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

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.

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

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.

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…

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.

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.

——————–

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

This week’s Saturday-to-Sunday routine was fairly typical. On Saturday night, my neighbors and I had our usual get-together, in this case to watch Band of Brothers just outside of our cans on CPT Baker’s ridiculously oversized big-screen laptop. After two episodes, a few of us hopped into Barney and headed to the DFAC for “midnight rats,” the half-dinner-half-breakfast meal served for those workers who can’t get to the regular meals because of work. I had a nice omelet, a couple of waffles, and grabbed some cereal for Sunday morning. Back home around 11:30, at which point I caught the remainder of the (crummy) Red Sox game versus the Angels on AFN. I usually stay up late on Saturday nights, because I don’t have to be anywhere on Sunday until 1 PM (first church meeting of the day). So, on Sunday morning, I attempted to catch up on my sleep.

I choose my words carefully here, because the reality is that, though I attempt to sleep late every single Sunday, I rarely succeed. This failure is, in itself, remarkable, as it is truly difficult to conceive of a more sleep-friendly scenario than mine on Saturday nights in Al Asad. To wit:

• I have no work to get to in the morning, since I’m generally off on Sundays.
• My family is out and about doing their own Saturday stuff thousands of miles away, and they generally do not call me after 11 PM (often, due to my spotty internet access, physically cannot do so). I’m like a doctor without a pager.
• I stay up late on Saturday nights, surfing the net, watching Saturday-afternoon baseball, blogging, etcetera, which means that I should be very tired by the time I hit the hay.
• I eat breakfast at midnight, stuffing myself to the gills with high-protein foods. (Mmm, L-tryptophan.)
• I have a small personal living area with entirely user-modifiable temperatures, and a nice, cozy bed, inside a hermetically-sealed plastic container. It is like I am in a sensory deprivation tank. Eerily like that, in fact.
• I am “The Major,” so none of my co-workers dare to knock on my door, barring emergencies. (This is not because I am mean; it’s just how my very professional soldiers have always treated me.)
• There is not much else to do except sleep.

In spite of all of this, my attempts to crash past about 0730 have generally been unsuccessful. I have diligently attempted to ascertain the reasons for this, so that I can eliminate them. One possible explanation was that I am awakened and stripped of melatonin by the very bright light that comes shining into my window starting at around 0430 (Iraq does not follow daylight savings time). I have eliminated this as a possibility by hanging my thick green army blanket over the window on Saturday night. Didn’t help.

Another possibility is the noise. I do, in fact, live not only near, but actually inside the confines of the airport. Planes, helicopters, and strange creatures which are combinations of the two (true story, that) constantly fly over my tin can, rattling the walls in attempt to find the harmonic frequency and bust me open like Joshua at Jericho. This kept me up a bit initially, but now I hardly notice it; the machinery sounds are simply a part of the aural landscape, and they block out the Halo sounds next door. At this point, I’m pretty well convinced that when I finally get home, in order to get any rest I’ll probably have to go and buy one of those “soundscapes” alarm clocks, but one with a “Combat” setting (perhaps right in between “Ocean” and “Rainforest”). So, I don’t think it’s the noise.

So what gives?

Unfortunately, I and many (all?) of my family members are blighted with the “Rupard Curse.” This is a multi-functional curse, including (but not limited to) the following items:

• Male members get receding hairlines at an astonishingly early age. Want proof? Check out my yearbook picture. My high school yearbook picture.
• Multiple chins, again at an early age, and even when the rest of the body is at ideal weight.
• The “John Travolta” syndrome, in which approximately five-sixths of all weight gained at any given time goes directly to the noggin. Rupard men all have big heads, but when we get a bit overweight, they become medium-sized planetoids. I swear, some of my med school pix look like I had just moments before discovered my latent peanut allergy. (By the way, this is also known as the “Barry Bonds Phenomenon.”)
• Proctalgia fugax. I’m not even gonna tell you what this is, or link to it; you’ll just have to look it up yourself. (If you don’t have it, you won’t understand it.)
• A retentiveness which (let’s face it, compadres), occasionally crosses that fine line into the nether reaches of OCD.
• And finally, the raison d’etre of this particular digression: Rupardian Insomnia. This is not quite like regular insomnia, in which the poor sucker has to wade through two post-Letterman infomercials before finally dropping off to abbreviated-but-productive sleep. The Rupardian variant renders the protagonist willing and often able to fall asleep, but unable to remain out for more than about 45 minutes at a time. He/she is constantly waking up, looking at the alarm clock (”Crap! Only 2:45″), and laying there in the dark for 5 to 500 minutes or so, before eventually drifting back to sleep for another 45 minutes. I like to think of this as “Reverse Narcolepsy” and I have been suffering for years, as have all of the rest of us. It wasn’t until I was married and able to enviously watch my wife as she slept, on-and-on, with no alarm-clock-checks and no full-body-pillow-reshufflings, that I figured out my sleep behavior was not that of a normal hunam being.

