So I commence the first day of my last week as a provider in the Al Asad Troop Medical Clinic. In many ways, this is a prototypical day: our internet is completely down (“River City OPSEC,” we are told, which means that some unfortunate person[s] died over the past 24 hours, and next-of-kin have yet to be identified), and we have received notice that our electricity will be going down sometime this morning and should remain out for the rest of the working day. The weather is mild for August, probably in the mid eighties as I stepped out of my canister today, and there is a fine smog of dust hanging low over our camp.

My medics and other co-workers are cheery through a bit of Monday-morning grogginess. One hour into clinic, our patient load has been fairly typical:

• A pregnant soldier. She did a home pregnancy test a month ago, which was positive, but she spent the last month hoping that it would somehow turn negative (and thus she could avoid having to officially notify anyone of her circumstances, which usually results in disciplinary action). She remains positive on our tests today, and will be flying out of Al Asad even before I do.
• Back pain (fell on the rocks).
• Sexually transmitted disease workup: Likely all this soldier has is a case of genital warts, but we will be testing for HIV and syphilis as well. He is really worried about herpes, but we won’t know if he has that until a sore shows up.
• A soldier with an enzyme deficiency which causes him to have a hemolytic crisis every so often (hemolysis = the spontaneous breakdown of red blood cells). He is fatigued and jaundiced, and since our lights just went out, he’ll be heading to the CSH (Combat Surgical Hospital, pronounced “cash”) for labs and possible transfusion/admission. Being a hematologist myself, I’ll check on him later in the day as a medical consultant.
• A crush injury to the left leg: calf/tibia got slammed into a humvee door, and the soldier likely has a bruised tibia, possibly a broken one. We shall see.

Not bad for the first couple hours of clinic. Since I started writing this, the lights have indeed gone out, but a backup system devised by SGT Evans, wherein we have limited light for the hallways and 2 exam rooms, seems to be working well. No A/C, though, and the air is getting stuffier and warmer by the minute. Can’t complain too much: at least I’m not riding in a tank with ten other sweaty men. It’s good to be a Fobbit.

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Rupard Mailbag

I had an unexpected surprise on Sunday. One of my soldiers knocked on my door at 3 PM, which is well-established as a “DO NOT DISTURB—NAPTIME” for me. The exceptions to this rule are in case of emergencies and/or mail delivery. (Yes, we get mail on Sundays here, but don’t feel too jealous: there are at least three other random days each week in which there is no mail service, usually due to sandstorms.) I opened the doors of my frosty-cold trailer, and in rushed the 100-degree heat, along with SGT England’s hand holding a priority mail package from the Ainsworths, of Evans, GA. This is my third package from Craig and Kathleen, who are good friends back home, and I ripped it open, finding not one or two, but three boxes of donuts, including some of those sour-cream kind that I love so much. I immediately brought a box next door to the lair of the Halo Cowboys, and they hopped all over them (complaining loudly, of course, that I was unfairly trying to sabotage them with carbs). Mine lasted about 55 seconds, but it was a very good 55 seconds, indeed. Brought the other two boxes in with me this AM and I got literal cheers from the medics, who gathered around.

Also in the Ainsworths’ box was a loaf of cinnamon raisin bread, some peanut butter M&Ms, and a couple of CDs, which I will be transferring to the old ipod shortly. Craig likes the same kind of quirky, guitary pop music that I like, and so far has never steered me wrong. (Last package had Rogue Wave’s “Descended Like Vultures” which has been in constant rotation for the past couple of months.)

So Craig and Kathleen and family: thanks for the sugary goodness, literal or otherwise. You have some (real) mail on the way, from my lovely vacation spot.

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Especially For Maya #2

I usually brush my teeth after lunch. I’ve kept my toothbrush in an empty “Jelly Belly” container for some time now to protect it from the dust. When I reached to get at the brush today, I noticed this tiny little fellow, who had managed to get himself stuck in the plastic jar. He was probably about 3 cm long (missing part of his tail), and his skin was almost see-through. Below are a couple of pix for you, Maya.

