Many e-mailers and a few commenters have asked me about the people with whom I work in the clinic. I thought I’d take the time over the next two nights to explain a bit about how our clinic is organized; I think our staff “layout” is likely similar to those in other large Troop Medical Clinics in Iraq. I will discuss some necessary preliminaries tonight, and will discuss our clinic specifically in tomorrow’s post.

First, to offer some perspective: On Al Asad, there are at least six places to which a sick person can go and be seen by an bona fide physician (MD or DO). This rather large number of facilities surprised me when I got here; I had presumed that Al Asad had two clinics and that we were the smaller clinic, and the Combat Surgical Hospital (or CSH, pronounced “cash”) was the larger one. But I did not know how very many soldiers/sailors/airmen/marines we have here. I can’t give you that number here, for security purposes, but suffice it to say that we are a good-sized community. Like the CSH, our Troop Medical Clinic is also a big fish in this pond; we have a fixed facility with an MD, a PA, ten medics, one pharmacist, and one soldier who doubles as our lab technician and our medical records clerk. To be clear, the CSH is much larger in terms of staff (around a dozen doctors, at least that many nurses, an entirely staffed lab, pharmacy, operating room, emergency room—essentially all the things you would expect in a small community hospital). However, by all accounts (from my friends who work at the CSH), we are considerably busier than them, at least on a per-provider basis.

Probably busier still, however, are the “one-doc-shops” sprinkled throughout Al Asad. I don’t know where all of these are located (I think that is by design—there is a certain amount of “mandatory ignorance” in all things military during wartime), but they likely represent one- or two-room facilities in larger buildings. I think of a time many years ago, when I was a student at the Uniformed Services University of the Health Sciences, and was lucky enough to have been randomly assigned to the White House for my “Introduction to Clinical Medicine” class. We met with the White House physicians at that time (Drs. Cavanaugh, Mariano, and Elting) in a small “clinic” on the first floor. I suspect that some of the Marine and Navy units here have similar set-ups, so that they do not have to travel too far to get seen. Also, there is a tendency for members of the Navy to trust Navy doctors more than Army, and vice versa. This is silly, but I have found it to be the case quite often, outside of the medical centers where everyone works together.

So we see mostly Army personnel, with a lesser quantity of Navy and Marine servicemembers, and just a few Air Force. We also see DoD civilians and TCNs, as I have mentioned previously in the blog. I have an additional duty, as I have been designated (by nothing more than happenstance) as the Hematology consultant for the OIF theater of operations, and thus I have seen about one patient a week as a blood specialist; these specialty patients come in all uniforms.

The bottom line to all of the above is that there are multiple medical facilities here on Al Asad; we appear to be the second largest of these in terms of patients.

Now, before I get into how our clinic is set up, allow me to digress for a moment to discuss Army ranks, with some commentary.

ENLISTED
E1 (Private, PV1) – Our clinic has none of these. This is the lowest rank, reserved for those who are still in basic training. The lowest of the low.
E2 (Private, PV2) – Again, none of these, and they are rarely seen in theater. These kids are usually a bit too green for deployment; the only one I’ve seen here was a PFC who was busted down a rank for misbehavior. Soldiers who stay here too long after completing basic training, do not end up remaining in the Army for long.
E3 (Private First Class, PFC) – Again, we have none in our clinic, though most units here have a few. These are usually young guys who are moving up in the world, but still have a ways to go.
E4 (Specialist, SPC) – Soldiers of this rank are everywhere; probably the most populous rank in theater. Of my ten medics, we have six E4s, two E5s, one E6 and one E7. In some cases, E4s are in a position of authority over other E4s and lower ranks, and are called Corporals.
E5 (Sergeant, SGT) – Soldiers who rate E5 or higher are referred to as “non-commissioned officers” (NCOs). This is less of a “worker bee” position, and a bit more into the leadership and admin stuff. The great majority of E1-3 make it to specialist, but less than half of SPCs ever make it to SGT. These soldiers are expected to be top-notch, and to be an example to their fellow soldiers.
E6 (Staff Sergeant, SSG) – A sergeant with a bit more authority.
E7 (Sergeant First Class, SFC) – Yet more authority. Takes many years as an NCO to reach this level.
E8 and E9 get tricky, as there are multiple levels of each, with names like 1st Sergeant, Master Sergeant, Sergeant Major and so forth. Suffice it to say that even most careerists do not attain these ranks, and that these soldiers are generally cream of the crop, hard workers, and respected by their inferiors. We do not have any of these in our clinic.

OFFICERS
O1 (2nd Lieutenant, 2LT) – What I was for four years as a medical student; again, the lowest of the low. Though 2LTs outrank the higher enlisted personnel on paper, the reality is quite different. Those who do not show the proper respect to NCOs will severely limit their military careers.
O2 (1st Lieutenant, 1LT) – Usually an automatic upgrade after a year or two as a 2LT in the regular Army; in the Medical Corps, we skip this rank when we graduate, and become O3s. Low-ranking officers are (fairly or unfairly) not always respected a ton by the rest of the Army: higher officers see them as peons, and enlisted personnel see them as “greenies” with little practical Army experience.
O3 (Captain, CPT) - What I became on graduation. For most people, this is a six-year rank or longer. Again, precious little respect.
O4 (Major, MAJ) – As with E5, this is where the weeding-out starts to occur. Most lower officers do not survive this far, for various reasons. Majors get a decent amount of respect, as theye have generally been around for a while. In the Medical Corps, however, this is an “automatic” promotion as long as the doctor does not have a big black mark on his/her record (i.e., can’t pass the physical fitness test).
O5 (Lieutenant Colonel, LTC) – Getting up there. More respect, and most of these on-post get a “wet trailer,” i.e., a shower and toilet in their can. Not too shabby.
O6 (Colonel, COL, “full bird”) - Really hard to get here, though less so in the Medical Corps. This is a position of a great deal of authority, and these folks have generally earned the respect which they get from everyone.
O7 through O-10 (Generals of various types) – A tiny percentage of officers make it here, and practically no medical corps people. At Walter Reed, I saw Generals in the hallways every day, but since I left that place, sightings are relatively few and far between.

[To be continued...]