Thursday, October 28, 2010

The way to Iraq starts in Kuwait

I can’t say exactly when but I arrived in Iraq a few days ago after extensive additional processing in Kuwait. The two countries border each other and the distance was not that great however, the ordeal of traveling by military aircraft (the cargo bays get transformed into patient areas where you huddle down sitting on beach chair webbing secured with straps, ropes and clips) kept you on your toes. Additionally, we wear all our battle gear including full flak jackets, helmets, weapons and ammunition.

It was actually a lot of fun but we were already sleep deprived and this ordeal started at midnight and wasn’t over until noon the next day. It was stressful but it was so much fun and I wouldn’t have missed it for all the sleep in the world.

The military doesn’t want you to simply fly from the states to Iraq and the entire process has been carefully thought out into a series of gradual steps and transitions. I didn’t fully expect this and I actually thought that this would be more like a mad dash and you’ll learn things on the job. The military has discovered and become big utilizers of Power Point, focus groups, Instructor evaluations, equal opportunity clauses and they have an abundance of senior officers with a wealth of experience that are available for lectures and round table discussions.

The army calls their style of preparation and meetings “briefs” and they have nothing to do with brevity. Before I left Massachusetts I had several days of “briefs”. Whatever was discussed was again repeated in Texas and most of the same material was again repeated in Kuwait and repeated again when I got to Iraq. Before you get your equipment the quartermaster gives you a brief, before you go on the firing range that chief gives you a brief and before you’re allowed on the airplane the pilot and crew chief gives you a brief.

I’m in the general area of Tallil Air Base (google knows all about Tallil) and it is a big complex. It is presently quite quiet but there are signs of war everywhere. The area is covered with large reinforced concrete walls and sandbags and everybody now carries weapons with magazines but the area is quite secure and we are relaxed.

I no longer live in a tent I now live in a trailer park that has been transformed into barracks. Officers above the rank of Captain get their own room with water while the others have to share a room and have to go outside to either the male or female shower room. Toilets in the military are referred to as latrines which are porta-johns which are located all throughout the camp. There are endless rows of these trailers (as far as the eye can see) separated by blast walls, concrete bomb, shelters and sandbags. Everything has been built over flat arid dessert and the base and our trailer park home is barely shielded by a single tree.

I ‘m allowed to say that I will be working at the TMC (troop medical clinic) for the 224th Sustainment Brigade. I won’t explain what a Sustainment Brigade is but if you’re interested Google will give you a concise explanation

They also issued us these combat shirts, Boonie Hats (like the Australian's wear) because they have better protection from the sun, and I got the same set of cold weather gear that the soldiers in Afghanistan get for the winter even though it's 100 degrees every day.

The main thing they seem to emphasize is that you wear a proper uniform, carry your weapon (I have the Baretta pistol) & display your ID at all time. They also keep reminding us to report any acts of sexual harassment and that married soldiers that commit adultery will be prosecuted under the Uniform Code of Military Justice.
Depending on whose calendar you’re using day #1 of my 90 day deployment (I refer to it as my Diaspora) is the day I arrived in Kuwait which was either 10/23 or 10/24. We had thought that day #1 might be the day I arrived in Iraq, which was 10/27.

I actually saw some patients today but will write again after I catch up on my sleep and get more settled into Iraq.

Friday, October 22, 2010


Welcome to the CONUS replacement center. For those who do not know, CONUS stands for Continental United States. The term CONUS replacement center has a lot of significance in army circles.


The last I recall we had 50,000 troops in Iraq and around 100,000 troops in Afghanistan. Most of these troops arrive as entire units such as a company of perhaps 200 soldiers, a battalion containing about 750 soldiers or a division which might contain 15,000 soldiers. However, in addition to these large groups there is always a need for individual replacements for specific purposes.

My assignment is for 90 days in Iraq so I’m sent to a replacement center at Fort Benning, Georgia which processes as a group several hundred individuals every week. I believe there are several replacement centers. Just providing replacements for 150,000 overseas troops is a very big job. Most of the replacement soldiers are sergeants or officers since the lower ranking soldiers (privates & corporals) would likely be arriving with their units.

Although this is an army base only about half of us are in the military with the other half contractors. The contractors, who mostly have prior military experience, are older, and quite casually dressed. They usually go over for a year at a time and we won’t talk about their personal or family life. There is also a small group of Department of Defense employees and I’ll omit the details as to who they are and what their job is.

So we are in a sprawling compound on a military base for the purpose of being “processed” into an overseas military mission. We stay in single story dormitory type buildings with two bunk beds making it four to a room with a central bathroom with showers, a dining facility, a gym, a general store carrying stocked with the specific goods we need for our deployments and some large buildings for classes and support services. Because we were about half military and half contractors the atmosphere was like a cross between a military base and a frontier town. The contractors were a very varied lot with some being very high functioning and others looked like the crowd at the horse races or at an OTB betting parlor. They also reminded me of the male crowd at one of the old Jewish bungalow colonies except that most of them were tattooed and a few looked like they consumed body building supplements. There is also a day room with computers, lounge and a wide screen TV that is always featuring Rambo style movies or martial arts flicks.

