. When opposition was at a peak a dear friend who knew all the intimate details asked us “no matter what, are you still going to take care of the children?” Our answer was yes and his counsel was that the rest didn’t matter. He is right. I have seen Kirk and Ariunaa press on despite obstacles, despite opposition, despite criticism, despite consequences, despite difficulties, despite lies, despite slander…and I truly honor them for the faith and perseverance.
They accomplished a tremendous milestone this year. Kirk started going to Mongolia at the request of Samaritan’s Purse Children’s Heart Project in 2000 in order to teach Dr Byambasuren, the only pediatric cardiologist in Mongolia at that time, how to use an echocardiogram (heart ultrasound) machine that they had donated. What a pleasure to have Dr Byambasuren still working alongside us in the catheterization lab this week now 12 years later! Ariunaa was a pediatric resident and his translator then. She subsequently trained to be a pediatric cardiologist and it is not an understatement to say that we could not do what we do in Mongolia without her. As Kirk started screening children in Mongolia, he was finding children who were too old to have their defects repaired. Some of this was because of misinformation on the part of the doctors who were referring them for care too late. He had a vision for screening in every Aimag (province) in Mongolia in order to find these children earlier and to educate the doctors on referring them for care earlier. For Hearts and Souls started these screenings in 2003. Kirk and Ariunaa have led every single one. This year during our Searching for the Broken Hearts week, they accomplished their goal of screening in every one of the 21 Aimags at a total of 27 different locations. This year, they did not find any “too late” diagnoses or any children who need to be referred out of the country for care. Their goal of improving education and referral patterns has been met. Truly well done, good and faithful servants!! Thank you to the many of you who have gone along and supported and participated and made this possible!
Dr John Kupferschmid, our surgeon, and Dr Minnette Son, our lead pediatric cardiac intensivist, went with Kirk in 2004. They realized the number of children who needed care was too great to be able to refer them all out of the country for care. Unless cardiac care was improved in Mongolia, many children would continue to die. We started our Mending the Broken Hearts weeks in 2005 and have done one every Fall since then, as well as an additional week in April one year. Bart Hensler joined us as our perfusionist (he runs the cardiac bypass pump that makes the majority of our heart surgeries possible) and I joined as the cardiac anesthesiologist. The five of us have participated in every Mending week. We started doing cardiac catheterizations in Mongolia in 2006 and pediatric cardiac interventionalists Dr Mary Porisch, Dr Allison Cabalka, and Dr Dana Janssen have been faithful servants. Pediatric electrophysiologist Dr David Bush has been faithful in screening, research, diagnostic caths, and electrophysiology care, including placing and managing pacemakers. Cathy Woodward, PhD, doctor of nursing practice, has conducted a nursing conference every year and it also cannot be understated how much she has done to transform the quality of nursing care in Mongolia. Mike Andersen joined us as a pharmacist in 2007 and we wouldn’t want to do these weeks without him. Todd Poor has been a faithful biomedical technician and we wouldn’t and couldn’t do these weeks without him and his colleagues. Kayleen Lundstrom has returned again and again as a surgical scrub nurse. Tim Sanken and Ken Seim have been faithful servants year after year, handling logistics and whatever else needs to be done. The number of other dedicated doctors, nurses, pharmacists, biomedical technicians, child life specialists, chaplains, and other volunteers who pay their own way, give up their time, exhaust themselves for a week, and serve and even return year after year are numerous and we thank and honor every single one. Forgive me for not naming every single one of you.