He’s now happily living in our “dirt garden” out behind the clinic, where he will be able to dine on some very exotic-looking bugs. I truly love those squiggly toes…

On many occasions throughout these six months, I have talked about my bicycle rides around post. I have two basic routes I like to ride. One is about eight miles, and requires some off-roading and a few hills, but has some spectacular views. The other is referred to (by me, anyway) as “the big loop” and takes the rider fourteen miles completely around the airport. That one is my favorite. I rode it a couple of days ago, and CPT Baker took his camera so that we could get some pictures.

First, the biker gang:

Left to right, you see me, CPT Daphne Sims (the other doctor in our clinic), and 1LT Samuel Coleman, our clinic administrator. I kept the wide angle here, so that you can get a sense of the terrain. The crayola boxes in Iraq have exactly three colors: dirt-brown, asphalt-grey, and sky-blue.

An even wider angle. That speck in the middle is me and my red bike. I am coming around the back of one of the strange “pyramid” structures which are some sort of bunker. These are peppered throughout the base, and form a sort of connect-the-dots around the outer loop. I have climbed on these, ridden around them, sat on them, and have yet to find a door or other entrance.

About four miles into the loop is a graveyard for Iraqi planes. I am not allowed to take pictures of much of this, and can’t climb in or on them, as there are some reports of UXO (UneXploded Ordnance) in some of them, so sorry, dad, no cockpit pictures. That bike next to the sign is the one I’ve been riding for the past few months, courtesy of SGT Hert. The yellow bands around the bike and my waist are reflective and mandatory. Dig those cool wraparound shades.

We see a lot of these mini dust-storms as we ride, and occasionally ride right through them. Once, riding with CPT Hall on our way home from dinner, a big orange one threatened to hit us, so we raced the sucker down the road, only to get caught just as we turned into our cans. These eruptions and the more organized dust devils which we encounter are usually random acts of nature, but sometimes are man-made (i.e., a Humvee racing across the flatlands). That barbed-wire fence is one of many which separates us from the bad guys.

On this very hot day (115 F), we took a break in the little shade we could find, on the side of one of the pyramid-shaped bunkers. On the left, sucking on his CamelBak Hydration System (c) is SGT Villarreal. I’m next, then CPT Sims, and finally 1LT Coleman. CPT Baker is holding the camera.

Sitting on top of the pyramid are the three amigos: myself with CPT Baker, and 1LT Coleman, the two guys who, more than anyone else, kept me sane during this deployment. CPT Joshua Baker is our Optometrist, and my next-door neighbor back in Can City. The pose here is kind of dorky, and the careful observer will note that we were all trying not to touch too much bare flesh to the very hot clay surface of the bunker.

And off we go, into the wild brown yonder. Note the thin green backpack-like thingies. Those are the CamelBaks—pouches with a plastic, removable bladder which can carry three liters of water. Crucial on a hot day, especially in combat, where soldiers will be wearing 50 pounds of protective gear in the 100-plus degree heat. I will get to keep one of these after my deployment (sweet!) and would have bought one if that weren’t the case.

These rides will take us between 45 minutes and 1 hour fifteen minutes depending upon our pace. Of the “killer Bs” that I will remember from Iraq (bikes, breakfasts, barbecues), I think the bike rides will be my fondest and most enduring memory.

On Saturday, right after clinic, we had some business to attend to: one of our soldiers was re-enlisting (SGT Ernest Hert) and two were being promoted from Specialist (SPC) to Sergeant (SGT). The promotion to SGT is a very important event in a soldier’s career, as this moves the service member into the ranks of the Non-Commissioned Officer (NCO).

The re-enlistment ceremony was first, and I was honored to have been asked by SGT Hert to administer the re-enlistment oath to him. I took a few moments to memorize the oath, so that we would both being doing it without papers or prompting.

THE OATH: “I do solemnly swear that I [name here] will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice. So help me God.”

