Blog Entry Number One (or: “So, I Am Really Going To Iraq”)
Posted by Erik Rupard on January 15th, 2008
Ladies & Gentlemen:
Strong as my desire is to spare you the David Copperfield crap, I see that it’s probably necessary to provide some background information about how I ended up in the unlikely position of “combat oncologist.” And what better place to do that than in this, Blog Entry Number One.
It all started when I walked out of the LSAT (Law School Admission Test) in the fall of 1991. That will be a story for another day/blog entry, but suffice it to say that after years of planning to be an attorney, I had an epiphany (actually, a “stupor of thought“) at a fairly inopportune moment and suddenly knew that I would not be—nay, could not be—a lawyer. I called my sweet (though understandably concerned) wife Lorri, who picked me up in the same spot she had dropped me off 20 minutes earlier, and we were back to the drawing board.
One Christmas vacation later, I was signing up for pre-med classes, with the plan to apply to start medical school in 1994. Skip forward a bit, fall of 1993, and I am swinging up the east coast, visiting Emory University, Georgetown, Dartmouth, and a funny little school with an emerging reputation, but an ungainly name: Uniformed Services University of the Health Sciences. Less ungainly but more unattractive is the acronym “USUHS” (pronounced like “useless” without the “L”), a nickname hated by all concerned, but used by just about everyone anyway.
I applied for USUHS for exactly one reason: the application was free (as opposed to the $50 to $100 for nearly all other schools). The idea of going to a military medical school has one fatal flaw in my mind: I would have to be in the military to go there. I did not then (and do not now) see myself as a military person—in fact, even picturing myself in any of the uniforms seemed laughable to me back then. But as I learned more about the school, my mind became open ever-so-slightly, as it had a few undeniable advantages.
- The Army would pay for my education. This was a big deal in an era where med student could easily rack up a quarter million in bills, and in which doctors were being paid less and less to practice.
- For USUHS (and only USUHS-this did not apply to other military medical scholarships), the Army actually makes you a 2nd Lieutenant, and pays you the appropriate salary. Back in 1994, this was around $34,000, which doesn’t seem a like a lot now, but was certainly enough for my family of four to survive back then.
- Finally, I had heard from many that the general cut-throated-ness that had existed to some degree in my pre-med classes, was ten times worse in many civilian med schools, especially the more prestigious ones. But everyone who seemed to know about these things (BYU’s pre-med advisor, other students who had friends at USUHS, even the Princeton Review) stated emphatically that this was NOT the case at USUHS-that the students there had a strong “team” concept and really got along together well.
So, as I ventured into the University, it was with an open mind. I was impressed with the campus (compact, efficient, clean, and pretty, on the same Navy base as the well-regarded National Naval Medical Center). While walking to my interviews, students randomly came up to me and told me how much they like it at USUHS, and there was a real genuineness about their enthusiasm. After my interviews, which were very much along the lines of “We’d love to have you here” rather than the “You’ll be lucky if we accept you” vibe of some of the other schools, I was pretty well convinced that I could tolerate this military thing. After I read one of the pamphlets they gave me which showed that military doctors can actually make a decent living (not millions, or even hundreds of thousands, but a “comfortable living,” as my dad would put it), I was sold.
Fast forward again:
- graduated from medical school 1998
- Internal Medicine Residency at Walter Reed Army Medical Center (WRAMC), 1998-2001 (during which I realized that my calling in life is to be a Hematologist-Oncologist (a.k.a. a “Heme-Oncker”, a specialist in disease of the blood and cancers)
- one year as staff at WRAMC
- three more years of fellowship training in Hematology-Oncology, again at the great Walter Reed AMC
Finally, at the tender age of 37, I was finally fully qualified to practice in my chosen specialty, and was PCS-ed (Army lingo for “transferred”) to Dwight David Eisenhower Army Medical Center (DDEAMC), where I currently serve as a staff Hematologist-Oncologist. In 2006, the “taskings” (requests for deployment positions to be filled) started coming rapidly to our little hospital, and I am in the second wave of specialists and generalists who will be taking a middle-east vacation this year, scheduled to deploy to Iraq, starting 01 March 2008.
And that’s how I became a walk-on part in this particular war. If someone had told me twenty years ago that in 2008 I’d have … well, you know how that sentence ends.
