As The Sparks Fly Upward

Another week has flown by here on Camp Cupcake—just like at home, one weekend seems to flow directly into the next (though strangely, the Monday mornings seem to be lined up together also, funny how that works). Got a few thoughts and experiences to share with you today, pretty much all over the map.

Here goes:

The Fightin’ 581st

The military unit with which I am currently serving is the 581st Area Support Medical Company. They are an active duty unit, based out of Ft. Hood, TX. The 581st deployed as a whole in September 2007, and have been running the Troop Medical Clinic since they arrived on Al Asad. This means that they had all been here for six months before I arrived, and will continue to be here for three months after I go home in September. The recent announcements that deployments will be reduced to 12 months sadly does not apply to the 581st, as it is too late for them to get an “early” replacement in Sept 2008. The unit has very good morale in spite of this, and all have pretty much accepted the December homecoming, but most of the soldiers have at least a little groundhog fever.

They do get a bit of a reprieve, though. Every member of this unit gets a scheduled “R and R” (= rest and recreation, I think) leave, in which they are allowed to go home for 18 days. The Army does not include travel time in this (which is a crucial point, as it can take easily take 10 days to get out of Kuwait), so the soldier get a full 18 days in the comforts of their own home before they have to come back out. The only downside to this (a significant one) is that they have to travel, which, aside from being among the most dangerous activities in Iraq, is also incredibly inconvenient. I’ve discussed this in documenting my own experiences getting out here (go back to March 7th-9th on the calendar at the left side of this page to read those entries), but will recap: you carry your own bags everywhere, flights are not guaranteed by any means, you can be easily “bumped” off of your flight by someone on a more crucial mission, and all trips home go through Kuwaiti bases, which are confusing, busy, and full of transients like you. But at the end of the trip, the soldiers get to be at home for a good couple of weeks, plus. I have been offered a short four-day June or July R and R in Qatar, where I would have a nice place to stay and some sightseeing to do, but I’ve taken pass. Again, the hassle and risk of travel isn’t worth it (plus, Lorri would kill me if I climb aboard any military plane of my own volition prior to the one that brings me home). But if I were gonna be out here for a year, I would most definitely take that R and R at home. Which leads me to…

Home, Sweet Home

It is pretty easy here to get to a point where one simply cannot believe that there are places in the world not besotten by dust. I took another long bike ride around the entire outer ring of the post yesterday (with CPT Baker, our optometrist) and as I looked at all of the different living areas (usually green-tents-turned-brown, or else white canister housing units), I imagined that one of them might have an actual nice, clean fluffy couch, with curtains at the windows, a chandelier somewhere, and, best of all, clean shiny surfaces on the living room, the kitchen, anywhere. I mentioned this to CPT Baker, and he told me that there is such a place, or nearly so. In one of the civilian camps, the main boss (the grand poobah, so to speak) has a large, clean trailer, with a spit-shined mahogany desk. Baker spoke of this desk with reverence, and said that the soldiers who were with him all wanted their pictures taken sitting behind that desk.

One of the real blessings of being in Iraq is the forced realization that life is so very, very good in the United States, and that many of the day-to-day things there that I used to never think about, are actually real blessings. Like being able to leave food sitting out for 30 minutes without an accumulation of dust rendering it inedible. In other parts of the world, it may be something other than the dust (say, insects, pungent/toxic air pollution, no personal space, etc) that makes the place less livable. How truly great it is to have a spiritually and physically clean place to come home to each day, to lie down in a bed and not have little puffs of brown “smoke” shoot upwards for a moment before settling back down. There is a reason why our church sees not only the family, but also the home itself as sacred.

When I was a kid, my parents very rarely went out at night or had parties at our house. Mom and dad were just about always home, doing things with the kids, cooking, cleaning, and so on. Other kids’ parents went to play bridge one night a week, bowled, went to dinner parties, or had frequent events at their houses. But the Rupards stayed home as a family. I never thought this unusual until later in life, when I had kids of my own and noted that some of my friends, including those with families, often found reasons not to go home (poker games, extra work to do, playing multiplayer Quake at the hospital), or else constantly were on the run doing extracurricular activities not involving the whole family.

I have become a homebody dad myself, not out of any sense of duty, but just naturally. I would simply much rather be in my home, watching Sponge-Bob with the kids (especially the bubble-buddy episode, or that one with the hash-slinging slasher), than anywhere else in the world. I am grateful for having been born of goodly parents who constantly sent the message to their kids that their family was by far the most important thing in their lives. Nothing else came anywhere close. I am forty years old now and, as you can tell from the blog, this hasn’t changed a bit.

