Fixing Iraq's Bleeding Heart

ON THE SEVENTH FLOOR of Karbala’s modern Al-Kafeel Super Specialty Hospital, in a white-tiled operating room, Dr. William Novick has Dua, a 12-year-old girl from Baghdad, on the table with her chest cavity clamped open. Alongside three Iraqi doctors, the surgeon is struggling to repair the girl’s failing artificial heart valve. The room is quiet and cool, an icy cocoon insulated from Iraq’s desert heat sweltering just outside.

After eight hours of work, Novick pushes away from the table and peels off his bloodied blue surgical gloves. “Close her up,” he says. He reaches for his cane, gently stands up balancing his large frame, and slowly limps out of the operating room, exhausted.

Dua’s condition remains critical. It’s complicated cases like this one that Al-Kafeel hospital reserves for Novick and his team of physicians, imported from around the world, which make up the Novick Cardiac Alliance (NCA). All of them are committed to saving children’s lives in the world’s most dangerous countries.

Thirty-six hours later, in the pediatric intensive care unit (PICU), Dua’s vitals inexplicably go into free fall; monitors flatline as she drops into cardiac arrest. The NCA team begins an emergency procedure, frantically reopening Dua’s chest to reduce pressure on her heart. Novick reaches into her body and starts handheld compressions – Dua’s heart literally in his hand as he pumps blood through her veins. “We’re out of options here,” says Novick, after a few minutes. “We’re going to have to call it.”

The PICU falls silent as Novick falls back into a chair in the middle of the room – shattered, but not defeated.

“YOU HAVE TO LIKE FANTASY,” Novick explains the next day as be taps a coil of ashes into a tray on the coffee table in front of him. He's watching Harry Potter and the Half-Blood Prince, in English with Arabic subtitles on a flatscreen TV, chain-smoking in the shared quarters of a quiet guesthouse on Karbala’s dusty east side. Next to him is a basket filled with pain meds. A white neck brace from a car accident sits abandoned on the couch, and a beat-up wooden cane – the vestige of a life-threatening foot infection years ago – leans against the wall.

“I’ve read all of the Harry Potter books at least two or three times,” says Novick, 64, an imposing, bearlike man. Fantasy seems justifiable escapism for the Tennessee-based surgeon, who has logged more than 60 medical missions to Iraq with a team that has performed more than 1,100 surgeries. Dua’s death has hit him particularly hard, but he’s used to the struggle.

"Pugnacious is part of the NCA mentality,” says Novick as light another cigarette. “You have to bite it, hold on to it, and make it happen.”

Novick’s career as a globe-trotting pediatric cardiac surgeon began in the early 1990s, while he was still in residence at the University of Alabama. A Nigerian child came to the university hospital with a rare but treatable condition – if it had been fixed when she was 1 or 2 years old. Unfortunately, the girl was already 12 when Novick’s professor performed a procedure that bought her just some additional time. After her discharge, Novick had nightmares every night for six weeks. “I was chasing her on an open plain, and just as I was about to catch her, she fell off a thousand-foot cliff,” he says.

When relaying the girl’s story to some colleagues from Bogota, they asked Novick if would come down and aid a pediatric heart surgery program in their country. “I spent two weeks in Bogota helping them operate on poor children,” he says. “And when I returned to Birmingham, I told my boss I wanted to help kids in developing countries so that they would not suffer like the Nigerian girl.”

After two medical missions to Colombia and two to Croatia (during the breakup of the former Yugoslavia), he saw firsthand where the absence of qualified heart surgeons met a backlog of sick children. Novick quickly gained invaluable experience working in Ukraine and Belarus on the “Chernobyl kids” – pediatric cases involving some of the worst cardiac anomalies born from the 1986 nuclear disaster. In 1994, Novick started the International Children’s Heart Foundation (ICHF) to treat children suffering from congenital heart defects worldwide, but later split with the group over differences regarding where they would operate. His personal credo: “Screw politics, screw religion,” he says. “I don’t care who you pray to. I’m here to help.”

With that charter, Novick has been operating inside the world’s most dangerous countries and geopolitical flash points for the past 27 years – Colombia, Nigeria, Iran, just to name a few – and can back up his boasting. In Belgrade, Serbia, in 1999, he refused to stop performing an open-heart surgery on a child while NATO air strikes hit the city, rocking the hospital. In Libya in 2014, when Western embassies were pulling out, Novick held steadfast to his plan to build a world-class heart surgery program at the Tobruk Medical Center, just 70 miles from the ISIS stronghold of Derna.