Congrats if you read through this entire filibuster (even if you ARE my mom!). My plan is to continue writing somewhere between 3-5 times per week from now (6 weeks before my deployment) until I get back home (and possibly after that; we’ll see how it goes). Any comments you would like to make, you can do so my clicking below and just writing. Only the profane will be edited; all else is fair game.
January 19th, 2008 at 11:12 am
Greetings, Doc! And congratulations on this fabulous blog! This will be most handy while you are away. Your absence will give mom and me an opportunity to come and visit. Nothing would please me more than to shower some TLC on your love-starved automobiles and to burn up your gas.
Your blog is also a vehicle for us to exchange views on this, a very interesting and significant political season. We can compare notes on, oh, I don’t know… perhaps some of our choice thoughts on the current crop of wholly incompetent politicos. And some of the things they are doing: as Merideth Wilson would say “make your blood boil? Well, I should say…”
We hope you all are having a wonderful time in Utah. Is Maya behaving and staying out of trouble? I will expect a full report. In your absence, mom and I will check in with the girls from time to time just to let them know we love them. We are eager for another visit and hope to witness Maddy’s and Drew’s production. This will be great! See you all soon (we hope). Meantime, drive carefully. Love and kisses to all. Dad
January 20th, 2008 at 7:07 pm
Hello,
I was looking for some inside information about USUHS and I came across your blog. Your “stupor of thought” tipped me off that your are LDS, and of course, as I read along it became more evident. I am, too, and I also have found myself opened up to the idea of USUHS. In fact, I am very open to it and think I will have a hard time deciding if I get accepted there and the U. I have interviews at both, but of course, I could be denied at both, too. Anyway, your thought process sounded a lot like mine. I am very interested in your experience at USUHS, as well as your residencies and upcoming deployment—Yes, the “Big Catch,” I like to call it. Or, most often I refer to it as the “big committment” or the “price to pay” for such a great deal.
Anyway, it’s great to see your blog. I live in Logan and work as a cardiac technician at Logan Regional. I’ve been back and forth several times on my two current choices for medical school and perhaps your experience will help.
Thanks,
Brad
January 20th, 2008 at 7:47 pm
Brad,
Indeed, being in the military is a BIG catch (though there are also some very good aspects of it–I will be discussing the pros and cons of a career in military medicine as I make further entries in this site). When all of the dust settled after the very nerve-wracking application/interview process, I faced the exact choice you mention above: between U of U (an excellent medical school, and very inexpensive) and USUHS. I had some other options, but with two kids, a wife who wanted to stay at home with the kids, and a strong desire not to drain my parents’ bank accounts or rack up 200 grand in debt, really those were the only two realistic possibilities. Though not discussed much, I believe that this is not an uncommon scenario among people who have a family already when they apply to med school.
I had already heard from and accepted my invitation to attend the U of U when I got the word from USUHS. In making my final decision to go to USUHS, I was certainly swayed by the very large degree of satisfaction among USUHS students as described above, and documented in many reviews of medical schools (though the U of U as I recall had a very “happy” student population also–something which is definitely NOT always the case for medical schools–many of my tours of the various campuses were impressive for how down the student tour guide was on his/her own institution). However, the honest truth is that biggest factor was the lifestyle afforded me and my family by attending USUHS, where I would get paid enough to live a nice (if unextravagant) life while attending med school.
USUHS itself lived up to its excellent reputation for me: I loved my four years there. My family lived on Ft Meade, and my wife felt very secure there (plus, no rent!). My fellow students were really a nice group of people, generally very hard workers, some bona-fide war heroes, a mix of people ranging from their early 20s (sort of the traditional med student age) and early forties, and there was a spirit of camaraderie there which I really liked. (FYI, fully 10% of my 165-student class was LDS!) So, I am a huge fan of USUHS, and the Army is definitely not a bad place to practice medicine, especially early in one’s career. Stay tuned to my blog, and I think you’ll get more pros/cons of military medicine. I’ve sent you a private e-mail, Brad, with my cell #–feel free to give me a call some weekend if you want to talk about it.
I wish you luck in your applications.
January 23rd, 2008 at 3:26 pm
Brad,
I don’t know if you’re still on this blog. I’m one of Erik’s friends from USUHS (though he’ll probably deny that in public) and what he says is true, but I have a slightly different take.