Books

I have mentioned before that I brought a lot of stuff to watch, including about 5 whole seasons of shows, PBS specials, etc, and that I have watched little of it, in spite of the fact that I have more “disposable” time now than I have had since that last, lazy summer vacation before I went on my mission, in 1986. What have I been doing instead? Well, aside from Sundays, I get in at least an hour a day of exercise (trying to burn a bit of that cholesterol out of my arteries while I’ve got the chance), and I spend an inordinate amount of time writing (on this blog, as well as e-mails, real letters, etc). And I have been reading like a maniac. I re-subscribed to the Wall Street Journal. Though our mail has been erratic, I get one or two every so often at mail time, and I read through them, not quite as cover-to-cover as my dad, but I give them a good once over. Also, I have been reading actual books, including:

• Bleak House (Dickens, widely considered to be his finest novel, and so far, so good; I’ll let you know)
• War & Peace (Tolstoy—I figure if I am ever gonna read this monster, it’s gonna be now)
• Down & Out In Paris & London (Orwell, in which my favorite old-timey politico becomes an actual poor person for a couple of years, and describes how incredibly rotten it was to be poor at the turn of the century)
• 50 Essays (Orwell again. Absolutely brilliant. I am convinced that William F. Buckley ate this stuff up in his formative years.)
• The Book Of Mormon (of course; as they say, you can’t make this stuff up…)
• The Vision of the Anointed (Thomas Sowell; a brilliant conservative writer, who happens to be black, writes about how self-congratulation has become public policy.)
• They Marched Into Sunlight (David Maraniss; got this one out of the Borders bargain bin for a buck before I left, and it is awesome, sort of the “Band of Brothers” for Vietnam; depressing, but a constant reminder to me of how incredibly good I have it compared to those unfortunate soldiers.)
• Baseball Prospectus (Gotta have some fun, don’t I?)

Got a few others which I’ve recently completed or just started as well, but we’ll let those slide. The first four of those I am reading online at one of the project Gutenberg sites; the rest I either brought with me, or are audiobooks).

and finally

How to Become an Oncologist

I have had a few people ask me about the exact path one has to take to become a practicing specialist. So here’s the dealio:

After high school, the budding doctor of course has to get a four-year college degree. Doesn’t particularly matter what that degree is in (mine was English). To get into Medical School back in my day, you needed to be in the top third on the MCAT (roughly) and have about a 3.5 GPA, plus a good recommendation from the school’s pre-med program. I hear that it is a bit tougher right now, so the MCATs and the GPA may have to be higher.

Medical School is four years. You don’t do any specialty training during these four years; most of the classes (with exception of a couple of electives during the fourth year) are set in stone and the whole class takes them all together. It’s not like undergrad, where you get to choose your classes, teacher, etc. During the third year (or fourth year, in some cases), you have to choose a primary specialty. This can range from internal medicine (the only specialty with leads to most of the subspecialties, such as Oncology, Hematology, Nephrology, Rheumatology, Cardiology, Infectious Disease) to General Surgery, to Family Practice, to Pathology, and a few others. Once you have a specialty chosen, you apply for internships in that specialty. Some people do not choose a specialty at this point and instead apply for a “Transitional” internship, which can then lead to one of the above specialties (though they’ll often be behind the 8-ball a bit).

Internship is the first year of post-medical shool training, and provides more broad-based training than the later years in residency offer. It used to be that some doctors did only an internship, and then would go on to go general practice somewhere, but with the advent of Board Certification (read on), this is no longer really feasible. This is where the “slave labor” part of one’s training begins in earnest, though recently, at the threat of legislation, the US medical community has put strict rules on intern/resident hours, which has made life better for those in medical training.

A residency last from three years (Family Practice, General Internal Medicine) to 7 years (Neurosurgery). To become an Oncologist (or any of the other subspecialties listed above), the three-year Internal Medicine residency has to be completed. Then, the lucky resident gets to go through the application process all over again, for his sub-specialty training, which is called a “Fellowship.”

Fellowships are generally from two to three years. Mine was three. During fellowship, you have to take and pass the Internal Medicine board exams (two days of tests), to be eligible to board certify in the sub-specialty. The fellowship part of my training was easily the busiest, most time-consuming, and difficult. I worked my tail off, and it did not seem like I saw my family a whole lot.

When Fellowship is completed, then you get to take another board exam. In my case, I did two Fellowships in one (Hematology and Oncology, which often go together) and so I had two boards to take. I took Oncology the first year, and Hematology the next year. Did I pass? You can look it up. Just type Rupard into the “Last Name” field there.

So lets’ do the Math: 4 years of undergrad, 4 years of Medical School, 3 years of Internal Medicine Residency, and 3 years of Heme-Onc fellowship = 14 years to get some pretty certificates for my wall. Hey, Jacob worked that long, too, so that he could get permission to marry the love of his life. One might be excused for thinking that Jacob got the better deal for his 14 years’ labor. But remember: your trusty narrator got the degrees and the beautiful girl.

(Sorry, Jake.)