There is such a clear satisfaction in the accomplishments of the Searching weeks. There is satisfaction in the accomplishments of the Mending weeks too. When we started in 2005, surgical techniques were 1950s era and mortality was 50 percent. We did the first pediatric cardiac bypass case in Mongolia in 2005 and they now use exclusively cardiac bypass, as opposed to their old method, and their mortality is less than 5 percent. Mongolia is about thirty to fifty years behind pediatric cardiac surgical care in the U.S. We developed in the U.S. at the cost of high morbidity and mortality. Now that our outcomes have improved, we have low tolerance for allowing other countries to develop as we did. However, if we have such low tolerance that we don’t allow them to develop at all, more children will die. Surgeon Dr Tseengaav has been a faithful supporter and advocate since the beginning and perfusionist Drs Gerlee and Tuul have done a masterful job. Our Mending team has taken care of hundreds of children in the operating room and the cath lab and our morbidity and mortality while we are there is the same as care delivered in the U.S. But despite these accomplishments, we have encountered tremendous obstacles and opposition. And I fully confess I don’t want it to be difficult anymore. I have to remind myself of Galatians 6:9 “let us not become weary in doing good” over and over and over. And Lloyd Folsom, who served as our chaplain this year and last, when I was complaining to him and confessing anger and anxiety, had to remind me that the Lord would fight our battles for us. Oh, forgive us when our flesh rises up!
Such a great and profound lesson!! Am I seeing the hearts of others as I’m wishing them to see ours? Am I a source of encouragement for others? Am I acknowledging their efforts, their sacrifices, their accomplishments? The Lord has blessed us with an abundance of encouragement. Just recounting history and remembering the names of all who have traveled with us is a tremendous encouragement. It is doubtless that those that encourage far outweigh those who discourage. The Lord taught me this week to see and to treasure each delightful gift of encouragement. But I was still focused on the tremendous wound that I so badly want healed. As I was discouraged and praying about it as I woke up early Friday morning before starting our day, I felt that Lord telling me I was looking at man and not at Him. “[Fix] your eyes on Jesus, the author and perfecter of faith, who for the joy set before Him endured the cross, despising the shame, and has sat down at the right hand of the throne of God (Hebrews 12:2).”
Kirk started the week with a sermon at church on James 1:2-4: “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.” The trials began with getting all our supplies into Mongolia this year. We were unable to use a container as we have before, so we had to get everything there in suitcases, which was a huge logistical effort. Everything arrived, but we had to fight many battles starting throughout the Searching week to get everything through customs. These battles convicted Kirk to share the message he did. As Joshua and the Israelites did in Joshua 4, we need memorial stones to remind us how the Lord has been faithful. We also need to maintain an eternal perspective that the Lord desires to spend eternity with each of us and sometimes what we see as needless suffering is part of His plan to accomplish that goal. There’s the story of the child’s family who refused a pacemaker at the advice of their Buddhist lama and the child died, but that enabled a beautiful presentation of how the gospel is about us having a broken heart because of sin and needing to ACCEPT the free gift of Jesus’ death that is offered to all of us in order to save us that caused several people to accept Christ as their savior. There’s another story of the boy who had complications after his heart surgery that resulted in us meeting more of his family members who then accepted Christ. There’s the story of the beautiful girl that died after her heart surgery who desired her family members to come to Jesus…and many did at her funeral. He admonished us through tears to never forget that God is good despite circumstances that appear to the contrary.
Team member and cardiac intensive care doctor Heather Chandler told me on Saturday morning that the stage was perfectly set for the week with that message. We who take care of heart children are absolute control freaks. Heather told me that in spite of her wanting to be in control of everything, the Lord constantly reminds her that He not she is sovereign over her ICU and she is to use her gifts to serve Him and His children to the best of her ability and He is responsible for the outcomes.