Next, SPC (p) Castulo Vera and SPC (p) Andres Villareal each were promoted to SGT. I was asked by SPC Villareal to “pin” him—meaning that I would remove his old rank from his uniform and place the new rank on. Of course, the term “pin” is outdated, as the new Army Combat Uniform has rank attached by Velcro. (That crunchy “rrrip!” sound takes a bit away from the ceremony, I must say.) Nonetheless, I was honored to “pin” some brand spanking new sergeant stripes onto Villa’s uniform.

The woman standing behind us in the picture is CPT Melissa Thomas, our company commander, who traveled from another military base to be present for this ceremony.

Another part of the ceremony involves removing the old cap with and replacing it with a new one with the promoted rank sewn on.

In all seriousness, both SGTs Vera and Villareal are squared-away, first-rate soldiers, and will make outstanding Non-Commissioned Officers. SGT Villa has been one of the four gentlemen who have consistently worked out with and inspired me during my stay with the 581st TMC, and I am grateful to him for letting me be a part of this special occasion.

After the ceremony, the two fresh SGTs had to undergo a traditional test of thier toughness, as they were brought out into the sandy terrain next to the clinic, and underwent a series of exercises in the 110-degree heat. First were the pushups:

The tradition is to calculate the number of months that it took for each soldier to make it to SGT and make them do that many push-ups. However, since Vera and Villa both made SGT pretty quickly (3 and 2 years, respectively), the soldier standing to the right, SSG Cano-Perez (known as “C-P”) sort of intentionally lost count a few times, pushing each well over 100.

Next came a low-crawl, which requires that the soldier’s ear touch the ground at all times. This is usually done in a swampy or muddy terrain. Since we don’t naturally have anything even slightly damp in this particular desert, SGT Hert had to create some mud.

After the low-crawl, and with fairly muddy uniforms, Villa and Vera did some jumping jacks (or as we hooah Army types call it, the “side straddle hop”). Note that their feet are not touching the ground in this shot:

And a close-up of SGT Villareal, who looked like he might be getting tired of this game.

And finally, cool-down and clean-up were both accomplished in one fell swoop, with the other soldiers helping out.

Fun times were had by all. At the end of the day, we had one soldier signed up for another four years, and two other fine soldiers promoted to the rank of Non-Commissioned Officer.

Folks, it has been a long one today. For the past few days, Al Asad has been one big sandstorm, which has grounded many of our planes and created some other problems. Weather was especially bad today, with the rsult being that our clinic power was out most of the day. Because of this, I ended up seeing my last fourteen patients in the 100-plus-degree heat and considerable darkness inside of our clinic. Thankfully the lights are back on now, and the little A/C unit in my can is currently cranking non-stop. It is 9:30 PM, and I just arrived back home from the clinic an hour ago. Therefore, gonna keep it short/sweet tonight, but I do have a few thoughts to share.

Packing My Mental Baggage

For two years back in the late 1980s, I was an LDS missionary—you know, the young, clean-cut guys in suit-and-tie who ride around the city on bikes. We missionaries had a term for the peculiar behavior of those among us who were nearing completion of their 24 months, and occasionally showed the signs of being mentally “home” even before they physically left the mission field. The term was “trunky,” as in “Elder Johnson is a bit trunky, and therefore was not really excited about doing that service project.” I think that the term originally came from the mental image of a missionary sitting on his already-packed trunk, waiting for the ride to the airport. We generally forgave a bit of trunkiness—after all, it’s hard not to daydream a bit about sleeping in your own bed again after being away for a couple of years. Most missionaries fought off the trunkiness pretty well, and kept their eyes focused on the work at hand as much as possible.