Everybody seems to get along and I found everyone very helpful. They know I’m new at this and without even asking I’m constantly offered support and I’m coached as to how to do all this processing that is unique to the army.

My three roommates, all of whom I believe are in the National Guard, have prior deployments and a significant amount of military experience including combat experience. They’re all headed to Afghanistan and it seemed like two thirds of the soldiers and contractors are headed there with the other third (like me) going to Iraq.

I don't think anybody would imagine that my bunkmates are military veterans with combat experience and they are quite reserved about it. They all live in rural areas and are all extremely interesting, very physically fit and exceedingly bright. Two are younger who started out as privates and are now newly minted officers and it is so obvious that they have been promoted based on merit. I believe that two and possibly all three said that they're of German ancestry.

I would estimate that one of them is in his late 20's, the second one is in his early 40's and the third one, who is a Lieutenant Colonel (LTC) is probably in his 50's. I believe that when he first went into the military he was as a combat engineer and served in the First Gulf War. He later became an attorney practicing in a small town in one of the prarie states. He said he’s with the JAG (where the military puts lawyers) but in addition to legal work he is obviously involved in the actual operations of the military. Unlike the other two he’s not in superb physical condition however he certainly does carry himself the military bearing of a highlevel officer.

The LTC immediately showed his leadership abilities by showing his interest in all of us and making sure that our needs were addressed and that we got to know each other. We were only roommates and each of us are headed to different units and we really didn’t have to get to know each other. He simply took advantage of the fact that by bunking together this was an opportunity for us to get to know each other and help each other and it worked. I already know that because I interacted so much with my three bunkmates I will also feel close to them and be interested in their welfare.

Every day we went to various stations for more processing. I received at least six vaccinations including Smallpox & Anthrax and the soldiers going to Afghanistan have to take daily antibiotics due to the threat of malaria. In just one of the six days of actual processing I had to do the following:
Because I’m over forty I had to get labs, EKG and answer many pages of medical questions but when I finally got to see the doctor she said she didn’t have to examine me because I have no medical problems. We had to answer pages about our backgrounds including minute details about our first pet, first car, first girlfriend, first apartment etc which they said they needed to know in case we had to be identified in the future.

We also received some lectures about Middle Eastern culture, improvised explosive devices and similar subjects that I’ll pass on those details. They asked us from every possible angle you could think of as to what type of care we would want if we were hurt, who gets our life insurance if we die, who gets notified , who gets notified first, second & third, who gets to make medical decisions if we’re not competent and more details on top of details

I also had to qualify on a 9 millimeter pistol called a Beretta on a firing range with pop up targets and I’m happy to say that I did pass. I’ve been issued my firearm which I must keep double tied to me at all times. A few were issued M-16 automatic weapons but generally higher level sergeants and officers carry side arms.

Finally on the day of departure we are addressed by a series of high level sergeants and officers about properly representing our country everywhere we go, thanking us and our families for our sacrifices. Our names are called and we file past several different check points and we were told that our country is grateful to us and they are eagerly waiting for our safe return. As we are ready to pass through the gate and board the bus more high level people and a Chaplain shake our firmly shake our hands and look us straight in the eye and wish us Godspeed.

There is a two hour bus ride to the Atlanta airport and we are taken we meet our chartered commercial jet at the private & cargo terminals area. There is an advance party of military police which choreographs every stage as we board wearing our uniforms and carrying our weapons. We don’t have to go through any airline security as we walk out on the tarmac to board the plane. There are just a few airport employees around who wave & urge us on. When you get to read this chapter I have already deployed.

Saturday, October 16, 2010


When a group of us would go to the WWF/WWE wrestling matches and sometimes the Golden Gloves events in Holyoke we spent as much time looking at the spectators as at the matches. As outlandish as the wrestlers were they were tame compared to the many of the people in the crowd.

I had an enormous logistical challenge in arranging medical coverage for a 120 day absence. There's a shortage of Primary Care Physicians in Western Massachusetts and it seemed like mission impossible that I was going to find covering doctors who would see my patients in my office. In the end it wasn't that hard at all because everybody wanted to help. See the article written in The Republican 10/13/2010

Similarly, I had to tell patients, some with multiple medical problems who have seen only me for over a decade that I was going to Iraq. In the end it turned out to be easy.

The real story is not about a physician going to Iraq it's about eighty year old patients telling me that they're going to be fine because they actually like the idea that they're going to be inconvenienced so that our soldiers will get the medical care they need.