In 2008, Novick was visiting the Pakistani army headquarters in Rawalpindi and was introduced to the U.S. undersecretary of defense, who asked, “Dr. Novick, is there anything we, the United States government, can do to help you?” Novick responded “Mr. Secretary, yes, you can help us, and what I’d like you to do is go home and tell President Bush to quit bombing the children that I operate on.”

In spite of his gruff demeanor, Novick is highly respected by his staff. Stacey Marr, an advanced nurse practitioner from the U.K. who has worked closely with Novick in numerous hostile environments worldwide, concedes that Novick can be difficult but is also “perhaps the best pediatric heart surgeon in the world.”

NOVICK DOESN’T CARE what people think about his politics or his career; he just wants to save children’s lives – especially in Iraq. Outraged in the early years of the U.S.-led coalition to topple Saddam Hussein, Novick aligned with then secretary of state Colin Powell’s famous Pottery Barn war-room ethos of “you break it, you buy it.”

“I had a strong moral feeling, as an American, we had broken this country badly, and we had a responsibility to help provide some sort of a return to a semblance of normality,” says Novick, who made his first trip to Kurdistan, in northern Iraq, where security was sketchy. “There was a fair amount of insurgency going on.” Iraq’s vice president, Adil Abdul-Mahdi, invited the doctor to Iraq in 2009 to tour possible hospital sites in Baghdad and one in Nasiriyah, in the south, where it was relatively safe. “The drive from the airport was lined with concrete barriers, I think they were 12 maybe 15 feet high, so snipers couldn’t shoot you on the way from the airport into Baghdad,” says Novick.

“I toured three sites in Baghdad sand one in Nasiriyah accompanied by the chief of staff for the vice president of Iraq,” he says. Adul-Mahdi ultimately pulled together enough financing to build the new Nasiriyah Heart Center, where Novick quickly launched a pediatric heart program.

“We did that for a couple of years,” says Novick, who by 2012 had also built satellite programs in Najaf and Bazra, also in the south. Keen to expand ICHF’s footprint, Novick requested his colleagues at the heart center to take him on a tour of the newly constructed hospital in Fallujah, where ISIS was now a growing concern.

“We made a one-day tour of a new medical facility there, which was fully barricaded,’ says Novick. “Weeks later, ISIS overran Fallujah, blew up the hospital, and reduced it to rubble – it was terrible.”

By the end of 2014, the Islamic State had nearly taken over half the country, wreaking havoc on already war-weary civilians. But Novick’s perseverance led to the start of another NCA pediatric heart program in 2015, this time with his newly formed NCA at Karbala’s Al-Kafeel hospital, a well-funded facility with high security.

U.S.-backed Iraqi forces ultimately pushed ISIS out of Mosul in 2017, but the country is still waging an ongoing war on terror: random suicide bombers and armed attacks have created a massive security challenge. Soldiers wearing desert camo and wielding AK-47s man the country’s heavily fortified security checkpoints. This remains everyday life for Iraqis.

IT’S FRIDAY AFTERNOON, and Novick is upbeat, making bed rounds in the PICU. Wearing a white physician’s lab coat, he personally checks the vitals on six of the children he’s operated on over the past several days, all of them recovering nicely. The parents, mostly mothers wearing head scarves or dressed in full black niqabs, are playing at their childrens’ bedsides. For Novick, this is a sort of victory lap, and his stethoscope drapes around his neck like a decorative medallion.

Saif and Ashmaq, a 20-something couple from Mosul, arrive minutes later, eager to reconnect with their eight-month-old son, Sajad, on whom Novick performed reconstructive valve surgery the night before. When the U.S. invaded Iraq 15 years ago, Saif and Ashmaq were just kids themselves. They remember their parents fighting the U.S. military and have grown up in the troubled aftermath. Novick taps his cane across the polished floor tiles of the PICU, greets the family with a universal smile, and tickles Sajad’s tiny feet. These are his kids, both generations.

“What do parents want for their children?” he asks. “They want them to be healthy. They want them to be well-fed. They want them to be educated, and they want them to be more successful than they were. You can ask anybody in the world that question. Anybody in the world.”