I hereby admit to you that I am currently a bit “trunky” about getting back to the green green grass of home (not to mention my wife and kids, the pool, the uninterrupted power grid, etc), though I think I am mostly containing my restlessness. On days in which the lights go out, the sand slaps painfully against my skin every time I walk outside, and the heat is oppressive and uncomfortable, it is easy to dream about better days to come. The other provider in my clinic right now is CPT Daphne Sims, a pediatrician out of Ft Bragg. (And you thought I was practicing outside of my specialty!) CPT Sims and I came to Iraq at the same time, and it looks like we will leave at the same time—may even be on the same “freedom flight” home. So, we are both perhaps a bit on the trunky side. We’ve been keeping each other honest, though, and putting in a solid day’s work every day. But we occasionally talk across our shared desk of the places we’ll go, and the things we’ll be doing this time next month. Our “Calgon moment” is almost invariably interrupted by a medic telling us the sad, sad story of the patient in room three, who has “this thing” on his foot (or some other Al Asad-specific malady). Oh well, it was nice while it lasted.

Becky Anundsen, the Anti-Adkins

A few weeks ago, a study came out in the New England Journal of Medicine which demonstrated fairly clearly that the food pyramid which we have been taught for decades (the one with wheat, grains, breads and cereals as the “base” of the pyramid) is all wrong. In fact, an “Adkins”-style diet consisting of very few carbs, increased protein, and moderate fat intake appears to have superior health benefits on nearly all parameters when compared with even calorie-restricted, carbohydrate-neutral diets. When I read the study, I talked to my TMC staff about it, and the end result was that about half of us have been on a low-carb diet since the beginning of July.

That is, until last Saturday.

That was the day that two boxes sent by one Becky Anundsen (”little sis” to me, “Beckles” to everyone else) arrived via the Army Post Office. As mentioned previously in these pages, Becky’s package consisted of five boxes of cookies (sugar, peanut butter, white chocolate macadamia, and pecan choco chip), and the Al Asad TMC staff have been living off of the things ever since. All of the cookies are good, but those sugar cookies are un-be-stinkin’-lievable. They have that slightly doughy taste that all good sugar cookies must have, and they just spontaneously crumble on the tongue, as if on cue. I have not been able to stay away from that particular ziploc container. Unfortunately, I do not believe that Beckles cookies qualify as “low carb.” In fact, I have it on fairly good authority (two witnesses: my tongue and my stomach) that they are not even “medium carb.” But I simply cannot stay away, and neither can my medics.

So thanks for the cookies, Becky. Trust me, they are well worth the extra few (say 20) hours I’ll have to do on the treadmill this week to negate their nefarious effects. Well worth it, indeed.

I have spoken often of the people with whom I work on a daily basis. Here, then, a few more introductions for you, via pix of the weekend’s barbecue.

Pictured here in the obligatory card game are, from left, Staff Sargeant Carla Cano-Perez (C-P to all of us), 5′4 and with an “Hecho en Mexico” tattoo on the back of her neck, is in charge of the medics; SPC Cordero, whom you already know; SFC Catherine Langer, the Non-Commissioned Officer-In-Charge of our clinic. SFC Langer is the powerful, maternal figure who keeps our clinic together. She is a Wii-fitness fanatic, and has truly excellent taste in music, books, and movies (i.e., she agrees with me on most things).

SGT Stephen Evans, chillin'.

SGT Stephen Evans of Asheville, NC, who just got back from leave in Vegas. SGT Evans is another one of my favorite kids. A solid medic, and one of the best schmoozers I have ever known, which has served him (and us) well in Al Asad, where he has been able to finagle and trade for the things we so desperately need, from air conditioner parts to entire vehicles.

SGT Castulo Vera

And sauntering up the row of cans is one SGT Castulo Vera, known is our clinic as the World’s Tallest Mexican. Fortunately, SGT Vera is not standing sideways, or you would not be able to see him. Vera is a fine medic, and one of the few natural athletes in our company. A soft-spoken guy who doesn’t put much money in the “swear jar.”

