It is too early yet to know what my daily routine will eventually entail (i.e., I am still figuring out whether I will exercise in the morning or at night), but I have had a few people tell me that they would like to know about my typical day. So, for the curious, here is how my day went yesterday, start-to-finish. For the not-so-curious (or not-that-curious), well, at least there are some pictures.

7 AM: I wake up to the little $3.95 battery-powered Elgin alarm clock on my dresser. Actually, I was awake a bit earlier than this, but remained in my little warm cocoon until the alarm made me get out of bed. Bathroom, shave, dress, eat a PopTart (brown sugar cinnamon, of course—Is there any other kind?), and out of my canister, into the very bright Iraqi sun. I walk to work, and arrive by 8 AM, where my medics are gathered around their table, getting clinic ready for the day.

People do a lot of walking on combat-zone bases, as cars here are rented and very expensive, around $1000-plus per month, though you can’t beat the on-base gas prices (free!). There are three bus routes which run all day long, and are free, so if you don’t want to walk, you can wait at one of the many bus stops, and catch the bus to wherever you are going. So far, I’ve taken the bus one time. After it stopped, as I waited to get on, I watched a truly unbelievable quantity of very young marines in their PT gear (green on green) come off of the bus in front of me. It was like one of those surreal Monty Python scenes, where far more people come out of a small area than could actually fit in there. And when I got on the bus, the smell and humidity made it very evident that a bunch of sweaty kids had been crammed into the thing. That was my last bus ride for a while. But I digress…

8AM: Clinic starts, and the medics start seeing the patients. It takes a medic a minimum of 15-20 minutes to have the patient ready to “present” to the staff, so I’m really not on the clock until around 8:30. I use this time to make myself some Gatorade from the distilled water bottles they give us and powder packets that can be picked up at the mess halls. I also may sneak in a Diet Coke, though I am trying to cut those down and eventually out. We’ll see how that goes. I also get my notes from last night completed, if I had any left over. Finally, I’ll get a wipey of some kind, or a cloth, and clean the overnight accumulation of gritty dust off of everything: my chair, my desk, my keyboard, my Panasonic Toughbook’s touchpad, etc. This battle against dust, about which I have spoken before, is a constant one. I am not winning it.

8:30 - around 11:30 or noon: The medics see the patients, and then they come and “present” them to me, which means that they give me a brief summary of why the patient came into the clinic, what the past medical history is (usually not much for the group of patients we see), the physical exam findings, and then a brief assessment and plan. This should take about 3-5 minutes, but may be longer depending upon the diagnosis. I use this time to teach my little grasshoppers a thing or three about medicine, and they sometimes they throw a few tidbits back in my direction. We see the patient together, and I do whatever exam maneuvers are necessary to confirm the diagnosis, and the three of us (medic, patient, and doctor) talk in plain, understandable terms about what we think the diagnosis may be, and how we plan to treat it. The medics write the notes on the dreaded AHLTA system (though it is streamlined a bit out here, and hence not as painful), and I co-sign them. We get through about 3-4 patients an hour this way (with my colleague, Nurse Practitioner LTC Bullock-Price, doing roughly the same thing), and we go until noonish, when we…

NOON: …head to lunch. The vehicle which gets us there is a very dusty (of course) Mitsubishi bus, runs on diesel, which I have noted is the Official Smell of Al Asad.

We have a choice of two DFACs (mess halls), the smaller “rat” DFAC, or the big “Warrior Hall.” Both have their charms, but we all prefer the bigger one: easier to find a place to eat, a bit more selection. On Al Asad (and most other combat zone bases), if you are a uniformed military member, you cannot go anywhere (except the gym) without your weapon. For most soldiers, the weapon (don’t ever call it a “gun”; that is a baaaaad word in the military) is the good old M16 rifle, a military staple since 1964. I have an M9 semi-automatic pistol, and I am grateful for it, because it is not nearly as much of a pain to lug around. Before a soldier is issued either weapon, he has to learn how to completely dissassemble and clean it. I always enjoyed learning this, and occasionally will take mine apart, clean it out, oil it, and put it back together, partly to make sure it is in working order, and partly just for the fun of it. They taught us how to do all of this stuff at CRC, like so:

[picture removed upon request]

A quirk of Al Asad is that, before a soldier can enter any public building (including our clinic), he/she must “clear” the weapon: point it in a barrel and open the chamber to ensure that no ammunition snuck in there. After the fiftieth time, this seems rather redundant (especially for someone who rarely fires a weapon), but it’s probably saved a few lives along the way.

Ladies and gents, I apologize, but I’m gonna have to cut it short here. We had a couple of unexpected surprises in clinic today (nothing bad, just time-consuming) and after a run and a shower, it is already late and I really need to hit the sack. Will continue this tomorrow…