DON’T DO IT! Just say no. You know what they say about a deal that sounds too good to be true, it probably is.
At risk of loosing credibility allow be to be slightly more objective.
The honest truth is that every school has both pros and cons.
For USUHS, there are relatively very few (maybe none) cons while in school. The only two I can really think of are 1)that you where a polyester uniform to school instead of the more traditional (and comfortable) student apparel of jeans and a T-shirt, and 2)no one (friends, relatives, acquaintances, etc) will have ever heard of USUHS and you’ll spend a long time explaining where and what it is.
While in school, the rest is all good. You live in a very vibrant city, have beautiful, though small, campus, plenty of resources (including the aforementioned meager salary), and you’ll even do some traveling in your 3rd & 4th years (which may actually be a con if you have a family that can’t come with you).
All the cons come after. You’re restricted in which residencies you go to. Despite what people may tell you, the military residencies are middle of the road at best. After your residency you’ll have a HUGE commitment which in the current enviroment will include deployments into combat zones for 6-12 months at a time every 2 years or so. The commitment time afterward is deceptive. It doesn’t seem as long until you’re a little older, a little less flexible, have a few kids, your kids are a little older and much less flexible (and don’t want to be jerked out of the schools & away from their friends. These emotions are hard to anticipate if you’re a care free 20something or have infant or toddler children. The time adds up. 4yr med school, 3-7yrs residency, 7yrs pay back. That’s somewhere b/w 14 to 18 yrs until you get to take off the polyester, go to Logan or other town of choice, build your dream home & dream life, and live happily ever after. If you start as a 25yr guy, you’re into your forties and any kids you may already have will likely be done with high school before you finally settle somewhere. Thush he/she will never really ever “go home” since you’ll live somewhere else from where he/she grew up.
That’s my “realistic” take.
A few other random thoughts.
Unless you’re already in the military and LOVE IT, you likely will NOT like the military. The only people I know who actually like it are those who, prior to med school, “drank the Kool-aid” and learned to love the military in what are commonly referred to as “previous lives”. I don’t know anyone, honestly, that joined just for school/money and actually likes it. Some tolerate it better than others and there are a few “silver linings”, but none actually like it. I would say at least 80% of my colleagues have expressed hate for the military and military medicine. Many of my colleagues have a daily countdown of their time left in the army. Some of these are well over a 1000 days, and they just count them down. The distain for the institution can consume you if you let it.
If you do actually decide to go the military route, choose the Air Force. Erik and I are in the Army. Don’t do it.
If you do the military thing, try to limit your commitment, to 3yrs (4 at the very most). You can hold your breath for 3 years. It is only one assignment, and likely only one deployment (hopefully none, but lets be realistic). The only people I know that are really happy about their military time were those that had a very short commitment, made the most of it, then got out and lived happily ever after. A combination of a few loans and a short military commitment is a nice compromise.
There are other options. After matriculating at USUHS, my wife, who is an RN, got a job at GW university in DC. Only after that did we learn that I could have attended GW med school for 70% off due to her being an employee. I had just weeks prior declined an acceptance to GW b/c at the time (1994) it was the most expensive school in the country. If I had known, I could have gone there for less than a state school. Some practices will give loan reimbursements as part of a “sign on” once you’re done with residency. There are more ways to skin the “pay for med school” cat than the military. Use your resources and find them.
Your chosen specialty will dictate the wisdom of your choice. If you’re a pediatrician, who typically make 90K in civilian practice, you’ll likely never pay off loans >100K in your lifetime. If you’re a specialist (e.g. Neurosurgeon makein 750,000+ a year, you can pay off all your loans in one year. Additionally, over the course of your 7 yr commitment, you could easily be down 3-4 million dollars depending on your specialty. Money’s not everything, but that’s just not good business sense.
Hope this helps. It was cathartic to write it.
JT
January 23rd, 2008 at 10:23 pm
JT,
I appreciate your frankness and feedback. I know more of the positives at this point and have been looking to see the details of the cons. I need to weigh them all out and see what is best for our family. To know the reality of what I would be getting myself into is what I’m looking for. Thanks again for your comments.
Brad
January 25th, 2008 at 4:28 pm
Brad,
Its a big decision. I believe you’ll make a good one for you and your family. You’re obviously doing your homework and as you get all the information and really ponder and pray about it you’ll know whats best.