SGT Ernest Hert and CPT Joshua Baker

SGT Ernest Hert of San Diego, CA is on the left. He is NOT soft-spoken like Vera, but is a good guy who would take a bullet for any one of his comrades, and one heck of a barbecue chef—the man of a million seasoning salts. SGT Hert will be heading to Ft Carson in a few months, but he doesn’t want to stay there; Hert loves to be where the action is, and will probably be in Afghan sometime next year, heading up a team of medics somewhere.

To SGT Hert’s right is my closest friend here, CPT Joshua Baker, who is our clinic’s optometrist (and the only one on Al Asad or any of the surrounding posts). CPT Baker is originally from upstate NY and currently from Alaska. He has been the personal fitness trainer for our entire company. He’ll be heading to Germany when he gets out of Iraq. I have publicly predicted that Baker will be the top Optometrist in the Army within 10 years. Not a tough call, really, as he is the epitome of “squared-away”: smart, in good shape, and with unimpeachable integrity. (Also, note the pre-formed beef patties on the grill.)

SGT Andres Villareal

This is another one of my favorite kids, SPC (p) Andres Villareal, who will be a SGT in one short week, and has given me the honor of “pinning” him (i.e., putting the rank on his uniform for the first time in a ceremony). SPC Villa is another one of those quiet, reliable, solid medics, who does whatever he is asked to, quickly and efficiently, with no complaining or excuses. One of my work-out buddies along with Baker, though he doesn’t look too tough here with his pink-hued leukemia water. Villa plans to get his nursing degree and become an officer.

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Finally, this little guy did not attend our barbecue (at least, not that I know of), but Maya made me promise that I would post a picture of the lizard we caught in clinic a month back (a cute little dude, and well-behaved), so here it is:

Lizard in the Al Asad TMC

Barbie

Last night we had a farewell barbecue for SPC Cordero who has, by the time you read this, already arrived at another base. Though it was sad to lose a member of our little group, the party was fun anyway. The PX here sells a very limited selection of frozen meats, including some pre-formed burgers with Vidalia onions mixed in. Combine these with the amazing assortment of spices (up to and including Montreal Steak mix) which the medics have accumulated, and the occasional (sort of) fresh buns available at the PX, and you have a pretty good barbie.

1000 Words

Our resident Marine Corps pilot, CPT Deb Turley, brought her camera last Sunday, and sent me this picture, which will give you an idea of what our humble church meetings look like. You’ll notice that all services (Army, Navy, Air Force, Marines) are represented here (note the different uniforms). Front left is Sister Turley, middle is Brother Lloyd, the second assistant to Brother Manny Diaz (second from left in the back row), who is our group leader. The woman who appears to be glowing is Sister Lott, who is wearing a night-reflective badge. This sacrament meeting starts at 8 PM, and most of the congregants walk or ride bikes to church.

Rupard Mailbag

Have I mentioned how very much American soldiers love to see those red, white (mostly), and blue priority mail boxes? They are like manna from heaven, sometimes literally.

On Monday of this week, my Norelco razor bought the farm, which is very bad news for me, as I use it to groom not only my face, but also my expansive & bald noggin. Having to physically shave my head with razor & cream is a huge pain, and usually results in a few nicks and/or not-quite-baby-smooth areas. So, I needed a new Norelco, stat.

Lorri Rupard to the rescue! I called Lorri on Monday, she went to Target (her favorite store), scored me a nice inexpensive rotary, and put it in the mail with a bunch of other goodies (Batman Pez dispensers, peanut butter M&Ms, rice krispy treats). Unbelievably, I received the package on Saturday, just 5 days later, which means that I had a nice smooth head for church today. Thanks, Lorri!

I also received two priority mail boxes from the Anundsens of Reading, PA. Beckles & Company filled those boxes with ziploc bins full of cookies, including sugar cookies, chocolate chip with nuts (woo-hoo!), peanut butter, and white chocolate macadamia. These were delivered just before the aforementioned barbecue, and were heartily enjoyed by my whole company of soldiers during said party. I have to confess, though, that one box of the choco chips remained in my trailer. I will be working through that one over the next 27 days. Thanks, Beckles!