You have reached the preserved-in-amber version of a blog I kept while serving as a military doctor in Iraq between March and September of 2008. If you are new to my site, the best place to start is on page one (the bold blue appearance of this sentence is a clue that you are supposed to click on it), and then just use the arrows in the upper right corner (or the calendar at lower left) to work your way chronologically through the blog entries.

For those who are interested, I am now back in Georgia, working at Eisenhower Army Medical Center on Fort Gordon, GA, and life is very very good. Thanks to all who read, wrote, or contributed in any way to this web site, and especially to those who supported me with prayers, packages, and letters.

–EJR, November 14, 2008

Today was bittersweet, as three members of my company left Al Asad for elsewhere. CPT Daphne Sims, the pediatrician who will be on the same freedom flight with me in a couple of weeks, left to take care of some business before she goes. CPT Sims is one of those people who seems to always be happy, and genuinely so. She was fun to have around for the three weeks we had her. We’ll meet again in Kuwait soon.

Also leaving today were SSG Clementina (”Carla”) Cano-Perez, the 5′2 Staff Sergeant who is sort-of the “floor boss” of our clinic, keeping things moving and ensuring quality care is given and received by all. She is one of those rare leaders who is able to get tough with her soldiers when necessary, but also maintains a friendly, professional relationship with all of them. SSG C-P is a truly great medic, and a great Army leader. She has aspirations to go to Physician’s Assistant school, and is one of those self-motivated people who will excel at anything she chooses to do. She is going to an Audie Murphy competition which recognizes outstanding Non-Commissioned Officer, and it won’t surprise me if she comes back with a new medal. Unfortunately, I will not be here when C-P returns, so we said our goodbyes tonight.

Finally, SFC Langer, who is the ranking enlisted soldier in our unit, has also gone to Audie Murphy. SFC Catherine Langer is the strong maternal figure for our clinic, and has kept us on an even keel with her very steady leadership style. I have noted on several occasions when SFC Langer has made sacrifices for her soldiers (including this soldier) which have often gone un-noticed by the recipients of her kindness. She is a sweet and fun person, and is also aspiring to become a Physician’s Assistant, and again would excel at it. For both of these soldiers, I’ll be honored to write a letter of recommendation.

Clinic has been hectic over the first days of this week, but we were blessed today to have electricity throughout the day, with only a few flickers here and there. I was going to take tomorrow off to get some things ready for my impending travels, but with the departure of CPT Sims, I am a lone man in the clinic, so will have to find another day to get my stuff together.

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Got the following e-mail from my Dad today, and it made me smile just to read it, so I thought I would share it here. The kindness toward all living things is very very typical of my goodly parents.

Funniest thing: I mowed the lawn, today and after it was done, I came back to go into the house by the back door and I saw two little birds that appeared to have fallen out of the tree (the one adjacent to the big kitchen window). We had a summer storm last night and perhaps they were blown out of the nest. We looked around and saw the nest high up in the tree. I got my ladder and gently put the birds back in the nest with their bro/sis. While cutting the grass, I think I may have mowed over the top of them both, without injuring them. They may be a bit hard of hearing for a while, though. Mom and dad bird were close by and mom covered the nest a few minutes later. If the little rascals don’t fall out again, they should be ok. Maya might be interested in this little woodland drama since she is our resident omnitologist, loving all things living.

To my friends (and nieces) in the Waterford, Connecticut Young Women’s Program (and your leaders):

Yesterday was kind of a “blah” day in our clinic. It was stiflingly hot outside, the flow of patients was slower-than-usual (often happens when it is really hot out—even the sick people don’t want to leave the air-conditioning to get seen), and there was just not a whole lot going on.

At around 3:30 PM, we sent a medic out to pick up the mail. When he returned to clinic at 4:15, he looked pretty glum, as he brought in four priority mail boxes, and not much else. A few of the medics got up when he walked through the door, but he shooed them off, saying “don’t bother; it’s all for MAJ Rupard.” I looked at the return addresses, and knew right away that the boxes were from you, and were not just for me, but for everyone. When I explained this, everyone got pretty excited again, and we gathered around the boxes and opened them, one-by-one.

Some of the great things in the boxes included:

• drink mixes by crystal light (and other brands)
• lots of great books for our clinic library, including a couple of my all-time favorites (”Holes”!!)
• Quaker Granola Bars
• Peanut M&Ms
• Peanut Butter M&Ms (woo-hoo!)
• kudos bars
• gum
• Chips Ahoy cookies
• and a lot of other good stuff

In short, the boxes were packed with sugary (and sugar-free) goodness. By far, my favorite thing were the letters, though, which are so sweet and heartfelt.

So, to the young women of the Waterford Ward, and to your adult leaders, please accept a grateful “Thank You” from me, the medics, and the patients of the 581st Troop Medical Clinic in Al Asad, Iraq. Your generosity and kindness has touched many lives. There are a large number of soldiers and Marines out here who rarely or never receive packages from home, and the efforts of people like you go a long way toward making deployed life just a bit nicer for all of us.

Your brother,

MAJ Erik J. Rupard, MD
Medical Officer-In-Charge
Troop Medical Clinic
Al Asad, IQ

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.

Got a quick one for you tonight, as I am getting in late after the 8 PM session of church today. Early this week, I’ll have some neat pix from the weekend, in which I got to administer the re-enlistment oath to one of our SGTs, and to pin the new rank on one of our Specialists as he was promoted to SGT.

But for now, this one will have to suffice. It took me nearly six months, but I have at long last found that we have our very own Home Depot here on Al Asad. I came across this little store today as I was driving around with some fellow soldiers:

Al Asad Home Depot

Actually, I am pretty sure that this particular franchise has nothing to do with the real Home Depot company, as the “Al Asad Retail and Household Materials Store” had a kind, knowledgeable, and helpful salesperson, something virtually unheard of back in the states.

So, one question remains: Dad, would you mind coming over and helping me put in a deck off of the back of my can? I’m thinking six by eight, mahogany…

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.