So, I conclude that my inability to sleep beyond 7:30 is multifactorial, with my sleep genetics being the primary culprit. Ah well, at least I’m good looking…

——————————

Rupard Mailbag

About two weeks ago, I sent a true desperado of an e-mail to mom and dad, asking for a few items which were completely, entirely NOT essential, but which would make my time here a wee bit nicer. They responded, as they always do, by sending not one, but two packages just a few short days later. Unfortunately, when the United States Army and the United States Postal Service meet, as they do here in Iraq, the vaunted efficiency of both organizations dwindles just a bit.

So, although my parents sent the two packages quite literally at the same time, I received one last Saturday the 12th (included baby wipes, almond butter, Propel flavor packets, and the all-important Jelly Bellies), and spent the rest of the week expecting but not receiving package #2. After Monday and Tuesday passed, my hopes dropped a bit, and by Friday, I had given #2 up for lost. On Saturday, however, SGT Hert gave me hope when he told me that his wife’s boxes regularly got delivered a week or more apart from one another, and yesterday (Sunday), SPC Penkert knocked on my door and delivered said package #2 (more almond butter, much-needed black socks, more flavor packets, more baby wipes). Thanks very much, LymeRupards!

This bodes well for my post-office-happiness this week, as I am expecting a couple of packages from my sweet wife, who has an uncanny knack for sending me exactly what I need.

Goodnight.

Nope. Nada. (Actually, there was a nice display at the Ripper DFAC, but food-wise: nothing)

So, we made our own. Early on Friday, word got out that the PX had received a shipment of steaks from America, and we quickly dispatched a medic with a lot of twenties in hand to go check it out. She came back with a bunch of frozen goodies, including a couple of ribeyes for me. At lunchtime, outside the clinic in the covered triage area, we had an old-fashioned barbie, with some good onion burgers (I ate one of those) and our various steaks. SGT Christie England of Middlebury, CT cooked mine (and another one which I bought for our optometrist) and it was truly fabulous. I’m not usually a fan of previously-frozen steak, but this was melt-in-my-mouth delicious. Definitely the best thing I have eaten since my arrival to The Brown Zone many months ago.

Clinic in the afternoon was completely dead, with only two patients (bilateral lower extremity swelling in a foreigner who may just have hepatitis C, and an allergic rash). Right after clinic I had planned to hit the Gym and work off some of that ribeye, but we got a report that the Ripper DFAC had Reuben sandwiches, and we have been waiting for those. 1LT Coleman, SPCs Villareal, Lee, and Santiago all went with us there, where we each ate a sandwich and brought a few home for our buddies. I also brought an entire carry-out container full of olives and pickles, as I have been craving salty things of late.

Because I had royally pigged-out on Friday, I vowed to do a couple of cardio/aerobic sessions on Saturday. Clinic was again very light, and afterwards, before anyone could whisk me in a truck and off to lunch, I snuck off to the gym. After lifting weights a bit, I did 6.5 miles on the treadmill, and then went home to eat lunch. A couple of hours later, I was meeting COL Gober to do the fourteen-mile bike loop. CPT Baker came with me, but when we met COL Gober at the clinic, he had to make some calls.

Turns out there had been a MASCAL at the hospital, a military term for multiple casualties coming in at once. The story is that a suicide bomber had gone into an Iraqi facility (police?) and blown himself up, and injured seven of the good guys. There were a number of internal injuries, one Iraqi with a severe leg artery laceration, but no deaths among the good guys. The bomber himself had been fatally wounded. When the COL called back to get results of a CT scan, one of the patients had a kidney issue, so he had to head back to the hospital so would not be making the ride with us. Baker and I went, and with the winds picking up, it ended up being a very tough ride, and by the end of it, I felt completely wasted. Once I was back home, I watched a rather uninteresting Yanks-Sox game, and fell asleep pretty early on.

I think that when I look back at this July fourth, it will be a memorable one, in spite of the lack of formal celebration. The experience which, I believe, will most spring to my mind is a sweet one: On Friday night, I went to our small LDS congregation’s Family Home Evening meeting, during which we read aloud the Declaration of Independence, and played some dominoes in the little shack-like annex off of the back of the main chapel. During our meeting, the Jewish congregation shared the annex with us and, a bit apart from us, sang some rousing, traditionally Jewish-sounding songs in Yiddish. I will add that to the many surreal experiences I have had out here: a bunch of Latter-day Saints on one side of a slap-dash plywood building in the desert mountains of Iraq, with a gathering of Jewish soldiers on the other end, all of us acting out that most American of pursuits: the praising of God in accordance with our own consciences. Served well to remind me of the reasons why our forefathers declared independence in the first place.