As The Sparks Fly Upward

Deployed personnel in Iraq are not allowed, under any circumstances, to wear contact lenses. This regulation, officially put forth in Army DA PAM 40-506, is widely disseminated during CRC and other pre-deployment screenings, and is advertised on AFN and the walls of clinics and other buildings throughout the combat zone. But it remains widely ignored, in most cases because the alternative—wearing eyeglasses—is simply unacceptable, even unthinkable, to many soldiers. (If you’ve seen the Army-issue “BCGs,” a.k.a. “birth control glasses,” you will better understand this mentality.)

However, this particular rule is a pretty important one. The very fine silt-like dust in Iraq, along with the inability to keep hands clean for insertion and removal—all of this makes contact lens wear dangerous, and every Army optometrist and ophthalmologist has horror stories about eye infections, corneal ulcers, and subsequent permanent loss of vision in soldiers who have worn contacts in the field.

With that preface, I relate to you the following incident, which took place in our optometry clinic on Thursday:

A soldier, let’s call him “Private Eyegoo,” walks into clinic with his Non-Commissioned Officer in tow. Chief complaint: “It feels like there is something in my right eye, and there is yellow stuff on my eyelids in the morning.” On further questioning, the patient also complained of swollen lids, and itchiness of the right eye.

Our optometrist, sensing something very familiar about this particular complaint, asked the soldier if he had worn contact lenses at any time while being deployed. The soldier stated resolutely that he had not EVER worn contact lenses in Iraq, and went on to elaborate in detail how his NCO had seen him attempting to insert lenses in Kuwait and informed him that this was not allowed, so he had put them away, and never touched them again. “I haven’t worn any contacts for months.”

(It is right about at this point in my little narrative that the alert blog reader will begin to suspect that perhaps Private Eyegoo is not telling the whole truth. What makes this one more interesting is that “not-so-honest” is about to meet up with “not-so-smart”—a combination which is nearly 100% lethal to a military career.)

A few moments later, as the patient was examined, our fine optometrist noted an ocular surface infection in the right eye. But he also noticed something else: at that very moment, Private EG had contact lenses in both eyes. Being the nice guy that he is, our doctor gave the soldier another chance to right himself: “Let me remind you that you are speaking with an officer. Please tell me about your contact lens use over the past month.”

“I have not worn any contact lenses over the past month, sir.”

The Optometry Clinic Non-Commissioned Officer, along with the patient’s accompanying NCO, were then asked to report to the exam lane, where the patient was again asked if he had been wearing contact lenses. He again denied it. Our optometrist then calmly explained to the errant soldier that contacts were in his eyes right now. The patient stated that this was impossible, that the lenses were in his contact lens case.

At this point, our optometrist, who is apparently a much more patient man than I, removed the contact lenses in front of the two NCOs, and had both of them verify the presence of the lenses. At this point the soldier’s NCO looked ready to strangle him. The patient indicated that “I don’t know how they got in there.” He was put on antibiotics and asked to return to the clinic the next day, with his company commander present. He was then escorted from the clinic by his NCO, who looked about ready to strangle him.

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My optometrist and I have debated a bit amongst ourselves as to the motives of PVT Eyegoo. So far, we have two operative theories:

1. Private EG truly did not know the contacts were in his eyes. Perhaps he put them in a long time ago, and simply forgot about them. This would explain his willingness to be seen by an optometrist, where any reasonable person would know that the contacts would be instantly discovered.
2. Private EG is not a reasonable person, and thought that the presence of contact lenses would somehow go un-noticed by our optometrist as he examined him under the slit lamp. It may seem incredible to you, but having lived here for six months, I have seen how blatant misinformation is often quickly believed all-too-willing servicemembers. I can easily imagine that a buddy of PVT EG told him how “no one can prove that you have contacts in, not even an eye doctor.”

Either way, I don’t really want this guy walking around Al Asad carrying a weapon, and I am happy to report that he has been relieved of his M-16.

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.

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…

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 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.