Good luck and God speed.
JT
January 26th, 2008 at 8:18 pm
Thanks JT, I appreciate it.
Brad
January 28th, 2008 at 3:41 pm
Dear Brad,
it was with great interest that I read the words exchanged by you and Erik, and also by JT. i am Erik’s sister, and so have known him for many years, about 40 or so. In order for you to fully understand and appreciate Erik’s comments about his med school experiences , it is imperitive to understand the man behind the words.
Erik is an extraordinary guy. by that , I mean, not typical in any way, more than ordinary. sometimes this is hard for his loved ones, i.e, I haven’t had a true uninterupted telephone call with him in years. He is a true techno geek, in the kindest sense of the world, and he is always tapping away, or going through a drive through, or other sundry things when he calls. However, that being said, he calls on a regular basis, and was a huge emotional support to me at a much needd time, as I know he is for others. He’s just that kind of guy. Also,he loves me, and I’m not very lovable, so he gets kudos for that .
Why am I mentioning this? Because Erik will always sees things in a positive light, and he makes it a practice in his life to make the best of almost every situation handed to him, whether good or bad. I believe it is not a concious efort on his part, he is just like that. He has had many good things happen in his life, but also more than the typical person’s challenges, most of which weren’t a result of Erik’s actions, just bad luck. I can truthfuly say that given any circumstance in which someone is given the opportunity to rise to the occasion, or justifiably sink in despair or frustration, Erik has done the first almost every time. This attitude in facing life’s challenges is without a doubt one main reason his experience at USUHS was a positive one. He chose for it to be, and so it was. There is no doubt that one’s faith in the gospel, and one’s faith that the Lord hears and answers our prayers sets a person up both spiritually and temporally for a good outcome in life. If you expect to look in the mirror and see a happy person, chances are good that you will.
My point isn’t to tell you how great my brother is, just to tell you how my brother is. Brad, if you are lucky enough to have this kind of temperament, and wish to work in an environment such as Erik described, where there is no malpractice, you get to serve your country and fellow man, you get to have much say in where you live, based on how well you do in school and how valuable you make yourelf to whatever branch of service you choose, you will be very happy. Please note that in Erik’s entire stay in the Army, he has moved only once, and that was at his request. His children have lived very stable lives in terms of schools, etc., and lets face it, time passes no matter how you spend it, so it’s really immaterial whether you are 35 or 45 by the time you finish. The money to be had is such that one can live quite comfortably with a relatively large family. I would say if you asked my brother whether or not he was financially content with his lot in life right now, and he only has up to go, he would without a doubt say “yes”. But, please keep in mind that my brother feels like a rich man already. He more than adequately provides for his family and his needs, most of their wants, and his kids are happy and healthy. His wife is happy,and he loves his work. He contributes evey day to the quality of life to many people as an oncologist, and he has no HMO or other insurance companies telling him which drugs he can and cannot use in treating his patients. As an Oncologist/hematologist, this is especially important, because many of the prefered drugs in cancer treatment are considered either experimental or too expensive for an hmo to approve. Thus Erik feels his patients get the best healthcare available to them. Really, when you think about the people in this country who are certainly deserving of the best medical treatment available in modern medicine, it is the families and soldiers who protect our country at the risk of their own safety.
Someday, Erik will leave the service, and I guarantee you it may be with mixed emotions, but it win’t be in a huge sigh of relief. All he has learned as an adult he has learned from much revered teachers and colleagues who were and are soldier doctors themselves. Do we wish he didn’t hve to go to Iraq? Of course, and I am not willing to trade his life for any service he provides there, but he’s not mine to keep, and I can only hold onto him in my heart and keep the knowledge that he will be safe in the arms of the Lord wherever he is.
But…I’d give multiple much used body parts to keep him out of there if I were able to strike such a deal and not a day goes by that I don’t feel pain at his going. He is completely irreplaceable, and I’m not ready to even consider anything but Erik coming home again to us fully in one big healthy piece.
Erik is my little brother, but I try to model many aspects of my life around his, especially his ability to make good out of not so good. It is rare to meet someone like that in your life, and when you do, you know it and you cherish it.
So, Erik’s answer to you was completely honest , because that is how he ses things in life. He’s one of the golden boys.
November 15th, 2008 at 12:43 am
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