In a world where we routinely put ourselves first and we're all out for number one and whether we listen to rap music or any music everything seems to be about ourselves and getting more for ourselves. I admit that I've always been a military wannabe but wannabes generally stay as wannabees and just fantasize about things that are never going to happen. I'm headed for Iraq because someone told me that our soldiers had a critical shortage of medical providers and somebody looked me in the eye and asked me to do it.

Well, since the recruiter had such good results by simply looking me in the eye and asking me to help our soldiers I decided to do the same thing when I went out looking for the help that I needed. I put out the word that I needed help from other physicians and amazingly getting commitments from other physicians was not hard at all. In the end I had more coverage lined up than I could use. I now have three different physicians and a nurse practitioner covering my office and every one has made a point of telling me how glad they are to be helping me to bring medical care to our soldiers.

Additionally, my office needs to be covered every day after closing and every weekend which involves coverage from my existing call group in which we share call. Same problem and the same enthusiastic response. I had to inform my call group not only that I couldn't do my share of the call for the next 4 months and additionally that I needed them to cover my practice through these four months which will all include the holidays. They quickly stepped forward, thanked me for for my decision to serve and told me how proud they would be to cover my share of the call and cover my practice as well.

The story is not just about a 58 year old doctor deciding to join the National Guard and go to Iraq it's about countless vulnerable patients who have only seen me for years and years and now that I'm leaving they want to tell me that they're going to be fine with the covering doctor because they even as senior citizens they want to make this sacrifice for the sake of American soldiers who are fighting a miserable war. It's about other doctors, several of whom were not born in the United States, delighted to find themselves in a situation where they can indirectly help our soldiers. It's everybody I know, which includes the educated and the uneducated, extreme liberals and extreme conservatives, atheists, orthodox Jews and born again Christians all showing the same degree of support with nobody injecting politics into my sendoff.

Please look at the big picture. When we'd go to the wrestling matches we'd constantly remind each other to look out into the stands at the people to see the real show. The real show is out there in the stands involving my patients, the medical community & everybody I know who, when given the chance, knew immediately how to do the right thing.

Monday, October 11, 2010


I finished my "Tactical Combat Medical Course" (TCMC) which was the week of 09/27/2010 and returned to my office to work the week of 10/04/2010 which I finished 10/08/2010 and that was my final day in my office.

Monday, 10/11/2010 is Columbus Day and the office is closed. Starting on Tuesday, 1012/2010 I will spend the week processing with the National Guard. Officially, on Wednesday 10/13 I go on active duty and early Friday, 10/15 Joan will drive me to the airport for my flight to Fort Benning, Ga. I spend about a week there getting equipment and I presume some more training and from there we are flown to the Middle East. I believe all deployed soldiers fly to the same Middle Eastern country, which I'm going to leave unsaid for now, and from there we are either dispatched to Iraq or Afghanistan.

It appears that I indeed am going to Iraq and the people I'll be working with and especially the physician I will be relieving have already been e-mailing me. A PA who sat next to me for the TCMC course is also headed for the same place. It sounds like they really are short of medical providers and they're already trying to speed me through my processing when I arrive and get me set up quickly which is fine with me. Also, the sooner I arrive the sooner the clock starts on my 90 days "in country". If you're stuck somewhere in the dessert porocessing you're delaying the beginning of the 90 days of your deployment "in theatre." Even when the army truly needs you they have a way of delaying and making you wait and do nothing.

For next weeks processing, as usual with the army, I need bring in documents that nobody ever asks you for. I need to produce my marriage license, the birth certificates of all of my children, copies of my mortgage and the list goes on and on. The packing wasn't hard because you wear the same style of clothing every day. Since I've always been fashion challenged this is a relief for me. The army is now highly digitalized and each soldier essentially needs to bring a computer. Orders, memos etc are sent out by computer and this part has been good for my poor computer skills.

I'm not really worried other than the concern I have for Joan who will have to run things here without me. I am very concerned about everything she will be left to deal with but that doesn't really belong in a blog.

People have been very good to me and for the sake of those who are serving much longer tours than I will be I'm very happy to see how much people really do support our deployed soldiers. I happen to know a lot of people who voted against George Bush both times he successfully ran for president and who completely oppossed his decision to launch the 2nd Gulf War. Some of these individuals are what I call "Too Liberal To Function" but there is no diffierence in the concern they show for our soldiers and the concern I see from the Republicans and The Conservatives. They all seem to show pride and support for our military and concern for our Armed Forces on overseas deployment.

Last week I finally received my "orders". In the military you don't go anywhere without your orders which start out saying "You are ordered to active duty as part of Operation Iraqi Freeding/Operation New Dawn starting on............

It will begin on 10/15 and the planning and training stages are over. My concern now is that I perform on the level that is expected of me and that I provide these soldeirs with the highest standards of medical care available anywhere in the world.

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