We got everything out of customs on Sunday and in hindsight that seems just a minor annoyance. We took care of 29 children this week, 9 in the operating room and 20 in the cath lab. The second surgery on Monday was incredibly hard. We were at the hospital until after midnight and we were very concerned the child could die. What a discouraging and exhausting start to the week! But what an encouragement to walk into the ICU on Tuesday morning and see him stable and hear him cry because he was no longer on the ventilator! The Lord continued to provide grace, stamina, and good outcomes, despite the normal challenges that come with providing pediatric heart care in Mongolia, through Thursday. We were supposed to take care of two children in the operating room that day. We took care of one, finished after 4 p.m., and she seriously nearly died. We thought we were not going to successfully get her off the cardiac bypass pump and Kirk started asking team members to pray. What a beautiful picture to look through the window into the room where so many of our team members observe the operating room and see them praying, with tears rolling down their faces. There was literally a moment where the girl’s heart got dramatically better and we knew she would survive. It was absolutely a miracle and we praise the Lord for it. Another joy to walk in Friday morning and see her stable and not on the ventilator!! We have had two children die since 2005 and every year we beg God not to have to go through that again. We canceled the second case Thursday because it was so late in the day, we were all exhausted, and we always want to re-evaluate if things do not go as expected. What we do is incredibly challenging and fraught with risk and every year we do harder and harder cases because we want to teach and develop the system, but we never want to take unnecessary risk. Friday went incredibly well in the operating room. We took care of two children relatively easily and efficiently and were done by 5 p.m. An early day is always a gift and I was ready for the end of the week euphoria. It never came.
When I arrived with the surgical patient in the ICU, there was two-year-old boy Ireedui, who had been taken care of in the cath lab, who was not doing well. Kirk has known this baby since he was born. His mother is a doctor. He has very complex heart disease. He would have received care in the U.S. as a newborn. No such care is available in Mongolia yet nor is it easy for such children to get care outside the country. The longer he has gone without care, the harder it is to do anything for him and the more likely it is that he could die at any time. Kirk had counseled the parents numerous times about this. He was not originally on our cath list for the week, but we were asked to look at him again. John evaluated him with Kirk and John thought he could personally offer him some sort of repair in the U.S. (he would be far too difficult to take care of surgically in Mongolia, even with our team) but that he would need a diagnostic cath first in order to determine if he was operable. If the lungs get too much blood flow as a result of a cardiac lesion they can be irreversibly damaged and it is actually more dangerous to do a repair than to let the child live as long as possible as is. Everyone, including the parents, knew he was a high risk, challenging case, but agreed to proceed. The news with the cath was not good. And now he was doing poorly. My first concern was that he had malignant hyperthermia, a complication of general anesthesia, but we were able to rule that out. Our next concern was either a medication reaction or bacterial contamination from something that was injected in the cath lab. Our final devastating realization and current working diagnosis was that he had had a stroke. With normal hearts, the lungs can usually filter accidental air or emboli. Not so with this boy, any accidental air or emboli returning to his heart gets ejected to his body, placing his brain at risk for stroke. We think this is what happened.
No joy in the morning on Saturday. He was no better. Our remaining team had a time of tears and prayer. We spent lots of time talking with and praying with the family. And we had to arrange to transport him to the Children’s Hospital. Cardiac care is fractured in Mongolia. The surgeons, the perfusionists, and the cath lab are all at the adult hospital where we work. The pediatric intensive care unit is at the Children’s Hospital. It’s a wacky, frustrating system that I have to have Ariunaa help me understand every time we deal with it. For the intensive care that this boy would need after we left, we would need to transfer him to the Children’s Hospital. Ariunaa and I did this harrowing adventure in an ambulance that afternoon. He got progressively worse in transport and on arrival. I was impressed by the care I witnessed delivered to him there, which prompted me to have Ariunaa explain the system to me yet again. Ariunaa and I spent most of Saturday afternoon with this transport. We spent over 2 hours at the Children’s Hospital after we arrived with him there. We had some time to get away into a quiet room with just the two of us. We have never felt so discouraged. The outcome is devastating for this boy and his family. Our hearts break for them. The situation uncovers so much that is still deficient about pediatric heart care in Mongolia. And it absolutely provides fodder for our opposition. We prayed together and reminded each other that God is good, God is in control, God knew this was going to happen, and He knows the future. I confess it is absolutely tempting to quit. While we were doing this transport, however, Kirk was screening another 20 children and being convicted again how great the need is.
I’m so thankful for Heather’s encouragement on Saturday morning. We offer our hands, our gifts, our training to the Lord and His children to the best of our ability…and we trust Him for the outcomes. “Therefore, those also who suffer according to the will of God shall entrust their souls to a faithful Creator in doing what is right (1 Peter 4:19).”